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Kaiser working to decrease hip and other fractures – Nov 2011

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Leading Health Organizations and Patient Groups Call for 20 Percent Reduction in Fractures by 2020

"20/20 Vision" Summit Shares Best Practices for Osteoporosis/Fracture Prevention and Care
WASHINGTON, Nov. 15, 2011 /PRNewswire/ — The National Bone Health Alliance (NBHA) and Kaiser Permanente unveiled on Monday their "20/20 Vision" for reducing hip and other fractures by 20 percent by 2020 at a best practices sharing event Monday at the Kaiser Permanente Center for Total Health on Capitol Hill.

Each year, 325,000 hip fractures are reported in the United States. Of that number, approximately three-quarters are women. The combined number of all osteoporosis-related fractures is greater than the incidence of heart attacks, strokes, and new breast cancer cases each year combined, and 90 percent are people age 65 and older.

Osteoporosis-related fractures were responsible for $19 billion in costs in 2005, a figure expected to rise to $25 million by 2025. About 5.3 million people over age 50 have osteoporosis at the femur and another 34.5 million have low bone mass, or osteopenia, experts report. After sustaining a fracture, these very high-risk individuals are usually not treated with calcium, vitamin D or a prescription medication for the prevention of future fracture, a major failing of the U.S. health care system.

"Reducing the expected number of hip and other fractures by 20 percent by the end of the decade is a public health imperative," said Richard M. Dell, MD, lead orthopaedic surgeon, Healthy Bones Program, Kaiser Permanente. "It would be a monumental achievement, sparing half a million Americans of horrible pain and suffering and a loss in quality of life—as well as producing enormous cost savings throughout the health care system. The time to act is now as a growing number of Americans are reaching the age where hip and other osteoporosis-related fractures are common but are still preventable in many cases.”

Representatives of a number of groups—leading physicians and experts in bone health and fracture prevention—shared best practices and laid out a plan to achieve this nationwide goal. A key element is a proposal to establish a fracture liaison service facilitated by NBHA within Medicare and other health systems modeled on successful programs that currently exist in the United States at Kaiser Permanente, Geisinger Health System the American Orthopaedic Association and the Department of Veterans Affairs as well as internationally in the United Kingdom, Canada and elsewhere. The service would assess patients who suffer a fracture for osteoporosis and, if found, provide them treatment and follow-up to manage the disease in an effort to prevent repeat fractures.

"One of the NBHA's major priorities is the implementation of this successful fracture liaison service model in a number of health systems, including the Medicare population," said Sundeep Khosla, MD, Mayo Clinic and chairman, NBHA Governance Committee. "This model has been shown in a number of countries and health care settings to not only decrease health care expenditures but also reduce the number of subsequent fractures which, in this high-risk population, can cause significant mortality and morbidity.”

The Kaiser Permanente's Healthy Bones Program has successfully reduced hip fracture rates by more than 37 percent, according to published research. If this program were implemented nationally, it would prevent more than 100,000 fractures and save the health care system more than $5 billion annually.

Also discussed was the American Orthopaedic Association's Own the Bone Program, a quality improvement initiative introduced in the open health care system that addresses the need to assess and treat patients age 50 and over with osteoporotic fractures and promotes coordination of care between specialties. Own the Bone has touched more than 3,000 patients in 31 states and continues to grow rapidly.

"While as orthopaedic surgeons we are the initial treating physicians for fracture patients, we know that a multi-specialty approach is required to ensure appropriate treatment of patients to prevent repeat fractures and that working together we can positively impact the assessment and treatment of patients with osteoporosis," said Douglas R. Dirschl, MD, president of the American Orthopaedic Association.

Robert A. Adler, MD, Richmond Veterans Affairs Medical Center and Virginia Commonwealth University School of Medicine, described an osteoporosis disease-management process as part of the Veterans Affairs Patient-Aligned Care Team program. "Veterans Affairs pharmacists can use the electronic medical record to identify patients at highest risk for osteoporotic fracture, particularly those who have already suffered a fragility fracture," Adler said.

"We know this can be done," said Robert M. Pearl, MD, chief executive officer of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. "The combination of our Kaiser Permanente integrated care delivery system and 21st century technology has allowed us to dramatically lower the mortality from cardiovascular disease, sepsis and cancer. Now we can apply the same approaches to improving osteoporosis outcomes and decreasing the frequency of hip and other bone fractures.”

Also presenting at this summit were Robert Lindsay, MD, PhD, Helen Hayes Hospital, Columbia University and NBHA Executive Committee; David B. Lee, MPA, NBHA; and Paul J. Mitchell, BSc (hons), CChem MRSC, Synthesis Medical Limited and University of Derby, U.K.
More than 100 attendees participated in the event – half of them attending in person at the Center for Total Health and half via web conference. Dozens of participants signed a placard pledging their commitment to reaching the goal of 20 percent reduction in hip and other fractures by 2020.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.

About American Orthopedic Association

The American Orthopaedic Association, founded in 1887, is the oldest national orthopaedic association in the world. The AOA's mission is to identify, develop, engage and recognize leadership to further the art and science of orthopaedics. The Own the Bone secondary fracture prevention quality improvement initiative was launched in 2009 to demonstrate orthopaedic commitment to reducing the burden of osteoporotic fractures. For more information visit www.aoassn.org.

About National Bone Health Alliance

Established in late 2010, the National Bone Health Alliance is a public-private partnership that brings together the expertise and resources of various partners across a broad spectrum to promote bone health and prevent disease; improve diagnosis and treatment of bone disease; and enhance bone research, surveillance and evaluation. The NBHA is a platform that allows all voices in the bone health community to work together around shared priorities and develop projects that can become reality through pooled funding. The 30 members of the Alliance (in addition to liaisons representing the National Institutes of Health and U.S. Food and Drug Administration) are working from a shared vision: to improve the overall health and quality of life of all Americans by enhancing their bone health. For more information on the NBHA, visit www.nbha.org.

About McGuire Veterans Affairs Medical Center

McGuire Veterans Affairs Medical Center is an academic tertiary care center in Richmond, Virginia, with a long-standing affiliation with Virginia Commonwealth University School of Medicine. It has an active osteoporosis program and has been a leader in the recognition that one-third of all hip fractures occur in men. The Department of Veterans Affairs has utilized its outstanding electronic medical record system to improve medical care of our nation's heroes.

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