In other countries, and in some US health networks, including the Kaiser Permanente system in California, there are coordinated services to ensure proper post-fracture follow-up. In 2013, the International Osteoporosis Organization launched a campaign called Capturing a fracture to ensure that “people with a brittle fracture are evaluated and intervened appropriately to reduce the risk of fractures in future, ”but such organized preventive measures are still rare in the United States.
The establishment of communication services for fractures, as they call it, faces a huge setback in this country. There is no mechanism to pay a coordinator of care between orthopedic surgeons and practicing physicians. “So there is no incentive to put the patient after a fracture into the medical arm,”; said Dr. Siris. Many primary care doctors don’t even know that their patients have a hip fracture.
Given the terrible costs of Medicare for a hip fracture, Dr. Khosla calls the inability to pay the coordination of services to prevent a second fracture “wise and stupid. (This is, of course, one of the many questionable economic limitations of Medicare. Consider, for example, not having a hearing aid, the lack of which increases the risk of dementia and falls. and a host of other expensive medical problems that Medicare pays for.)
The 13 consensus group recommendations for fracture prevention include advice not to smoke or use tobacco, to limit alcohol intake to two drinks a day for men and one drink for women, and regular exercise. regularly, at least three times a week, including weight training, muscle strengthening and balance and posture exercises. Physicians are encouraged to discuss both the benefits and possible risks of medications that may help prevent fractures.
Many patients have been terrified, said Dr. Khosla, of the rare risks of atypical femoral fracture or deep jaw fracture when bisphosphonates such as Fosamax can help maintain bone strength.
“When the drugs are being used properly for three to five years, then it’s time to stop taking them and pay attention to warning symptoms like leg or tooth pain, the benefits of a great treatment than the risk, ”he said.