Session III - Injury Prevention

Osteoporosis in Hospitalized Orthopaedic Trauma Patients: An Opportunity to Intervene?

Cory A. Collinge, MD¹; Laura Gehrig, MD²; Tiffany Draper, MA³;

(n-all authors)

¹Harris Methodist Hospital/John Peter Smith Orthopaedic Surgery Residency, Fort Worth, Texas, USA;

²Louisiana State University - Shreveport Medical Center,

Shreveport, Louisiana, USA;

³Orthopaedic Specialty Associates, Fort Worth, Texas, USA

Purpose: Trauma patients tend to carry many of the risk factors for osteoporosis substance abuse, use of psychotropic drugs, inactivity, etc. Our goal is to identify the characteristics of osteoporosis on the inpatient orthopaedic trauma service at a busy trauma center, and provide a simple algorithm to initiate treatment for this disease.

Methods: After IRB approval, all patients treated for acute injury by a fellowship-trained orthopaedic trauma surgeon at our trauma center were identified from a prospectively designed orthopaedic database. 200 consecutive adult patients with >500 skeletal injuries were evaluated and treated over a 6-month period after establishment of an "osteoporosis protocol." This protocol included a validated bone density test (Achilles InSight^®, General Electric) administered at bedside; prospective data collection regarding medical, osteoporosis, ovarian, nutritional, and family histories; current injuries and mechanism; and T- and Z-scores. For patients screening positive for osteoporosis (T-score <-1.6), intervention was initiated with (1) patient education, (2) initiation of calcium supplement therapy, and (3) referral to the patient's primary care physician with a copy of their test results for discussion on further treatments.

Results: Osteoporosis or osteopenia was found in 88 patients (44%). Intervention with education and initiation of medical therapy was achieved in all but 4 of these patients (95%). Only 16 of the osteoporosis patients (18%) had been previously diagnosed with osteoporosis and only 3 of these patients were being treated. Multiple risk factors for osteoporosis were demonstrated in this patient population.

Conclusions/Significance: Osteoporosis appears to have been dramatically underdiagnosed and undertreated in orthopaedic trauma patients. Up to 98% of our patients would likely not have been treated for osteoporosis without initiation of this "osteoporosis protocol." It appears that orthopaedic trauma surgeons may quite easily play a key role in diagnosing and treating osteoporosis, which ultimately may prevent secondary fractures.