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Osteoporosis: Survey of Hand Surgeons' Interest and Competency in its Management
Michael Rivlin, MD; Nayoung Kim, BS; Asif Ilyas, MD
Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Introduction: Osteoporosis is a growing medical and economic burden on our society. The AAOS, among other organizations, has spent significant capital on the education of its membership on osteoporosis care. Hand surgeons are particularly well-positioned for the treatment of osteoporosis as they routinely see and manage upper extremity osteoporotic fractures. However, hand surgeonsí understanding, interest, and comfort with osteoporosis diagnosis and management is not well understood.

Methods: An internet-based survey was e-mailed to all members of the ASSH, with the approval of the society. Data was collected anonymously and included demographics, knowledge-based questions, and practice management patterns. Statistical analysis included two-tailed significance bi-variate correlation analysis of over 105 variables.

Results: A total of 497 hand surgeons responded (82% Orthopaedic and 9.6% Plastic surgeons). Whether they routinely counsel patients about osteoporosis, 70% responded yes. Whether they would personally treat osteoporosis if they had dedicated training on the topic, 55% responded no. Even if they were financially penalized for not treating osteoporosis, 36% would still not treat it. Less than 2% believe that the treating surgeon should be responsible for treatment and 78% believe the primary care physician should treat osteoporosis. Reasons listed by more than 50% of the participants in the survey for not treating osteoporosis include no interest, unfamiliarity, inadequate training, and medico-legal liability. ?The correct response rate to the knowledge-based questions on vitamin and calcium dosing and drug mechanism of actions ranged between 40-70%. More than 25% or hand surgeons do not know the definition of osteoporosis based on T-scores. ?Completion of orthopaedic training (p<0.05), being in practice less than 5 years (p<0.05), and practices with designated medical professionals that manage osteoporosis (p<0.05), all statistically correlated with correct knowledge of vitamin D and calcium requirements, and knowledge of osteoporosis diagnosis, testing, and treatment modalities.

Discussion: There is a wide disparity and relatively poor understanding of osteoporosis and its treatment within the hand surgical community. Hand surgeons with orthopaedic training and are recent graduates are more likely to have a better understanding of osteoporosis diagnosis and management. Regardless, even though the majority of the surgeons counsel patients regarding osteoporosis after fragility fractures, most have very low interest in managing their osteoporosis and refer patients to their primary care physicians. This deficit in knowledge and interest should be taken into account when advocating osteoporosis management by our community of surgeons.

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