The New York Times recently published a compelling article. No, in case you’re wondering, it wasn’t about the recent presidential election. It did, though, focus on a medical problem affecting many people around the ages of both presidential candidates—bone fractures.
Although the meat of the research detailed in the article is quite helpful, one of the interesting points that’s discussed is the disconnect between surgical and medical fields in the treatment of bone density and fractures.
As a Houston, Texas medical malpractice lawyer, I see this type of disconnect all the time in a variety of settings.
Medical doctors in non-surgical fields sometimes refer patients to surgeons for acute problems, without taking into account the overall need for prevention preventative care. On the other hand, surgeons are focused—many with a laser-like intensity—on cutting on things in operating room, but not so much on preventing future injuries. Like Tarzan, some swing in and out of patient’s lives so quickly, it can seem like a whirlwind.
This brings us back to the topic of bone density and fractures. In routine preventative medicine in higher risk and senior populations, there’s a focus on bone density testing to identify a patient’s risk of developing a fracture. Bone density test is quick and simple, essentially a specialized x-ray.
That’s all well and good, but what about patients who already had a fracture? The Times article included a quote that—pardon the pun—was bone chilling to me. “The person at highest risk of a fracture is the one who’s just had a fracture,” according to Dr. Ethel Siris, an endocrinologist and director of the Osteoporosis Center at the Columbia University Medical Center. These second fractures are typically osteoporotic fractures, meaning that the poor condition of brittle bones was the dispositive factor.
Yet, research has revealed that the high risk of repeat fractures is often lost on patients and physicians. Many doctors and surgeons exclusively focus their attention on mending the broken bone, rather than working up the reason for the fracture and ways to prevent future broken bones. This is particularly important when a person experiences a broken bone that’s not the result of a major trauma, such as a motor vehicle collision.
According to a 2015 research report by the National Osteoporosis Foundation, of two million Medicare patients who were studied after being hospitalized for a bone fracture, over 300,000 had a second fracture within two to three years. The bean counters took notice of the huge additional cost of $6.3 billion in healthcare resources.
What was telling about this outcome is that less than 10% of these patients had been referred for testing for bone loss within the first six months after the first fracture and, when necessary, given drugs to promote healthy bones.
I think that there is still a significant disconnect between orthopedic surgeon to repair fractures and primary care and other medical physicians who handle the overall treatment of patients. When patients experience a fall unexplained by trauma, the standard of care requires:
• Ordering blood work to assess calcium and Vitamin D levels. Both of these levels play a tremendous role in the body’s calcium balance, including bones retaining or losing calcium.
• Consideration for prescribing medications to promote healthy, strong bones. Bisphosphonate medications are typically the first-line treatment for osteoporosis, including drugs like Fosamax, Actonel, Boniva, and Reclast. Other drugs, such as Forteo, Tymlos, and Evenity can be prescribed for people with osteoporosis -related fractures, to increase the speed of bone growth.
• Recommend appropriate weight-bearing physical activity and exercise and good nutrition. Doctors should consider referral to a physical therapist and dietitian.
If you’ve suffered from a broken bone unrelated to trauma, share this information with your physician to make sure that your care doesn’t fall through the cracks. If you’ve been seriously injured because of repetitive bone fractures and think that you’ve been provided with appropriate care in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer to discuss your potential case.