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Providers & patients united for improved care.
New data on patient care after a fragility fracture; Pilot proves successul.
Click here for more information.
What is Own the Bone?
Own the Bone is a web-based quality improvement program designed to improve the diagnosis and management of patients' bone health after suffering fragility fractures. The American Orthopaedic Association (AOA) developed this Bone Health Initiative in response to the October 2004 Surgeon Generals Report identifying osteoporosis and fragility fractures as a major public health problem.
Fragility Fractures: The Rationale
A fragility fracture is defined as a fracture of the distal radius, proximal humerus, vertebrae or proximal femur (hip) that results from minimal trauma, such as a fall from a standing height. These are not fractures related to
car crashes - these are low energy injuries that occur from everyday activities. People with healthy, normal bones will not suffer from fragility fractures.
The AOA has chosen to focus on fragility fracture care, rather than osteoporosis prevention, believing that the seriousness of the fracture episode provides physicians with a definite “teachable moment” in which it is possible to make a major impact on patients’ and primary care physicians’ behaviors. The AOA believes that if the patient, as well as their primary physician, becomes engaged in improving bone health, there is the possibility of a ripple effect that can spread out to entire communities.
Magnitude of Problem
Fragility fractures have become nearly epidemic among the elderly US population as 1.5 million incidences of bone disease (over 300,000 hip fractures, and approximately 700,000 vertebral fractures; 250,000 wrist fractures, and 300,000 fractures at other sites) related fractures occur each year with a price tag of $18 billion dollars annually (2002).
Alarming Statistics
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· 1.5 million incidences of bone disease related fractures each year with a price tag of $18 billion dollars annually (2004) |
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· 800,000 emergency room encounters |
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· 500,000 hospitalizations |
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· 2,600,000 physician office visits |
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· 20% of senior citizen who suffer a hip fracture die within a year |
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· Nearly 1 in 5 hip fracture patients ends up in a nursing home within a year |
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· There are 3 times more fragility fractures than there are heart attacks, 6 times more fragility fractures than strokes and 7 times more fragility fractures than cases of breast cancer each year in the United States |
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· Over 43 million Americans has osteoporosis in 2002 and this number is expected to top 61 million by 2020 |
Sources for statistics from 2004 Surgeon General’s report, National Osteoporosis Foundation, and other published data.
These alarming statistics regarding the frequent failure of physicians to adequately evaluate and treat patients with osteoporosis and fragility fractures energized the AOA to take action.
Why is the AOA involved?
In December 2004, the Surgeon General released a major report on bone health and osteoporosis noting fragility fractures as a major public health crisis. The report expressed that there is a significant gap between known evidenced-based therapies and actual clinical practice. As a leadership organization, the AOA recognized this as an opportunity to assume a role in advancing guideline based care aimed at quality improvement and published an article in the Journal of Bone & Joint Surgery to further support this initiative.
The Pilot
In 2005, the AOA conducted a pilot program in 14 hospitals nationwide in which it applied an easy-to-use series of educational prompts, administered through a web-based registery, to change physician and patient behaviors in eight important areas related to the management of osteoporosis in patients who sustained a fragility fracture.
Participants were asked to:
- Organize a multi-disciplinary team meeting to review the pilot program.
- Identify internal champions to implement the program in one area within the institution. These champions or their designees worked directly with the AOA Pilot Help Desk to:
- Obtain IRB approval, if applicable;
- Use the pilot materials to implement the program within the institution;
- Participate in monthly calls.
- Provide feedback at the end of the pilot.
Pilot Participants
- Columbia Presbyterian Medical Center, New York, NY
Carolyn Becker, MD, Louis Bigliani, MD, Gail Torres, MS, RD, Richard Yoon, BS
- Cornell Hospital for Special Surgery, New York, NY
Joseph Lane, MD, Lisa Shindle, RN
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Linda Eickhoff, MS, Kenneth Koval, MD, Kristi Genuario, OD
- SUNY Buffalo School of Medicine, Buffalo, NY
Lawrence Bone, MD, Cathy Buyea, MS
- Loyola University Medical Center, Chicago, IL
Victoria Davidson-Bell, CNP, Terry Light, MD, Steven Rabin, MD Anthony Rinella, MDM
- Northwestern University Medical School, Chicago, IL
Andrew Bunta, MD, Beatrice Edwards, MD, Lidia Andruszyn, DNP, APN, CNP
- Rush University Medical Center, Chicago, IL
Patricia Piasecki, RN, Walter Virkus, MD
- Springfield Hospital, Springfield, VT
Bob DeMarco, RN, Maria Fiallos, RN
- Truman Medical Center, Kansas City, MO
James Hamilton, MD, Robin Barber
- University of Iowa Health Care, Iowa City, IA
J. Lawrence Marsh, MD, Tess Sommer, RN
- University of Maryland School of Medicine, Baltimore, MD
Sandra Brinson, Vincent D. Pellegrini, MD, Elizabeth A. Streeten, MD
- University of Minnesota, Minneapolis, MN
Marc F. Swiontkowski, MD, Renee Lewis, Kathy Zimmerley, RN, BSN
- University of North Carolina School of Medicine, Chapel Hill, NC
Douglas Dirschl, MD
- Washington Hospital Center, Washington, DC
Andrew Holmes, MD, Stephen Gunther, MD, Maria Leber, RPAC, Catherine Pulford, CANP, Laura Tosi, MD
Pilot Results Published in the Journal of Bone & Joint Surgery
The pilot program documented significant improvement compared to baseline in most areas. Detailed data regarding pilot results has been published in the Journal of Bone & Joint Surgery in January 2008. Click here to access the abstract online.
Own the Bone Committees
Pilot Program Design Committee
Jospeh A. Buckwalter, MD, Chair
Kenneth Koval, MD
Joseph M. Lane, MD
Jay R. Lieberman, MD
Marc F. Swiontowski, MD
Laura L. Tosi, MD
Richard Gliklick, MD, vendor
Own the Bone Scientific Steering Committee
Andrew D. Bunta, MD
Charles N. Cornell, MD
Douglas R. Dirschl, MD
Thomas A. Einhorn, MD
Kenneth J. Koval, MD
Joseph M. Lane, MD
Mary I. O’Connor, MD
Marvin E. Steinberg, MD
Marc F. Swiontkowski, MD
Laura L. Tosi, MD
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The Own the Bone Study was developed by the American Orthopaedic Association in consultation with Outcome Sciences, Inc. dba Outcome. The web-based system is TotalQuality™, Outcome, Cambridge, MA. For more information on the AOA's Own the Bone program e-mail: info@aoassn.org or call AOA headquarters at 847.318.7330.
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