Building a Multidisciplinary Care Pathway Supported by a Surgical Approach to Local Bone Formation

Osteoporosis is the most common disease of bone mineral metabolism. In Spain, it affects approximately 3 million people, of whom 80% are females and 20% are males. Despite the advances that have been made in this field, we continue to witness alarming levels of fragility hip fractures. In 2010, the cost of osteoporosis in the European Union was estimated to be 37,000 million euros, which included the costs for the treatment of incident fractures (66%), pharmacological prevention (5%), and long-term fracture care (29%). A multidisciplinary care pathway supported by a surgical approach to local bone formation is needed. Recently, the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis (ESCEO) included in their treatment guidelines a local osteo-enhancement procedure (LOEP) as a treatment option. In the Ossure™ LOEP technique (AgNovos Healthcare USA, LLC, Rockville, MD), a calcium-based triphasic osteoconductive implant material (AGN1), which has been shown to increase bone mineral density (BMD) and proximal femoral strength, is introduced percutaneously in the femoral neck and intertrochanteric region. Basically, the procedure consists of three percutaneous steps: prepare, clean, and fill the cavity with AGN1. It can be carried out with sedation and local anaesthesia or spinal anaesthesia. This report presents a clinical case and discusses how to select patients who could potentially benefit from this technique.