Bobbie Sanders remembers the moment she broke her hip. She and her husband, Larry, had driven to Cedarburg on a Sunday morning last spring from their home in Mequon. Bobbie was bringing Larry’s tea and her coffee out to the car when she lost her balance, falling backwards.

“I knew when I hit that I broke my hip,” Bobbie said. “It’s like cracking an egg. You know when the egg is cracked.”

It probably helped that Bobbie, 69, is a retired nurse. In fact, she was the director of surgical services at Froedtert Menomonee Falls Hospital, part of the Froedtert & the Medical College of Wisconsin health network. When the ambulance came, she directed the EMTs to take her to her old stomping grounds.

“That’s my operating room,” Bobbie said. “I spent 23 years working there. I knew I would get excellent care, and I did.”

Bobbie needed a total hip replacement, which was performed a day later by Joseph Schwab, MD, orthopaedic surgeon and MCW faculty member. Her surgery and two-day hospital stay were only the first step in a multilayered, comprehensive care program designed to reduce her risk of falling and breaking another bone.

Bobbie experienced what Dr. Schwab called a fragility fracture, meaning a fracture caused by little or no trauma. People who have a fragility fracture automatically meet the criteria for a clinical diagnosis of osteoporosis, a disease that weakens bones and puts them at a greater risk for fractures.

“Osteoporosis can be sneaky because it starts as a silent disease,” Dr. Schwab said. “In many cases, the first time a person realizes they have it is when they show up with a broken hip or a broken wrist.”

Assessing Bone Health

Dr. Schwab referred Bobbie to the Froedtert & MCW Orthopaedic Bone Health Clinic, a one-of-a-kind clinic that evaluates and treats people who have broken a bone or are at risk for osteoporosis. Bobbie worked with Erin Zepezauer, MSN, an advanced practice nurse practitioner. Zepezauer ordered several tests, including a bone density scan, to determine the extent of Bobbie’s bone loss and her risk for future fractures. The workup also included a discussion of calcium and Vitamin D intake and a test for conditions that can contribute to osteoporosis.

Zepezauer opted to treat Bobbie with a prescription medication that builds bone and reduces bone loss. This medication, combined with physical therapy and continued screening, can reduce the risk of another fall and fracture.

The Orthopaedic Bone Health Clinic, which started in 2017, typically serves patients after a fracture. The clinic also receives referrals for patients with bone diseases like osteopenia or osteoporosis, as well as patients facing spinal surgery or total joint surgery. With locations in Milwaukee, Menomonee Falls and West Bend, the clinic is easily accessible.

“Because we know spine and hip fractures are such life-affecting fractures, we have pathways within our health network that include a consultation with the clinic if a patient is admitted,” Zepezauer said.

Bobbie’s care plan also included several physical therapy sessions with Katie Soja, DPT, who developed a series of exercises and routines to improve Bobbie’s balance and strength.

“As people age, they tend to lose their balance and aren’t as quick to react as they used to be,” Soja said. “Exercise can make a difference in their recovery.”

“I’ve been pretty faithful with my exercises,” Bobbie said. “I get one day off a week, and I’m always happy about that.”

Treatment Before and After a Fall

Froedtert & MCW orthopaedic surgeons have a long history of putting broken bones back together and replacing broken or worn joints. The Froedtert & MCW health network is also a leader in treating bone disease medically. Dr. Schwab credits the health network’s involvement in national organizations that develop protocols and pathways for treating osteoporosis. The American Orthopedic Association’s Own the Bone program, launched in 2009, encourages medical professionals to marry the idea of treating bone issues both surgically and medically.

“Ideally, people can be treated before they fall,” Dr. Schwab said. “The next best-case scenario is a comprehensive plan to treat the underlying issues that caused the fall and fracture. I use an analogy of a ‘bone attack.’ Just as heart attacks can signal underlying heart disease, bone attacks like fractures indicate a deeper problem within the body. You can fix a fracture, you can do a hip replacement, but you still have to address the underlying bone disease to prevent that next bone attack from happening.”

Bobbie said she’s doing better every day. She continues to work on her balance and admits to being a little wobbly. While she had great care during her hospital stay, she’s not interested in repeating the process.

“With this treatment, that’s the idea — to prevent another break,” Bobbie said.