Orthopaedics and Rehab
Medical therapy for fragility fractures improves patient mobility, reduces recurrence
February 13, 2018
Fragility fractures rank high on the list of worrisome health considerations for seniors, their caregivers, and their physicians. Arm, hip, or spine fractures caused by falls or traumatic injuries affect more than 2 million people in the U.S. every year.
For decades, fragility fracture treatment has been severely siloed across health care organizations. After surgical repair of the fracture, hospital discharge was the end of a patient’s care. The patient would be sent to rehabilitation with no preventive measures in place.
This single-modal approach and abrupt cessation of care led to avoidable infections, loss of mobility, recurrent falls, and even death. This myopic approach creates a vast financial burden to the health care system and society. Historically, hip fractures have been notoriously life-threatening, with a mortality rate between 12 and 37 percent in the year after the fracture, and just half of patients able to regain normal independence after surgery. By 2050, hip fractures are expected to increase 310 percent in men and 240 percent in womencompared to data from 1990.
The U.S. population is trending older, and a national movement is underway for the development of bone fragility programs that incorporate prevention for seniors, such as ours at UT Southwestern. Our protocol begins with surgery and includes rehabilitation and preventive medication therapies for all patients. As part of an academic medical center, our surgeons, endocrinologists, therapists, and other vital providers are in constant communication to provide multidisciplinary care. The Bone Fragility care team focuses on two distinct, patient-focused goals.
Two main goals of the Bone Fragility Program
1. Help patients regain prior functional status
When a patient enters our program, we strive to fix or stabilize the fracture surgically within 24 hours. The goal is to get the patient up and walking the same day whenever possible, even patients who undergo full and partial joint replacements or transsacral-transiliac screw stabilization.
Every day a patient spends in bed reduces strength and increases the risk of bed sores and infections. These deficits contribute to morbidity and mental health concerns related to decreased mobility and quality of life. Expedited physical and occupational rehabilitation mitigates deficits and increases the chance of full recovery.
2. Prevent future fragility fractures
UT Southwestern’s Endocrinology Department spearheads the prevention component of our Bone Fragility Program. This team helps pinpoint and medically manage the underlying causes of a patient’s bone fragility. In doing so, we can reduce the risk of recurrent fractures and potentially prolong high-quality years of a patient’s life.
Our high-risk osteoporosis clinic (HiROC) provides laboratory testing of a patient’s vitamin D, calcium, and parathyroid and thyroid hormone levels, all of which affect bone fragility. We consult with our endocrinology colleagues to determine the proper medication therapy to improve bone stability and prevent recurrent fractures. Medical therapies might include:
- Calcium supplementation
- Vitamin D supplementation
- Nutritional support
Research has shown that providing medication therapy in conjunction with expeditious physical rehabilitation after surgery can reduce fragility fracture recurrence. After the first fracture, a patient is at greater risk for another without systemic treatment.
If your patient suffers a fragility fracture, or if you would like to consult with us about our approach, we invite you to connect with our Bone Fragility Program. If a referral is needed, our endocrinologists, surgeons, and therapists will ensure your patient receives comprehensive care before, during, and after surgery.