Managing bone health a practice-wide effort

According to the National Osteoporosis Foundation, 50 percent of American women will suffer a fragility fracture in their lifetime. The financial cost of this silent disease is estimated to be $26 billion annually by 2020. The sociological impact of this disease is not so easily tabulated. Roughly 20 percent of seniors who suffer a hip fracture die within one year. Fear, pain, depression, financial ruin, and collateral damage to the family are all common occurrences in addition to surgery, hospitalization, and extended care.

Certified PAs are well suited to proactively identify and manage osteoporosis and associated fragility fractures, including the ongoing patient education and monitoring that it requires. It is crucial to routinely and proactively screen all patients over the age of 50. While there are medications to treat the disease, there are strategies and lifestyle changes that can delay and minimize the chances of sustaining fragility fractures and poor orthopaedic and neurosurgical outcomes.

I started the Bone Health Clinic in the offices of our orthopedic practice, Utah Orthopaedics, three years ago with the support of my husband who is a fellowship-trained foot and ankle orthopaedic surgeon who also takes trauma call and does elective joint reconstruction. While in the operating room we would often lament on the poor bone quality of various patients and how that would sometimes change our surgical decisions. It only takes one intraoperative fracture to motivate one to change practice protocols.

As a PA, I believe one of my primary roles is to stay current on research and best practices.  It’s also important to develop relationships with leaders in the field so that I may provide the best information and education to my patients. My job is to inform and support patients in the decision-making process as they decide if and/or how to treat and manage their osteoporosis. Many patients are fearful and often tearful but my goal is to empower them with the tools to regain control of their (bone) health and quality of life.

In addition to pharmaceutical intervention, there are many other ways that patients can improve their bone health as well as overall health with the help of their healthcare partners.

• Seek appropriate and sustainable exercise.
It has to be enjoyable and effective. As a group fitness instructor for 30 years, I encourage joining a gym with classes. Patients benefit from a set schedule, professional supervision, and the social support of a group fitness environment. Yoga and water classes are my most common recommendations.

• Monitor diet and supplementation.
For years, calcium supplements were widely recommended. What we know today is that there can be serious side effects and it is best to eat a calcium-rich diet. A vitamin D supplement, however, is important for most patients. Levels need to be monitored periodically.

• Improve lifestyle habits.
Avoid smoking, limit alcohol, strive for a healthy body composition, minimize narcotic use, and improve the quality of diet.

• Identify risk factors.
Document the family history, medications, previous fragility factors, diseases of malabsorption and rheumatoid arthritis, early menopause, and tendency to fall.

• Explore treatment options.
It may be enough to recommend vitamin D supplements and a healthy diet but valuable medications such as bisphosphonates, FORTEO®, and Prolia® may be needed. These drugs require patient understanding and commitment as well as monitoring.

• Look forward.
Reinforce the importance of compliance with the treatment and of re-evaluation over time.

Because May is National Osteoporosis Month it is a good time for clinicians to screen for and help prevent and minimize the impact of this silent disease.

Alexandra Rocco, PA-C, has been certified by the National Commission on Certification of Physician Assistants (NCCPA) for 18 years. She provides comprehensive bone health care at Utah Orthopedics in Ogden, Utah.