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Ortho Update

Changing the Status-Quo of Osteoporosis Screening and Treatment

x-ray image of hip fracture

Osteoporosis fracture in a 48-year-old patient

Osteoporosis-related fractures are associated with costs reaching into the tens of billions of dollars annually in the United States. Many of these fractures may be prevented if at-risk patients received timely diagnosis and treatment. Specific treatment may include starting a pharmaceutical agent; calcium and vitamin D are good for healthy bone metabolism, but are not enough by themselves to stave off age-related and menopause-related bone loss. Yet, notes Edward J. Fox, MD, professor at Penn State Bone and Joint Institute, “Less than 25 percent of women who experience a fragility fracture receive any further workup for osteoporosis.” Fox and his colleagues are currently exploring ways to improve osteoporosis detection in this highly at-risk population.

In a study presented at the 2013 Orthopedic Research Society’s annual meeting1, women ages 50 years and older who presented at the Penn State Hershey emergency department (ED) with a low-energy fracture were randomly assigned to an intervention group, who received a follow-up letter within three months advising evaluation for osteoporosis, or a control group, who were contacted by telephone within three months of the ED visit, to determine whether they received any osteoporosis-related follow-up. Among women who received the intervention letter, 60.19 percent received followup osteoporosis evaluation; only 14.29 percent of the control group did so.

xray image of hip joint fracture

Osteoporosis fracture in a 78-year-old patient

Fox explains “Very few women in the control group had any osteoporosis testing after their fracture. These findings show that a simple, timely follow-up letter can significantly increase osteoporosis screening in high-risk patients.”

Other researchers have shown that telephone follow-up also can significantly increase the number of women who undergo osteoporosis testing. Given such promising results, Fox and colleagues will continue studying ways to further boost the followup rate. “We would like to see 90 percent or more follow-up among these patients, because, in time, they are very likely to experience another fracture.”

A second study is already underway, in which the effects of a combination letter and telephone intervention are being examined. Fox, however, explains “Ultimately, in any given community or region, it will take a physician to champion this cause and support the role of a care coordinator, who can take charge of follow-up.” Some organizations, like Kaiser-Permanente in California, have implemented bone care coordination with a high level of success, marked by significant reductions in fractures.

Fox says, “We know that simple interventions can work, but to close the gap between fracture and osteoporosis diagnosis and treatment, and improve care, physicians and health care systems must play a leadership role.”

A head-and-shoulders photo of Edward J. Fox, MD

Edward J. Fox, MD

Professor, orthopaedics and rehabilitation
Surgeon, orthopaedics and musculoskeletal oncology
Phone: 717-531-4816
Fellowship: Musculoskeletal oncology surgery, Massachusetts General Hospital—Harvard Medical School, Boston, Massachusetts
Residency: Orthopaedic surgery and general surgery, Stony Brook University School of Medicine, Stony Brook, New York
Medical School: University of Rochester School of Medicine and Dentistry, Rochester, New York
Connect with Edward J. Fox, MD, on Doximity


  1. Varacallo, MA, Fox, EJ, Hassenbein, SE, et al. Evaluation of patient’s response toward intervention automated osteoporosis intervention program. Poster presented at: Orthopaedic Research Society Annual meeting, San Antonio, TX, January 26-29, 2013.
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U.S. News & World Report 2023-2024

Penn State Bone and Joint Institute represents the clinical aspect of Penn State Orthopaedics and Rehabilitation. Faculty from Penn State Orthopaedics and Rehabilitation teach and perform leading-edge research in the department, and provide innovative care in the multi-disciplinary Penn State Bone and Joint Institute. As a department, Penn State Orthopaedics and Rehabilitation faculty, clinicians and researchers have been recognized nationally, ranking twentieth in orthopaedic research funding from the National Institutes of Health.


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