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Call for Fracture Liaison Service (FLS) Site Applications: Due Friday, March 2, 2012
The American Orthopaedic Association (AOA) is a member of the National Bone Health Alliance (NBHA). The NBHA recently submitted a $29 million, 3-year funding request to the Centers for Medicare & Medicaid Services (CMS) Innovation Center through its "Health Care Innovation Challenge" cooperative agreement funding mechanism. The request would implement a fracture liaison service (FLS) in the Medicare population at a maximum of 80 sites across the country. Click here for more information about FLS programs.
If funded, this project will provide salary support for an FLS coordinator at up to 80 sites across the country. Participating FLS coordinators will be trained in osteoporosis assessment and management and provided with practical tools to establish a care coordination system within a multidisciplinary team environment. Coordinators can be nurse practitioners, physician assistants, nurses or other allied health care professionals. Salary support will be provided based on the fragility fracture volume, up to a maximum of $125,000 per year.
The NBHA is currently soliciting applications from interested sites. The project will leverage the Own the Bone program, and current Own the Bone sites are invited to apply. Site selection decisions will be based on established site selection criteria. The AOA will manage the site application process on behalf of the NBHA. Final site selection decisions will be made by the NBHA Executive Committee and NBHA Secondary Fracture Prevention Initiative Project Team.
Applications for consideration will be due no later than Friday, March 2, 2012 at 5:00pm EST; Final site selection decisions will be made by March 30, 2012. Final site selection and funding is contingent on the NBHA receiving the grant award.
Click here to begin the application. For questions or concerns related to your application, please contact Own the Bone at (847) 318-7336 or ownthebone@aoassn.org.
Headlines
Program Updates and Announcements:
Welcome New Own the Bone Sites
Upcoming Bone Health Conferences: Learn More about Own the Bone
Release of 2011 Aggregated Registry Data - How does Your Site Measure Up?
Registry Training – February 29th
Own the Bone Registry Updates
ISCD 18th Annual Meeting, Los Angeles, CA, March 7th – 10th
12th International Symposium on Osteoporosis, Orlando, FL – April 25th – 28th
Link to Bone Health News:
No Extra Risk of Breaking Bones After Ovary Removal
Study: Vitamin D Helps Bone Health Only With Calcium
Deer Antlers Inspire a New Theory on Osteoporosis
Instance of Arm Bone Fractures Increases as US Population Ages, Study Finds
Osteoporosis Screening: Many Strategies Work at Reasonable Cost
The Association of Low Bone Mineral Density With Systemic Inflammation in Clinically Stable COPD.
Notice to PCP Improves Care After Fracture
Higher Bone Mineral Density Related to Drinking Yerba Mate
Bisphosphonate-Linked Femur Fractures Rare
Traditional, Disease Risk Factors ID'd in SLE Osteoporosis
Whole-Body Vibration Platforms Fail at Slowing Bone Loss
Program Updates and Announcements:
Welcome New Own the Bone Sites
The Own the Bone team welcomes the institutions below who have recently enrolled in the Own the Bone program and congratulates those that are the first in their state to implement Own the Bone.
- Aurora Medical Center Grafton, Grafton, WI - First in State Wisconsin
- Berkshire Medical Center, Pittsfield, MA
- Lakeshore Bone and Joint Institute, Chesterton, IN
- Mid Coast Hospital, Brunswick, ME - First in State Maine
- Newton Wellesley Orthopedic Associates, Newton, MA – First in State Massachusetts
- St. Cloud Orthopedics, Sartell, MN
- University of Florida, Gainesville, FL
- University of Texas Southwestern Medical Center, Dallas, TX – First in State Texas
Upcoming Bone Health Conferences: Learn More about Own the Bone
Visit the Own the Bone team at the following meetings to find out how Own the Bone can transform the way your hospital or medical center treats fragility fracture patients:
International Society for Densitometry (ISCD) Annual Meeting
March 7 – 10, 2012 in Los Angeles, CA
www.iscd.org
Michigan Orthopaedic Society (MOS) 2012 Annual Orthopaedic Trauma Program
April 20, 2012 in Plymouth, MI
www.mosonline.org
National Association of Orthopaedic Nurses (NAON) 31st Annual Congress
May 19-22, 2012 in New Orleans, LA
www.orthonurse.org
Release of 2011 Aggregated Registry Data - How does Your Site Measure Up?
