Fixated on Bone: How Orthopaedic Leaders Built Own the Bone

Fracture fixed, problem solved? Not even close. Dr. Andrea Spiker sits down with two orthopedic leaders, Dr. Marc Swiontkowski and Dr. Kyle Jeray, who helped turn a quiet crisis—osteoporosis-related fractures—into a national movement that’s changing how surgeons practice, teach, and lead.

You’ll hear the untold origin story of Own the Bone and why it succeeded where earlier efforts stalled: simple, reliable interventions, clear follow-up, and a registry that reveals what works. There’s a proven playbook, real people at the AOA ready to help, and shared best practices that make programs sustainable.

Owning bone health is an act of professionalism and empathy—treating the person behind the fracture and preventing the next one. If you’ve wondered how to move from “bone broke, me fix” to truly comprehensive care, this conversation gives you the history, the tools, and the push to start today.

Visit the JBJS Orthopaedic Forum to read Dr. Jeray’s presidential address: https://journals.lww.com/jbjsjournal/abstract/2025/11050/out_of_left_field__leadership_lessons_i_didn_t_see.18.aspx.

Transcript

Meet The Host And Guests

SPEAKER_02 0:06

Many orthopedic traumatologists recognized early on that osteoporosis and poor bone health have devastating impacts on patients. Today, this is increasingly clear to spine, total joint, and even sports medicine orthopedic surgeons, all of whom are seeing increasing numbers of complications, including periprosthetic fractures and insufficiency fractures. That's why we're convening some of the leading voices in the bone health world to talk to orthopedists and their teams about the rationale for the orthopedic surgeon's growing interest in bone health, including tips and tricks for getting bone health programs integrated into practice and the evidence behind it all. I'm Andrea Spiker, a sports medicine and hip preservation surgeon at the University of Wisconsin, and I'll be your host for a special news series of the AOA Lessons in Orthopedic Leadership podcast called Fixated on Bone, which is brought to you by the AOA's Own the Bone Program. So I'd like to welcome our two esteemed guests to today's podcast, Dr. Mark Swenkowski and Dr. Kyle Geray. Dr. Mark Swenkowski is a professor and former department chair at the University of Minnesota. He is a trauma orthopedic surgeon and was president-elect of the AOA at the time of the founding of the Own the Bone Program. Dr. Kyle Jeray is chair of the Department of Orthopedic Surgery at the University of South Carolina. Dr. Jeray is a trauma orthopedic surgeon and was Own the Bone Committee Chair for a couple of terms and is currently president of the AOA. So first, I would like to welcome both Dr. Swenkowski and Jeray for being the very first guests on our special podcast series. Dr. Swinkowski and Dr. Deray, if you can please start our conversation by giving the listeners a little bit of information about who you are and what your practices are. Dr. Swenkowski, would you mind starting?

SPEAKER_01 1:56

No, I don't mind at all. And uh thanks very much for the invitation. Uh I am uh in the winding down phase of a career. I've been an orthopedic trauma surgeon my whole career, starting uh the completion of my residency in 1984. Generally worked at level one trauma centers. Uh, and uh in the year 2005, when I was department chair of the University of Minnesota, we opened up a large uh outpatient orthopedic center uh that has a a service called the Acute Injury Clinic that now serves over 200 patients a day that come in with musculoskeletal complaints, and a certain number of those will have fractures, and I'm basically working uh at that center fixing tibial plateaus and proximal humerus fractures, ankles, etc., many of whom are related uh to osteoporosis. Um so that's what I'm doing today, and I'm actually in my final year of surgery uh after quite a long time.

SPEAKER_02 3:07

Well, congratulations on me reaching that milestone. Uh, Dr. Dre, can you tell us a little bit more about yourself and your practice?

Birth Of Own The Bone

SPEAKER_00 3:16

Sure. So I've been practicing at the University of South Carolina in Greenville since graduating uh residency and fellowship back in uh the late 1990s. So I've remained at the same place for a very long time. And as an orthopedic traumatologist, I started seeing our older patients come back with recurrent fractures and started to recognize that there isn't a problem that we're not really addressing. And as a young orthopedist, I learned a lot from Dr. Swinkowski when he started that program uh in 2008 with his sort of what I consider a landmark article that really drove me to create an osteoporotic program at our institution, which we started in 2009. And uh, and so that's really how I got interested in bone health. And as a traumatologist, seeing these fractures over and over, I got involved in the AOA. And at some point I was lucky enough to run uh the committee uh for two different terms, and uh have really gotten to know Dr. Swinkowski, and he's been, I think, a true inspiration for me and has really helped drive me with my interest in bone health uh for the last 20 plus years.

