To the Editor:

The editorial by Drs. Tosi and Kyle on "Fragility fractures: the fall and decline of bone health" accompanying the article by Gardner et al. in the January 2005 J Bone Joint Surg struck a responsive cord. First of all, the term "bone health" should come to be more widely used, for it signifies a patient-oriented awareness that can promote a greater understanding of how favorably diet and life style habits can influence bone status throughout life.

Second, patients and physicians alike must be made aware of "bone health across the generations" as I emphasize in my article recently published as a Current Opinion in Maturitas (1).

Third, education about bone health must be a dominant theme for health providers in all disciplines. There needs to be a "pre-fracture" mentality. In the case of orthopaedic surgeons who "claim to own the bone", they play a crucial role in committing diagnostic resources and appropriate follow-up for those patients they care for at the first instance of a fragility fracture presentation - especially a distal radius fracture where the patient is often a peri-menopausal or early postmenopausal woman. There is frequently a lack of appropriate recognition of this significant event, and often a failure of follow-up documented in the orthopaedic literature (2). The same holds true in terms of follow-up if the orthopaedic surgeon is consulted for back pain where x-rays reveal a compression vertebral fracture.

It is perhaps ironic that in the decade ahead, where the orientation of life-long attention to bone health could make fragility fractures due to osteoporosis a thing of the past, the role of the orthopaedic surgery in hip fracture repair might be sharply reduced. But the word play (probably unintended in the title) will never eliminate hip fractures entirely, since the "fall" will likely remain a significant geriatric event that often contributes to this catastrophic outcome.

I wish the American Academy of Orthopaedic Surgeons success in their educational campaign.

Sincerely,

David Hamerman, MD; Distinguished University Professor of Medicine; Professor of Orthopaedic Surgery

References

1. Hamerman D. Current Opinion. Bone health across the generations: a primer for health providers concerned with osteoporosis prevention. Maturitas 2005; 50:1-7.

2. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg 2000; 82A:1063-1070.