Initiative Encourages Orthopedists to Own Bone Health

When patients more than 50 years old present with a fragility fracture, the American Orthopaedics Association has a message for the orthopedists who treat them: own the bone.

In fact, Own the Bone is the name of an AOA initiative designed to change both physician and patient behavior when it comes to ensuring that patients don't suffer a second similar bone break.

"We wanted to become more than just broken-bone doctors. We wanted to actually think about treating the bone from the standpoint of making it healthy like we do with our patients," said Kyle J. Jeray, MD, a South Carolina orthopedic surgeon with expertise in orthopedic trauma. Jeray directs Own the Bone at the Greenville Hospital System University Medical Center and is an AOA spokesman for Own the Bone. He described the program as a Web-based, quality-improvement strategy that's "just so easy to roll out to hospitals nationwide."

A Little History

Seeds for Own the Bone were planted in 2004. That's when the Surgeon General's Report on Bone Health and Osteoporosis revealed that "red flags" signaling osteoporosis were being ignored – and one of the most important danger signs was a fragility fracture.

Jeray said most orthopedists probably recognized the connection between osteoporosis and fractures years ago, "but nobody really wanted to take charge. Some of that fault is our own; we're all busy doctors, and we all have different things on our agenda. We looked at the patient as a broken bone, and we're trying to change that mentality in orthopedics, especially around these fragility fractures."

Thus, the AOA launched a pilot Own the Bone program in 14 hospitals, where data was collected for nearly a year in 2005-2006. "We declared the pilot a success in terms of trying to prevent additional fractures," Jeray said. What the data showed was that only 12 percent of patients over 50 who were treated for a fragility fracture in vulnerable areas such as the hip, wrist or spine had been receiving necessary follow-up treatment at the pilot hospitals. After Own the Bone was implemented, 80 percent of the patients in those 14 hospitals then were referred, diagnosed and/or treated if necessary.

Own the Bone's recommended measures to improve bone health and ward off future breaks include:

A duel energy X-ray absorptiometry (DXA scan) to gauge bone density,Calcium and vitamin D supplements,Weight-bearing and muscle-strengthening exercise,Fall-prevention education,Smoking cessation,Limitations on excessive alcohol intake andPharmaceuticals to treat osteoporosis.

"If patients are on appropriate medicines, that decrease (in the number of subsequent fractures) can be sometimes as much as 30 or 35 percent, and that's a big deal," Jeray said.

Own the Bone's measures are consistent with recommendations from the National Osteoporosis Foundation, the Centers for Medicare and Medicaid Services, the Joint Commission, the World Health Organization and the American Medical Association.

Own the Bone's Objectives

A top goal of Own the Bone is to ensure that orthopedists and subsequently their patients are cognizant of osteoporosis. "With patient and doctor education, we improved the care significantly," Jeray said. The pilot results were published in a 2008 edition of The Journal of Bone and Joint Surgery. Then in 2009, AOA began the push to introduce Own the Bone to all 50 states, Puerto Rico and the Virgin Islands. To date, more than 80 hospitals, hospital systems, hospices and other appropriate patient-care institutions are onboard.

Jeray likened Own the Bone to the American Heart Association's Get with the Guidelines™ program, which successfully changed the way physicians treat patients who suffer a myocardial infarction. Now those heart attack patients receive beta-blockers, a precaution that was far from guaranteed before Get with the Guidelines changed the paradigm. Own the Bone hopes to one day effect that same kind of change, introducing an evidence-based standard of care that drives future treatment of older adults. Don't be surprised if those standards aren't someday adopted by the Product Quality Research Institute as a measure to improve healthcare, Jeray added.

In addition, osteoporosis treatment faces a hurdle that Jeray compared to the battle against hypertension. "Patients don't feel bad, but they have high blood pressure. The internal medicine doctors recognize it as a problem with bad consequences, so they treat patients with hypertension preventatively," he said. "I think, in some ways, osteoporosis is that same way. Without really good education, patients don't understand why they need to take medicine if they don't feel bad."

How OTB Works

Institutions pay to be members of Own the Bone, with $2,000 annually the top price per institution. (The more hospitals in a system, the less the per hospital fee.) Membership offers institutions the ability to log-in to the system and enter the necessary data on each patient, thus allowing hospitals to compare their service with their peers. The system also offers support features, such as the ability to printout prewritten letters to help orthopedists notify patients' primary care physicians when a patient suffers a fragility fracture. The letters include recommendations for action by the primary care doc. The system also provides a wealth of information to help practitioners educate patients about osteoporosis risks.

Jeray said that his Greenville hospital assigns a nurse practitioner as the Own the Bone point person. She begins educating fragility-fracture patients "when they hit the door," Jeray said, and ultimately spends about 30 minutes with each patient entering appropriate data and printing out and explaining educational materials. In Greenville, the Own the Bone data is easily linked to the system's electronic medical records, thus ensuring that patients' follow-up care doesn't fall through the cracks.

"The more our patients and physicians are educated about this, the better chance we are going to be successful at treating osteoporosis," Jeray said. "Ultimately, what we would like to do is use this for our research to really document that this is successful."

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