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First Step Fracture Service

Helping health care systems take the first step to connecting fractures and osteoporosis.

Photo of Estela Kennen
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What challenges or opportunities are you trying to address within the problem? (200 characters or less)

Fracture Liaison Services (FLSs) are proven, cost-saving programs to decrease subsequent fractures. Yet for health care systems without one, the time and resources needed to begin can feel daunting.

The osteoporosis care gap is an all too real and emotionally and financially costly problem. Existing practice guidelines and program such as Own the Bone, Capture the Fracture provide a clear and thorough path to eliminate this gap. But for hospitals and health care systems that lack the time, buy-in, personnel, or coordination to carry them out, guidelines may feel overwhelming and inaccessible. Providers and administrators then default to standard care: treating the acute fracture, not the underlying cause.

We must narrow the gap between today’s reality and needed action. The key may be for hospitals to create (or add to) standing discharge orders for all geriatric fractures:

  • Vitamin D and Calcium prescription
  • Weight-bearing as tolerated
  • a bone density test scheduled at six weeks

Standing discharge orders can be overridden if medically indicated, but ease provider burden by creating a highly usable default. Health care systems can easily absorb these particular orders. Vitamin D and Calcium are well-tolerated, inexpensive, and can be started before an osteoporosis diagnosis is confirmed. Weight-bearing as tolerated allows physical therapists to start evidence-based PT immediately, as opposed to a common post-fracture instruction: non-weight bearing.

Meanwhile, the DEXA scan can be key to confirming an osteoporosis diagnosis. Studies show better outcomes when the DEXA is ordered at the hospital versus through a primary care provider (PCP).  Scheduling it for six weeks gives patient time to heal and allows a smoother handoff to the PCP for follow-up.


Finally, there need to be standing orders so that a nurse can provide quick patient education: the break happened for a reason, a reason that puts patients at risk for repeat fractures, but we are going to investigate the root cause, and provide treatment to prevent this from happening again.

Are these measures enough? No. But research suggests they are starkly better than nothing— and they are easy to implement. Perhaps more importantly, the orders allow a person to be identified as osteoporotic, thus activating the entire healthcare ecosystem so a host of other interventions may follow.

Who is your target end user and why will they be interested? (650 characters or less)

The typical target user will be the orthopaedic surgeon at a hospital or health care system, though the program would work with hospitalists or other physicians identified as being most appropriate for a specific organization. Secondary audiences include nurses, NPs, and PAs that may execute the standing orders, and health care administrators that would approve the program and track outcomes. Ortho surgeons are busy handling large loads of complex cases, but would be happy to follow guidelines to improve outcomes if it does not increase their cognitive load or time requirements.

How is your idea scaleable? (650 characters or less)

While having local or nationally recognized leaders/influencers introduce the program can positively impact engagement rates, video-based CMEs can introduce the concept and program/protocol details can be distributed through online PDF, making the cost of entry modest. Once health care systems become active participants of this gateway program, they can be encouraged to use established programs like Own the Bone or Capture the Fracture to build more robust local programs.

What do/will you measure to know if your solution worked? (500 characters or less)

Primary outcome measures: Percent Vitamin D/Calcium prescriptions. DEXA scans scheduled, any additional goals tracked. Medical personnel and patient satisfaction with the program. Secondary measures: DEXA scans completed, osteoporosis found, treatment initiated. Tertiary measures: Subsequent fracture rates, cost-savings.

What is the current stage of development of your idea?

  • Blueprint: We are exploring the idea and gathering the inspiration and information we need to test it with real users.

If you were to become a Top Idea, would you want to actively participate in piloting your idea?

  • I want my idea piloted, and I prefer to do my own piloting in collaboration with the health system and with assistance from the Challenge partner
  • I want my idea piloted, but I’d prefer not to be involved in the pilot and prefer that the health system adopts my idea for piloting with assistance from the Challenge partner

Tell us about yourself or your team (500 characters or less)

I have a Masters in Industrial/Organizational Psychology and a love for design thinking and the design process. That combination leads me to think a lot about structural problems and structural solutions. I conducted public health and health communications research at LSU Health Sciences Center and was the Geriatrics and Palliative Care Education Coordinator at Mercer University School of Medicine. That combination gives me some insight into elder care and how health systems work. Finally, after this challenge started, my mother was diagnosed with osteopenia. I must admit, though, the care gap feels so flagrant that this challenge already felt personal before it “hit home.”

Location (50 characters)

Osan Air Base, South Korea

What is your legal / organizational structure?

  • We are individuals

Innovator/Organizational Characteristics

  • Female-led organization

How did you hear about the Challenge?

  • OpenIDEO announcement email

Why are you participating in this Challenge?

As I read through the challenge brief and supporting documentation, it struck me that the osteoporosis care gap is a civil rights issue, and I got mad, and I got activated. I am here because osteoporosis may affect me as a daughter, a wife, a mother, a friend, a citizen—- and as the owner of a skeletal system. It is too prevalent and too costly a disease to shy away from.


Join the conversation:

Photo of Mojisola Adewumi

Dear Estela

Your research in healthcare system and initiatives is quite amazing.

Photo of Estela Kennen

Thank you Mojisola. I wanted to make sure I understood the ecosystem around osteoporosis so I could find and leverage opportunities for improvement.

Photo of Estela Kennen

Thank you Mojisola. I wanted to make sure I understood the ecosystem around osteoporosis so I could find and leverage opportunities for improvement.

Photo of Mojisola Adewumi

Thank you so much

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