Fragility fractures: Taking control of management, follow-up and assessment

The National Osteoporosis Foundation estimates 54 million Americans have low bone density or osteoporosis, with 50% of women and 25% of men older than 50 years expected to have an osteoporosis-related fragility fracture.

“There are between 1.5 million and 2 million fragility fractures in the United States, about 300,000 hip fractures and about 750,000 vertebral fractures that occur every year,” Susan V. Bukata, MD, told Orthopedics Today.

However, according to Laura L. Tosi, MD, the rate of hip fractures has been declining since the mid-1990s, which may be due to people taking better care of themselves.

“Prior to the mid-1990s, hip fracture rates were going steadily upward. Since the mid-1990s, they have been going down and we do not understand why that is,” Tosi said. “We are seeing a phenomenal change in the physiologic well-being of our citizenry. They are exercising more and they have better nutrition. People, particularly in the United States, are smoking less, drinking less and wearing their seat belts.”


Susan V. Bukata, MD, (left) discusses the case of a hip fracture patient with members of the geriatric fracture care team orthopedic nurse Shane Fierst (center) and Director of Orthopedic Nursing at UCLA Santa Monica Kim Ternavan (right).


However, the statistics are not as clear on osteoporotic vertebral fractures, which, according to Steven D. Glassman, MD, may be diagnosed if patients are having persistent pain.

“A high percentage of older osteoporotic patients, if you X-ray them, have compression fractures,” Glassman said. “The people who get to an orthopedist are the ones who have severe pain or persistent pain after their fracture.”


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