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The Osteoporosis Consultation Program at the University of Maryland Medical Center (UMMC) sees inpatients with osteoporosis related fractures. When a patient is admitted for treatment of a fracture following a mild fall, the treating orthopaedic physician requests an endocrine consultation to evaluate for secondary causes of osteoporosis and to initiate osteoporosis treatment.
Dr. Elizabeth Streeten, a Medical Center endocrinologist, started the program in 2001 after numerous studies showed that in the U.S., only a small fraction (0-5%) of patients admitted to the hospital with fractures resulting from minor trauma were treated medically for the osteoporosis that actually caused the fracture. The program was formed in collaboration with the orthopaedic service.
Dr. Elizabeth Streeten and her colleagues have found that inpatients with fractures are all vitamin D deficient. Consequently, their inpatient treatment starts with a high “loading dose” of Vitamin D, followed by a maintenance dose. In addition, patients are started on one of several osteoporosis medications (usually a bisphosphonate) that reduce the risk of further fracture by half.
Dr. Streeten’s team found that patients who start osteoporosis medications during a hospitalization for a fracture tend to stay on their medication after discharge at higher rates than patients who are started on these drugs as outpatients during a routine office visit to treat osteoporosis.