
The Problem
The Need for Better Management of Fall and Fracture Risk Patients
- Bone density and independent risk factors such as oral steroid use, prior vertebral fracture, difficulty standing up and parental history of hip fracture contribute to fracture risk
- Leading bone health treatments such as bisphosphonates reduce fracture risk between 40-70% (assuming that patients are compliant with medications as they typically are in clinical trials) and can take up to 3 years to have fracture risk protection
- Fracture risk scores, such as FRAX, address clinical risk factors including BMD, but cannot be used with patients already under treatment with bone medication.
- The above assessment and management strategies do not address spine loading, spinal curvature, and falling which are critical factors in understanding fracture risk.
Spiraling cost of healthcare
- 12 billion dollars for hip fractures annually
- 17 billion dollars for total fractures
- By 2025, the number of osteoporotic fractures is projected to increase by almost 50%
Punitive Medicare preventable rule
- October 2008, the Centers for Medicare and Medicaid Services ceased reimbursing hospitals for "reasonably preventable" conditions developed during patient stays, this includes hip fracture from a fall.
- To be reasonably preventable, “ there should be solid evidence that by following guidelines, the occurrence of an event can be reduced to zero or near zero," said American Medical Association President-elect J. James Rohack, MD.
The Joint Commission
- The fall reduction program must include an evaluation appropriate to the patient population, settings, and services provided.
- National patient Safety Goal 9: Reduce the risk of patient harm due to falls
Falls and Bone Health Link
- Simply being over the age of 65 raises fracture risk
- About one-third of people aged 65 or over fall at least onece a year.
- Balance control is more impaired in patients with osteoporosis
- - Increased postural sway with kyphosis
- - Increased use of hip strategy