Own the Bone: What’s Next in Fractures?

Kevin Kirk, DO speaking at TOA’s 2019 Annual Conference in Houston.

Kevin Kirk, DO, of TSAOG Orthopaedics & Spine in San Antonio recently co-chaired last week’s Own the Bone symposium on June 17 at the American Orthopaedic Association’s Annual Meeting in Providence, Rhode Island. Dr. Kirk recently became Vice Chair of the Own the Bone Steering Committee.

TOA recently sat down with Dr. Kirk to take a look at the Own the Bone campaign and the status of fracture management.

TOA: Why have you and AOA taken such a strong interest in the Own the Bone program?

Kevin Kirk: In 2004, the U.S. Surgeon General released a report on bone health and osteoporosis (“Bone Health and Osteoporosis: A Report of the Surgeon General”), which featured a call to action to respond to the epidemic of fragility fractures caused by osteoporosis.

In fact, as of 2020, 14 million people experienced osteoporosis, and 80 percent of those who experienced osteoporosis were women. One in two women and one in four men over the age of 50 will have an osteoporosis related fracture during their lifetime. The mortality rate after a hip fracture is 30 percent.

Even more concerning is the loss of independence; 50 percent will never regain their prior level of function, meaning that if they were able to walk independently prior to the fracture, they would now require a cane or walker. And the problem only escalates: For those who were using a walker, they will probably need a wheelchair. Up to 40 percent will require a nursing home after the fracture. The fracture leads to a progressive decline in function and independence.

Regarding costs, the cumulative osteoporotic costs over the next two decades is estimated to be $474 billion. The cost of a hip fracture is approximately $40,000, and that cost is expected to triple by 2040.

Osteoporotic fractures result in more hospitalization days than heart attacks, breast cancer or prostate cancer. The annual cost of osteoporotic fractures is estimated to be $19.1 billion more than CHF/asthma combined. The nearly two million fragility fractures outnumber the new cases of cancer/stroke/heart attacks combined (and that was simply 2010 data).

As you can see, the problem is enormous in terms of health care dollars and quality of life. So, what can we do about it? It seems futile. However, a 2007 study by Kaiser in California demonstrated a cost savings $50 million over a five-year-period after the development of an osteoporosis and fracture prevention program.

TOA: What has the AOA done regarding osteoporosis and bone health?

Kevin Kirk: Well, the AOA was founded in 1887 and is the oldest orthopedic organization in the world and is composed of surgeon leaders who focus on the delivery of quality musculoskeletal care.

After the release of the 2004 Surgeon General report, the AOA had a call to action to reduce secondary fractures and to educate orthopaedic surgeons regarding the need for bone health management post-fracture. At the 2005 AOA Annual Meeting, a Bone Health Task Force was established, and the committee developed a position statement regarding the obligation to evaluate for osteoporosis and prevent secondary fractures and called the program “Own the Bone,” as a call for orthopedic surgeons to “own” the underlying bone health of their patients.

After the position statement, a pilot study was conducted at 14 institutions in 2008. The results published in The Journal of Bone and Joint Surgery demonstrated that instituting a program can improve the performance of patient counseling on calcium and Vitamin D supplementation, exercise, fall prevention and communication with primary care physicians and patients. Since that time, the program has been instituted at over 286 sites.  An analysis of Own the Bone data from 2010 to 2015 published in The Journal of Bone and Joint Surgery demonstrated improvements in provider behaviors in the areas of osteoporosis treatment and counseling, BMD testing, initiation of pharmacotherapy, and coordination of care for patients who have experienced a fragility fracture.

TOA: Are these programs important to orthopedic surgeons?

Kevin Kirk: I say yes, but there has been slow to no improvement among far too many orthopedic surgeons. When fractures occur, patients turn to an orthopedic surgeon (not a primary care physician, rheumatologist or endocrinologist). So, we can take advantage of this sentinel event, the fragility fracture, and use the discharge process to educate the patients on the larger issue of bone health and osteoporosis as they relate to the prevention of secondary fractures.

2008 study in The Journal of Bone and Joint Surgery showed that the orthopedic management improved the rate of early osteoporosis treatment after hip fracture by twofold when compared to care as usual. Patients managed by orthopedics were two times more likely to be on pharmacotherapy at six months after fracture than if treated by PCP.

Personally, my interest is that my mom is one of the statistics. Fall, fracture, wheelchair, nursing home: I don’t say it for sympathy, but for empathy, and for far too many families that need to go through it.