Multidisciplinary team supports patients at greater risk of fragility fractures

Roughly 44 million Americans have low bone density, placing them at an increased risk for broken bones. These individuals often experience fragility fractures, the result of a fall from standing height or less.

UC Davis Health’s departments of orthopedic surgery, endocrinology, rheumatology and geriatric care have teamed up to create a multidisciplinary Fragility Fracture Program to ensure these patients receive comprehensive treatment to prevent future fractures. They’re also working to identify patients at risk for future fractures.

“Fragility fractures, which most commonly occur at the hip, spine, or wrist, are an indication that the body’s bones have been weakened by an underlying condition,” explained Hai Le, assistant professor of orthopaedic surgery. “Therefore, the patient at the highest risk of a fragility fracture is someone who has just had one.”

A recent study conducted by Le and his team found that patients who have had a fragility fracture are more likely to experience another one in the future. It also highlighted the lack of follow-up care to prevent these patients from potentially suffering another fragility fracture. The researchers suggested cases of osteoporosis should be treated earlier in the medical process.

“When a patient experiences a fragility fracture that requires surgery it is our job to get those patients back on their feet, but we are not the experts when it comes to preventing the next fracture,” said Le. “That's when we bring in our colleagues from endocrinology and rheumatology, who are the experts in diagnosing and treating osteoporosis or other illnesses related to low bone density.”

Diagnosing and treating osteoporosis early

“My role in diagnosing osteoporosis includes conducting a complete laboratory screening of potential risk factors from a hormonal standpoint,” explained Polly Teng, assistant professor of endocrinology and orthopaedic surgery.

Some of the laboratory tests include a patient’s vitamin D, calcium, and parathyroid and thyroid hormone levels, all of which can affect bone fragility. Other tests might be ordered as well, based on each individual patient’s needs.

“These treatments can help manage the underlying causes of a patient’s bone fragility, improve bone stability, and prevent future fractures,” said Barton L. Wise, associate professor of rheumatology and orthopaedic surgery. “There are many good medications to treat illnesses that effect bone density and diagnosing our patients properly allows us to identify the best care plan for each patient, and also evaluate if they have any other underlying disorders.”

Patients also receive visits from nutritionists who provide dietary guidance, and physical therapists who lead them through exercises to strengthen supporting muscles and improve balance and mobility to address fall risks.

The patient at the highest risk of a fragility fracture is someone who has just had one.”—Hai Le, assistant professor of orthopaedic surgery

Improving mobility to prevent falls

Upon discharge, patients 65 and older who have been hospitalized for a fragility fracture are referred to UC Davis Health's new mobility program at the Healthy Aging Clinic. This one-stop clinic serves patients and their caregivers, allowing them to leverage integrated specialty clinical care and services that can lead to better quality of life and facilitate independent living.

“We take a geriatric approach with our mobility clinic,” said Alia Tuqan, who is a board-certified geriatrician and interim medical director of the clinic. “We start with a physical exam to assess their risks for an additional fall, then work with the patient and any caregivers to formulate a plan to prevent another fall.”

The mobility program is run by clinic nurse practitioners. During the exams, they evaluate a patient's vision, neuropathy, orthostatics, cognitive impairment and any medicines that could increase the patient’s risk of falling.

Increased preventive treatment programs like UC Davis Health’s Fragility Fracture Program could have a major impact on public health in the United States and the high costs associated with it. The National Osteoporosis Foundation reported that approximately 1.8 million Medicare beneficiaries suffered approximately 2.1 million osteoporotic fractures in 2016.

“If we could reduce secondary fracture development by just 20%, we could potentially save Medicare over one billion dollars annually,” Le said. “Comprehensive fracture programs could improve patient outcomes, and also provide our Medicare system additional resources to support other programs.”