- Email: [email protected]
Fragility Fractures
Fragility Fractures
Preface Fragility Fractures
Susan M. Friedman, MD, MPH, Daniel Ari Mendelson, MS, MD, FACP, AGSF FACP, AGSF, CMD Editors
Fragility fractures are on the rise, as a function of our rapidly expanding older adult population. Fragility fractures, and particularly hip fractures, can lead to devastating consequences, including loss of mobility, institutionalization, and death. By their nature, these fractures occur in patients who are frail, who often have many comorbidities, and who may have already experienced functional decline. In addition to the personal costs of fragility fractures, they are also associated with very significant financial burdens. Because these patients are vulnerable and the consequences are substantial, it is critically important to provide thoughtful, optimized care in the perioperative setting and beyond. A great deal of work has been done in the recent past to reduce the morbidity and mortality associated with fragility fractures. Improvement in operative techniques and implant technology, increasing appreciation of complexity and utilization of comanagement, optimized models of care through lean practices, and improved secondary prevention have all contributed to better outcomes. This issue of Clinics in Geriatric Medicine will critically evaluate recent advances in the treatment of fragility fractures. As this is an interdisciplinary problem, we have asked experts from several fields, including Geriatrics, Orthopedics and Trauma Surgery, Anesthesiology, Rehabilitation Medicine, and Metabolic Bone, to participate in the writing of this issue. The focus of this discussion will be the perioperative setting, but we will also address issues related to rehabilitation and secondary prevention. We have been extremely fortunate to work with outstanding colleagues across the globe whose driving mission is to improve the care of frail older adults. These individuals continue to inspire and motivate us to “do our part” to educate, with the goal of changing practices. Meliora! We would like to thank our coauthors on this project, who have been our supporters, friends, and collaborators for years. We greatly appreciate the help and guidance of our editors, Yonah Korngold and Jessica McCool, and their staff. We thank the Department of Medicine and Administration at Highland Hospital for providing the resources Clin Geriatr Med 30 (2014) xiii–xiv http://dx.doi.org/10.1016/j.cger.2014.01.019 geriatric.theclinics.com 0749-0690/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
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Preface
to complete this project as well as the interdisciplinary team at Highland that has made our work possible. We are also grateful to our spouses and children, whose support has allowed us to do work that is so personally meaningful and rewarding. Susan M. Friedman, MD, MPH, FACP, AGSF Associate Professor of Medicine Division of Geriatrics University of Rochester School of Medicine and Dentistry Department of Medicine Highland Hospital, 1000 South Avenue, Box 58 Rochester, NY 14620, USA Daniel Ari Mendelson, MS, MD, FACP, AGSF, CMD Associate Professor of Medicine Division of Geriatrics University of Rochester School of Medicine and Dentistry Director, Consultative Services, Highland Hospital Co-Director, Geriatric Fracture Center, Highland Hospital Medical Director, Monroe Community Hospital Medical Director, Highlands at Brighton Department of Medicine Highland Hospital, 1000 South Avenue, Box 58 Rochester, NY 14620, USA E-mail addresses: [email protected] (S.M. Friedman) [email protected] (D.A. Mendelson)
Preface Fragility Fractures
Susan M. Friedman, MD, MPH, Daniel Ari Mendelson, MS, MD, FACP, AGSF FACP, AGSF, CMD Editors
Fragility fractures are on the rise, as a function of our rapidly expanding older adult population. Fragility fractures, and particularly hip fractures, can lead to devastating consequences, including loss of mobility, institutionalization, and death. By their nature, these fractures occur in patients who are frail, who often have many comorbidities, and who may have already experienced functional decline. In addition to the personal costs of fragility fractures, they are also associated with very significant financial burdens. Because these patients are vulnerable and the consequences are substantial, it is critically important to provide thoughtful, optimized care in the perioperative setting and beyond. A great deal of work has been done in the recent past to reduce the morbidity and mortality associated with fragility fractures. Improvement in operative techniques and implant technology, increasing appreciation of complexity and utilization of comanagement, optimized models of care through lean practices, and improved secondary prevention have all contributed to better outcomes. This issue of Clinics in Geriatric Medicine will critically evaluate recent advances in the treatment of fragility fractures. As this is an interdisciplinary problem, we have asked experts from several fields, including Geriatrics, Orthopedics and Trauma Surgery, Anesthesiology, Rehabilitation Medicine, and Metabolic Bone, to participate in the writing of this issue. The focus of this discussion will be the perioperative setting, but we will also address issues related to rehabilitation and secondary prevention. We have been extremely fortunate to work with outstanding colleagues across the globe whose driving mission is to improve the care of frail older adults. These individuals continue to inspire and motivate us to “do our part” to educate, with the goal of changing practices. Meliora! We would like to thank our coauthors on this project, who have been our supporters, friends, and collaborators for years. We greatly appreciate the help and guidance of our editors, Yonah Korngold and Jessica McCool, and their staff. We thank the Department of Medicine and Administration at Highland Hospital for providing the resources Clin Geriatr Med 30 (2014) xiii–xiv http://dx.doi.org/10.1016/j.cger.2014.01.019 geriatric.theclinics.com 0749-0690/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
xiv
Preface
to complete this project as well as the interdisciplinary team at Highland that has made our work possible. We are also grateful to our spouses and children, whose support has allowed us to do work that is so personally meaningful and rewarding. Susan M. Friedman, MD, MPH, FACP, AGSF Associate Professor of Medicine Division of Geriatrics University of Rochester School of Medicine and Dentistry Department of Medicine Highland Hospital, 1000 South Avenue, Box 58 Rochester, NY 14620, USA Daniel Ari Mendelson, MS, MD, FACP, AGSF, CMD Associate Professor of Medicine Division of Geriatrics University of Rochester School of Medicine and Dentistry Director, Consultative Services, Highland Hospital Co-Director, Geriatric Fracture Center, Highland Hospital Medical Director, Monroe Community Hospital Medical Director, Highlands at Brighton Department of Medicine Highland Hospital, 1000 South Avenue, Box 58 Rochester, NY 14620, USA E-mail addresses: [email protected] (S.M. Friedman) [email protected] (D.A. Mendelson)