Orthopaedic APNs Run University of Chicago Medicine’s Bone Health Clinic

The risk of fragility fractures due to osteoporosis is one of the most serious public health problems in the U.S., costing about $19 billion a year in direct care alone.

That figure is expected to hit $25 billion in about 10 years.

Roughly 50% of women over the age of 50 will experience a fragility fracture, and, more frighteningly, once she has a first break she’s 200% more likely to suffer a second one.

The recognition of this growing problem led to the creation of the University of Chicago Medicine Bone Health Clinic earlier this year. It supports the American Orthopaedic Association’s “Own the Bone” program that seeks to identify and evaluate the best treatment options for patients.

The clinic is run by three UCM orthopaedic advance practice nurses, Svetlana Bielecki, MSN, CNP, Lauren Creighton, MSN, CNP, and Kimberly DeVine, DNP, CNP.

UCM's Bone Health Clinic

Svetlana Bielecki, MSN, CNP, left, Lauren Creighton, MSN, CNP, and Kimberly DeVine, DNP, CNP.

The goal is to identify  high risk individuals, either from a pool of existing orthopaedic patients or from other UCM clinics, and educate them on the various preventative measures to minimize the risks of debilitating fragility fractures.

“Given the dramatic growth of the elderly population , there’s going to be a huge increase in the amount of people we’re seeing with osteoporosis,” said Creighton, who joined UCM about 15 months ago.

The numbers surrounding fragility fractures are staggering. There are roughly two million people over 50 who suffer such fractures each year – three times the combined cases of heart attacks, strokes and breast cancer. Unfortunately, less than 20% of these individuals receive proper evaluation and treatment for their declining bone density and tissue loss.

Furthermore, 80% of all people who have had fragility fractures due to osteoporosis are likely to have another break.

“Our goal is to capture this 80% and get them on a comprehensive treatment plan to prevent them from having another fracture,” said Creighton.

In an older population, having a hip fracture can be devastating to the person’s quality of life.

“Healthy bone is needed to maintain body mobility, function, and to keep a person independent,” said Seon-Kyu Lee, MD, PhD, Associate Professor of Radiology, Surgery and Neurology and Director, Interventional Neuroradiology. He collaborates with the bone clinic on high-risk patients. “Aging populations are known to have relatively higher risk of developing osteoporosis and related bone fractures. Therefore, the Bone Health Clinic will play an essential role for not only bone health but for overall health and quality of life especially for an aging population.”

Many of these patients are rendered immobile for a period of time which can lead to unrelated problems such as depression, pressure ulcers, and blood clots.

“If these patients do not get treatment for their low bone density, the chances they’ll have another fracture if they fall is greatly increased,” said Creighton.

Bielecki, Creighton and DeVine have seen upwards of 100 patients in clinic over the past several months. They also do week-long rotations checking on orthopaedic inpatients who could be at risk for another fracture.

The holistic approach the nursing profession takes to patient care, which includes a focus on preventative care and education, makes it logical that UCM nurses would run the clinic.

Douglas Dirschl, MD

Douglas Dirschl, MD

“APNs have exemplary training in speaking with patients about preventative medicine, have an outstanding knowledge base, and can provide complete care for the vast majority of these patients,” said Douglas Dirschl, MD, Chair of the Department of Orthopaedic Surgery and Rehabilitation Medicine, who started a similar clinic at the University of North Carolina.  “The APN model for a bone health clinic (also called a fracture liaison service) has been the most successful of all models attempted in the US.”











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