What type of doctor for osteoporosis

Secondly, fragility-fracture patients require additional preoperative work-up. This is often best accomplished with a multidisciplinary team that includes geriatricians, internists, cardiologists, and anesthesiologists, among others.

Much has been published regarding the timing of hip fracture treatment and the thresholds and reasons for preoperative delay. Patients with unstable cardiac disease typically benefit from medical optimization prior to surgery. Additionally, correction of electrolyte abnormalities and dehydration, both of which are common in this patient population, is warranted.

Osteoporotic fractures occur with lower energy and seem to cause less stiffness and dysfunction for comparable displacement or deformity. Patients with osteoporosis also tend to have lower functional demands and be more adaptive, resilient and accepting of deformity. Older patients tend to be less enthusiastic about surgery. I may also use a longer plate both to improve fixation and limit the potential for a fracture at the end of the plate.

Finally, some complex fractures with poor bone quality are best treated with arthroplasty. Garland: Is your postoperative management altered by the diagnosis of osteoporosis? Faciszewski: The postoperative management is altered as patients with severe osteoporosis should have marked limitation in their bending, twisting and biomechanical forces across their spine not only in the perioperative period, but for the rest of their lives.

Every patient who has an osteoporotic fracture will have physical therapy instruction in the immediate post fracture period. The patients who had large intravertebral clefts filled with PMMA may be braced with either a thoracolumbo-sacral-orthosis TLSO or Jewett brace postoperatively, depending on the vertebral fracture level, to reduce stresses across this damaged vertebral segment. Frailty, deconditioning, and social factors in the elderly may mean a lower threshold for discharge disposition to a nursing home.

Gardner: As with the preoperative management, a multidisciplinary approach, often spearheaded by a geriatrician, facilitates the coordination of care. The tenuous physiology and cardiac comorbidities of many of these patients makes them relatively sensitive to fluid shifts immediately postoperative.

While intravenous antibiotics, intravenous fluids, urinary catheters and nasal oxygen are important in the first 24 hours, the goal is to discontinue these treatments as soon as is safe, as these modalities can inhibit the patient from mobilizing.

Early mobilization with a physical therapist, often as early as postoperative day 1, is beneficial for multiple systems, including cardiac, pulmonary, and integument.

Many of these patients are also malnourished and have clinical depression, and these should be kept in mind by the treating physicians. Initiating diagnosis and treatment for suboptimal nutrition and depression can provide a critical impetus for long-term treatment.

For instance I may delay starting exercises for a month, or I may avoid shoulder abduction which places varus stress on the elbow. Older patients seem to have less pain and take less pain medication, but that is probably more related to mindset than bone quality.

The role of guidance on exercises from an occupational and physical therapist has more to do with how counterintuitive it is to do painful stretches to recover, but again, that seems to have little to do with osteoporosis. Specific to fractures of the distal radius, when using a volar locked plate I usually get stable fixation and I tend to treat osteoporotic and nonosteoporotic fractures the same.

As soon as the finger and forearm motion are full, I allow patients to remove the wrist splint and work on wrist motion. I am in no rush to move the wrist in either group because I prioritize the hand and forearm and because a randomized trial showed no difference between mobilizing the wrist 10 days after surgery compared to 6 weeks after surgery.

Garland: Are there any differences in healing times or fracture complications? Faciszewski: The healing time for osteoporotic compression fractures is quoted in the literature as being equivalent to that of fractures through bones with normal bone density. However, this is a gross generalization that does not incorporate the varied types of osteoporotic fractures. As an example, the rate of aseptic necrosis in osteoporotic VCF is much higher than that of high energy fractures through normal bone.

The former is associated with a much higher rate of nonunion in all bones, with the vertebra being no exception. Intravertebral clefts and dynamic mobility are example of intrinsic fracture characteristics that have the potential to limit healing potential. Many osteoporotic patients are on steroids and this complicates healing and postoperative care. As such, there is much left to be studied in the area of bone healing as it relates to osteoporotic compression fractures.

Gardner: As far as healing times, the effect of osteoporosis on fracture healing is not entirely clear, and clinical evidence is lacking. In a study of femoral neck fractures by Nieminen and colleagues, age was not a predictor of the rate of fracture union. Most of the quoted data is derived from studies of ovariectomized rats, and the majority of these data indicates no difference in the fracture healing times.

During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only certain bones are checked — usually in the hip and spine. Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If your risk isn't high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include:. Side effects include nausea, abdominal pain and heartburn-like symptoms. These are less likely to occur if the medicine is taken properly.

Intravenous forms of bisphosphonates don't cause stomach upset but can cause fever, headache and muscle aches. A very rare complication of bisphosphonates is a break or crack in the middle of the thighbone. A second rare complication is delayed healing of the jawbone osteonecrosis of the jaw. This can occur after an invasive dental procedure, such as removing a tooth.

Compared with bisphosphonates, denosumab Prolia, Xgeva produces similar or better bone density results and reduces the chance of all types of fractures. Denosumab is delivered via a shot under the skin every six months.

Similar to bisphosphonates, denosumab has the same rare complication of causing breaks or cracks in the middle of the thighbone and osteonecrosis of the jaw. If you take denosumab, you might need to continue to do so indefinitely. There is no physician specialty dedicated solely to osteoporosis, nor is there a board certification program for physicians who treat the disease. A variety of medical specialists treat people with osteoporosis, including internists, gynecologists, family doctors, endocrinologists, rheumatologists, physiatrists, orthopaedists, and geriatricians.

There are a number of ways to find a doctor who treats osteoporosis patients. If you have a primary care or family doctor, discuss your concerns with him or her. Your doctor may treat the disease or be able to refer you to an osteoporosis specialist. If you are enrolled in a health maintenance organization HMO or a managed care health plan, consult your assigned doctor about osteoporosis.

This doctor should be able to give you an appropriate referral. If you do not have a personal doctor or if your doctor cannot help, contact your nearest university hospital or academic health center and ask for the department that cares for patients with osteoporosis. Loren Wissner Greene , MD.

Meryl S. Mark , MD. Valerie Peck , MD. Susan Zweig , MD. Sonal Chaudhry , MD. Stephen B. Richardson , MD. Ira J. Goldberg , MD. Sanjiv V. Kinkhabwala , MD.