Para que a primeira fratura seja a última The first fracture will be the last

We are losing the battle ... We can win the war

 

 

BEHIND PREVREFRAT IS A CONCEPT AND A PHILOSOPHY, AS WELL AS PROTOCOLS OF PREVENTION, DIAGNOSIS AND TREATMENT.

I'M AN ORTHOPAEDIC SURGEON THAT DEAL WITH METABOLIC BONE DISEASES. I ANALYZE A DXA WITH], OSTEOPENIA, TREAT A VITAMIN D DEFICIENCY, MONITORING LEVELS OF CTX, SEE AN INCREASE IN PTH (BELIEVE ME!).

BUT I ALSO SEE (AND OPERATE) HIP FRACTURES, SCARS, PULMONARY EMBOLISM, DEATHS, CRUTCHES, WHEELCHAIR. REHABILITATION IS JUST FOR THOSE WHO CAN, IT'S NOT FOR THOSE WHO WANT ... I SEE THOUSANDS OF KYPHOTIC OLD LADIES (SOMETIMES NOT SO OLD) AND CLAUDICATING MEN.

I SEE AMBULANCES RUNNING SEVERAL HOSPITALS, LOOKING TO GET BEDS. I SEE THE PASSENGER AGONIZING FROM PAIN EACH HOLE IN THE ROAD. WHO SHOULD BE OPERATED IN 24 HOURS, AND SOMETIMES IT TAKES 24 DAYS.

FOR MORE THAN 20 YEARS I SAW CAMPAIGNS TO DRINK MORE MILK, TO WALK IN A SUNNY DAY. I SAW TWO POPES HAVING OSTEOPOROTIC FRACTURES. IN THOSE 20 YEARS, SOPHISTICATED AND ACCURATE TESTS HAVE BEEN DEVELOPED, EFFECTIVE MEDICINES LAUNCHED (WHO COULD IMAGINE TREATING A DISEASE USING A DRUG ONCE OR TWICE A YEAR?) AND THE INFORMATION GROWING LIKE MUSHROOMS IN THE RAIN.

AND WHAT HAPPENS? EACH YEAR MORE FRACTURES, FEWER HOSPITAL BEDS (HAPPENS IN ALL INDUSTRIALIZED COUNTRIES) AND THE POPULATION GETTING OLDER.

OUR CHILDREN WILL SEE THE COLLAPSE OF THIS HEALTH (?) SYSTEM AS WE ARE GETTING OLDER, WE MUST PRAY FOR ALL SAINTS NOT TO BREAK OUR HIPS. ALSO HAVE OSTEOARTHRITIS? PROSTHESIS? FORGET, THERE ARE NO VACANCIES IN HOSPITALS. THERE ARE FULL OF FRACTURES. UNLESS THERE IS A DEVELOPMENT OF A WAY AN OUTPATIENT ARTHROPLASTY (THIS MAY BE TO OUR GREAT-GRANDCHILDREN).

WHO IS TO BLAME? OKAY, UGLY CHILD HAS NO FATHER...

WHO TO BLAME DOES EXIST. DO YOU WANT TO SEE?

IMAGINE A GUY WITH CHEST PAIN, PALLOR, AND HYPOTENSION (EVEN AN ORTHOPEDIC SURGEON CAN DO THE DIAGNOSIS). HE WENT TO A HOSPITAL, ECG, ONE OR MORE STENTS (SOMETIMES EVEN A CORONARY BYPASS). AFTER A FEW DAYS OF INTENSIVE CARE UNIT, CORONARY UNIT, BEDROOM (OR WARD), HE LEAVES WITH A LOT OF INSTRUCTIONS, DIETS AND MEDICATIONS. WHAT FOR? IT IS CLEAR ... UNLESS AN ACTION IS TAKEN, HE WILL HAVE A HEART ATTACK AGAIN. THEREFORE ALL GO HOME WITH PRESCRIBED TREATMENT.

GUESSED?

TRY TO REMEMBER WHAT WAS THE LAST TIME YOU RECOMMENDED A PATIENT WITH A COLLES FRACTURE, HUMERAL NECK FRACTURE, OR VERTEBRAL FRACTURE (EVEN THAT OLD) WERE TO DO TREATMENT. OF COURSE IF THIS PATIENT DOES NOT GET TREATMENT, HE WILL FRACTURE AGAIN AND WILL TAKE A RIDE WITH THE BROKEN FEMUR IN AN AMBULANCE... FEWER THAN 10% OF PATIENTS WITH FRAGILITY FRACTURES ARE ORIENTED OR DIRECTED TO TREAT THE DISEASE – THE OSTEOPOROSIS.

SOME OTHER DETAILS… WHO HAVE HIGH RISK OF FRACTURES MUST HAVE PHYSICAL ACTIVITY. WHO DOES EXERCISE HAVE BETTER BALANCE, FEWER FALLS, AND OF COURSE, BREAK LESS. IT’S NO GOOD JUST GIVING MEDICINE!!!

SPEAKING OF MEDICINE … PRESCRIBING DRUGS THAT COMPLIANCE IS ADMITTEDLY VERY POOR, THIS PATIENT WILL HAVE NEW FRACTURES… IS IT APPROPRIATE? IT IS SOMETHING TO BE RETHOUGHT … WE ARE THE ONLY PROGRAM IN THE WORLD TO USE A SYSTEMATICALLY ANNUAL DRUG BECAUSE WE THINK THAT WE CAN NOT HAVE NO FULL ADHERENCE IN SUCH PATIENTS. THE DRUG IS EXPENSIVE, SAY THE "MANAGERS". MY ANSWER IS THAT, WITHOUT ANY DOUBT, A FRACTURE IS MUCH MORE EXPENSIVE...

FRACTURES IN GENERAL NOT ONLY REDUCE THE LIFE QUALITY, BUT ALSO LIFE EXPECTATION, WHICH MEANS THAT A PERSON WHO HAS FRACTURES DIES EARLIER.

THE SECONDARY PREVENTION PROGRAMS (TRANSLATING, ONCE THE INDIVIDUAL HAS HAD A FRACTURE) HAVE A REDUCTION OF 50% REFRACTURE RATES.

HALF OF HIP FRACTURES is SOURCED FROM 17% OF PATIENTS WHO HAVE HAD A PREVIOUS FRACTURE. MORE THAN HALF PATIENTS WITH HIP FRACTURE HAVE HAD PRIOR FRACTURE.

AS THEY SAY ON TV, THE RULE IS CLEAR…

A DECREASE OF 50% REFRACTURES MEANS REDUCING HALF FROM THE HALF (25%) HIP FRACTURES.

NO WONDER THAT IOF, ASBMR AND OTHER ENTITIES AND MEDICAL INSURANCE, GOVERNMENTS, HEALTH OPERATORS IN EUROPE, UNITED STATES, CANADA, AUSTRALIA, NEW ZEALAND AND OTHERS ARE INVESTING HEAVILY IN THIS CONCEPT.

THIS IS THE SEED WE ARE PLANTING.

 

 

BERNARDO STOLNICKI

PREVREFRAT COORDINATOR

 

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