Fractures in the Elderly: A Guide to Practical Management

David A. Ontjes

doi:10.1001/jama.2011.1006

Ontjes, David A.

2011-07-20 00:00:00

Edited by Robert J. Pignolo, Mary Ann Keenan, and Nader M. Hebela 335 pp, $219 New York, NY, Humana Press, 2011 ISBN-13: 978-1-60327-466-1 One of 2 women and 1 of 4 men will sustain an osteoporotic fracture during their lives. As emphasized by this text, a woman's risk of hip fracture in the United States is equal to her combined risk of breast, uterine, and ovarian cancer. Most fractures occurring in elderly persons are related to osteoporosis. This timely book aims to provide up-to-date information on the prevention of fractures in the elderly as well as current best management practices for dealing with fractures once they have occurred. Because many patients with fractures will have concurrent medical problems affecting their surgical risks and prospects for recovery, this text takes a broad, multidisciplinary approach. Most of the 31 contributors are drawn from the departments of medicine, orthopedics, and anesthesiology at the University of Pennsylvania School of Medicine. The first section deals with the changes of aging that lead to fractures. The first chapter, on the osteobiology of aging, is a concise but thorough summary of the molecular mechanisms controlling bone remodeling and the pathways leading to osteoporotic bone loss. The second chapter, on pathological fractures, concentrates on the practical aspects of evaluating and treating tumor-related fractures, including surgical, radiological, and pharmacological options. The authors provide little discussion of the mechanisms of bone metastases, why metastatic tumors tend to localize and grow in bone, and how they weaken bone strength, although this has been a productive field of research in recent years. The third chapter, written by 2 geriatricians, provides a concise and practical guide for addressing the needs of the elderly patient at risk for falls. The second section, on perioperative management, covers a range of issues facing the elderly patient undergoing surgery for a serious fracture. Most of these chapters, including preoperative risk assessment, anticoagulation, prevention, and management of perioperative delirium and postoperative complications, are written by well-qualified geriatricians. These chapters present a set of options and guidelines for the surgeon or medical consultant responsible for patient care. The chapter on anesthesia and postoperative pain control, written by an anesthesiologist, is particularly strong. The author discusses the physical changes of aging and how they require special consideration in preoperative assessment, intraoperative management, and postoperative care. The third section includes 6 chapters dealing with the operative approach to a series of fractures common in elderly persons, most of which are considered related to osteoporosis. The orthopedists authoring these chapters effectively describe the biomechanics leading to each type of fracture, the surgical options for management, and the steps required for rehabilitation. The discussions of current surgical techniques are not detailed but are concise and clearly presented for both the surgical and the nonsurgical reader. The fourth and final section includes a chapter on rehabilitation and a chapter on bone fragility and fracture prevention. The chapter on rehabilitation, emphasizing the importance of a team approach in obtaining an optimal outcome, overlaps somewhat with the earlier chapters dealing with specific fractures. The final chapter notes that, despite the impressive progress in the diagnosis and treatment of osteoporosis, physicians still do not apply this new knowledge in the real world. According to information from the US Surgeon General, less than 15% of elderly patients with recent fragility fractures are being evaluated and treated for osteoporosis. The author proposes a combination of clinical risk assessment, laboratory testing, and bone mineral density measurement for determining whether a patient should be treated with one of the currently available antiosteoporosis drugs. This chapter was apparently written prior to the availability of the FRAX tool developed by the World Health Organization, which allows a clinician to estimate the absolute fracture risk for a given patient using readily available data. Fractures in the Elderly is a readable, concise guide for clinicians whose task is to prevent or to treat fractures in elderly persons. Its multidisciplinary approach, focusing specifically on fractures, is not readily available in other general textbooks dealing with osteoporosis, orthopedic surgery, or geriatrics. It should be a useful reference for geriatricians, orthopedists, anesthesiologists, and primary care physicians. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Ontjes reported receiving payment for a lecture on osteoporosis from Novartis.

http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

JAMA American Medical Association

http://www.deepdyve.com/lp/american-medical-association/fractures-in-the-elderly-a-guide-to-practical-management-7CBfrP8VBL

