MUSC Health Combats Rise in Fragility Fractures with Dedicated Center

For someone over 50, a fragility fracture is often the first sign of weak bones. Patients who don't receive comprehensive treatment are liable to suffer more fractures, losing their mobility or even their life, says Dr. Kristoff Reid, an MUSC Health orthopaedic surgeon and assistant professor.

As the population ages, the incidence of fragility fractures will increase, he says.

To help ensure that patients receive treatment to minimize their risk for more fractures and maximize their chances for a positive outcome, MUSC Health established the MUSC Center for Fragility Fracture Care, Osteoporosis, and Bone Health in 2014.

As the Lowcountry's longest-running fragility fracture program, the center provides a full range of clinical, surgical and procedural services, bringing together specialists from rheumatology, endocrinology, radiology, occupational and physical therapy, and orthopaedics.

"A fragility fracture is considered a sentinel event, one that demands a multidisciplinary approach to providing optimal treatment so patients can regain function, mobility and quality of life," Dr. Reid says.

Follow-up education is an integral part of the care.

Stacey Rothwell, PA-C, fracture liaison coordinator, serves as a clinician on the trauma service and is a key member of the care team. Rothwell, who is certified by the National Osteoporosis Foundation, is the point of contact for patients, coordinating and directing patient education, follow-up and treatment.

"This follow-up and monitoring are critical for patients, particularly those with co-morbidities," Dr. Reid says. "Stacey follows up on patients' surgery, their scans and any osteoporosis-related problems to make sure they're progressing appropriately."

MUSC's Fragility Fracture clinic hours coincide with Dr. Reid’s clinic, an advantage for patients and for him so he can conduct post-op visits and follow patients' progress while they are being counseled and treated for their underlying osteoporosis.

Dr. Reid is enthusiastic about results. "Our outcomes are encouraging," he says. "Our fragility fracture team meets monthly to evaluate our progress and identify ways to continually deliver the best treatment for our patients. This is particularly important since fragility fractures are increasing."

MUSC Health has earned Star Performer recognition by the American Orthopaedic Association for its participation in Own the Bone, the AOA's national fragility fracture prevention initiative. MUSC Health is one of only two centers in South Carolina and 76 nationwide to be singled out by the program for its commitment to improving bone health after a fracture.

According to the AOA, fragility fractures among older adults have become nearly epidemic in the United States. More than 2 million fractures occur each year, surpassing the number of heart attacks, strokes and breast cancer combined. By 2025, the annual cost of fractures is projected to grow to more than $25 billion. Vertebral compression fractures predominate, followed by hip fractures and distal radius fractures, Dr. Reid says.

A vertebral column fracture, which typically occurs without a fall, is considered a "harbinger fracture" because patients are 1.8 times more likely to sustain a hip fracture and five times more likely to sustain another vertebral column fracture. Moreover, the two-year mortality rate is equal to that of hip fractures, he says.

Even though hip fractures are slightly less frequent than VCFs, they're a significant medical issue because of the mortality rate and physical impairment, Dr. Reid says.

"About 320,000 hip fractures occur every year, and three-fourths require some form of surgical treatment. There is a 5- to 8-fold increase in mortality in the first three months after surgery. The one-year mortality rate is 25 percent, and the two-year rate is 35 percent. Without surgery, the odds ratio is 1:7."

Simple mechanics and the frailty of these patients contribute to the high mortality rate.

"Simply not getting up and moving or being bed-bound and immobile leads to an increase in pneumonia," he says. "Only about 50 percent of hip fracture patients regain their previous level of ambulation. They may need a cane or a walker or end up in a wheelchair. One-third end up having to leave their home and go to a long-term care facility."

MUSC Health's Fragility Fracture Clinic concentrates on getting patients home faster and preventing future fractures. "As participants in Own the Bone, I can tell you we want to make sure patients and physicians understand and follow through on osteoporotic care and counseling, from appropriate pharmacotherapies, proper nutrition, exercise, lifestyle changes and testing."

To reach Dr. Reid or the MUSC Center for Fragility Fracture Care, Osteoporosis, and Bone Health for an appointment or to make a referral, call 843-876-0111.