Principal Investigators at enrolled Own the Bone sites will soon receive a series of graphs comparing their institution’s performance through the end of 2011 against the aggregated data of all participating sites nationwide. This will show how sites are improving patient care compared to other institutions enrolled in Own the Bone.
Registry Training – February 29th
Own the Bone subscribers can join us on Wednesday, February 29th at 10:00am EST for a live registry webinar training hosted by Clinipace, the Own the Bone registry provider.
This session will provide existing Own the Bone sites an opportunity to learn the technical aspects of using the Own the Bone web-based registry, such as entering patient data, producing reports, generating patient and physician letters and more.
To register, please call (847) 318-7336 or e-mail ownthebone@aoassn.org.
Own the Bone Registry Updates
A number of improvements have been made to the Own the Bone registry effective as of December 22, 2011. The following changes have been implemented:
- Mandatory Fields throughout the Registry: All mandatory fields in the registry will now be red and marked with an asterisk (*).
- Site of Current Fracture and Fracture History: Patella has been added as a sub-field option under Knee within Site of Current Fracture and Fracture History.
- Fracture History: Age at time of fracture is no longer a mandatory field. Sites are still encouraged to make an educated guess regarding the patient’s age at the time of a previous fracture if an exact age is unknown. Age at time of fracture can be an estimate.
These improvements are the result of feedback from Own the Bone registry users. We value your input and continue to look for ways to improve and streamline data collection for participants.
ISCD 18th Annual Meeting, Los Angeles, CA, March 7th – 10th
Join the International Society for Densitometry (ISCD) for their Annual Meeting March 7th – 10th at the Westin Bonaventure in Los Angeles, CA. This year’s theme is Contemporary Management of Skeletal Health: Partnering to Image, Diagnose and Treat. ISCD offers a unique opportunity for anyone engaged in the care of patients with skeletal health concerns. Clinicians, technologists and researchers, in all related disciplines and specialties, will find something to be learned at this meeting, including valuable opportunities to interact with others in a spirit of partnership and cross learning.
For more information on ISCD and their annual scientific meeting, and to register, visit www.iscd.org.
ISCD is an Own the Bone® Organizational Alliance member.
12th International Symposium on Osteoporosis, Orlando, FL – April 25th – 28th
The National Osteoporosis Foundation will hold its annual meeting, the International Symposium on Osteoporosis (ISO12) in Orlando, Florida, April 25 - 28, 2012. ISO12 is the premier scientific meeting dedicated entirely to the treatment and study of osteoporosis.
ISO12 will feature many of the world’s top researchers and clinicians as faculty where each will present cutting-edge clinical and basic research findings and share their expertise and insights. For more information about this event, and to register, visit www.nof-iso.org.
The NOF is an Own the Bone® Educational Alliance member.
Bone Health News:
No Extra Risk of Breaking Bones After Ovary Removal
Women who have their ovaries surgically removed may experience early menopause, but this does not increase the risk of bone fracture, new research suggests. In natural menopause, women's estrogen levels and bone density decline. This has led to the concern that an early, and more abrupt, menopause caused by ovary removal could increase women's risk of broken bones. The new study, however, found no added risk, researchers reported in the journal Menopause. The study looked at data from more than 6,600 U.S. women, age 65 and up, of whom 1,157 had experienced surgical menopause. These women were no more likely to break a hip, wrist, or any other bone outside the spine when compared with women who experienced natural menopause. The study did not include spinal fractures. The bone fracture risk was also no greater in women who had not taken estrogen replacement after surgical menopause. Lead researcher Kimberly K. Vesco of Kaiser Permanente Northwest pointed out that the "long-term trajectory" of bone loss may not differ between woman who go through menopause naturally or because of ovary removal.
