Introduction

John Antoniou, M.D., FRCSC
Scientific Editor

Adult orthopaedic surgeons are treating an increasing number of patients with osteoporosis. Although all surgeons are well aware of this phenomenon, most patients are discharged from the hospital or from a physicians care without adequate evaluation and treatment of the osteoporosis. Few patients with recent fragility fractures are evaluated for low bone density or prescribed medications for osteoporosis despite the availability of therapeutic agents that effectively reduce the risk of fractures in patients who have suffered a previous fracture. It is important to remember that the responsibility of the surgeon does not end with the treatment of a fragility fracture.

It is incumbent upon todays orthopaedic surgeon to be aware of the various ways that osteoporosis will present in ones practice and whether or not the patients are receiving appropriate preventive treatment. Although fragility fractures are the most frequent way that a surgeon will be exposed to such patients, one must have a high level of suspicion of osteoporosis in young females who are underweight, have an eating disorder, do hyperexercise and have amenorrhea. In addition, patients with inflammatory arthropathies or renal disorders are often seen by orthopaedic surgeons and the surgeon must make sure that these patients have been properly evaluated and informed of this potential condition. Moreover, published guidelines on osteoporosis care state that most patients who are taking prednisone need an aminobisphosphonate such as alendronate to prevent steroid-induced osteoporosis.

Making orthopaedic surgeons aware of osteoporosis management in the various at risk populations will, we hope, increase diagnosis and treatment and will subsequently diminish the incidence of the ensuing fragility fractures. Much research has been performed looking at the best ways to achieve this goal. Clinical pathways have been developed and implemented in various communities with various levels of success. All the while, new and effective treatment modalities are being advanced. It is encouraging to note that Canadian orthopaedic surgeons are actually doing better than others. In October 2003, a large majority of Canadian orthopaedic surgeons polled in Winnipeg expressed agreement that they should be involved in the referral or management of osteoporosis in fracture patients, and stated that they make regular efforts to do so. It is this attitude that should be fostered and encouraged throughout the country.

Over the next two issues of the COA Bulletin, we have invited Dr. Earl R. Bogoch of Toronto, Ontario to chair a series of themes articles addressing the topic of osteoporosis as it relates to modern orthopaedic care. The topics to be covered include:

PART I:

1) The Diagnosis of Osteoporosis; Identifying the patient at high risk of fracture by Drs. Jonathan D. Adachi and Alexandra Papaioannou

2) Epidemiology of Osteoporosis: Applying Relevant Figures to your Practice! by Dr. Pierre Guy

3) A Systematic Approach to the Diagnosis and Treatment of Osteoporosis in Fragility Fracture Patients by Dr. Earl R. Bogoch and Victoria Elliot-Gibson

4) Bisphosphonates and Fracture Healing in Orthopaedic Fracture Patients by Dr. Joseph M Lane, Dr. Paul S. Issack and Margaret H. Lauerman

PART II: (to be published in the May/June 2006 edition of the COA Bulletin)

1) Falls Prevention by Dr. Karim Khan

2) Pharmaceutical Agents for the Treatment of Osteoporosis by Dr. Thomas A. Einhorn

3) New Treatment Modalities by Dr. Sophie Jamal

4) The Role of the Trauma Surgeon by Dr. Julie Switzer

It is our hope that this in-depth discussion will inform the orthopaedic surgeon about the extensive clinical and research efforts being performed in this field. More importantly, we hope to emphasize the surgeons evolving responsibility in the treatment of this condition.