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. 2019 Mar 6;14(1):72.
doi: 10.1186/s13018-019-1103-3.

Orthopedic surgeons' views on the osteoporosis care gap and potential solutions: survey results

David W Barton  1 , Daniel C Griffin  2 , Jonathan J Carmouche  2   3
Affiliations

Orthopedic surgeons' views on the osteoporosis care gap and potential solutions: survey results

David W Barton et al. J Orthop Surg Res. .

Abstract

Introduction: Osteoporosis is often not recognized until one or more fractures occur, yet post-fracture screening remains uncommon. Orthopedic surgeons are well situated to address this care gap. Both a protocol-based approach and fracture liaison services (FLS) have been proposed. The present surveys assess orthopedists' attitudes to these alternative models for addressing this care gap.

Methods: Two digital surveys were sent to all orthopedic surgeons and orthopedic midlevel providers at a large level 1 trauma center 1.5 years apart.

Results: Thirty-six of 47 survey recipients (77%) responded to the first survey; all 55 recipients (100%) responded to the second. Respondents recognized the importance of osteoporosis care, the inadequacy of current measures, and the potential of orthopedic surgeons to help address this gap. Respondents reported regular encounters with fragility fracture patients but limited familiarity with core aspects of osteoporosis screening and treatment, especially pharmacotherapy. While some respondents (40%) reported willingness to attempt a protocol-based approach to addressing this care gap, many others expressed reservations (60%) and support for a FLS-based approach was much higher (95%).

Conclusions: A fracture liaison service model best fits the observed attitudes of orthopedic surgeons at this level 1 trauma center relative to a protocol-based approach. Protocol-based approaches may be preferable in alternate settings.

Keywords: FLS; Fracture liaison service; Fracture prevention; Fragility fracture; Osteoporosis; Protocol; Quality improvement; Survey.

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Conflict of interest statement

Ethics approval and consent to participate

This study was ruled exempt by the Carilion Clinic Institutional Review Board. Participation in the survey was completely voluntary.

Consent for publication

The hospital IRB ruled that informed consent was not necessary for this study as it did not meet the criteria for human subjects research given its focus on expert opinions. As such, specific participant consent for publication is not required.

Competing interests

The authors declare that they have no competing interests. The first and senior authors have a complementary interest as they were involved in the planning and implementation of the fracture liaison service at our institution.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Respondents’ areas of specialization based on responses to the second survey. Information on subspecialty area was not collected in the first survey. Three respondents selected multiple areas of specialization
Fig. 2
Fig. 2
a Respondents’ perceptions of the importance of osteoporosis care. b The perceived adequacy of osteoporosis care by setting. c How responsible respondents felt for initiating osteoporosis care
Fig. 3
Fig. 3
a Depiction of whether respondents knew what the FRAX score is. b Depiction of the frequency of FRAX score use in respondents’ clinical practice
Fig. 4
Fig. 4
a Respondents’ self-reported comfort with providing patient guidance on various aspects of osteoporosis care. b Respondents’ self-reported frequency of osteoporosis management steps in MTF patients
Fig. 5
Fig. 5
a A summary of prescriber comfort with and self-reported use of different osteoporosis medications when summed across all providers in the department. b Respondents’ self-reported reasons why survey respondents felt uncomfortable prescribing medications
Fig. 6
Fig. 6
a, b Respondents’ attitudes towards either a protocol-based or FLS-based approach to osteoporosis management
Fig. 7
Fig. 7
a Depiction of respondents’ perceptions of whether having access to a dedicated bone health ACP (NP, PA) would improve patient care. b Depiction of the anticipated impact of adding a bone health ACP on respondents’ workloads. c Free-text response themes to survey #1 (n = 13)
See this image and copyright information in PMC

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