Healthy Bones Program Reduces Hip Fractures By 37 Percent, Kaiser Permanente Southern California Study Finds

Main Category: Bones / Orthopaedics
Article Date: 05 Nov 2008 - 3:00 PST

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A study conducted by Kaiser Permanente Southern California has shown that proactive measures can reduce hip fracture rates by an average of 37.2 percent -- and as much as 50 percent -- among those at risk. The study was published online on November 3 by The Journal of Bone & Joint Surgery, a peer-reviewed journal.

The five-year study led by Richard M. Dell, MD, an orthopedic surgeon at the Kaiser Permanente Bellflower Medical Center, tracked more than 625,000 male and female patients over the age of 50 in Southern California who had specific risk factors for osteoporosis and/or hip fractures. The implementation of a number of initiatives in the Kaiser Permanente Southern California Healthy Bones Program reduced the hip fracture rates well beyond the goal rate of 25 percent.

"One-half of all women and one-third of all men will sustain a fragility fracture in their lifetime. The mortality rate due to osteoporosis-related fractures is greater than the rates for breast cancer and cervical cancer combined," notes Dell. "I'd like to dispel the misconception that nothing can be done to prevent or treat osteoporosis. It is possible to achieve at least a 25 percent reduction in the hip fracture rate in the United States if a more active role is taken by all orthopedic surgeons in osteoporosis disease management. We've seen it; we've done it."

Participating physicians implemented a number of initiatives including increasing the use of bone density test (DXA Scans) and anti-osteoporosis medications; adding osteoporosis education and home health programs; and standardizing the practice guidelines for osteoporosis management. The full article is found at http://www.ejbjs.org/cgi/content/abstract/90/Supplement_4/188

The National Osteoporosis Foundation reports that, although osteoporosis can affect people of all ages, the problem of osteoporosis has reached epidemic proportions with the rapidly aging population. Of the 10 million Americans who have osteoporosis, 80 percent are women. More than 300,000 hip fractures are reported annually in the United States. Twenty-four percent end up in a nursing home, fifty percent never reach their functional capacity, and twenty-five percent of patients with a hip fracture die in the first year after the incident.

"We realize that Kaiser Permanente has a significant advantage in osteoporosis disease management. We have an integrated healthcare delivery program with an advanced electronic medical record that allows for identification, risk stratification, and tracking of our patients," said Dell. "Kaiser Permanente also has the advantage of care managers that use our information systems to help manage and treat our patients with osteoporosis."

"Nonetheless, significant improvements are achievable wherever orthopedic surgeons and treatment teams are willing to take a more active role in osteoporosis disease management."

Study authors include: Richard M. Dell, MD and Denise Greene, RNP, MS, Department of Orthopedics, Kaiser Permanente Bellflower; Steven R. Schelkun, MD, Department of Orthopedics, Kaiser Permanente San Diego; and Kathryn W. Williams, MSG, Department of Orthopedics, Kaiser Permanente Fontana.

We Own The Bone

The following recommendations will assist orthopedic medical professionals in the prevention and treatment of osteoporosis disease:

1. Be a Champion. Remember that addressing the problem of fragility fractures is multifaceted and will require a multidisciplinary solution. Identify potential partners in your community.

2. Be Proactive. Identify high-risk patients and don't wait until your patient has a fragility fracture.

3. Teach your patients about osteoporosis and falls.

4. Develop pre-printed admission sheets and orders.

5. Develop a discharge checklist for fragility fracture patients, and improve your discharge documentation.

6. Set realistic goals and measure what you've done.

7. Use the new fracture risk assessment tool called FRAX.

For the detailed list, go here.

About the Kaiser Permanente Department for Research and Evaluation

The Department of Research and Evaluation conducts high quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences, and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women's and children's health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit http://www.kp.org/research.

About Kaiser Permanente

Kaiser Permanente is one of the nation's leading integrated health plans. Founded in 1945, it is a nonprofit, group practice prepayment program with Southern California headquarters in Pasadena, California. Kaiser Permanente serves the health care needs of 3.3 million members in Southern California. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Southern California Permanente Medical Group. Kaiser Permanente's Southern California Region includes more than 55,800 technical, administrative and clerical employees and caregivers, and more than 6,400 physicians representing all specialties.

Kaiser Permanente