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Dr Abraham seems to imply that orthopedists may be culpable for the undertreatment of osteoporosis in patients with fracture. Patients with atraumatic fractures often have low bone mineral density¹ and are at heightened risk for additional fractures.² Orthopedists recognize that there is a window of opportunity to educate patients with fracture about osteoporosis and perhaps even initiate treatment.³ However, fracture repair is the immediate concern of the orthopedist. Patients often do not return to see their orthopedist after the fracture is healed; thus, it may be inappropriate for the orthopedist to initiate long-term treatment.

We would argue that there is plenty of culpability to go around. Cuddihy et al⁴ evaluated postfracture treatment of 343 women (mean age, 70 years). After 12 months, 83% had seen a nonorthopedic physician: the 12-month actuarial estimated cumulative incidence of any intervention for osteoporosis was only 18%. Thus, orthopedists are not the only . . . [Full Text of this Article]

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Fractures, Osteoporosis, and the Endocrinologist
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Arch Intern Med 2003;163:2796-2796.
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