What is the role of the orthopaedic surgeon in management of fragility fractures?

J Orthop Trauma. 2011 Jun;25 Suppl 1:S47-50.
Sharif KM, Dimitriou R, Giannoudis PV.
Trauma & Orthopaedics, Manor Hospital, Walsall, UK.

Fragility fractures are the most prevalent trauma condition that orthopaedic surgeons face today. Osteoporosis and susceptibility to falls are the key predisposing factors. Despite evidence supporting the impact of treating osteoporosis on reducing the incidence of fragility fractures, it is often left untreated. Orthopaedic surgeons are often the first physicians to assess and treat the patient after a fragility fracture. Their role therefore does not end in the skillful fixation of the fractures, but they have a unique opportunity to ensure that preventive measures are implemented. This includes falls prevention, investigation of possible causes underlying osteoporosis, attention to diet, exercise, calcium, and vitamin D supplementation as well as prescription of anti-resorptive and anabolic medication. The need for a dedicated multidisciplinary team needs to be emphasized and therefore effective communication between the different parties is of paramount importance.

PMID: 21566474
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Hardly talked about vitamin D at all

From the article

“Most of the surgeons in Germany, Italy, and Spain felt competent in prescribing calcium/vitamin D and bisphosphonates compared with less than 50% of their colleagues in France, the United Kingdom, and New Zealand.”
Reference for the quote: Dawson-Hughes B, Tosteson AN, Melton LJ, et al. Implications of absolute fracture risk assessment for osteoporosis practice guidelines in the USA. Osteoporosis Int. 2008;19:449–458.

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See also VitaminDWiki

• Should orthopaedic surgeons prevent future fractures with vitamin D etc – June 2011
• Overview: Falling - Fractures - Vitamin D
• Overview: Bone fractures and vitamin D
• Vitamin D and Fracture Prevention – June 2010
• Vitamin D and calcium for the prevention of fractures
• Cochrane review finds that Vitamin D helps prevent fractures– downloaded Feb 2010
• Both Calcium AND vitamin D needed to prevent elderly fractures – Sept 2010
• Would there be fewer stress and bone fractures with vitamin D
• Fewer falls and fractures as vitamin D is increased – 1800 to 4000 IU July 2010
• 39% fewer falls with 2000 IU than 800 IU – RCT June 2010
• Wrist fracture is also associated with vitamin D inadequacy – Feb 2011
• Half of orthopedic surgeries had vitamin D less than 32 ng – Dec 2010
• Low vitamin D before orthopedic surgery – dark skin 5X more likely – Oct 2010
  • suspect not just dark skin, but those also at risk of being low on vitamin D: sunlight, elderly, medical problems, etc.
• Upper body bones fractured along with hip when extremely low on vitamin D – Sept 2010
• Vitamin D and Fracture Prevention – June 2010
• 4000 IU Vitamin D intervention helped elderly bones – March 2010
• Calcium and just 900 IU of vitamin D can improve Bone Density – July 2010
• 400 IU of Vitamin D Magnesium and Calcium helped Twin bones – Feb 2011
  • 400 IU is the least amount of vitamin D - wonder how low of vitamin D needed if take all of the co-factors
• 75 percent of hip fractures associated with vitamin D deficiency - Jan 2011
• Hip fractures worse if very low on vitamin D – Mar 2011
• Low vitamin D assocated with all-cause mortality and fraility – Mar 2011
• Fracture patients with bone diseases lacked vitamin D and calcium – Mar 2011