Addressing Osteoporotic Fractures: In-patient Fracture Liaison Service Collaboration Between Orthopaedic Surgery and Endocrinology
November 22, 2024
Osteoporotic fractures pose a significant health risk, particularly among older adults. After the first fracture, the likelihood of a second fracture increases substantially. Prior research shows that approximately 20% to 25% of patients who suffer a fragility fracture experience another fracture within five years. The consequences of these secondary fractures can be quite severe, leading to increased mortality, decreased mobility, and a greater dependence on long-term care services.
To mitigate these risks, Gele Moloney, MD, an orthopaedic trauma specialist at UPMC Orthopaedics and Sports Medicine and associate professor of Orthopaedic Surgery at the University of Pittsburgh, co-created an in-patient Fracture Liaison Service at UPMC Mercy.
Developed in collaboration with colleagues from the Division of Endocrinology and Metabolism, including Diana Pinkhasova, MD, and Karen Selk, DO, the program aims to address the gap in osteoporosis care, particularly for those at risk of a second fracture by conducting a comprehensive osteoporosis evaluating and, when appropriate, initiating treatment while in the hospital.
Also collaborating on the project are orthopaedic surgeon Aaron Taylor, MD, and Matt Tagliaferro, PA-C, as well as the entire team of orthopaedic surgery physician assistants and the endocrinology team at UPMC Mercy.
A Proactive Approach to Osteoporosis
"Once a patient has an osteoporotic fracture, they are at significant risk for another," says Dr. Moloney. "Unfortunately, there’s a gap in care when it comes to preventing those secondary fractures."
Clinical guidelines suggest osteoporosis evaluation and treatment after a hip fracture, but many patients do not receive timely follow-up, particularly for medication management that can make a substantial difference in mitigating the risk of a second fracture.
The Fracture Liaison Service at UPMC Mercy ensures osteoporosis care begins as soon as possible. The program is designed to identify patients with fractures caused by low-energy trauma, such as ground-level falls, and provide appropriate osteoporosis screening and initial treatment during their acute recovery time in the hospital.
A Collaborative, In-patient Model
What makes the Fracture Liaison Service distinct is its in-patient model. Instead of waiting for outpatient appointments, the program involves endocrinology specialists who assess and treat patients while they are still hospitalized.
“Our role in orthopaedics is to identify the problem, explain it to the patient, and then refer them to an endocrinologist or another expert to manage their osteoporosis,” says Dr. Moloney.
In this case, the endocrinology team evaluates the patient's bone health and often prescribes medication that can provide an initial full year of coverage.
"Endocrinologists now see patients in the hospital, which is a key part of the program’s success," says Dr. Moloney.
As Dr. Moloney explains, anyone over the age of 60 who sustains a fracture (hip, distal femur, pelvic, proximal humerus, etc.) from a low-energy mechanism like a ground level fall – essentially a fragility fracture – gets a consult from the endocrinology team to investigate the possibility of underlying osteoporosis.
Early Results and Future Plans
Since the program’s formal launch in July 2023, the endocrinology team has more than 350 patients.
About 25% of these patients have received osteoporosis medication during their hospital stay — something that was not happening prior to the program's creation. By starting treatment early, the program provides a window to connect patients with ongoing osteoporosis care, either through their primary care provider or an endocrine specialist.
While the program is currently only operational at UPMC Mercy, the goal is to expand it to other UPMC hospitals where a high volume of orthopaedic trauma cases also are treated annually.
"We’re looking to expand this service where it makes the most clinical sense," says Dr. Moloney.
In addition to expanding the program across other facilities, Dr. Moloney and her team aim to strengthen outpatient follow-up care.
"We’ve made progress in the hospital, but osteoporosis should be considered a chronic disease, and we want to ensure these patients continue to get the care they need after discharge," says Dr. Moloney.
Comprehensive Care for Osteoporotic Fractures
In addition to addressing bone health, the Fracture Liaison Service emphasizes fall prevention strategies as part of its comprehensive approach to patient care. Physical therapy focused on balance and gait training is integral to reducing the risk of falls, which are a leading cause of initial and second osteoporotic fractures.
"We’ve made great strides, but there’s more to be done," says Dr. Moloney. "Our ultimate goal is to ensure that no patient with an osteoporotic fracture is overlooked, and that they receive the care they need to reduce the risk of another fracture."
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