From "No Extra Risk of Breaking Bones After Ovary Removal"
Reuters (01/04/12) Norton, Amy
Study: Vitamin D Helps Bone Health Only With Calcium
The review of nearly 50 studies on vitamin D by the U.S. Preventive Services Task Force (USPSTF) indicates that it is too soon to tell if vitamin D supplements can help prevent cancer. Report author Mei Chung, assistant director of the Evidence-based Practice Center at Tufts Medical Center in Boston, said she was not able to advise specific recommended doses based on the review. The review itself concluded that vitamin D reduces fracture risk in those over 65. "I think vitamin D likely has more benefits than we currently know and also [presents] little harm," said Dr. Robert Graham, a vitamin D researcher and internist at Lenox Hill Hospital in New York City. "An acceptable level is always a moving target," Graham added. "It's a very controversial topic, although I honestly don't know why it's so controversial." The USPSTF review comes about a year after a more extensive report by the Institute of Medicine (IOM), which said that most Americans and Canadians up to age 70 need no more than 600 IUs of vitamin D per day to maintain health, while those 71 and older may need as much as 800 IUs. In a related study also published in the Annals of Internal Medicine issue, the USPSTF noted that there is still no evidence to support vitamin D supplementation to prevent heart disease. Limited data suggest that high dosages can reduce the risk for all kinds of cancer, but more research is needed to draw a firm conclusion, according to the USPSTF. Additionally, concerns remain regarding proper dosing, since too much vitamin D can raise the risk for kidney and urinary tract stones. Chung, also an investigator at Tufts Medical Center's Institute for Clinical Research and Health Policy Studies, said that research focusing on bone mineral density could be useful to further determine correct vitamin D doses for various age groups.
From "Study: Vitamin D Helps Bone Health Only With Calcium"
USA Today (12/21/11) Salamon, Mareen
Deer Antlers Inspire a New Theory on Osteoporosis
According to researchers at the University of Castilla-La Mancha (UCLM) in Spain, the loss of manganese could mean that calcium does not stick to bones and could cause osteoporosis. Through the study of deer antlers, the researchers suggest that the origin of osteoporosis could not be directly linked to the lack of calcium but rather to the lack of a mineral essential to calcium absorption. More specifically, they believe that this could be manganese. Previous antler studies have shown that manganese is necessary for calcium absorption. The researchers hypothesized that when the human body absorbs less manganese or when it is sent from the skeleton to other organs that require it, such as the brain, the calcium that is extracted at the same time is then not properly absorbed and is excreted in the urine. It is in this way that osteoporosis can slowly strike. The researchers suggest that manganese is extracted from the bones when it is required by the "most important" organs, such as the brain. Additionally, "maintaining the bones is important, but even more so is sustaining the working of the brain, which uses 25 percent of our energy intake when at rest," they say. The team also points out that when this vital mineral runs out after the onset of osteoporosis, conditions like Alzheimer's disease, Parkinson's disease, and senile dementia could strike.
From "Deer Antlers Inspire a New Theory on Osteoporosis"
EurekAlert (01/03/12)
Instance of Arm Bone Fractures Increases as US Population Ages, Study Finds
A study by researchers at the University of California, Davis, found that fractures in the humerus bone of the upper arm were found to be substantially higher in the United States than in other countries, and that these fractures are occurring with increasing frequency in a growing elderly population. Lead author Sunny H. Kim, and her team analyzed the 2008 Nationwide Emergency Department Sample, which contained about 28 million emergency department records. The study identified cases of interest using diagnostic codes for proximal, shaft, and distal humerus fractures. According to the study, about 370,000 emergency department visits were the result of humerus fractures, with proximal humerus fractures accounting for 50% of those visits. The researchers saw a high number of proximal humerus fractures in women aged 40 years to 84 years and in men aged 60 years to 89 years. Additionally, while the peak occurrence of distal humerus fractures was in children aged 5 years to 9 years, the study found that older women had an increased risk as well. As the baby boomer generation ages, the researchers believe more than 490,000 emergency department visits will be for humerus fractures in 2030 unless fracture prevention efforts improve. The researchers conclude that the high incidence rates of humerus fractures in the expanding elderly population may contribute to the recent trend of fast increase in shoulder anthroplasty in the United States. To counteract this trend, the researchers say that rigorous safety measures to reduce falls and improve preventative programs and treatments of osteoporosis are needed.