What The Program Looks Like Today

SPEAKER_02 4:30

Excellent. Thank you. And I would like to ask Dr. Duray, for the listeners who may not be familiar with the Own the Bone Program, can you briefly describe what the current what the current state of the Own the Bone Program is?

SPEAKER_00 4:46

Well, you'll hear a little bit of the history, I think, from Mark, and so I'm not gonna spoil that. But where we are today is a long way from where we started back in 2008. So if you can imagine, uh not quite 20 years yet, we have continued to grow this program to more than 325 sites across the country with tens of thousands of patients in our database. And the whole philosophy behind own the bone really was to recognize that not just taking care of fractures is what we do as orthopedic surgeons, but we need to understand that there's a reason behind a lot of these fractures, especially in our patients that have bone health problems. And for own the bone, it's osteoporosis. That really was the driver, and you kind of heard where we're at now, and we're continuing to grow, and we continue to spread the word of the importance of managing bone health as an underlying reason for fracture. You had mentioned uh briefly about spine and fractures, so we think trauma and we think total joints, but there's also now we're recognizing it's the shoulder and elbow that have a lot of fractures that we see. It's our ankle fractures for our foot and ankle docks, and it's um it's our wrist fractures in our hand. And we learned a lot of that through our registry over the years with uh with our own the bone program. So it affects all walks of orthopedic surgery, and I think we have really spent a lot of time and energy trying to develop the program and make it better.

SPEAKER_02 6:24

Fantastic. Thank you very much.

unknown 6:27

Dr.

SPEAKER_02 6:28

Swankowski, can you tell us the story about how AOA came to start the Own the Bone program?

Leadership, Kindness, And Prevention

Expanding Across Subspecialties

SPEAKER_01 6:36

Yeah, I'd be happy to, uh within the limits of my uh my memory, uh, which is actually pretty good on this topic. So um I was uh very privileged to be uh nominated uh and elected into the presidential line. And at the time, uh one of the uh biggest topics was uh the fact that we were being approached by outside organizations that were very much interested in bone health. Um and there were uh several organizations that had tried to address this problem of identifying patients with osteoporosis based on the first fracture and getting them appropriate diagnosis and treatment. And we received communication from these groups, uh uh and the Association of Bone and Mineral Research, etc., other groups. Um there was an earlier attempt by the American Academy of Orthopedic Surgeons that was led by Dr. Laura Tosi, who was very critical in bringing this issue to the AOA, a long-term AOA member, uh, and uh it failed. Uh there was not much interest on the part of Academy members to work to identify these patients at the time of treatment. Uh, and so that program failed after a couple of attempts. So we had uh the issues of other organizations approaching us, a other failed attempt in um our major orthopedic organization. Uh, and the whole question was should AOA get involved with a clinical issue? Uh the AOA historically, as the oldest orthopedic association in the world, had never really collectively, and still to this day, it's the only only clinical problem that we have focused attention on because uh our identity is a leadership organization, and this was going to be a massive undertaking that was going to take on orthopedic, uh it was going to require orthopedic leadership to be successful. So after a lot of debate, uh Dr. Ed Hanley was the president of the organization. Uh Dr. Terry Light was uh behind me in the presidential line. A lot of deliberation, how are we going to pay for it? We found out that there was some interest on the part of industry, the groups that were manufacturing drugs that can help to limit risk of fracture. So uh we we set out to organize a program. I was asked to lead the effort because I I was I I uh spoke earlier about the center that we built, and that was done in collaboration with a community-based uh uh specialty, not a specialty group, uh health systems organization called Park Nicolet. And one of the rheumatologists there was a uh a world-renowned osteoporosis researcher named John Scousbow. I also, in University of Minnesota, we had Dr. Chris Ensrud, who was at the VA here in Minneapolis. These are individuals that have been responsible for developing treatments for uh osteoporosis. Um and they, particularly Dr. Scousbow, had attempted to organize a program at the Methodist Hospital in the Park Nicolet system, and it failed because the orthopedic surgeons didn't really buy into the program and worked collaboratively to help identify these patients. So I had these uh experts, uh, and together working with them and a couple of other experts, we had a very interested member of the AOA named Andy Bunta that Kyle worked with uh very well, his predecessor as chair of the Own the Bone Committee. And Andy had experts and was known nationally uh as being an orthopedic surgeon interested in the problem. So we developed an intervention uh that was eight simple clinical items that we would collect, uh, and then a patient instruction module uh and a follow-up module, uh, and then we recruited eight centers uh that agreed to participate in this program to collect that eight-item interest and then look at how many of those patients, generally inpatients admitted with fragility fractures, actually received appropriate diagnosis and treatment after their hip fracture, generally hip fracture patients, was were appropriately treated. And then we put the intervention in place and then studied it for another two years, and the the intervention was greatly successful uh in improving the appropriate diagnosis and treatment. And that's what really led us to move full being uh into this whole program as an organization, and I believe the committee started shortly thereafter, uh, and Andy Bunta was the first chair, followed by uh Dr. Juray. And as you heard Dr. Jeray outline earlier, it's been wildly successful. We are we are not as successful as we'd hoped we'd would be, but we have made a difference in this clinical problem.

