Bone density decreases with age, which increases the risk of fragility fractures — low-energy trauma caused by a fall from standing height or less. The WHO reports that prevalent cases of acute or long-term symptoms following a fracture increased 70% from 1990 to 2019.

“The sequelae of hip fractures are as serious as those of a heart attack,” says orthopaedic trauma surgeon Christian A. Pean, MD, MS, clinical director of the Duke Fragility Fracture Clinic. “The outcomes are just as poor: 20% to 30% of patients over the age of 70 with a hip fracture pass away within a year, and the majority of surviving patients will lose one level of mobility, such as needing an assistive device for the first time.

“For those who’ve already had one fragility fracture, 7% to 20% have another within two years — and the second causes higher mortality, longer hospitalizations, and lower quality of life.”

Often patients do not realize that are at risk or that there are treatment options available for them. The Fragility Fracture Clinic was established to help educate and treat patients over the age of 55 who suffered a low-energy trauma, especially of the hip, femur, or shoulder, to help them recover and prevent future fractures.

While Pean cautions that anyone over the age of 50 is at risk, other factors can increase that risk, some of which can be modified:

• Female sex (especially postmenopausal women)
• Tobacco smoking
• Alcohol use
• Low body weight
• Sedentary lifestyle
• Poor nutrition
• Bone health issues such as osteoporosis or osteopenia
• Medications and comorbidities that can weaken bones including kidney disease, diabetes, or history of cancer
• Personal or family history of fractures

The clinic’s multidisciplinary team of orthopaedic surgeons, endocrinologists, and a bone health nurse practitioner come up with a comprehensive care plan to educate patients and their caregivers and treat not only the injury but underlying bone health. “Our goal is to prevent that second fracture,” says Pean.

Outcomes have been positive. “To date, over 90% of our clinic’s patients are treated for bone health with medication,” says Pean. “That decreases their chance of having another fracture within a year by 50% to 60%.”

“If you have a patient over the age of 50 who’s had a fracture of the hip, femur, or humerus, consider referring them for evaluation,” says Pean. “Patients are drastically undertreated for bone health, and we’re committed to bridging that gap.”