From "Instance of Arm Bone Fractures Increases as US Population Ages, Study Finds"
Physical Therapy Products (12/29/2011)
Osteoporosis Screening: Many Strategies Work at Reasonable Cost
According to a recent study published in the Annals of Internal Medicine by researchers from the University of Pittsburgh, a number of strategies work well and are cost effective when screening postmenopausal women for osteoporosis. Researchers evaluated the effectiveness and cost-effectiveness of screening methods—no screening, central dual-energy x-ray absorptiometry (DXA), calcaneal quantitative ultrasonography (QUS), Simple Calculated Osteoporosis Risk Estimation (SCORE) tool—initiation ages (55, 60, 65, 70, 75, and 80 years), treatment thresholds, and rescreening intervals. “Multiple osteoporosis strategies are effective, including strategies involving screening initiation at age 55 years. In general, the differences in average effectiveness and costs between evaluated strategies are small,” the authors write. “Expansion of osteoporosis screening could improve health outcomes at a reasonable cost.” At all initiation ages, the best strategy was DXA screening with a T-score threshold of -2.5 for treatment and follow-up screening every 5 years. When results were compared across screening initiation age groups, DXA -2.5 screening starting at age 55 and repeated every 5 years was the best strategy. The best strategy with an incremental cost-effectiveness ratio less than $100,000 per quality-adjusted life-year was to start screening at age 55 using DXA with a T-score threshold of -2.0 or lower for treatment and rescreen every 10 years. Many other strategies, including screening using QUS and SCORE, also were cost-effective.
From "Osteoporosis Screening: Many Strategies Work at Reasonable Cost"
Modern Medicine (12/22/11)
The Association of Low Bone Mineral Density With Systemic Inflammation in Clinically Stable COPD.
Chronic obstructive pulmonary disease (COPD) is known to be a systemic inflammatory disease which affects the function of many organs, and the low bone mineral density (BMD) may be the result of systemic inflammation. Researchers studied the association of BMD with systemic inflammation in patients with clinically stable COPD. BMD and inflammatory markers, including C-reactive protein, tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6), were determined in all the recruited patients with clinically stable COPD. As the abnormality of BMD went severer, COPD patients with osteoporosis had significantly higher levels of systemic inflammation than those with either normal BMD or osteopenia. The presence of systemic inflammation was associated with a greater likelihood of low BMD, and multivariate logistic regression analysis showed that TNF-α and IL-6 were independent predictors of low BMD. The researchers concluded that systemic inflammation is a significantly independent predictor of low BMD in patients with clinically stable COPD.
From "The Association of Low Bone Mineral Density With Systemic Inflammation in Clinically Stable COPD."
Endocrine (12/24/11) Liang, B.; Feng, Y.
Notice to PCP Improves Care After Fracture
Researchers at the University of Manitoba found that patients who suffer a fracture receive better follow-up care if their primary care physicians are notified of their injury and given guidelines on preventing another fracture. In total, 15.8 percent of women and 7.6 percent of men in the usual care group were tested for bone mineral density or started medication for osteoporosis within 12 months following a fracture, compared to 30.3 percent of women and 19.0 percent of men whose PCPs received notifications of the fractures. By sending PCPs notifications of a patient's injury, the absolute increase for the combined endpoint of bone mineral density testing or pharmacological treatment was 14.9 percent in the study. Despite notifications resulting in improvements, the researchers noted that a large persistent gap in care still remained, with treatment levels barely going above 30 percent. The authors speculate that one reason may have been a requirement to let the physicians know it was a research study, which may have made them less interested in reading the information contained in the letter. Additionally, the primary care physician may have changed between the time of the fracture and when notifications were sent. Some patients may have also declined additional evaluation or may have decided that the suggested interventions would not benefit them. In other cases, non-pharmacological measures like diet and fall prevention may have been deemed the best option for treatment. "Creative strategies are needed to enhance postfracture care, which remains suboptimal," the authors write in the online Canadian Medical Association Journal. "A relatively simple process using mailed notifications to physicians improves, but does not close, the gap in postfracture care."