SPEAKER_02 12:22

Well, thank you for that wonderful history. And it was around that time that I believe the Surgeon General had mentioned that bone health was an epidemic in our nation. And so I think you describe AOA as a as an orthopedic leadership uh group really stepping up to the plate and and taking care of this.

SPEAKER_01 12:44

Attempting to take care of this.

SPEAKER_00 12:46

We we have work to do. It's an ongoing process, absolutely.

Training Residents To Treat Causes

SPEAKER_02 12:51

Well, and that leads right into my next question. So, fast forward about 20 years later, Dr. Duray, you're now the current president of the AOA. And in your presidential address this year, you highlighted own the bone as something that connects kindness and humility and leadership. Can you speak to us about that?

SPEAKER_00 13:12

Well, I think it's very important for us to take ownership about taking care of our patients. And a big part of that is recognizing the underlying problems. Too often we see a broken bone, we don't associate it with a patient, we think that it's uh something that we have to fix, and we do, but we really forget about the fact that there's other problems associated with it. And the burden of the disease and the quality of life that impacts these patients is huge. And really, if you recognize that and understand that, I mean, that's really the part about the kindness and and trying to respect and appreciate your patients and make them better, but not just by fixing the fracture, but understanding the problem they have that's underlying and preventing those additional fractures in the future.

SPEAKER_02 14:06

And uh for the listeners who would like to see the text of Dr. Juray's presidential address, this can be found online on the JBJS Orthopedic Forum. Now, Dr. Juray, how have you seen the Own the Bone program and movement spread across orthopedic specialties and generations?

Why Orthopedic Leadership Is Essential

SPEAKER_00 14:24

Well, I think it's really been quite remarkable. I mean, as as Mark and I just mentioned, we'd love to see it grow more and we'd like to see it bigger than it is. But it if you consider that in 2008, we started out with almost nothing. A good example would be heart attacks and beta blockers. Uh when they recognized that beta blockers can change heart attacks for patients in the cardiology world, it took them more than 20 years to make a difference for it to become routine. And so we're not even at that 20-year mark yet. And we've made a huge dent in orthopedics. And I think what's equally important is not just with the trauma doctors, but I think we're getting the hand surgeons to recognize it, the foot and ankle, the shoulder surgeons, the spine surgeons, and we're not recognizing it only for preventing fractures, but we're also realizing that there's some benefit to maybe improving bone quality before you do a spine fusion, maybe improving that bone quality before you do a press fit hip replacement, for example. So it's it's important and not just for fracture care in orthopedics. And that's something that's newer and it's more progressive, but we're slowly seeing that as we understand more about this, we can make a difference, not just with fractures, but our patients and a whole lot of other areas in orthopedics.

SPEAKER_02 15:46

Yeah, and I think one component that's very uh central to my own practice in sports medicine, as we see master athletes, aging athletes, we are also seeing more and more bone health-related issues in sports medicine as well.

SPEAKER_00 15:59

It's definitely not just related to women, and that and that's something that people forget. But men have osteoporosis as well.

SPEAKER_02 16:07

Absolutely.

SPEAKER_01 16:08

I would just like to highlight, if I may, that uh Dr. We talked about people that have chaired the On the Bone Committee. Dr. Paul Anderson, your your colleague at in Madison, I think deserves a lot of credit for bringing these other areas uh to our attention of how assessing patients in joint replacement and spine surgery, etc., can be a really important uh advance. So uh Dr. Anderson deserves a lot of credit. Absolutely.

