Medical management of osteoporosis and the surgeons' role

Osteoporosis is a worldwide public health issue and with the aging population the resultant increase in fragility fractures has generated a significant socioeconomic impact. Robust scientific research has increased our knowledge of the endocrine mechanisms and pathophysiology of osteoporosis. This information has led to Level 1 randomized clinical trials which demonstrate the beneficial effects of appropriate regimens in reducing the fracture risk and the coincident mortality. Despite these contributions the public health problem remains and has stubbornly failed many public awareness campaigns by governmental and private professional organizations. Effectiveness in delivering the message is greatly enhanced following the sentinel fragility fracture whether it be distal radius, hip, or spine. The treating orthopedic surgeon has the full attention of the injured patient who can be steered into osteoporosis screening programs and ultimately treatment. Studies in Canada have shown that if the surgeon initiates the process by so much as ordering the bone densitometry exam the patient is more likely to get treatment for their underlying disease than if it is just suggested that the patient see their medical doctor at some future date. The patient takes the cue from the surgeon. Patient compliance goes up and the treatment is instituted. We as surgeons must be part of the solution. This has been emphasized in the worldwide efforts in orthopedic surgery such as the "Bone and Joint Decade" and "Own the Bone" programs. This commitment to bone health and restoration is important. Our patients deserve no less.