MedStar Georgetown Launches Project to Improve Bone Health and Prevent Fractures in High Risk Patients

MedStar Georgetown University Hospital has launched a pilot project to coordinate care for people at risk for debilitating and potentially deadly bone fractures. In collaboration with groups that work to promote bone health, clinicians at MedStar Georgetown are seeing patients through a new Fracture Liaison Service (FLS) that evaluates people who have had a fracture for osteoporosis, and offers them treatment.

June 26, 2014

Bone Health Collaborative Looks to Close a National Gap in Care

(Washington, D.C. June 26, 2014) MedStar Georgetown University Hospital has launched a pilot project to coordinate care for people at risk for debilitating and potentially deadly bone fractures. In collaboration with groups that work to promote bone health, clinicians at MedStar Georgetown are seeing patients through a new Fracture Liaison Service (FLS) that evaluates people who have had a fracture for osteoporosis, and offers them treatment.

Osteoporosis is a skeletal disorder that causes bones to thin and weaken, making them more likely to break.

Gloria Trumpower receives bone density scan to test for osteoporosis.

“People with osteoporosis are at higher risk for suffering bone fractures,” said Andrea Singer, M.D., an internist and director of Bone Densitometry at MedStar Georgetown and medical director for the new FLS program. “Statistics show that only half of people over 50 who suffer a hip fracture ever return to their previous level of functioning and 25 percent of patients who break their hip die within the first year. So, this is an important disease to find and treat early.”

66-year-old Gloria Trumpower of Virginia is an active boater and ball room dancer. When she tripped and fell over her kayak and broke her arm recently she was invited to enroll in the FLS program at MedStar Georgetown. That’s where she learned from Dr. Singer that her fracture places her at higher risk for a potentially life-threatening second fracture. A bone density scan as part of the FLS program confirmed a diagnosis of osteoporosis. Gloria is now considering medication to treat the condition.

“The accident made me feel so vulnerable. I still can’t do normal things with my arm like zip a zipper or brush my teeth,” Gloria said. “I really hope to get back to my kayaking and ballroom dancing which I was doing three to five times a week until now. I also want to avoid a second fall at all costs.”

Here’s how the FLS works. Patients over the age of 50 who suffer a fracture after a low trauma incident will be identified through the inpatient service, emergency room, interventional radiology, orthopaedics, and other outpatient practices. They will next be invited to meet with a member of the FLS team to discuss their risk for osteoporosis and to undergo a painless bone density scan.

“If the scan or clinical situation is consistent with osteoporosis or a high risk for future fracture, I will offer the patient strategies to improve their bone health including nutrition, exercise and medication,” said Dr. Singer.

Andrea Singer, M.D. discusses test results and treatment options with Gloria Trumpower.

“To me osteoporosis has been a silent disease,” said Gloria. "I didn’t feel bad and couldn’t see my bones on a daily basis so I guess I took my bone health for granted.”

“One of the biggest obstacles in identifying and treating people with osteoporosis is our sometimes fragmented healthcare system,” said Dr. Singer. “We hope a Fracture Liaison Service will demonstrate a model of improved care that many hospitals in the U.S. can adopt.”

The Centers for Disease Control and Prevention reports that 10 percent of women and two percent of men over age 50 have osteoporosis.

“The numbers are devastating,” said Dr. Singer. “Of the 99 million Americans over age 50, half have osteoporosis or low bone mass, putting them at increased risk for fracture. And that number will continue to grow.“

The National Osteoporosis Foundation reports that half of women over 50 and about a quarter or men over 50 will break a bone in their lifetime due to osteoporosis. That works out to two million fractures each year due to osteoporosis.

The National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) reports that only 23 percent of women over age 67 who suffer a hip or other fracture are ever tested or treated for osteoporosis. Medicare spends more than $5 billion each year to treat bone fractures in seniors, yet most of the patients are not being evaluated for osteoporosis.

Dr. Singer recommends people ensure they’re getting enough calcium and vitamin D in their diets and supplementing with vitamins if necessary. Weight bearing and muscle strengthening exercises also help to strengthen bones. “And if you’re over 50 and have a low-trauma fracture seek an evaluation for osteoporosis that includes an easy 15-minute bone density scan.”

Bone density images can be compared with previous scans.

Those at highest risk for osteoporosis are Caucasian women with a small build. There are many other risk factors for osteoporosis and fracture including increasing age, a family history of broken bones and osteoporosis, current smoking, alcohol intake (3 or more units per day), poor calcium intake, low vitamin D, and inactivity to name a few. Certain medical conditions and medications can also cause bone loss.

Calcium rich foods include dairy products, fortified juices, cereals and other foods and some vegetables like leafy greens.

Dr. Singer says daily calcium requirements differ based on age and gender but generally the following is recommended from diet and supplements combined:

  • Women age 50 and younger 1000 mg calcium
  • Women age 51 and over 1200 mg calcium
  • Men age 70 and younger 1000 mg calcium
  • Men age 71 and over 1200 mg calcium

Women and men age 50 and older should get 800-1000 International Units of vitamin D each day, although some people need more.

The Bone Health Collaborative coordinating the FLS project is made up of the National Bone Health Alliance, the National Osteoporosis Foundation, and technology partner CECity which is providing its cloud-based MedConcert platform and an FLS application that includes a patient registry and care coordination application. The Johns Hopkins Armstrong Institute will analyze the collected data from MedStar Georgetown as well as the two other clinical centers, Alegent Creighton Health in Omaha, Nebraska and University of Pittsburgh.

Merck is providing funding to CECity for the pilot program.

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