The Age of Osteoporosis – Part 3

I had an interesting conversation about osteoporosis with Dr. Paul Howard, a prominent rheumatologist in my area.  He told me the story of a big presentation he gave to a large consortium of prominent rheumatologist when he was in training in the mid-1980s.  Don’t forget, this is before the time of computer presentations and PowerPoint.  These were the days of painstaking slide presentation and Kodachromes.  His topic was osteoporosis.  After the nerve-racking presentation, his mentor congratulated him on a good presentation.  Then he questioned Dr. Howard about why he gave a presentation on a problem they couldn’t do anything about.  Well, we’ve come a long way in 25 years, but we are just scratching the surface of treating the epidemic of osteoporosis.

While ideally we would like to adequately prevent osteoporosis and osteoporotic fractures from ever occurring, this is often not the case.  Osteoporosis, much like hypertension and diabetes, tends to be a silent problem until it is too late.  A large percentage of people are diagnosed as osteoporotic after a sentinel event like a low energy fracture. The involvement of orthopedic surgeons in overall treatment of osteoporosis is critical.  As orthopedic surgeons, we are often the providers on the front line as we are seeing these patients first as we treat their fracture.  The orthopedic community has been promoting a concept of “Own the Bone.”  The idea is for the orthopedic providers to not only treat acute events like a fracture, but also promote good overall bone health.  This has been difficult as osteoporosis is essentially a chronic problem requiring chronic treatment.  For this reason, a lot of the responsibility has fallen to the primary care physician, who inevitably, treats most chronic conditions.

We know that one of the biggest predictors of an osteoporotic fracture is a history of a previous osteoporotic fracture.  In these cases, our biggest goal is to prevent another fracture.

Written by  Dr. Brimacombe, MD 

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