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Published on November 14, 2017

Left Unchecked, Osteoporosis Gains Ground

Physicians have long advocated that patients undergo cholesterol, colorectal, diabetes, prostate, Pap, mammography and other health screenings, but screening for osteoporosis has not gained the same footing. Leaving osteoporosis unchecked can have dire consequences for patients, the most significant being fragility fractures that lead to additional fractures and other co-morbidities.

Needed Screening

NKCH post-hip Fracture Surgery Osteoporosis Guidelines

  • Perform vitamin D screenings on all hip fracture patients.
  • Order an outpatient bone mineral density scan on all hip fracture patients over age 60 who have not had one in the last two years; send to the patient’s orthopedic and primary care physicians.
  • Send discharge summaries to primary care physicians.
  • Manage patients with a T score of <2.5, if appropriate.

About 10 million Americans have osteoporosis and another 44 million have low bone density, according to the National Osteoporosis Foundation. Although the disease is the cause of about 2 million broken bones annually in the U.S., approximately 80% of older Americans who suffer from bone breaks are not tested or treated for osteoporosis, notes the NOF.

“Oftentimes, primary care physicians screen for other chronic illnesses, but bone density sometimes gets forgotten, leaving many men and women unscreened for osteoporosis,” said Christopher L. Wise, MD, an orthopedic surgeon with Drisko, Fee & Parkins and medical director of trauma for the NKCH Ortho-Spine Co-managagement Company.

The public’s lack of awareness is evidenced by a 2017 national survey, which found 82% of postmenopausal women do not correlate a fracture, especially one caused by falling from a standing position or less, as a possible risk factor for osteoporosis. The 1,012 women age 50 and older in the U.S. included those with osteoporosis.

“I refer my patients back to their PCPs because I only see them four or five more times after surgery,” Dr. Wise said. “That opens the door for the PCPs to manage their patients’ biannual BMD scans and monitor their medications, which may include pharmacotherapy to try to lessen their chance of future fractures.”

Screening Parameters

The NOF recommends bone mineral density scans of the hip and spine for:

  • Women age 65 and older and men age 70 and older, regardless of clinical risk factors
  • Younger postmenopausal women, women in menopausal transition and men age 50-69 with clinical risk factors for fracture
  • Adults who have a fracture after age 50
  • Adults with a condition associated with low bone mass or bone loss
  • Adults taking medications that can cause low bone mass or bone loss

Interventions

Although damage caused by osteoporosis cannot be reversed, the disease can be slowed to help prevent future fractures. Interventions to reduce fracture risk include adequate calcium and vitamin D intake, regular weight-bearing and muscle-strengthening exercise, cessation of tobacco use, and identification and treatment of alcoholism.

Calcium Recommendations

  • Men age 50-70: 1,000 mg per day
  • Men age 71 and older: 1,200 mg per day
  • Women age 51 and older: 1,200 mg per

“Intakes in excess of 1,200 to 1,500 mg per day have limited potential for benefit and may increase the risk of kidney stones, cardiovascular disease and stroke,” Dr. Wise added.

Vitamin D Recommendations

Osteoporosis Risk Factors

Uncontrollable
  • Over age 50
  • Female
  • Menopausal and/or family history of menopause
  • Low body weight/small and thin frame
  • Broken bones
  • Height loss
Controllable Risk Factors
  • Low calcium intake
  • Insufficient vitamin D
  • Inadequate consumption of fruits and vegetables
  • High protein, sodium and caffeine intake
  • Inactive lifestyle
  • Smoking
  • Alcohol abuse
  • Extreme weight loss
  • Adults age 50 and older: 800-1,000 IU per day for maintenance
  • Adults who are vitamin D deficient:
    • 50,000 IU of vitamin D2 or vitamin D3 each week or
    • Equivalent daily dose (6,000 IU vitamin D2 or vitamin D3) for 8-12 weeks (follow with maintenance therapy of 1,500-2,000 IU per day)

Risk Assessment

Referring physicians can use the World Health Organization’s online Fracture Risk Assessment Tool® to calculate a patient’s risk of incurring another fracture within 10 years.

“I’ve seen patients with hip fractures who are 80 years old who have never had a bone density scan. I’ve seen others who are healthy-looking at 61, but have had hip fractures and osteoporosis,” Dr. Wise said. “I would ask physicians to try to be vigilant with at-risk individuals by making vitamin D testing and BMD scanning a part of their screening protocols.”


Photo of Christopher L. Wise, MDChristopher L. Wise, MD

Dr. Wise earned his medical degree from Saint Louis University. He completed his orthopedic surgery residency at Michigan State University and orthopedic surgery fellowship at Carolinas Medical Center.