Preventing Hip Fractures: Have We Encountered a Perfect Storm?

Andrew M. Kaunitz, MD


March 15, 2018

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville. Today I'd like to discuss hip fractures—have we encountered a perfect storm?

Hip fractures represent an important cause of morbidity and disability among menopausal women. From 1995 to 2005, the incidence of hip fractures in US women steadily dropped. Investigators used Medicare data from more than 2 million women to assess more recent trends.[1]

The frequency of hip fractures was noted to steadily decline from 2002 through 2012. However, for subsequent years, fracture incidence leveled off. In fact, for women 65-74 years of age, hip fractures actually rose after 2012.

The earlier decline in hip fractures likely reflected more women undergoing bone mineral density (BMD) testing, greater awareness of the importance of adequate calcium and vitamin D intake, and increasing use of fracture-reducing medications—in particular, bisphosphonates.

However, recent decreases in Medicare reimbursement for dual-energy x-ray absorptiometry (DEXA) means that physicians and institutions feel less incentivized to provide this service, and fewer women are undergoing BMD testing.

Some may remember the actress Sally Field and other spokeswomen appearing years back in ads to promote use of bisphosphonates. With oral bisphosphonates now generic, I have not recently seen any direct-to-consumer promotion for this class of medications. Finally, fears regarding the safety of menopausal hormone therapy and bisphosphonates have led to declines in use of medications that prevent fractures.

When considering these trends, it seems that a "perfect storm" has emerged, resulting in fewer women being tested and treated for osteoporosis.

However, we can prevent osteoporotic fractures in our menopausal patients by keeping detection and treatment of osteoporosis on our radar screens. Consistent with current guidelines, we should encourage our average-risk patients to undergo DEXA at age 65, recognizing that this test should be performed earlier in higher-risk women.

Finally, existing and newer medications offer women with osteoporosis excellent options for fracture prevention. The bottom line: Our patients merit a proactive approach to detection and treatment of osteoporosis.

Thank you for the honor of your time. I'm Andrew Kaunitz.


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