From "Notice to PCP Improves Care After Fracture"
MedPage Today (12/21/11) Ullman, Kurt
Higher Bone Mineral Density Related to Drinking Yerba Mate
According to a report by Andrea Conforti, MD, from the Program for the Prevention and Treatment of Osteoporosis in Mendoza, Argentina, and colleagues in the January 2012 issue of Bone, postmenopausal women who consumed yerba mate tea had higher bone mineral density (BMD) compared with women who did not drink the tea. Yerba mate is a xanthine-containing beverage that is popular in South America. Investigators identified postmenopausal women in the osteoporosis program who drank at least 1 liter of yerba mate tea daily for at least 5 years and matched them by age and time since menopause with an equal number of women who did not drink yerba mate tea. The two groups were well matched for age, time since menopause, height, body mass, and calcium intake; however, the tea drinkers had a body mass index 1.1 kg/m2 greater than the nondrinkers. Measuring BMD by dual-energy X-ray absorptiometry, the researchers found that the tea drinkers had 9.7 percent greater lumbar spine BMD compared with non–tea drinkers, as well as 6.2 percent greater femoral neck BMD. Although the yerba mate group had higher lumbar spine and femoral neck BMD at all ages compared with control patients, the slopes of the regression lines overall indicated that loss of BMD over time was similar for the tea-drinkers and the control participants. The authors concluded that chronic consumption of yerba mate tea was associated with greater BMD at the lumbar spine and femoral neck, "suggesting a protective effect of this tea on bone mass of postmenopausal women." Results may not be generalizable to younger women, men, or children.
From "Higher Bone Mineral Density Related to Drinking Yerba Mate"
Medscape (01/02/12) Keller, Daniel M.
Bisphosphonate-Linked Femur Fractures Rare
Health Canada officials' review of research found that patients receiving bisphosphonate therapy for osteoporosis have a slightly increased risk of an 'atypical femur fracture,' a highly uncommon occurrence that covers less than 1 percent of femur and hip fractures. Officials note that though the risk sees a small increase with bisphosphonate use, the benefits of this therapy outweigh the risk. Health Canada issued a statement saying the health professionals needed to be aware of the potential risk and should re-evaluate the need for bisphosphonate therapy on a periodic basis for all patients.
From "Bisphosphonate-Linked Femur Fractures Rare"
UPI.com (12/20/11)
Traditional, Disease Risk Factors ID'd in SLE Osteoporosis
In patients with systemic lupus erythematosus (SLE), osteoporosis involves a variety of factors, both traditional and SLE-related. In a review published in the January issue of Arthritis Care & Research, Irene E.M. Bultink of the VU University Medical Center in Amsterdam, Netherlands, looked at the causes of bone loss and fractures in patients with SLE. Among patients with SLE, between 25 percent and 74 percent had osteopenia, and 1.4 percent to 68 percent developed osteoporosis. Etiology involved traditional risk factors, including inflammation; adverse events from medication; and metabolic and hormonal factors. Fractures were nearly five times more frequent in women with SLE. Age, postmenopausal status, disease duration, and reduced bone mineral density were all found to be risk factors for fractures in women with SLE. Glucocorticoid treatment is predictive of osteoporotic fractures. Lifestyle interventions, adequate calcium intake and serum levels, and immunosuppressive medications to reduce inflammation may help prevent or treat osteoporosis and fractures.
From "Traditional, Disease Risk Factors ID'd in SLE Osteoporosis"
DoctorsLounge (01/03/12)
Whole-Body Vibration Platforms Fail at Slowing Bone Loss
Whole-body vibration platforms do not help prevent osteoporosis, according to a study of 202 post-menopausal women in Canada. These platforms, which sell for $200 to $3,000, send mild vibrations through the feet into the rest of the body. Post-menopausal women frequently experience progressive bone loss, and thus have a higher risk for bone fractures. Weight-bearing exercise, even walking, can help fight this bone loss by increasing bone mass the way exercise increases muscle mass. Some research suggests that sending vibrations through bones places enough stress on them to increase bone mass. The findings of this new study, however, do not support this idea. The study used low-magnitude platforms, designed to be stood on. Of the women in the study, two-thirds received vibration platforms to be used for 20 minutes each day. All participants received calcium and vitamin D supplements. After a year, there were no differences seen in bone density among the groups, and no evidence that using the platforms helped prevent bone loss. The findings were summarized in an article in the Nov. 15, 2011, issue of Annals of Internal Medicine.
From "Whole-Body Vibration Platforms Fail at Slowing Bone Loss"
The Atlantic (12/10/11) Wagner, Neil
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