SPEAKER_02 16:37

Now, for either Dr. Swankowski or Dr. Dere, how would you say the own the bone movement has affected orthopedic resident training over the years?

SPEAKER_00 16:49

Mark, you want to start. Sure.

SPEAKER_01 16:52

Yeah, uh I'm I uh would say that beyond any shadow of a doubt, orthopedic residents today are more familiar uh with the importance of diagnosing the condition, are more familiar with the pharmacologic interventions, are more familiar with other preventative strategic strategies like rehabilitation for balance improvement, uh resistance training, et cetera, than uh we were teaching them in 2008. There's no doubt in my mind, and most residents have examples of uh fragility fracture uh treatment programs in their centers. I would say the vast, vast majority, I would guess at least 80% of residents are exposed uh to these programs in their centers.

Future Goals: Catching First Fractures

SPEAKER_00 17:43

And if you think about that, there was none of that exposure prior to probably 2008 for most centers across the country. And uh and it's sort of a grassroots effort, right? You try to teach the young people the importance of bone health, and then they continue to learn through their residency. When they get out, they propagate that same thing to their partners in different centers, and you hope that it kind of hit acts like a tumbleweed and continues to uh attract more and more traction. And that's really what it's done. And we've even tried to do that beyond the residence and looking at the American Board of Orthopedic Surgery and the opportunities there for making sure the questions related to bone health come on uh part one and part two. And when we're doing oral exams, we emphasize the importance of bone health to um our uh candidates that are taking the oral exam. And and you can see the change over the years. I mean, Mark's been an oral examiner. This has become really part of what they understand is important when they're taking care of these patients. And I think for me, that's really enlightening and something that we should be proud of. And and and the AOA as as a leadership role has really helped progress that, I think, throughout the programs like Mark had mentioned.

SPEAKER_02 19:02

And I think this reflects back to your comment, Dr. Dure, about uh approaching the patient in a more holistic manner. So each of those things that we are now looking at um in residency training that Dr. Swenkowski mentioned really do look at more than just the fracture, which is admirable. Now, uh for both of you, why do you think that the on the bone movement remains relevant for AOA members and for orthopedic leaders in all subspecialties?

Overcoming Excuses And Building Teams

SPEAKER_01 19:37

Well, it it's it's absolutely relevant, uh and it's a it's a a a true core issue with professionalism. Uh if if we are not to be perceived as technicians, as people that only want to do procedures, if we are to be perceived as physician surgeons, uh people that want to treat the whole patient, including prevention, um it it matters that we show leadership and emphasize in our centers we're not just bone broke me fix kind of people. Uh we're uh thoughtful people that that would would prefer to prevent an injury rather than treat one. Uh so it it's just a part of the the oath that we all took when becoming physicians to care about the whole patient.

SPEAKER_00 20:29

Yeah, I I couldn't have said it any better. It's definitely professionalism and it's what you know sets us apart when we are taking care of our patients. And I think one of the things that we've noticed is just like I mentioned with uh beta blockers and heart attacks, we tried for a long time to get primary care to be interested in bone health. And and not to say that there isn't some interest in endocrinologists, but across the country, we're the ones that see these injuries or we see these patients that are at risk. So we have the best opportunity to make a difference, I think. And so that's why I think you've seen a lot of this gravitate more towards orthopedic surgeons. And a lot of us have established our own programs, usually with the aid of our primary care people. Um, but oftentimes it's the orthopedist that's uh really running these programs. And I think that's uh it's a big part about having leadership in this area and being professional.

SPEAKER_02 21:28

And I agree, you know, having all of this come from an orthopedic leadership organization such as the AOA may be one of the reasons we've seen such incredible strides in a relatively short period of time. So congratulations to both of you and and to everyone who has put a lot of hard work and effort into this program. Now, can you talk a little bit next about your hopes for the Own the Bone program moving forward into the future?

SPEAKER_01 21:57

I would say my my hope uh comes. From a realization that occurred in our own center, uh, probably in 2012-2013, that the patients that we were seeing with hip fractures we saw 10 years earlier with a distal radius fracture. I remember a day in clinic when I saw three post-op hip fracture patients, and looking through their medical record, they've been treated eight to ten years earlier with a distal radius fracture. And my hope is that we can really move the whole uh program more towards the patients being treated as an outpatient, where it's a little bit harder to identify because the numbers are greater, the clinics are busy, uh, there's not as much time individually with a patient as you have when they're an inpatient, but the bang for the buck is much, much greater if you catch them with the first fracture rather than the second or the third.

