“It happened at home. I was just walking and don’t really know how I fell,” recalls Lois Fledderjohann, 77, describing the accident that sent her to Ohio State’s University Hospital East last fall, where her broken hip was repaired by a multidisciplinary team focused on the unique needs of geriatric patients with fractures.
Fledderjohann is not alone. “About 1.5 million fragility fractures, which are fractures that happen when a person falls from their standing height or less, happen in the United States each year. Our bodies should be able to sustain a fall from this height without a fracture,” says Michael Quackenbush, DO, an orthopaedic physician at Ohio State. “And as the baby boomers age, that number is only rising.”
In response to this increase, the Orthopaedic Trauma team at University Hospital East instituted an innovative system for treating geriatric patients with fragility fractures.
“We’ve optimized the process so that we can get patients to surgery safely and faster,” says Laura Phieffer, MD, director of Orthopaedic Trauma.
The streamlined system engages patients in the Emergency Department, where all personnel are trained to efficiently and safely manage their transition to the operating room. “Patients are not laid up for days waiting for surgery,” says Dr. Quackenbush. “We focus on fixing their fractures and making them mobile again.”
“We give these patients high priority status,” says Dr. Phieffer. “We know they have better outcomes when we can stabilize them quickly.”
The expedited process, with a goal of moving patients into surgery within 24 hours of arrival, has additional benefits to the patient. “We lower the number of complications by transitioning patients faster,” says Corey Van Hoff, MD, assistant professor of Orthopaedics. “Patients are doing much better sooner. And, most importantly, they are feeling like themselves again so much more quickly.”
BACK IN ACTION
For Fledderjohann, that means getting around with a walker while she recovers at her daughter’s home in Homer, Ohio. “I think my new hip is wonderful,” she says.
And, for her daughter, Doreen Fletcher, that means ongoing care with a clinical team that really cares about her mom. “They are doing everything they can to accomplish what mom needs,” she says. “But they don’t make it a hassle for us in the process!”
Dr. Phieffer points out that the first goal for the Orthopaedic Trauma team was to create the first Fragility Fracture Center of Excellence in central Ohio, closely followed by focusing on outreach and prevention.
“We want to educate people who are at risk for these fragility fractures,” adds Dr. Quackenbush, who notes a close relationship between this type of fracture and osteoporosis. “If we can identify people who may be at risk for osteoporosis earlier on, perform a bone density scan and make sure
they get the right supplements, we hope to delay or even prevent the fractures in the first place.”
While prevention is important, it is also important for patients and their families to know that specialized care is available when they need it at University Hospital East.
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A bone mineral density scan helps identify those at risk for fragility fractures.
Bone mineral density testing looks at the patient’s bone mass. Normal bone mass appears in the top image. As bones lose mass, they become more porous, as seen in the middle and bottom images. More porous bones can fracture easily, even from seemingly innocuous activities like bending or coughing.
Spotlight on Osteoporosis
The most important thing you can do to prevent fragility fractures is to ask your primary care physician about a simple screening tool called a bone mineral density scan. “That is the baseline for monitoring bone mineral density and determining osteoporosis,” says Dr. Quackenbush.
This safe, painless, noninvasive test calculates a T-score, which compares the patient’s bone mineral density with that of a healthy 30-year-old of the same sex and race. The score indicates the risk for fragility fractures. Those at risk may be put on medication to help strengthen their bones.
According to Dr. Quackenbush, osteoporosis is characterized by a loss of bone mass caused by a deficiency of calcium, vitamin D and other minerals. Osteopenia, a thinning of the bone mass, is a transitional stage between normal bone and osteoporosis.
Ask Your Advocate
Q. Is it ever too late to treat osteoporosis?
A. It is never too late! There are many different treatment options, making it easy to find one that you can tolerate with minimum side effects. Many commercial products are now fortified with calcium and vitamin D so both men and women can benefit from them. Treating osteoporosis can also help with some pain relief.
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