Best practices in systems interventions to reduce the burden of fractures

Abstract

The importance of bone health is far greater than the amount of attention given this topic. Considering osteoporosis alone, about ten million Americans already have the disease, and about 34 million others are at risk. Estimates suggest that among those over 50 years, about half of all women and up to one in four men will break a bone because of osteoporosis. Bone health issues are not exclusive to older people. They can impact men and women of every age and ethnic group. As the baby boomer generation ages, the urgency for action to improve bone health is increasing. It is timely for the Bone Health Conference to be focusing on best practices in systems interventions to reduce the burden of fractures. I was reflecting recently on a good friend who had a compression fracture earlier this year. She is 80 years old and what surprised me most about the situation was her experience with prednisone. This was not someone who was a stranger to medical care, and she was clearly at high risk: age 80 years, Caucasian, and of relatively small build. She had been treated for polymyalgia rheumatic and had been struggling for the past few years to get off the 5–7 mg of prednisone, but could not quite stop using it altogether. No one had talked to her about this issue. I do not know if more information at the outset might have enabled her to prevent this problem, but it was shocking to me that she was hearing it from me for the first time. Thankfully she is better, but we can do better than that. We believe that comparative effective research, or patient-centered outcomes research, is the foundation of improving the quality of care, including identifying and developing the evidence base for systems interventions. When you shop for a new car, phone, or camera, you have lots of information about your choices. But when it comes to choosing the right medicine or the best health care treatment, clear and dependable information currently can be very hard to find. As we consider best practices in systems interventions to reduce the burden of fractures, we focus on: