OrthoVirginia Blog

Osteoporosis primer for physician assistants, part 1

Blog post written by OrthoVirginia Lynchburg's Daniel Acevedo, PA-C for the Healio Orthopaedics Today blog. Read the full blog post here

Mrs. Smith is a 65-year-old woman who fell outside her apartment complex 2 days ago. She did not report feeling dizzy or lightheaded and lost no consciousness prior to her fall. It was raining 2 days ago, and she lost her footing and fell from a standing height onto an outstretched right hand. Mrs. Smith says her hand and wrist hurt immediately but just thought it was sprained. Two days later when her right hand was so swollen and bruised that she could not use it, she presented to your clinic. Appropriate radiographs were ordered and a distal radius fracture was appreciated. There was enough intra-articular extension and displacement to warrant surgical fixation. Six weeks later, postoperative films showed a healing fracture, and with her pain improved, she was discharged from her surgeon’s care and was told to follow up as needed.

This is a common scenario played out in many orthopedic clinics. In fact, distal radius fractures account for 20% of all emergency department visits and is the most common upper extremity fracture in elderly patients. However, we are not doing justice to the underlying problem by simply calling this a simple distal radius fracture. This injury is a fragility fracture, likely caused by osteoporosis. Mrs. Smith is likely to fall again and is at risk for future fractures. She also has a statistically significant chance of fracturing her hip and thus, increasing her 1-year mortality risk.

The purpose of this article is to highlight the importance of recognizing the underlying metabolic cause of Mrs. Smith’s fracture — her underlying osteoporosis. More than 10 million Americans are osteoporotic and another 40 million have low bone mass. Of those who suffer an osteoporotic hip fracture, 24% will die within 1 year. These are staggering statistics. What is more alarming is that most patients who suffer a fragility fracture are not treated for their underlying osteoporosis.

In this multipart series, I will present the basics of diagnosis, treatment and prevention of osteoporosis for physician assistants (PAs). This is applicable to those PAs practicing in orthopedics, primary care, emergency medicine and any specialty caring for those patients older than 65 years.

Osteoporosis defined

According to Kloztbuecher and colleagues, osteoporosis is “a systemic disease, characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.” Objectively, the World Health Organization criteria for the diagnosis of osteoporosis is 2.5 standard deviations below the average peak bone mass for a healthy 20-year-old sex-matched person, as measured on a DEXA scan. Osteoporosis is a common disease. For example, 750,000 osteoporotic vertebral fractures occur every year and up to a quarter of patients older than the age of 50 years will sustain at least one vertebral fracture in their lifetime.

Why is osteoporosis a problem?

Osteoporosis represents significant public health and economic burdens. According to Miller and colleagues, fractures caused by osteoporosis “were responsible for an estimated $19 billion in costs in the United States. By 2025, experts predict that these costs will rise to approximately $25.3 billion.” Osteoporosis accounts for 80% to 90% of all fracture hospitalizations for patients between 60 years and 74 years of age. Osteoporosis-related fractures account for more than 400,000 hospital admissions and 2.5 million medical office visits per year. Hip fractures, which are most commonly caused by osteoporosis, will kill more women than breast cancer. At the very least, two-thirds of patients who sustain a hip fracture will never regain their previous level of function.

Fragility fractures

A fragility fracture is any type of fracture that results from a low-energy trauma and is likely due to osteoporosis. For example, a fall from a ground level or seated height that results in a hip fracture is considered fragility type injury. Classically, fragility fractures occur around the hip, distal radius, proximal humerus and vertebrae. However, any break can make this classification if it results from low energy and the risk of subsequent fractures appears to increase with the number of prior fractures.

In the next series of articles, we will delve into the risk factors for osteoporosis, diagnostic modalities and treatment strategies.

Visit Orthopaedics Today Healio Blog for the full article and more blogs written by Daniel Acevedo PA-C

Daniel J. Acevedo, PA-C, is a board-certified physician assistant who practices at the Orthopaedic Center of Central Virginia in Lynchburg, Va. His research interests include physician assistant education, osteoarthritis and periprosthetic joint infections.
dan.jpg

Comments
in house mold making and design
Thank you for sharing a detailed description about this Osteoporosis problem. The article describes the problem in detail and all the associated features related to it. I am eagerly waiting for the next session of this article to know in detail about these risk factors for osteoporosis.
6/20/2017 12:05:17 AM

Citrix Platinum Partner
Really a very good read and very motivating.
5/8/2017 7:39:40 AM

assignment help online
Thanx for sharing such useful post keep it up
4/24/2017 12:50:34 AM

uk assignment help
wow really great information for me.the pediatrician is a born related medicine.thank you fro sharing this information. thank you so much
4/7/2017 12:44:07 AM

academic writing help
We proffers different styles of academic writing tasks with structured paragraphing and concrete information to ease the immense academic workload of students.
3/22/2017 2:30:31 AM

essay writing service
wow really great information for me.the pediatrician is a born related medicine.thank you fro sharing this infromation.thank you so much
3/17/2017 5:52:51 AM

essay writing service reviews
Thank you fro sharing this information.I really like to read this information.Keep it fro sharing .This is my first visiting to this site.I really enjoyable to read
3/17/2017 5:50:33 AM

ayurveda hospital in kerala
thank you fro sharing this information.The orthopedic means born special treatment.today all most all peoples have the born problem.The patient are very disappointed to this decease .Thank you for sharing this type of helpful information.
3/17/2017 1:08:02 AM

whatsapp for ipad download
WhatsApp Messenger is the best among the standalone messaging apps that are available today.
3/13/2017 7:44:13 AM

Write my essay paper
This is unique played out in ceaseless orthopedic workplaces. In all honesty, distal cross breakdowns address of all fiasco separation appointments and is the most for the most part filed most remote opinion riven in aging patients.
2/20/2017 6:24:29 AM

Bluestacks download for pc
Wow! Excellent description about your experience. Really a mind touching one. Details about osteoporosis health blog will helpful for the readers to visit their for treatment. Thanks a lot
2/14/2017 2:35:22 PM

write my essay
This is especially enlightening substance and created well for a change for good health and tackling well to osteoporosis.
2/2/2017 8:00:42 AM

Admission essay writing services
Wow! Excellent description about your experience. Really a mind touching one. Details about osteoporosis health blog will helpful for the readers to visit their for treatment. Thanks a lot.
2/2/2017 6:46:53 AM

Buyassignment.com
This is a distinctive situation played out in frequent orthopedic facilities. Truth be told, distal span breaks represent of all disaster division visits and is the most widely documented furthest point crack in elderly patients.
1/30/2017 6:59:36 AM

top rated essay writing service
I had read several blog post, but the blog post is so special one for me. It impressed me a lot and I enjoyed each section. Way of presenting the content is the most highlighting one and I am working as a writer at top rated essay writing service company and want to know more...
1/30/2017 4:54:00 AM

Homework help websites
Fitting radiographs were requested and a distal sweep crack was valued. There was sufficient intra-articular expansion and uprooting to warrant surgical obsession. A month and a half later, postoperative movies demonstrated a mending break, and with her agony enhanced, she was released from her specialist's care and was advised to catch up as required.
1/25/2017 1:32:47 AM

 Security code