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    New approaches to prevent debilitating hip fractures

    Senior Scientist Steve Cummings, MD, pioneers new approaches to prevent debilitating hip fractures in people with serious medical illnesses

    Nov. 21, 2016

    Hip fractures cause prolonged disability and increase the risk of weakened bones and further falls, especially in older individuals. People with major medical illnesses such as Parkinson’s disease, recent stroke, HIV, and heart failure have a high risk of these potentially debilitating bone breaks. But despite the evidence pointing to the impact and risk of hip fractures in over 10 million Americans who have these conditions, a relatively small percentage of people receive drugs shown to reduce their risk. New findings on the topic were published this week in the Journal of Bone and Mineral Research.

    “Drug treatments that strengthen bone also reduce fractures in patients whose risk may be due more to traumatic falls than osteoporosis. There is a major opportunity to substantially reduce the burden of hip fracture by reaching more of them with drug treatments shown to reduce this risk,” said Steve Cummings, MD, CPMC Research Institute Senior Scientist and Director of the San Francisco Coordinating Center, whose perspectives are presented in a review paper in the journal.

    Dr. Cummings and investigators at the University of Sheffield reviewed diseases listed in the in the U.S. National Osteoporosis Foundation Physician’s Guide that are generally managed by specialists, and for which studies have shown an associated risk of hip fracture. The burden of disease was tallied for Parkinson’s disease, stroke, dementia, heart failure, and HIV, and the literature was searched for studies showing decreased risk of hip fracture with pharmacologic treatments.

    “Although data are limited, we suspect that a small proportion of patients with these conditions and a high risk of hip fracture are receiving drug treatments to reduce that risk,” said Dr. Cummings. “Considering the increased risk of post-surgical mortality that has been demonstrated for most of these conditions, there is a pressing need to prevent mortality and disability due to hip fracture in patients with these illnesses,” said Dr. Cummings.

    “Giving specialists in-depth information about new strategies to prevent hip fractures in their patients, and conveying knowledge on the potential impact of delivering preventive drug treatments, can help solve some of the challenges presented in this field,” said Dr. Cummings.

    He noted that new approaches to improve prevention and treatment could include direct outreach to at-risk patients (with physician consent), measuring bone mineral density to refine the estimate of risk, using emergency medical records for earlier identification of at-risk patients, and at-home treatment by home nursing services.