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A New Initiative To Prevent Osteoporosis Fractures—But Does It Go Far Enough?

November 28, 2011

Each year, 325,000 hip fractures are reported in the United States. Of that number, approximately three-quarters are women. The combined number of all osteoporosis-related fractures is greater than the incidence of heart attacks, strokes and new breast cancer cases each year combined, and 90 percent are people age 65 and older. About 5.3 million people over age 50 have osteoporosis at the femur and another 34.5 million have low bone mass, or osteopenia, experts report. Despite these statistics, after sustaining a fracture, these very high-risk individuals are usually not treated with calcium, vitamin D or a prescription medication for the prevention of future fracture, a major failing of the US health care system.

To address this, the National Bone Health Alliance (NBHA) and Kaiser Permanente recently unveiled their “20/20 Vision” for reducing hip and other fractures by 20 percent by 2020 at a best practices sharing event Monday at the Kaiser Permanente Center for Total Health on Capitol Hill.

“Reducing the expected number of hip and other fractures by 20 percent by the end of the decade is a public health imperative,” said Richard M. Dell, MD, lead orthopaedic surgeon, Healthy Bones Program, Kaiser Permanente. “It would be a monumental achievement, sparing half a million Americans of horrible pain and suffering and a loss in quality of life—as well as producing enormous cost savings throughout the health care system. The time to act is now as a growing number of Americans are reaching the age where hip and other osteoporosis-related fractures are common but are still preventable in many cases.”

Representatives of a number of groups—leading physicians and experts in bone health and fracture prevention—shared best practices and laid out a plan to achieve this nationwide goal. A key element is a proposal to establish a fracture liaison service facilitated by NBHA within Medicare and other health systems modeled on successful programs that currently exist in the United States at Kaiser Permanente, Geisinger Health System the American Orthopaedic Association and the Department of Veterans Affairs as well as internationally in the United Kingdom, Canada and elsewhere. The service would assess patients who suffer a fracture for osteoporosis and, if found, provide them treatment and follow-up to manage the disease in an effort to prevent repeat fractures.

“One of the NBHA’s major priorities is the implementation of this successful fracture liaison service model in a number of health systems, including the Medicare population,” said Sundeep Khosla, MD, Mayo Clinic and chairman, NBHA Governance Committee. “This model has been shown in a number of countries and health care settings to not only decrease health care expenditures, but also reduce the number of subsequent fractures which, in this high-risk population, can cause significant mortality and morbidity.”

Of course, what’s really needed is a plan to treat osteoporosis before a fracture, prevent osteoporosis by diagnosing osteopenia sooner (usually with a simple, non-invasive bone density test) and, even better, instituting programs that show women how to build more bone earlier in life and then follow lifestyle habits that will preserve bone health.

One such plan is the Kaiser Permanente’s Healthy Bones Program, which has successfully reduced hip fracture rates by more than 37 percent, according to published research. If this program were implemented nationally, it could prevent more than 100,000 fractures.

The American Orthopaedic Association has its Own the Bone Program, a quality improvement initiative introduced in the open health care system that addresses the need to assess and treat patients age 50 and over with osteoporotic fractures and promotes coordination of care between specialties. Own the Bone has touched more than 3,000 patients in 31 states and continues to grow rapidly. However, this program is aimed at avoiding secondary fractures. Unfortunately, of the more than 300,000 hip fractures reported annually in the United States, 24 percent of patients end up in a nursing home, 50 percent never reach their functional capacity and 25 percent of patients with a hip fracture die in the first year after the incident—for them, secondary efforts are futile.

Robert A. Adler, MD, Richmond Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, described an osteoporosis disease-management process as part of the Veterans Affairs Patient-Aligned Care Team program. “Veterans Affairs pharmacists can use the electronic medical record to identify patients at highest risk for osteoporotic fracture, particularly those who have already suffered a fragility fracture,’” Adler said.

“We know this can be done,” said Robert M. Pearl, MD, chief executive officer of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “The combination of our Kaiser Permanente integrated care delivery system and 21st century technology has allowed us to dramatically lower the mortality from cardiovascular disease, sepsis and cancer. Now we can apply the same approaches to improving osteoporosis outcomes and decreasing the frequency of hip and other bone fractures.”

More than 100 attendees participated in the best practices event, half in person and half via web conference. Dozens of participants signed a placard pledging their commitment to reaching the goal of 20 percent reduction in hip and other fractures by 2020.

The bottom line? Take bone health into your own hands. Learn more at the National Bone Health Alliance. Established in late 2010, the National Bone Health Alliance is a public-private partnership that brings together the expertise and resources of various partners across a broad spectrum to promote bone health and prevent disease; improve diagnosis and treatment of bone disease; and enhance bone research, surveillance and evaluation. The NBHA is a platform that allows all voices in the bone health community to work together around shared priorities and develop projects that can become reality through pooled funding. The 30 members of the Alliance (in addition to liaisons representing the National Institutes of Health and U.S. Food and Drug Administration) are working from a shared vision: to improve the overall health and quality of life of all Americans by enhancing their bone health. For more information on the NBHA, visit