Ortho-geriatric co-management: transforming fracture treatment and prevention in older adults

As populations get older, the incidence of fragility fractures is escalating worldwide. But traditional surgical intervention for these fractures has not accounted adequately for crucial patient factors such as medical comorbidities, cognitive impairment, and physical frailty, leading to suboptimal results. However, a paradigm shift is underway with the emergence of ortho-geriatric co-management models—a collaborative approach that is yielding remarkable improvements in patient outcomes.

Our society is aging. And as populations get older, the incidence of fragility fractures is becoming ever higher mainly due to osteoporosis and the soft bones that people get as they age. So almost every country is seeing a huge rise in the number of older adults who suffer osteoporotic fractures of the wrist or hip, many of which will require surgical intervention.

But for the fragility fracture patient, it's about more than just surgery. The older adult very often has other medical comorbidities—and without also managing these properly, we cannot achieve the outcomes that we as physicians, and our patients, want. Even in the absence of specific co-morbidities, many fragility fracture patient s are frail.

When we talk about frailty, we’re referring to the aging of the important hardware of the body, and the difficulty with recovery from surgery, illness, or immobility. All the organ systems start to fail slowly with age but especially the neurologic system and bone and muscle—i.e., osteosarcopenia, the co-existence of osteoporosis and sarcopenia. Osteoporosis being the deterioration of bone mass and tissue, sarcopenia being the loss of muscle mass, strength, and function. This makes the body susceptible to injury but also makes it harder to recover from surgery and more difficult to tolerate different medications.