SPEAKER_00 23:00

Yeah, I mean, I definitely agree. And uh what I'd like to see own the bone or at least some version of bone health in every program in the United States and internationally. I mean, I think that's a lofty goal, but I mean, I think that's where we need to be when we treat these patients. And uh doing a lot of traveling as president of the AOA, I see the same problem uh in the rest of the world. Australia is no better. Uh they they struggle with uh treatment for patients with osteoporosis that present with fractures. About one in five are only being treated, very similar to what we see in the United States. And it's not just Australia. So it's it's an international problem, and I think a lofty goal would be able to say that you know the AOA has made a difference across the world in uh in bone health.

SPEAKER_02 23:52

So when you meet an orthopedic surgeon who still doesn't buy in to orthopedists' role in post-fracture care, what do you tell them to try to convince them to see the light?

SPEAKER_01 24:05

I ask them what's the excuse. And when they give me the usual I'm too busy, uh I explained how they can create a program that others in their work environment can help to identify these patients and that all they have to do is support them. There are lots of people that they work with that would love to take on the problem. And so a little shame goes a long way. I'm not sure how effective it is, but um that's the approach that I've been using.

SPEAKER_00 24:38

Yeah, I mean, you have to have a site champion at each center, and you really need to push it with your partners. And uh what I find to really help be successful is that if you can get the residents on board, and they're usually a little easier to get on board because as attendings, we tend to have just a little bit more power over them, and you get your nursing staff and you get your APPs on board, uh, that uh your your partners start to feel a little ashamed and they recognize that this is a true problem and that you know that they're being a bit selfish if they're not recognizing it and wanting to at least help in part to try to manage it. We've set up a framework around where they can do it. They don't have a lot of excuses, and so I think that helps a good bit.

SPEAKER_02 25:23

And I think for those busy orthopedic surgeons, the fact that the AOA and the On the Bone program has done such an amazing job of making it easy for them is incredibly helpful as well. So uh great resources available at the AOA and on the bone uh program websites as well.

SPEAKER_00 25:43

Yeah, in a time when it's hard to get anybody on the phone and talk to someone, a person, uh still with the uh AOA and on the bone, if you have issues, comments, questions, problems, if you call, a person will actually answer the phone and will talk to you about your problems and help you. And that's really something that's nice to see that we still do. And we often have lots of centers that are very anxious and willing to allow you to come visit and see the different programs and the way uh we've established them. And it's a little different everywhere, and so you just need to find some places that may be very similar to you and and our staff here at uh on the bone can do that.

Making Programs Sustainable

SPEAKER_01 26:26

Well, as I would say, sorry for interrupting, but I I would say that one of the excuses uh has been historically that it will it will cost resources and it doesn't pay. And I will give uh Kyle a lot of credit for creating a committee environment where best practices are shared from all over, from multiple perspectives, from the DEXA scanning perspective, from the coding and building perspective. Uh and it's resulted in a uh a real deep source of potential ways to make it so these programs can pay for themselves, which has been one of the concerns uh that you hear quite often.

Final Charge: Do The Right Thing

SPEAKER_02 27:11

Excellent points. As we conclude our conversation today, do you have any final thoughts related to the Own the Bone program that you want to leave our listeners with?

SPEAKER_00 27:21

Uh I would just go ahead, Mark, please.

SPEAKER_01 27:25

I would say get involved and do the right thing for your patients. Stop making excuses. You're not too busy to do what's important, and that's take care of your patients.

SPEAKER_00 27:36

I agree. I couldn't have said it any better. Just do the right thing.

SPEAKER_02 27:41

Excellent. Well, Dr. Swinkowski and Dr. Duray, thank you both so much for being our inaugural guests on the Fixated on Bone podcast. It's been an honor having you both, and I want to thank you for your tireless and critical work for the Own the Bone program. And I look forward to more to come with this program as well.

SPEAKER_00 28:00

Thank you very much. Thank you, Mark. Sorry for talking.

SPEAKER_01 28:05

Great to see you, Kyle, and uh thanks for the invitation.

SPEAKER_02 28:09

Thank you for joining us, and we hope you'll tune in to our next episode of the AOA Own the Bones Fixated on Bone Podcast.