Fracture prevention is emerging as a larger priority for health systems as providers seek to improve outcomes for an aging population while reducing avoidable hospitalizations and repeat procedures.
Irvine, Calif.-based Hoag Orthopedic Institute, which was recently recognized as an American Orthopaedic Association Own the Bone Star Performer for excellence in bone health and fragility fracture prevention, shared how it is approaching that challenge.
In emailed responses to Becker’s, Kim Mikes, RN, CEO of Hoag Orthopedic Institute and Marisa Swain, MSN, RN, a clinical nurse specialist, said long-term success depends on coordinated care, earlier osteoporosis intervention and stronger investment in fracture prevention programs.
- What does a successful fracture prevention program look like in practice, and what have been the biggest factors driving its success at Hoag Orthopedic Institute?
MS: A successful fracture prevention program is one that reduces repeat fragility fractures while improving the patient’s long-term bone health and quality of life. I frequently tell patients that our goal is not to just treat the fracture but to prevent future fractures from even happening. One of the biggest contributors to our success has been Hoag Orthopedic Institute’s long-standing commitment to fracture prevention.
As a participant in the American Orthopaedic Association’s “Own the Bone” program within our first couple years of opening, our physician and administrative leaders recognized early on that improving bone health required a coordinated, system-wide approach. We have been awarded Star Performer status since 2015. Our community engagement has also been a driving force and has expanded significantly. We have increased our osteoporosis education offerings from two classes annually to eight classes across Orange County, Calif. in 2026, reflecting the growing public interest in bone health and healthy active aging.
- Despite growing awareness of osteoporosis and fragility fractures, where do you see the biggest gaps in care today, even among high-performing organizations, and what needs to change to close them?
MS: The greatest gap in osteoporosis care remains fragmentation across the continuum of care. Bone health should be addressed throughout life- not only after a fracture occurs. Opportunities for education, risk assessments and early screening exist from childhood through older adulthood. Organizations should promote care coordination or identified resources to help people navigate within the healthcare system. Clinical nurse specialists are uniquely positioned to lead this type of program as an advanced practice registered nurse who treats patients, leads evidence-based practice and improves healthcare systems outcomes.
- As the U.S. population continues to age, how do you expect fracture prevention strategies to evolve over the next five to 10 years?
MS: Over the next decade, I expect fracture prevention and bone health to become a much more prominent public health priority. I think the women’s health movement we are seeing now will only have a positive effect in promoting awareness about bone health. Advances in screening, risk assessment technology and coordinated care models will enable earlier identification of individuals at risk for fractures and more personalized prevention strategies. Ultimately, success will be measured not only by fewer fragility fractures but by helping our community make active aging possible.
- As hospitals continue to navigate reimbursement challenges and workforce constraints, what’s the business case for investing in fracture liaison services and other bone health initiatives? How do these programs create value for both patients and health systems?
KM: Reducing repeat fragility fractures through a bone health initiative can significantly lessen financial burdens on the healthcare system. These fractures are always costly and often result in repeated hospitalizations, multiple surgeries, rehabilitation services and, in many cases, long-term care needs for the patient. At Hoag Orthopedic Institute, we have long recognized the importance of educating our patients about osteoporosis and osteopenia and empowering those who have experienced a fracture to take an active role in optimizing their bone health. Our commitment extends beyond the hospital setting; we regularly engage with local senior centers and community groups to provide education and resources to at-risk adults, advocating lifestyle and dietary changes to reduce fracture risk.
Once a patient suffers a fragility fracture, a coordinated bone health program can help prevent subsequent fractures, decrease emergency room visits and improve overall patient outcomes. These efforts also create operational efficiencies by allowing orthopedic surgeons to devote more capacity to elective procedures and reduce the strain on inpatient beds and healthcare resources.
In addition to our nationally recognized Own the Bone program, we are currently planning a comprehensive fragility fracture prevention initiative that will work collaboratively with a patient’s care team to deliver a coordinated, proactive approach to identifying and managing individuals who are at risk for future fractures. This investment will not only improve a patient’s quality of life but will also support long-term sustainability across the healthcare system.
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