Osteoporosis in orthopaedic trauma patients: a diagnosis and treatment protocol.

OBJECTIVES: The purpose of this study was to determine the prevalence of patients at risk for osteoporosis and fracture in a cohort of orthopaedic trauma patients and to subsequently determine the efficacy of a protocol for evaluation, education, and treatment in these patients.
DESIGN: Prospective study of "osteoporosis protocol" for evaluation, education, initiation of treatment, and 1-year follow-up in orthopaedic trauma patients.
SETTING: Level 2 regional trauma center. PATIENTS: Two hundred sixty consecutive adult patients treated by an orthopaedic trauma surgeon for an acute orthopaedic injury were prospectively enrolled in an osteoporosis protocol between January and August 2005. INTERVENTION: Patients were evaluated using quantitative ultrasound (QUS) of the heel administered at the bedside and with comprehensive medical, osteoporotic, ovarian, nutritional, family, and current injury histories. For patients identified as high risk for osteoporosis (QUS of the calcaneus-derived T-score <or= -1.6), treatment was initiated. Intervention included (1) direct patient education, (2) twice-daily calcium and vitamin D therapy during the hospitalization and a prescription to continue after discharge, and (3) referral to the patient's primary care physician (PCP) with a copy of the QUS results for discussion of further treatments. A telephone interview was conducted at 12 months to determine the status of the patients' osteoporosis treatment. MAIN OUTCOME MEASUREMENTS: Patient and injury data including QUS results (osteoporosis risk), treatment efficacy at hospitalization, and 12 months postinjury
RESULTS: Complete data were available for 238 (92%), in whom the average age was 51 years (18-93). Seventy-three patients (30%) had a high risk for osteoporosis, and an additional 51 patients (21%) were at moderate risk. Intervention with education and initiation of medical therapy was successfully achieved in 69 of the 72 (96%) patients in the high-risk group. Odds ratios for variables and high-moderate osteoporosis risk were determined. At the 12-month follow-up, 57% of patients in the high-risk osteoporosis group reported that they had consulted their PCP regarding the osteoporosis, and 47% had continued medical treatment. Bisphosphonates therapy was initiated in 29% of the high-risk patients.
CONCLUSIONS: Following a protocol for osteoporosis identification and initiation of treatment, almost one-third of patients were identified as being at high risk for osteoporosis in this orthopaedic trauma population. Specific components of the protocol included patient education and referral to the PCP, and nearly half of high-risk patients continued osteoporosis treatment at 12 months follow-up. Orthopaedic trauma surgeons can play a significant role in the diagnosis and treatment of osteoporosis in hospitalized patients and may be able to reduce the incidence of secondary fragility fractures.