After a broken bone, the risk of a second fracture

In other countries, and within some medical networks in the United States, including the Kaiser Permanente system in California, there are coordinated services to ensure proper post-fracture follow-up. In 2013, the International Osteoporosis Foundation launched a campaign called Capture the Fracture to ensure that “people with fragility fracture receive appropriate assessment and intervention to reduce the risk of future fracture”, but such preventive measures organized have remained rare in the United States.

Establishing fracture liaison services, as they are called, faces a major hurdle in this country. There is no mechanism to pay the person who coordinates care between the orthopedic surgeon and the medical practitioner. Medicare does not cover the cost of a coordinator, said Dr Siris, “So there is no incentive to put a post-fracture patient into medical hands. Many primary care physicians don’t even know their patients have broken hips.

Given the astronomical costs to Medicare of hip fractures, Dr Khosla called failure to cover the cost of coordinating services to prevent a second fracture as “dime and stupid.” (Of course, that’s just one of Medicare’s many economically questionable limitations. Take, for example, its inability to cover hearing aids, the absence of which increases the risk of dementia, falls, and many other costly medical problems that Medicare does. Medicare does. Pay for.)

The Fracture Prevention Consensus Group 13 recommendations include advice not to smoke or smoke, limit alcohol intake to two drinks per day for men and one for women, and exercise. regularly, at least three times a week, including weight-bearing, muscle building and balance, and postural exercises. Doctors are encouraged to discuss both the benefits and possible risks of medications that can help prevent fractures.

Many patients have been unduly frightened, Dr Khosla said, by the attention paid to the rare risks of atypical fracture of the femur or jaw decay when taking bisphosphonates like Fosamax, which can help maintain strength. bones.

“When drugs are used correctly for three to five years, followed by time off for drugs, and attention is paid to warning symptoms like leg pain or toothache, the benefits of treatment outweigh. largely on the risks, ”he said.