A love of physics influenced Chris Heck, MD when choosing his medical specialty.
"I initially wanted to follow my father's footsteps and become a cardiothoracic surgeon," Heck says. "I grew up seeing patients and their families appreciate his efforts.
"However, during medical school, I realized that was not the career path for me. Having been intrigued by physics in college, orthopaedics attracted me as it utilized the effect of physics to mend the body."
After a 10 year stint as a surgeon at Southern Orthopaedics in Montgomery, he recently joined Southlake Orthopaedics in Hoover.
Over the course of his career, his work has led him to a side interest in osteoporosis.
"Initially, the pharmaceutical company representatives called on me and made a point that as orthopedic surgeons, we see the patients most in need of treatment - those who have already broken a bone," Heck says. "Since the goal of osteoporosis medication is to prevent future fractures, the patients most in need of this treatment are those who have already broken bones. They are the highest risk group for future fracture as they have already demonstrated that their bone is of poor quality.
"As a spine surgeon who is an orthopedic surgeon, I not only see the broken hips, wrists, and ankles, but also the vertebral fractures of the spine which far outnumber hip, wrist, and ankle fractures.
"Coincidentally, I had recently hired my physician assistant and was looking for a way to get her busy quickly. As an undertreated medical population, this was a perfect opportunity to find a patient population that needed care and for whom there was little competition.
"My PA and I subsequently went to educational seminars and became 'Physician Champions' which means we understand the problem, believe in the treatment, and educate other health care providers to provide treatment or refer to us for treatment.
"An astonishing statistic is that each year more than 34,000 hip fractures occur (more than 90 a day) in the U.S. But published medical studies show that while 80 percent of patients who have a heart attack will begin medication to prevent future heart attacks, only 20 percent of patients who break a bone due to osteoporosis will begin medication to prevent future fractures.
"And consider this: a patient over 65 years of age with a hip fracture has a 20 percent chance of breaking his/her other hip within a year. That's two hospitalizations, two recoveries, and two events that risk the patient's life within a single year. A patient who sustains an osteoporotic fracture is eight times more likely to sustain an osteoporotic fracture of any type than a patient who has not broken a bone."
Why is recognition and treatment for osteoporosis problematic? Heck says patients are in denial about needing treatment. Some say they are healthy and don't need it, while others think they are too old to take more medicines. Heck tries to educate them on their high odds of having breaking another hip, explaining that medication is the only way to avoid this.
Heck believes that physicians can also be are in denial. "Whether it's your primary care physician or your orthopaedic surgeon, most physicians assume that your only problem was the broken hip," he says. "The problem is that the bones were never good to begin with.
Another road block to treating osteoporis is that medications cost money that patients may not have. Fortunately, the drug companies will provide assistance to any patient in financial need.
His advice for family physicians: "Don't rely on the DEXA (osteoporosis screening) as the holy grail. Use the entire clinical picture (history of fracture, family history, comorbidities such as smoking, diabetes, and renal failure) to determine if treatment is needed."
Heck hopes that more orthopaedic surgeons will work on caring for the cause of the fracture, rather than focusing on the effect which is the fracture itself.
