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Osteoporosis Maryann Alexander, RN, MS
The number of patients who suffer from the sequella of osteoporosis is alarming. Each year, 1.5 million patients are afflicted with the pain and debilitation effects of a fracture. Twenty-five percent of all women beyond the age of 65 developed skeletal deformity and it is the twelfth leading cause of mortality in women. The financial burden this disease places on the health care system is phenomenal. Currently, the estimated cost of osteoporosis on the U.S. health care system is $13.8 billion. Unless health care professionals play an active role in education, assessment, treatment and prevention of this public health problem, these numbers will increase as the population of elderly in the United States continues to rise. What makes these numbers even more disconcerting is the fact that this disease can now be readily diagnosed and managed through a variety of treatment options.
Orthopedic surgeons, who are recognized for their experience and expertise in the management of skeletal disorders and bone pathology, have often take a back seat to other specialists who are identifying patients at risk and initiation care and preventative measures. The retrospective approach of treating the result of the disease, not the disease itself is an archaic approach to contemporary problem. Orthopedic surgeons must start learning about this disease and treating it aggressively.
Recent studies have documented the efficacy of new medications and the benefits of preventive care. Two important resources to facilitate physicians treating osteoporosis patients have become available. The Physician’s Guide to Prevention and Treatment of Osteoporosis published by the National Osteoporosis Foundation provides algorithms for physicians caring for patients with this disease. This eliminates some of the questions and confusion surrounding the various treatment protocols and the Current Concepts Review by Mirsky and Einhorn provides an overview on bone density testing and interpretation.
The problems with payment for bone density studies have been eliminated. The "Standardization of Medicare Coverage of Bone Mass Measurement" was signed into effect in July of 1998. This piece of legislation ensures Medicare coverage of bone density studies across all states.
In the November 1998 issue of JBJS (vol. 80-A) Tosi and Lane provide a comprehensive overview of the reasons orthopedic surgeons can and should address this problem.
The World Health Organization has described osteoporosis as a disease which has reached epidemic proportions. Ignoring this problem raises ethical/legal questions.
There is reason to believe we can prevent osteoporosis in future generations. Orthopaedic surgeons must rise to the challenge.
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