Fragility fractures affect up to one-half of women and one-third of men over age 50, and are often associated with low bone density.
Also known as a low-trauma fracture, this type of break occurs as a result of a fall from a standing height or lower, such as a trip on a curb that leads to a fractured hip or wrist.
Although the link between fragility fractures, osteoporosis, and future fractures has been well known for more than 30 years, only about 20 percent of the nearly 2 million Americans who sustain this type of break are tested or treated for osteoporosis.
Fortunately, efforts are underway to heighten awareness that people over 50 who suffer fractures need to undergo bone mineral density testing, monitoring and, if necessary, treatment in an effort to prevent a subsequent fracture.
One way some healthcare providers are addressing the issue is by establishing fracture liaison services. This type of multispecialty program emphasizes prevention, coordinated care, and personalized medicine, and can be made available through a variety of healthcare settings, including large hospitals, managed care networks, Medicare providers, and private health insurers.
Research has shown that such programs are effective, reducing the number of fractures and fracture-related hospitalizations, improving quality of life, and saving money. The following example demonstrates how a typical fracture liaison program might work:
• The fracture liaison service coordinator—typically a nurse or other allied health professional— schedules an initial visit for any patient over age 50 who has had a fracture. This visit entails a comprehensive review of the person’s medical history and a physical examination, after which relevant laboratory tests, X-rays, and a bone mineral density scan are ordered.
• Based on the results of those tests, an individualized plan is developed for the patient that usually includes recommendations for lifestyle modifications, including diet and exercise; nonprescription dietary supplements (vitamin D and calcium); and, if needed, prescription medications. The program may also assess the risk of future falls, based on the person’s history of falls, a review of medications used, and vision, gait, balance, and mobility evaluations.
• Follow-up visits are scheduled as needed to review the patient’s progress and adjust the care plan if needed.
If you or a loved one you’re caring for suffers a fragility fracture and appropriate follow-up care is not offered, don’t hesitate to take the lead. The doctor who diagnoses the fracture may be able to refer you to a nearby fracture liaison service. If you don’t have access to such a program:
• Inform your primary care doctor about the fracture. She or he can order a bone mineral density test to assess your bone status and calculate your risk for a future fracture. Alternatively, the doctor may refer you to a specialist to manage your care.
• Ask for an individualized plan to enhance your bone health, including lifestyle and, if necessary, medication recommendations.
• Ask about ways to reduce your risk of falling in the future.
Some medications, balance problems, and certain cardiovascular problems, such as blood pressure that’s too low when you stand (orthostatic hypotension), can increase your risk of falling.
Safety hazards in the home, such as throw rugs, lack of handrails, and poor lighting, also can contribute to an increased risk of falling.
Read more about how hip fractures are treated and regaining independence after a fracture.