Are people getting proper diagnosis and treatment after a fracture?
A common recommendation in the Newsletters on this Website is that in order to assure proper diagnosis and treatment of your osteoporosis it behooves you to become educated about your condition and to be active in discussions with your care provider. Here's another study showing why this is so important. See Osteoporos Int 2003 Dec 16, Skedros JG, PMID 14676993. In this study the participating orthopedic surgeons were instructed to mail a letter requesting an osteoporosis work up to the primary care provider (PCP) for each low-density fracture patient they saw. Interestingly, only 9 of the 14 surgeons involved were fully compliant and consistently sent the letter to the PCP. The author suggests that rather than a letter, standing discharge orders for medications, PCP follow up, bone density scanning, etc., might be more effective. Here's the problem: A non-orthopedic surgeon diagnosis and treats osteoporosis, but an orthopedic surgeon treats patients that have fractures due to their osteoporosis. Thus, the orthopedic surgeon is the first physician to see this person who has osteoporosis but but this person doesn't yet realize it (and unfortunately, all too many orthopedic surgeons apparently don't realize it either). Low-energy trauma that causes a fracture is virtually diagnostic for osteoporosis of itself, yet it is wise to get blood tests, bone density tests, etc., done to have a baseline view of the problem or to be certain of the diagnosis. There appears to be a need to educate orthopedic surgeons of their duty to refer these patients for diagnosis and treatment after the fracture repair. A common concern among physicians is the litigious society we live in where so many patients appear to be looking for a lottery ticket. Yet, I have written articles on this Website about study after study dealing with this problem of failure to refer patients for proper diagnosis and treatment after low-trauma fracture, and the problem just keeps being reported. It is surprising that there aren't more lawsuits than you hear about over this issue. There has to be some way to get the attention of the offending physicians, I wish it was something easier than a lawsuit, but I'm not sure how to do it. Hopefully they will read Skedros' article and just write a standing order for all low-energy trauma fracture patients they see to have an osteoporosis work up done. This certainly seems like a simple and effective solution to the problem. But, in case the orthopedists don't do this, be sure to tell your friends and family when they do have a low-energy fracture that they need an osteoporosis work up. See this update for more information on this topic.