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Friday, April 19, 2024

UC Davis Health develops Fragility Fracture Program to identify and provide care for patients at risk of osteoporosis

A fragility fracture, which can result from a fall from standing height, can be indicative of weakened, brittle bones and even osteoporosis

By BRANDON NGUYEN — science@theaggie.org 

The National Osteoporosis Foundation finds that roughly half of all women and up to a quarter of men will suffer a fragility fracture in their lifetime. As individuals grow older, the time needed to recover from a broken bone is prolonged and may be an indicator of a more serious health concern. 

Dr. Hai Le, an orthopedic surgeon at the UC Davis Medical Center, provided a medical definition of a fragility fracture.

“A fragility fracture is a fracture of the spine or long bone with minimal energy and with minimal trauma,” Le said. “This usually results from a fall from standing height or lower and can indicate that the bone density is very poor. It happens quite frequently, especially among postmenopausal women or women above the age of 50 with poor bone density, as well as men above the age of 65.”

Fragility fractures are most common in the hip or spine and can suggest that the bones of an individual have weakened or have become brittle, a condition known as osteoporosis. 

A recent study conducted by Le and his team found that patients who have had a fragility fracture are more likely to experience another one in the future. The study also brought  to light the lack of follow-up care to prevent these patients from potentially suffering another fragility fracture and to treat cases of osteoporosis earlier on in the medical process.

“We found that among most of these [fragility fracture] patients, only 20% of these patients are receiving post-fracture chronic care, and that indicates the undertreatment of the patient population, leading to an increased risk for recurrent falls and recorded fractures,” Le said. “The other important aspect is that fragility fracture patients have a very high mortality risk, so, within one year, [27%] of patients will pass away because these fractures can severely affect their mobility and quality of life.”

Because of the lack of attention to care for these types of patients and the associated high mortality rate, UC Davis has developed the Fragility Fracture Program, an interdisciplinary collaboration of departments at the UC Davis Medical Center organized in order to quickly identify those who have suffered from a fragility fracture and to provide comprehensive treatment to reduce risk of future fractures.

Dr. Polly Teng, an endocrinologist at the UC Davis Medical Center, described her role in the Fragility Fracture Program.

“Many hormones govern our bone health, so in normal bone remodeling, breakdown of old bone occurs in order to form a new bone, a risk factor that may put people at higher risk for osteoporosis and fragility fractures,” Teng said. “My role as an endocrinologist includes diagnosing osteoporosis, and to determine if they have risk factors that put them at risk for osteoporosis. Common risk factors can include vitamin D deficiency, inadequate calcium intake or absorption of other things that could be underlying endocrine disorders, such as people who are hyperthyroid, or have too much thyroid hormone production.”

Fragility fractures are just one indicator of osteoporosis, and Teng’s role in diagnosing osteoporosis includes conducting a complete laboratory screening of potential risk factors from a hormonal standpoint. Diagnosis, rheumatology and endocrinology specialists like Teng may prescribe pharmacologic and nonpharmacologic lifestyle modifications depending on the patient’s needs, including vitamin D or calcium supplements as well as referrals to physical therapists. 

The Fragility Fracture Program has grown to better cater to its patients by including more in-patient therapies for those with hip fractures, for example. This is immediately followed by a referral to the mobility clinic — part of the Healthy Aging Center — at UC Davis Health to work on treatments for these patients. 

More than 53 million individuals in the U.S. either already have osteoporosis or are at high risk of fragility fractures due to low bone density, according to the National Osteoporosis Foundation. Providing care among Medicare beneficiaries, including direct medical care as well as indirect costs from productivity lost and informal caregiving, has been estimated at $57 billion in 2018 and is projected to increase to over $95 billion by 2040. As both Teng and Le emphasized, preventative treatment early on in a person’s experience with fragility fractures can have a major impact on public health.  

Dr. Barton Wise, a rheumatologist at the UC Davis Medical Center, explained how the 

Fragility Fracture Program could not have been initiated without the interdisciplinary collaboration among the various health departments.

“This is a collaborative process among many different groups, including orthopedics, the emergency room, the Healthy Aging Center for the mobility clinic, endocrinology, rheumatology and so forth,” Wise said. “There are two points: one, to coordinate the care for the patients, and number two, to have a research component of it, so we can understand what is working, what is not working, so we can provide more comprehensive care to our fragility fracture patients.”

Written by: Brandon Nguyen — science@theaggie.org


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