The Journal of Bone and Joint Surgery (American). 2006;88:18-24.
doi:10.2106/JBJS.D.02949
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Knowledge and Opinions of Orthopaedic Surgeons Concerning Medical Evaluation and Treatment of Patients with Osteoporotic Fracture

John G. Skedros, MD1, Joshua D. Holyoak, BA1 and Todd C. Pitts, AAS1

1 Utah Bone and Joint Center, 5323 South Woodrow Street, Suite 202, Salt Lake City, UT 84107. E-mail address for J.G. Skedros: jskedros{at}utahboneandjoint.com

Investigation performed at the Utah Bone and Joint Center, affiliated with the Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Merck and Company and from the Utah Bone and Joint Center, Salt Lake City, Utah. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: With the exponential increase in osteoporotic fractures, orthopaedic surgeons are in a logical position to become more involved in the medical treatment of this disease. However, it has been hypothesized that surgeons may not be inclined to initiate such treatment if they do not view medical interventions as an extension of their surgical opportunities. The objective of this study was to determine the knowledge and opinions of orthopaedic surgeons with regard to their opportunities for initiating medical treatment of patients with an osteoporotic fracture.

Methods: A survey consisting of twenty-two questions was administered to 171 orthopaedic surgeons in Utah, Idaho, and Wyoming.

Results: Of the 171 surveys that were mailed, 107 usable surveys were returned (a 63% response rate). A majority of the orthopaedic surgeons thought that it was appropriate to expand their orthopaedic practice to include prescribing pharmacological treatments for osteoporosis (68% agreed or strongly agreed with that statement). However, 47% were concerned enough about adverse events related to some conventional pharmacological treatments that they would rather avoid prescribing them. Of the surgeons who were willing to prescribe these treatments, 74% felt most comfortable prescribing bisphosphonates and >77% felt most comfortable prescribing calcium and vitamin-D supplements. Fifty-one percent considered an apparent osteoporotic fracture and several other clinical risk factors for osteoporosis as sufficient evidence for initiating pharmacological treatments, whereas 72% thought that a bone-density scan should be made before initiating treatment. Although 32% thought that all nonoperative treatment should be the responsibility of a primary care provider, 63% thought that the orthopaedic surgeon should initiate a workup to look for secondary causes of the osteoporosis and should begin medical treatment of patients with an osteoporotic fracture before referring them.

Conclusions: Although a majority of orthopaedic surgeons believe that they should expand their role in the medical treatment of patients with an osteoporotic fracture, many do not institute medical treatment and think that the patient's primary care providers should be responsible for medical care.


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