The American Orthopaedic Associationʼs “Own the Bone” Initiative to Prevent Secondary Fractures
- 1 January 2008
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Bone and Joint Surgery
- Vol. 90 (1), 163-173
- https://doi.org/10.2106/jbjs.g.00682
Abstract
Background: The American Orthopaedic Association initiated its Own the Bone pilot project in 2005 in order (1) to assess current orthopaedic practices for the prevention of secondary fractures in adult patients who have sustained a low-energy fracture (fragility fracture), (2) to pilot quality-improvement tools designed to improve the application of evidence-based strategies for the prevention of secondary fractures, and (3) to identify barriers to the broader implementation of the Own the Bone project and explore how to overcome them. Methods: The ten-month pilot project took place at fourteen sites (thirteen inpatient sites and one outpatient site) and involved 635 participants with a median age of seventy-seven years. The primary outcome measures were the percentages of patients who received (1) counseling on calcium and vitamin-D supplementation, weight-bearing exercise, smoking cessation, and fall prevention, (2) bone mineral density testing, and (3) pharmaceutical intervention to prevent or treat osteoporosis. Secondary outcome measures focused on improved information flow and included the percentage of patients whose physicians were sent a letter recommending the evaluation and treatment of the fracture and the percentage of patients who received a letter recommending that they see their primary-care physician for evaluation and treatment of osteoporosis associated with the fracture. Results: The intervention produced significant improvements (p < 0.0001) in patient counseling on calcium and vitamin-D supplementation, exercise, fall prevention, and communication with primary-care providers and the patients themselves. No improvements were shown in the ordering of bone mineral density testing or the prescription of pharmacotherapy. The most significant improvements (p < 0.0001) were in improved communication with primary-care physicians and in efforts to educate patients about their risk of future fracture. Conclusions: The Own the Bone initiative offers tools to improve the prevention of secondary fractures and a structure to monitor physician compliance. The American Orthopaedic Association plans to use these quality-improvement tools to stimulate change in both physician and patient behavior following low-energy fractures.Keywords
This publication has 31 references indexed in Scilit:
- Zoledronic Acid and Clinical Fractures and Mortality after Hip FractureThe New England Journal of Medicine, 2007
- Eulogy for a Quality MeasureThe New England Journal of Medicine, 2007
- Public Reporting and Pay for Performance in Hospital Quality ImprovementNew England Journal of Medicine, 2007
- Risk of Subsequent Fracture After Low-Trauma Fracture in Men and WomenJama-Journal Of The American Medical Association, 2007
- The role of calcium in peri- and postmenopausal womenMenopause, 2006
- Orthopaedic surgeons and fragility fracturesThe Journal of Bone and Joint Surgery. British volume, 2004
- A meta-analysis of previous fracture and subsequent fracture riskBone, 2004
- Hip fracture patients are not treated for osteoporosis: A call to actionArthritis Care & Research, 2002
- Barriers to Osteoporosis Identification and Treatment Among Primary Care Physicians and Orthopedic SurgeonsMayo Clinic Proceedings, 2002
- Patients with Prior Fractures Have an Increased Risk of Future Fractures: A Summary of the Literature and Statistical SynthesisJournal of Bone and Mineral Research, 2000