If You Break a Bone Are You More Likely to Break It Again
Personal Wellness
Afterward a Broken Bone, the Risk of a Second Fracture
Far too few patients are referred for treatment that could stave off another costly, debilitating and sometimes deadly fracture.
Older adults who intermission a bone face a serious yet potentially preventable risk of breaking another, often within the next two years. This is peculiarly true for the more than 340,000 people 65 and older who break a hip and the almost 700,000 who develop a spinal fracture each yr.
Unlike lightning, which near never strikes the same identify twice, "the person at highest run a risk of a fracture is the one who'southward just had a fracture," Dr. Ethel S. Siris, endocrinologist and director of the Toni Stabile Osteoporosis Center at the Columbia University Medical Eye, told me.
These 2d fractures tin can event in life-limiting inability and a permanent loss of independence. One in v patients dies within a year of surgery for a hip fracture.
Nonetheless those at take chances of a repeat fracture often fall betwixt the cracks. Later on their cleaved bones have healed, far also few patients are referred for treatment that could stave off another costly, debilitating and sometimes deadly fracture.
Neither patients nor near physicians realize that if the fracture is not the event of a major trauma, like a car accident, older people who fall and break a hip or who lift something heavy and fracture their spine should be treated to diminish the risk of further fractures. Fifty-fifty if a bone density test suggests otherwise, past definition, older people who accept broken a os this way have osteoporosis and are at high risk of breaking more bones.
"We've become so wedded to the concept of bone density that we ignore the elementary fact that fracture is itself the definition of the disease," Dr. Sundeep Khosla, endocrinologist at the Mayo Dispensary in Rochester, Minn., said in an interview.
In a 2022 study of most ii meg Medicare patients hospitalized after a fracture, 307,000 had a second fracture during the post-obit ii to three years at an boosted cost of $half-dozen.iii billion.
Yet within half-dozen months of the showtime fracture, just 9 pct had been tested for os loss and, if needed, offered bone-protecting drugs that could accept prevented at to the lowest degree 20 per centum of the 2d fractures and saved more than a billion dollars as well as immeasurable pain and suffering among those affected.
"No one says to the patient 'yous just broke your hip, y'all've got osteoporosis, and information technology should exist treated'," Dr. Siris said. "The problem is that the fracture fixers — the orthopedic surgeons whose job is to get patients back on their anxiety — are not the fracture preventers who can avoid the next fracture. At that place's no one connecting the dots between the orthopedic surgeons, who are really good at what they do, and the medical service that can prescribe preventive treatment."
She outlined three critical measures that too often are non taken:
1. Assuring that patients' blood levels of calcium and vitamin D are adequate, considering "if they're deficient, it sets off mechanisms that are bad for bones."
2. Prescribing medication that can strengthen bones then that they're less probable to break when a person falls from a standing height or picks upwardly something heavy or even turns the wrong fashion in bed.
iii. Taking diverse steps to prevent falls, like exercises to strengthen supporting muscles and meliorate balance and mobility, and eliminating autumn risks in and around the home.
At the very least, following a hip or vertebral fracture, experts say patients should be referred to a physical or occupational therapist or a physiatrist (a specialist in rehabilitation medicine) for communication and exercises to help prevent more broken bones.
Last yr, a very large group of experts assembled by the American Guild for Bone and Mineral Inquiry published a consensus statement recommending steps clinical medicine should take to forestall 2nd fractures amongst people aged 65 and older with a hip or vertebral fracture.
These are people, the experts from diverse fields of medicine and several countries wrote, for whom "the benefits of treatment most always outweighed the adventure."
Dr. Khosla of the Mayo Dispensary, who was a member of this illustrious task force, said the current disconnect is "puzzling, a caput scratcher. For some diseases we do everything we can to preclude the side by side event. If a patient comes in with a heart attack, it's malpractice if the person is not put on a full preventive plan. But the effort to preclude second fractures is dismal. The majority of patients go out the hospital without any preventive measures."
In other countries, and inside some medical networks in the United States, including the Kaiser Permanente organization in California, there are coordinated services to assure appropriate mail-fracture follow-upward. In 2013, the International Osteoporosis Foundation introduced a entrada called Capture the Fracture to assure that "fragility fracture sufferers receive appropriate assessment and intervention to reduce hereafter fracture risk," but such organized preventive measures accept remained rare in the United States.
Establishing fracture liaison services, as they are called, faces a major stumbling block in this country. There's no mechanism to pay the person who coordinates care betwixt the orthopedic surgeon and the practicing physician. Medicare doesn't embrace the price of a coordinator, Dr. Siris said, "then there's no incentive to become a post-fracture patient into medical hands. Many main intendance doctors don't fifty-fifty know that their patients broke a hip."
Given the astronomical costs to Medicare of hip fractures, Dr. Khosla called the failure to cover the cost of coordinating services to prevent a 2d fracture "penny-wise and pound-foolish." (Of form, this is only 1 of many economically questionable limitations of Medicare. Consider, for example, its failure to cover hearing aids, the lack of which increases the risk of dementia, falls and a host of other expensive medical problems that Medicare does pay for.)
The consensus group'southward 13 recommendations for preventing fractures include advice to not smoke or use tobacco, to limit alcohol consumption to two drinks a day for men and one for women, and to exercise regularly, at least iii times a calendar week, including weight-bearing, muscle-strengthening and rest and postural exercises. Doctors are urged to discuss both the benefits and possible risks of medications that can help forestall fractures.
Many patients have been unduly frightened, Dr. Khosla said, by the amount of attention given to the rare risks of an atypical femur fracture or jaw disuse when taking bisphosphonates like Fosamax that tin help maintain bone forcefulness.
"When the drugs are used correctly for 3 to 5 years, followed by a drug vacation, and attention is paid to warning symptoms like leg or dental pain, the benefits of treatment style outweigh the risks," he said.
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Source: https://www.nytimes.com/2020/11/09/well/live/after-a-broken-bone-the-risk-of-a-second-fracture.html
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