Osteoporosis and Spinal Fracture Management Tool: Own the Bone^®

Doctor Kyle J. Jeray spoke to the audience about the American Orthopaedic Association’s (AOA) Own the Bone^® initiative to improve bone health. Dr. Jeray is an orthopaedic surgeon with expertise in orthopaedic trauma at the Steadman Hawkins Clinic of the Carolinas in Greenville, SC. During Dr. Jeray’s presentation, he discussed osteoporosis, its prevalence, and associated health problems and costs.
“Osteoporosis in its simplest terms is low bone mass. Its normal bone; it is just not enough."

FRAX is another tool available to physicians. FRAX is the World Health Organization’s Fracture Risk Assessment Tool. It includes the patient’s clinical risk factors, such as body mass index, history of a fracture, and parental history of hip fracture. FRAX can help predict the 10-year probability of hip fracture risk and 10-year probability of a major osteoporotic fracture.  

About Osteoporosis
“Osteoporosis in its simplest terms is low bone mass. Its normal bone; it is just not enough. If we look at the World Health Organization's classification, they use a T-score to classify it, and it is considered low bone mass or osteopenia if it is a -1 to -2.5 and anything less than -2.5 is considered osteoporosis,” stated Dr. Jeray.

Prevalence in the United States (US)

• 54 million Americans have low bone mass
• About 10 million have osteoporosis
• Men and women are affected

Fracture risk in the US:

• Women: 1 in every 2 over age 50 years
• Men: 1 in every 4 over age 50 years

Actual fractures in the US:

• >1.5 million annually
• >700,000 of these fractures are vertebral fractures

Dr. Jeray commented, “If we look at where they [vertebral fractures] are at 2006, and if we look at where they are going to be in 2030, we can see the fractures of the spine are increasing exponentially. A huge problem and area I think really needs to be addressed.”

Related Healthcare Costs
“The number of patients that spend their time in the hospital is more than heart attacks, breast cancer, and prostate cancer,” stated Dr. Jeray.

• In 2004, almost $25 billion was related to osteoporotic fractures
• Next 20 years: $500 billion will be spent on osteoporotic fractures
• Biggest cost is quality of life

Dr. Jeray commented, “As you would expect, hip fractures comprise a huge portion of it [2 million men, 80,000 per annum]. If we look at the spine fracture piece, it is only about 6%, but I would tell you that, that spine fracture piece is going to increase, and it is probably going to increase exponentially as we start operating on more and more spine fractures. As the number of spine fractures that are occurring in this age group [50 years and older] increase, it is going to demand more dollars.”

Underlying Problem
Only a small percentage of the patients who have sustained an osteoporosis-related fracture are being treated for osteoporosis. This represents a gap in health care that should be corrected. Who should be responsible to identify, diagnose and initiate treatment of osteoporosis? Orthopaedic surgeons, neurosurgeons, rheumatologists, the primary care physicians? Making the responsibility a medical community (eg, nurse practitioners, physician assistants) issue can help.  

Osteoporosis treatment works. Dr. Jeray pointed out, “We have good literature to show that it [osteoporosis treatment] makes a difference. If we look at Kaiser Permanente, they must save $50 million in five years by treating these patients, because they target risk reduction and reduction in fractures from 3-7 fold. So it can work and be successful.”

How Own the Bone^® Works
How do you initiate the program and make it successful in your practice? Dr. Jeray explained, “You need someone who is going to be a site champion. It doesn't have to be an orthopedist; it doesn’t have to be a neurosurgeon. Sometimes it is a nurse practitioner.” Furthermore, Dr. Jeray’s practice started the program with just residents and himself in a group of 26 orthopaedic surgeons and neurosurgeons in a Level 1 trauma center. It wasn’t until Dr. Jeray got a nurse practitioner dedicated that the program became very successful.

“We use Own the Bone, as I said, it is customizable, so you take what you need to make it work in your institution,” concluded Dr. Jeray.