After a Fracture: The First 48 Hours

My grandmother Esther found out she had osteoporosis in 1977 the way too many people still do today – in the hospital. She took a bad spill on tiles being installed in her apartment and broke her hip. X-rays confirmed not only the fracture, but also thinning of the bones so severe that diagnostic tests were done to rule out cancer and other causes.

Not yet 65 at the time of the fall – the age now recommended for most women to begin regular bone density tests – there would have been no practical way of knowing about her condition or its seriousness beforehand. But armed with the new knowledge, she was able to modify her lifestyle to live with the disease and avoid serious falls. She went on to live another 30 vibrant years and died in May from conditions unrelated to her osteoporosis. During that time, she watched her four grandchildren grow up and even saw her great-grandson learn to walk.

Despite the many advances in osteoporosis treatment in the last 30 years, however, studies have shown that awareness and management of this disease, characterized by compromised bone strength, still lags behind for too many patients – especially for those who discover their osteoporosis by sustaining a fracture. Orthopedic surgeons and other medical personnel concentrate on repairing the fracture, as well they should, but too often a discussion and intervention upon the patient’s brittle bones is neglected. And a patient who is in pain and possibly confronting a temporary loss of independence may be unprepared to start the conversation.

Nevertheless, it is vital to start thinking about osteoporosis within the first 48 hours after a fracture and diagnosis.

“You have to make sure the patient doesn’t get lost,” says Dr. Carlos Lozada, associate professor of rheumatology and immunology at the University of Miami Miami Miller School of Medicine and director of its Rheumatology Fellowship Program. And he cited an important reason why those who have already broken bones are especially in need of an osteoporosis consultation: “If you have a hip or vertebral fracture, you’re at much higher risk of more fractures,” he said.

In fact, at a seminar he led in May at Cedars Medical Center in Miami, Fla. on the diagnosis and treatment of osteoporosis, Dr. Lozada discussed research that demonstrated that sustaining a fracture indicates a significantly higher risk for another one within a year. The risk goes up with each subsequent fracture, he said. In other words, those patients who suffer a fragility fracture have the most to gain from treating their osteoporosis.

Dr. Lozada said that in the past, such patients were sometimes overlooked for treatment, perhaps because after a fracture was considered too late to help those with osteoporosis. “These patients are not lost causes,” he said. However, “most fracture patients receive no treatment for the underlying disease.”

Dr. Lozada noted that a tiny minority of patients treated at a hospital for a fragility fracture receive osteoporosis follow-up such as a bone density scan, a test that can diagnose low bone mass in an individual. Some studies have pegged the figure receiving such care at three to five percent, depending on the type of fracture. “It’s obvious there’s a problem, but it’s not being picked up,” Dr. Lozada said.