Background: With the exponential increase in osteoporotic fractures,
orthopaedic surgeons are in a logical position to become more involved in the
medical treatment of this disease. However, it has been hypothesized that
surgeons may not be inclined to initiate such treatment if they do not view
medical interventions as an extension of their surgical opportunities. The
objective of this study was to determine the knowledge and opinions of
orthopaedic surgeons with regard to their opportunities for initiating medical
treatment of patients with an osteoporotic fracture.
Methods: A survey consisting of twenty-two questions was
administered to 171 orthopaedic surgeons in Utah, Idaho, and Wyoming.
Results: Of the 171 surveys that were mailed, 107 usable surveys
were returned (a 63% response rate). A majority of the orthopaedic surgeons
thought that it was appropriate to expand their orthopaedic practice to
include prescribing pharmacological treatments for osteoporosis (68% agreed or
strongly agreed with that statement). However, 47% were concerned enough about
adverse events related to some conventional pharmacological treatments that
they would rather avoid prescribing them. Of the surgeons who were willing to
prescribe these treatments, 74% felt most comfortable prescribing
bisphosphonates and >77% felt most comfortable prescribing calcium and
vitamin-D supplements. Fifty-one percent considered an apparent osteoporotic
fracture and several other clinical risk factors for osteoporosis as
sufficient evidence for initiating pharmacological treatments, whereas 72%
thought that a bone-density scan should be made before initiating treatment.
Although 32% thought that all nonoperative treatment should be the
responsibility of a primary care provider, 63% thought that the orthopaedic
surgeon should initiate a workup to look for secondary causes of the
osteoporosis and should begin medical treatment of patients with an
osteoporotic fracture before referring them.
Conclusions: Although a majority of orthopaedic surgeons believe
that they should expand their role in the medical treatment of patients with
an osteoporotic fracture, many do not institute medical treatment and think
that the patient's primary care providers should be responsible for medical