The Journal of Bone and Joint Surgery (American). 2008;90:2346-2353.
doi:10.2106/JBJS.G.01246
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Orthopaedic Management Improves the Rate of Early Osteoporosis Treatment After Hip Fracture

A Randomized Clinical Trial

Roberto A. Miki, MD1, Matthew E. Oetgen, MD2, Jessica Kirk, MD2, Karl L. Insogna, MD3 and Dieter M. Lindskog, MD2

1 Department of Orthopaedics, Miller School of Medicine, University of Miami, 900 N.W. 17th Street, Miami, FL 33136. E-mail address: rmiki2{at}med.miami.edu
2 Department of Orthopaedic Surgery, Yale University School of Medicine, 800 Howard Avenue, New Haven, CT 06510
3 Department of Internal Medicine, Section of Endocrinology, Yale University School of Medicine, P.O. Box 208020, New Haven, CT 06520-8020

Investigation performed at the Department of Orthopaedic Surgery, Yale University School of Medicine, New Haven, Connecticut

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Although osteoporosis is strongly associated with hip fractures, the initiation of osteoporosis treatment following hip fractures occurs at surprisingly low rates of between 5% and 30%. Currently, most patients receiving treatment have been referred back to their primary care physician for osteoporosis management. The purpose of this study was to compare the effect of osteoporosis management initiated by the orthopaedic team and osteoporosis management initiated by the primary care physician on the rates of treatment at six months.

Methods: A prospective randomized trial was conducted to assess the difference in the rate of osteoporosis treatment when an in-house assessment of osteoporosis was initiated by the orthopaedic surgeon and follow-up was conducted in a specialized orthopaedic osteoporosis clinic compared with osteoporosis education and "usual" care.

Results: Sixty-two patients were enrolled in the study. Thirty-one patients each were in the control and intervention groups. The percentage of patients who were on pharmacologic treatment for osteoporosis at six months after the fracture was significantly greater when the evaluation was initiated by the orthopaedic surgeon and was managed in a specialized orthopaedic osteoporosis clinic (58%) than when treatment was managed by a primary care physician (29%) (p = 0.04).

Conclusions: An active role by orthopaedic surgeons in the management of osteoporosis improves the rate of treatment at six months following a hip fracture.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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