After a Damaged Bone, the Threat of a Second Fracture
In different nations, and inside some medical networks in the US, together with the Kaiser Permanente system in California, there are coordinated providers to guarantee acceptable post-fracture follow-up. In 2013, the Worldwide Osteoporosis Basis launched a marketing campaign known as Seize the Fracture to guarantee that “fragility fracture victims obtain acceptable evaluation and intervention to scale back future fracture danger,” however such organized preventive measures have remained uncommon in the US.
Establishing fracture liaison providers, as they’re known as, faces a serious stumbling block on this nation. There’s no mechanism to pay the one that coordinates care between the orthopedic surgeon and the working towards doctor. Medicare doesn’t cowl the price of a coordinator, Dr. Siris mentioned, “so there’s no incentive to get a post-fracture affected person into medical arms. Many major care docs don’t even know that their sufferers broke a hip.”
Given the astronomical prices to Medicare of hip fractures, Dr. Khosla known as the failure to cowl the price of coordinating providers to forestall a second fracture “penny-wise and pound-foolish.” (After all, that is however one in every of many economically questionable limitations of Medicare. Contemplate, for instance, its failure to cowl listening to aids, the dearth of which will increase the chance of dementia, falls and a number of different costly medical issues that Medicare does pay for.)
The consensus group’s 13 suggestions for stopping fractures embrace recommendation to not smoke or use tobacco, to restrict alcohol consumption to 2 drinks a day for males and one for ladies, and to train usually, at the least 3 times per week, together with weight-bearing, muscle-strengthening and steadiness and postural workout routines. Docs are urged to debate each the advantages and attainable dangers of medicines that may assist forestall fractures.
Many sufferers have been unduly frightened, Dr. Khosla mentioned, by the quantity of consideration given to the uncommon dangers of an atypical femur fracture or jaw decay when taking bisphosphonates like Fosamax that may assist preserve bone energy.
“When the medication are used accurately for 3 to 5 years, adopted by a drug vacation, and a focus is paid to warning signs like leg or dental ache, the advantages of therapy means outweigh the dangers,” he mentioned.
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