Early Screening, Osteoporosis and Hip Fractures | Arthritis Information

Orthopaedic surgeons preparing to cope with a tidal wave of new hip fractures in aging populations are revving up warnings about the need for early bone health screening and treatment, experts told the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Decreasing the rate of hip fractures saves lives, prevents loss of function, and decreases costs,” said Tad Funahashi, MD, regional chief of orthopaedic surgery and assistant area medical director for Kaiser Permanente Southern California, and clinical professor of orthopaedic surgery at the University of California Irvine’s College of Medicine. “If we screen for osteoporosis at the earliest onset of the disease,” said Dr. Funahashi, “we can implement treatment and help to decrease the rate of hip fractures by 45 percent.”

Too few referred for bone density test after first fracture

Osteoporosis is also a huge problem in other parts of the world. In another study, Leonid Kandel, MD, an orthopaedic surgeon at Hadassah-Hebrew University Medical Center in Jerusalem, Israel, looked at improving the diagnosis rate of osteoporosis in post-menopausal women, who fracture the distal radius bone. Dr. Kandel says these fractures are often the first clinical symptom of osteoporosis, yet only 15 to 25 percent of these women are referred for a bone density test by a family physician after the fracture.

“It is important that patients understand the connection between their current problem, the fracture, and the possibility that the underlying cause is osteoporosis.” Dr. Kandel also suggests that there should be a stronger connection and better communication between the hospital and the community. He feels this will increase the number of patients who are diagnosed and treated for the disease.

RA patients have high fracture risk, even with vitamin D

Rheumatoid arthritis is associated with significantly increased risk of fragility fractures, even if patients are taking vitamin D supplements, according to Francesco Pegreffi, MD, and colleagues from Cervesi Hospital, Cattolica, Italy. They studied a group of patients, 80 percent women and 20 percent men, who were affected by rheumatoid arthritis and were taking vitamin D supplementation.

“We wanted to analyze the correlation between a person’s age, sex, how long they had rheumatoid arthritis, whether they were taking vitamin D supplements and whether they had fragility fractures due to osteoporosis,” said Dr. Pegreffi. “We found that women affected by rheumatoid arthritis for more than three years were osteoporotic and had a fracture risk significantly higher than those without the disease. Also, vitamin D therapy is not enough to prevent further bone loss and fragility fractures in these patients.” Men in the study faired much better. Those with rheumatoid arthritis did not have a significant risk of fracture.

References

1. Inacio MCS, Funahashi TT. Effect of an osteoporosis management program on hip fracture rates: an analysis of 527,266 patients. Oral presentation at the AAOS 2009 meeting, Las Vegas, February 27, 2009. Presentation No: 474.
2. Kandel LA, Kessous R, Brezis M, et al. Improving The Diagnosis Rate Of Osteoporosis In Women After A Fracture Of The Distal Radius. Oral presentation at the AAOS 2009 meeting, Las Vegas, February 27, 2009. Presentation No: 475.
3. Pegreffi F, Giunti M, Sandri G, et al. Age, Sex, Rheumatoid Arthritis Duration: Risk Factors in Osteoporotic Patients. Oral presentation at the AAOS 2009 meeting, Las Vegas, February 27, 2009. Presentation No: 477.