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managing these patients after discharge.5 With the growing burden of the aging population and its associated health-care costs, improving the efficiency of care will increasingly be the center of attention. Though the risk of non-hip fractures obviously increases with age, their peak incidence is earlier. Forearm fractures, for example, peak in the sixth decade, whereas hip fractures tend to occur in the eighth decade.3 The appropriate diagnosis and treatment of osteoporosis after the forewarnings provided by lower-impact fractures can lead to the secondary prevention of additional fractures – potentially preventing much more ominous hip fractures. The LGH GFP is currently working with representatives from the Radiology department to have automated letters generated based on the results of all X-rays performed in the LGH system. This has the potential for outreach to a vast number of patients who may not receive osteoporosis education otherwise. The treatment of osteoporosis in geriatric hip fracture patients remains a challenge for the GFP. Because patients are scattered throughout the postacute care network, many with new primary care physicians, and because use of resources is currently focused on recovery and rehabilitation, the diagnosis and treatment of osteoporosis is often neglected. This area will remain an active area of future development for the GFP. 116 Osteoporosis, the Silent Disease 1. Lorentzon M, Cummings SR. Osteoporosis: the evolution of a diagnosis. J Intern Med. 2015;277:650-61. 2. Pisani P, Renna MD, Conversano F, et al. Major osteoporotic fragility fractures: risk factor updates and societal impact. World J Orthop. 2016 Mar 18;7(3):171-81. 3. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteopros Int. 2006 Dec;17(12):1726-33. 4. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide Improvement in the Undertreatment of Osteoporosis Following Hip Fracture BY MICHAEL J. GARDNER, MD, KYLE R. FLIK, MD, PEKKA MOOAR, MD, AND JOSEPH M. LANE, MD Investigation performed at New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York; New York Hospital Queens, Flushing, New York; and Medical College of Pennsylvania and Hahnemann University School of Medicine, Philadelphia, Pennsylvania Background: Osteoporosis is a common disease characterized by decreased bone mass and increased fracture risk in postmenopausal women and the elderly. Hip fractures are among the most common consequences of osteoporosis and unfortunately usually occur late in the course of the disease. When a patient is admitted to the hospital with a fragility hip fracture, a unique opportunity for diagnosis and treatment presents itself. Fortunately, several medications have proven to be effective in lowering the risk of future fractures. The purposes of the present study were to test the hypothesis that most fragility hip fractures go untreated and to determine whether educational efforts to raise physician awareness have led to an improvement in osteoporosis treatment rates. Methods: A retrospective cohort study was performed with use of the patient databases at two university medical centers and one university-affiliated community hospital. The charts of 300 randomly selected patients were sorted with use of ICD-9 (International Classification of Diseases, Ninth Revision) codes for femoral neck fractures. There were 100 patients from each center, with twenty-five patients from each year between 1997 and 2000. The admitting diagnosis, mechanism of injury, admission medications, procedures performed during hospitalization, and discharge medications were then extracted and analyzed. During this period, the National Osteoporosis Foundation established guiding principles for the treatment of fragility fractures. Results: Of the seventy-five patients from all centers for each year from 1997 to 2000, 11%, 13%, 24%, and 29%, respectively, were discharged with a prescription for some medication targeting osteopenia, either supplemental calcium or an antiosteoporotic medication (estrogen, calcitonin, a bisphosphonate, or raloxifene). A trended chi-square analysis of this increase revealed a p value of 2.5 standard deviations below the normal peak value) and 37% to 50% of women (thirteen to seventeen million women in the United States) have osteopenia (defined as a bone density between one and 2.5 standard deviations below the normal peak value). An additional 3% to 6% of men (one to two million men in the United States) have osteoporosis, and 28% to 47% of men (eight to thirteen million men in the United States) have osteopenia4 . If untreated, it is estimated that more than half of all Caucasian white women will sustain an osteoporotic (fragility) fracture during their lifetime5,6 . The hallmark osteoporotic fractures include femoral neck, O 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). Downloaded from www.ejbjs.org on October 1
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