Division of Rheumatology (Muscles, Tendons and Joints) Phone: (718) 661-7105
Department of Orthopaedics and Rehabilitation Phone: (718) 670-2558
To learn more about osteoporosis, visit our Osteoporosis page in Health Information.
“Osteoporosis is my passion,” says Magdalena Cadet, M.D., and one can
hear in the tone of her voice that it’s true. Dr. Cadet, a
rheumatologist, is director of the Rheumatology Division of the
Department of Medicine. In that capacity, she treats systemic
inflammatory diseases such as rheumatoid arthritis, systemic lupus
erythematosus, and gout. But rheumatology also deals with bone health
and bone disease, she notes, and that is her main focus. Her division
works closely with the Department of Orthopaedics and Rehabilitation.
Osteoporosis is characterized by a decrease in bone mass and an increase in bone porosity and fragility, contributed to by a loss in estrogen. Estrogen loss results in decreased bone strength and quality. “This condition is not acutely life- threatening,” Dr. Cadet explains, “but can lead to fractures of the hip and spine along with various complications. You can be hospitalized for a long stay, and you may not walk very well afterward. Complications from an osteoporotic fracture may significantly impact a patient’s daily activities and quality of life.”
Dr. Cadet cites a surprising statistic – that the risk of osteoporosis for women is equal to the risk of breast, ovarian, and uterine cancers combined. “Women begin to lose bone mass in their 30s,” she notes, but they are at greatest risk following menopause, when their ovaries stop producing estrogen, which helps to keep bones strong.”
It is estimated that one out of every two women over the age of 50 will be affected by osteoporosis in her remaining lifetime, and that each year, osteoporosis causes an estimated 1.5 million fractures. The cost of hip fractures alone is estimated to be $10-20 billion annually in the United States, and the aging of the population is likely to mean a dramatic increase in these costs.
At New York Hospital Queens, Dr. Cadet is implementing a model of care, the “Improving Bone Health Initiative,” for the prevention and treatment of osteoporosis in women who are at risk for this bone disorder.
The goal is to have all internists, gynecologists, orthopedic surgeons, and emergency room personnel who see women patients for fractures refer those patients to her for an evaluation to determine future risk of fracture.
Using a risk assessment tool developed by the World Health Organization, she will assess them for bone density and strength, weight, height, calcium and vitamin D status, smoking and alcohol intake, family history and other factors. The assessment will diagnose osteoporosis status and produce a 10-year probability of additional fractures. Once the patient’s risk is determined, she will be asked to participate in a prevention and/or treatment program.
Each woman will be seen by a team that includes a nutritionist and a physical medicine and rehabilitation specialist. She will be given education and counseling along with an individual treatment plan, and called at home regularly to check on compliance. “Most patients are not educated about the realities of this disease, Dr. Cadet says, “and if they don’t understand it, they can’t prevent it.”
The plan is now in place in the Emergency Department, where each woman seen for a hip fracture is referred to her and seen while still in the hospital.
“Osteoporosis is a major U.S. public health concern, Dr. Cadet observes, “where some 10 million people have it and 34 million more are at risk. The purpose of this model is to improve bone health, reduce fractures, and decrease costs.”
Every patient who thinks he or she may be at risk for osteoporosis should have the physician obtain a bone density test, measuring the bone mass in the hip, spine, wrist, heel or hand. This is called a DEXA scan.