Taking Care of Your Bones is Essential For Good health and Quality of Life
Sometimes, a “simple” bone fracture—say, a broken arm from a fall—is just that, a simple broken arm. Other times, especially in people 50 or older, it can signify a condition that can endanger health and longevity. Catherine Metz , PT, MBA, a service line administrator at Hurley Medical Center in Flint, said the hospital screens every patient over 50 who comes into the emergency department with a fracture. “If a bone breaks in a car accident or other trauma, it’s expected,” Metz said. “But if we see a break from a standing fall or something like that, we call it low-impact. That’s not normal.”
The half-century mark is when age-related bone density issues begin to show themselves. If only the break is treated, and not the underlying cause, bigger problems may develop later, she said.
Screening for Risk
Hurley’s protocol helps identify patients who are at risk for future breaks. “We have a screening process for fracture patients over 50,” Metz said. “So while the patient is being treated, we have physicians assistants and a nurse practitioner who are trained to review the patient’s history and screen for risk factors.” Those include a history of steroid treatment, low vitamin D levels, smoking, diabetes, early menopause and a history of osteoporosis in the family. Hurley also conducts an outpatient osteoporosis follow-up at Ortho Michigan, Flint, an orthopedic medicine practice in Genesee and Lapeer counties, reaching out to patients to make sure they are aware of risks and how to increase bone health. “We have a very robust outpatient bone fracture clinic,” Metz said. “While the patient is following up with their orthopedic surgeon, they are also able to have an appointment with Hurley’s own clinician specialist who reviews the patient’s lab work provides education and prescribes any medications so it doesn’t happen again.”
Taking care of Hips
Of all bone fractures, perhaps the most feared—and rightly so—is the hip fracture. Metz noted that many people know about an elderly person who “went in with a broken hip and died a few months later.” “We’re changing all that now,” she said. “We have a specific care system in place for hip fractures now. We approached the University of Rochester (N.Y.), the ‘gurus’ of hip fractures, and we developed a process of dealing with them that drastically reduces mortality (death) and complications.”
Hurley calls the process “Door to floor in 4, surgery in 24.” As soon as a hip fracture is identified with a few questions and an X-ray, the process begins. “The moment they arrive, we start the timer, so to speak,” Metz said. A single command given to Hurley’s computer system initiates a whole setof orders at once, a big improvement over waiting for one test result before beginning another.
“The primary care physician is notified and a social worker comes down to make sure we get immediate consent for the surgery, and we deal with any ongoing medical problems (unless immediately life-threatening) after surgery,” she said. “We need to go ahead and operate. Each hour that surgery is delayed increases the risk of death in the first year, so we move fast.” The result is patients who heal faster, go home sooner and recover quicker. Shorter hospital stays and less physical therapy are required and overall outcomes are better, including fewer deaths, Metz said.
Upgrading Quality of Life
Along with better fracture care, bone health has increasingly come to include joint replacement. The current thinking is not to wait until pain or immobility become unbearable.
“With improved replacement joints, they now can last 20 or 30 years, so there’s really no need to wait until an advanced age,” Metz said. “Improved quality of life is very important, and with joints lasting longer, patients can remain mobile and pain free for longer.”
She said that waiting longer for joint replacement creates a greater risk of declining health due to pain, a sedentary lifestyle and lack of mental stimulation if the patient can’t carry on his or her usual activities. “Patients need not suffer,” she said. “We’re trying to change the mindset.” Metz reflected on the mindset change that’s already occurred at Hurley. “Hurley is the safest place for seniors around. It adds layers of safety over and above the reason they came to us in the first place.”
By: Helen Bas