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Q J Med 2004; 97: 101-104
© Association of Physicians 2004; all rights reserved.

Commentary

The patient with a fragility fracture: an evolving role for the orthopaedic surgeon

T.J. Schnitzer1 and L.E. Wehren2

From the 1Department of Medicine, Northwestern University, Chicago, and 2Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, USA

Osteoporosis can now be diagnosed readily, and treatments that increase bone mineral density and decrease fracture risk, even after fragility fracture has occurred, are now available. Clinical guidelines for management of osteoporosis unanimously recognize that fracture risk is highest among those who have already sustained a fracture, and encourage prompt evaluation and treatment of these individuals. Despite these guidelines, most women who experience fragility fractures remain untreated (for osteoporosis) by any of the physicians involved in their care. Barriers to diagnosis and treatment have been identified, including uncertainty about the responsibility for such management. The orthopaedic surgeon has a unique opportunity to initiate definitive osteoporosis evaluation and treatment in patients who present with fractures, and recent guidelines support the evolution of the role of the orthopaedist in this direction.

Address correspondence to Dr L.E. Wehren, Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 660 West Redwood Street, Suite 200, Baltimore, Maryland 21201, USA. e-mail: lois_wehren{at}msn.com


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