$Edited by Robert J. Pignolo, Mary Ann Keenan, and Nader M. Hebela 335 pp, $219 New York, NY, Humana Press, 2011 ISBN-13: 978-1-60327-466-1 One of 2 women and 1 of 4 men will sustain an osteoporotic fracture during their lives. As emphasized by this text, a woman's risk of hip fracture in the United States is equal to her combined risk of breast, uterine, and ovarian cancer. Most fractures occurring in elderly persons are related to osteoporosis. This timely book aims to provide up-to-date information on the prevention of fractures in the elderly as well as current best management practices for dealing with fractures once they have occurred. Because many patients with fractures will have concurrent medical problems affecting their surgical risks and prospects for recovery, this text takes a broad, multidisciplinary approach. Most of the 31 contributors are drawn from the departments of medicine, orthopedics, and anesthesiology at the University of Pennsylvania School of Medicine. The first section deals with the changes of aging that lead to fractures. The first chapter, on the osteobiology of aging, is a concise but thorough summary of the molecular mechanisms controlling bone remodeling and the pathways leading to osteoporotic bone loss. The second chapter, on pathological fractures, concentrates on the practical aspects of evaluating and treating tumor-related fractures, including surgical, radiological, and pharmacological options. The authors provide little discussion of the mechanisms of bone metastases, why metastatic tumors tend to localize and grow in bone, and how they weaken bone strength, although this has been a productive field of research in recent years. The third chapter, written by 2 geriatricians, provides a concise and practical guide for addressing the needs of the elderly patient at risk for falls. The second section, on perioperative management, covers a range of issues facing the elderly patient undergoing surgery for a serious fracture. Most of these chapters, including preoperative risk assessment, anticoagulation, prevention, and management of perioperative delirium and postoperative complications, are written by well-qualified geriatricians. These chapters present a set of options and guidelines for the surgeon or medical consultant responsible for patient care. The chapter on anesthesia and postoperative pain control, written by an anesthesiologist, is particularly strong. The author discusses the physical changes of aging and how they require special consideration in preoperative assessment, intraoperative management, and postoperative care. The third section includes 6 chapters dealing with the operative approach to a series of fractures common in elderly persons, most of which are considered related to osteoporosis. The orthopedists authoring these chapters effectively describe the biomechanics leading to each type of fracture, the surgical options for management, and the steps required for rehabilitation. The discussions of current surgical techniques are not detailed but are concise and clearly presented for both the surgical and the nonsurgical reader. The fourth and final section includes a chapter on rehabilitation and a chapter on bone fragility and fracture prevention. The chapter on rehabilitation, emphasizing the importance of a team approach in obtaining an optimal outcome, overlaps somewhat with the earlier chapters dealing with specific fractures. The final chapter notes that, despite the impressive progress in the diagnosis and treatment of osteoporosis, physicians still do not apply this new knowledge in the real world. According to information from the US Surgeon General, less than 15% of elderly patients with recent fragility fractures are being evaluated and treated for osteoporosis. The author proposes a combination of clinical risk assessment, laboratory testing, and bone mineral density measurement for determining whether a patient should be treated with one of the currently available antiosteoporosis drugs. This chapter was apparently written prior to the availability of the FRAX tool developed by the World Health Organization, which allows a clinician to estimate the absolute fracture risk for a given patient using readily available data. Fractures in the Elderly is a readable, concise guide for clinicians whose task is to prevent or to treat fractures in elderly persons. Its multidisciplinary approach, focusing specifically on fractures, is not readily available in other general textbooks dealing with osteoporosis, orthopedic surgery, or geriatrics. It should be a useful reference for geriatricians, orthopedists, anesthesiologists, and primary care physicians. Back to top Article Information Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Ontjes reported receiving payment for a lecture on osteoporosis from Novartis.$

Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Fractures in the Elderly: A Guide to Practical Management

Fractures in the Elderly: A Guide to Practical Management

Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Fractures in the Elderly: A Guide to Practical Management

Fractures in the Elderly: A Guide to Practical Management

References (0)

Abstract

Journal

Recommended Articles

There are no references for this article.

Our policy towards the use of cookies