Symposium: Bone Quality: From Bench to Bedside

Clinical Orthopaedics and Related Research®

, Volume 469, Issue 8, pp 2248-2259

First online:

Bone Quality: Educational Tools for Patients, Physicians, and Educators

  • Junaid ShamsAffiliated withGeorge Washington University School of Medicine
  • , Allison B. SpitzerAffiliated withGeorge Washington University School of Medicine
  • , Ann M. KennellyAffiliated withBone Health Program, Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center
  • , Laura L. TosiAffiliated withGeorge Washington University School of MedicineBone Health Program, Division of Orthopaedic Surgery and Sports Medicine, Children’s National Medical Center Email author 

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Defining bone quality remains elusive. From a patient perspective bone quality can best be defined as an individual’s likelihood of sustaining a fracture. Fracture risk indicators and performance measures can help clinicians better understand individual fracture risk. Educational resources such as the Web can help clinicians and patients better understand fracture risk, communicate effectively, and make decisions concerning diagnosis and treatment.


We examined four questions: What tools can be used to identify individuals at high risk for fracture? What clinical performance measures are available? What strategies can help ensure that patients at risk for fracture are identified? What are some authoritative Web sites for educating providers and patients about bone quality?


Using Google, PUBMED, and trademark names, we reviewed the literature using the terms “bone quality” and “osteoporosis education.” Web site legitimacy was evaluated using specific criteria. Educational Web sites were limited to English-language sites sponsored by nonprofit organizations


The Fracture Risk Assessment Tool® (FRAX®) and the Fracture Risk Calculator (FRC) are reliable means of assessing fracture risk. Performance measures relating to bone health were developed by the AMA convened Physician Consortium for Performance Improvement® and are included in the Physician Quality Reporting Initiative. In addition, quality measures have been developed by the Joint Commission. Strategies for identifying individuals at risk include designating responsibility for case finding and intervention, evaluating secondary causes of osteoporosis, educating patients and providers, performing cost-effectiveness evaluation, and using information technology. An abundance of authoritative educational Web sites exists for providers and patients.


Effective clinical indicators, performance measures, and educational tools to better understand and identify fracture risk are now available. The next challenge is to encourage broader use of these resources so that individuals at high risk for fracture will not just be identified but will also adhere to therapy.