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is the only most thorough investigation comparing vertebroplasty and conservative treatment. Unfortunately, the report stated “Vetebroplasty may provide a modest reduction in pain at 1 year, compared with the control procedure; and no difference in functional disability was observed”. The discouraging remark might not discourage miserable patients and energetic surgeons. However, it should have reminded the surgeon on individualized considerations [10]. Do Nutritional Supplements Help?: Vitamin D supplementation is widely prescribed as it is contained as part of the clinical guidelines for osteoporosis management and fracture prevention. However, recent meta-analyses of randomized controlled clinical trials failed to confirm any benefit of vitamin D and calcium supplementation in patients without pronounced deficiency of these factors. These findings highlight the need to re-assess its wide-spread use in clinical practice. Procuring a healthy lifestyle with a balanced diet and remaining physically fit remain the main pillars of a sustainable bone health [11]. Does specific Genomic predisposition influence the outcome of Osteoporosis?: A large international collaboration has tracked down 15 variations in the genome that are related to the risk of suffering osteoporotic fractures. The collaboration went a step further and used genomic information on other risk factors to examine their causal role on developing fractures. Results showed that only bone mineral density and muscle strength are directly involved in fracture susceptibility. Genetic predisposition to other clinical risk factors like vitamin D levels and calcium intake, historically considered to be crucial mediators of fracture, were not found to be directly predisposing fracture [11]. Conclusion Orthopaedic Surgeons of today could comfortably conclude that increasing muscle and bone strength through the maintenance of a healthy life style with balanced diet and plenty of physical training remain the most important practice in the prevention of Osteoporosis, and even when early signs of deterioration (i.e.Osteopenia) are GINAL ARTICLE The orthopaedic surgeon’s role in diagnosing and treating patients with osteoporotic fractures: standing discharge orders may be the solution for timely medical care John G. Skedros Received: 25 June 2003 / Accepted: 11 November 2003 / Published online: 16 December 2003 International Osteoporosis Foundation and National Osteoporosis Foundation 2003 Abstract Patients who suffer osteoporotic fractures do not typically receive medical/pharmaceutical treatment for osteoporosis. Orthopedic surgeons are concerned about, but not always diligent in following up on, the medical treatment of their fracture patients. The objective of this study was to determine whether orthopedic surgeons could effectively and consistently refer patients with osteoporotic fractures to a primary care provider (PCP) for possible work-up and treatment of osteoporosis. Fourteen orthopedic surgeons participated in the program. Sixty-nine qualifying patients were ‡50 years old, had a low-energy fracture, and had no prior treatment for osteoporosis. For each patient, two letters requesting a PCP appointment were sent to their PCP: one within 10 days of fracture and another 3–10 weeks after fracture. Patients were also instructed that they might have osteoporosis, and were directed to see their PCP. Results showed that of 69 patients (59 females, ten males: average age 69.5±10.9 years), 30 (43.5%) did not see a PCP within 84 days. Thirty-nine (56.5%) patients saw a PCP within 84 days, but osteoporosis was not addressed in four (average days to PCP, 39.8±18.6: range 7–78 days). Of patients seen within 84 days, antiresorptive medications (e.g. bisphosphonate) were started in 21/39 (53.8%), but typically not within 41 days of fracture. Of the 14 orthopedic surgeons, five were noncompliant and seven were inconsistent in their participation, forgetting to send the letters and/or inform patients to make PCP appointments. Standing discharge orders (for medications, PCP follow-up, bone-density scanning, etc.) may be more effective in achieving timely medical treatment for patients of orthopedic surgeons with osteoporotic fractures. Keywords Orthopedic surgeons Æ Osteoporotic fractures Æ Primary care providers Introduction Patients with osteoporotic fractures typically do not receive subsequent medical treatment for this disease Following an osteoporotic fracture, the timely initiation of pharmacological treatment with an anti-resorptive agent (e.g. some bisphosphonates) can significantly increase bone mineral density (BMD) within months of fracture, which reduces the risk of subsequent fracture [8, 9, 10]. These commonly used agents have also been shown to have minimal or no adverse affects on fracture healing [11]. In turn, orthopedic surgeons are becoming increasingly aware of the necessity of the timely initiation of medical treatment for osteoporosis, especially for their middle-aged or older patients with low-energy fractures However, a recent survey of 107 orthopedic surgeons showed that most are hesitant to increase the scope of their responsibilities to include anti-resorptive pharmacological agents for patients with osteoporosis [16]. This survey also showed that surgeons would prefer to refer their patients with osteoporotic fractures to a primary care
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