Bone fractures are a major health issue, especially among individuals with osteoporosis. For perspective, in the U.S. there are approximately two million osteoporosis-related bone fractures per year. Some annual estimates suggest about 700,000 osteoporosis-related fractures are vertebral compression fractures.
And, the prevalence and cost of fractures related to osteoporosis is only expected to grow. That's because according to the National Osteoporosis Foundation, approximately 10 million Americans have osteoporosis and another 44 million have low bone density, placing these individuals at increased risk. The NOF also cites data predicting that by 2025, osteoporosis will be responsible for around three million bone fractures per year, resulting in about $25 billion in costs.
To learn more about challenges and trends in bone health, as well as opportunities to improve outcomes and population health, Becker's Spine Review recently spoke with Lee C. Levanduski, chief operating officer, and Jeffrey T. Kannen, D.O., M.S., primary care sports medicine, at Tampa-based Florida Orthopaedic Institute, which operates an innovative Bone Health Clinic.
Costly gaps in bone care
"Current screening and prevention of osteoporosis is underwhelming and fails to address the current population of patients who need to be treated, as only one in seven patients with osteoporosis receives treatment," Mr. Levanduski said. Gaps in care mean there is lack of education for patients, lack of prevention and lack of appropriate treatment.
When osteoporosis is untreated, bones can grow weak and break. A result is that in the United States, about 50 percent of women and 25 percent of men over the age of 50 will break a bone because of osteoporosis-caused bone weakness. This includes frequent spine-related fractures.
Fractures create a physical and psychological burden for patients and caregivers, in that a fracture reduces function as well as quality of life. In addition, fractures are costly for patients, payers and the U.S. healthcare system. In fact, a bone fracture related to osteoporosis can have a total cost of more than $30,000 including care in the emergency room, hospitalizations, surgical interventions, rehab, follow-up office visits and pharmacologic treatment.
A better approach — Education, prevention and tailored treatment
Florida Orthopaedic Institute's Bone Health Clinic is focused on improving the health of the populations it serves and achieving better bone health outcomes. The Clinic emphasizes education and prevention treatment that is tailored to each individual.
- Education: "The most important role of the Bone Health Clinic is to promote awareness and education about osteoporosis for patients, clinicians and the local health care system," Mr. Levanduski said.
- Prevention: The key to the Bone Health Clinic's preventive care is a proactive, individualized assessment of each patient's current fracture risk. This assessment includes a detailed history and examination of the patient's current risk factors, followed by bone density testing (DEXA) and blood marker testing. This assessment helps determine the appropriate course of action to decrease a patient's risk and to try to prevent worsening of osteoporosis or a fracture.
- Tailored treatment: The assessment also informs decisions about the treatment options, which are tailored for each patient based on their specific fracture risks. Patients who are at high risk for fracture are immediately offered appropriate treatments, which delays the need to wait for further testing or return for additional office visits.
An example is a patient who has sustained a recent hip or vertebral fracture, who would immediately qualify for pharmacologic treatment. Providing immediate treatment helps decrease the risk of the patient sustaining another fracture; without treatment the risk for another fracture would be very high. This simplified approach helps improve patient satisfaction and health outcomes.
Promoting access and leveraging technology
"Promoting access to necessary care is paramount," said Mr. Levanduski, referencing the Bone Health Clinic's plans for the future. Technology, especially mobile technology, will allow the Bone Health Clinic to reach and educate more patients and clinicians on prevention and management of osteoporosis. There are also opportunities to leverage technology platforms, such as remote patient monitoring, to increase treatment plan compliance.
In addition, wearable technology, such as smartwatches or phones, can help patients track their health progress, monitor their activity levels and promote physical well-being. Patients can review their health information through portals and make informed decisions on their care.
Especially exciting is promising research on wearable devices to treat osteoporosis using vibration technology to improve bone density; this technology — which has been used by NASA to treat astronauts in space who are at risk for low bone density due to absence of gravity — provides an alternative to costly pharmacologic therapies.
Continuing to innovate by increasing access and leveraging technology to improve outcomes are among the Bone Health Clinic's top priorities.
Conclusion
Bone fractures related to osteoporosis, including spinal fractures, are a major health issue in the United States. The prevalence and cost are expected to grow as the population ages.
The approach taken by the Florida Orthopaedic Institute's Bone Health Clinic aims to improve the health outcomes for individual patients and the larger population. This approach emphasizes awareness and education about osteoporosis and the risks of bone fracture, stresses prevention through a personalized assessment and tailors the treatments provided based on each patient's personal situation and risks. This preventative approach can lower risks, improve outcomes, decrease costs and improve the quality of life.
References
Economic Burden of Osteoporotic Fractures in US Managed Care Enrollees (ajmc.com)
Bone Health Clinic | Florida Orthopaedic Institute
Osteoporosis-Fast-Facts.pdf (bonehealthandosteoporosis.org)
Osteoporosis and the Burden of Osteoporosis-Related Fractures (ajmc.com)