As more and more baby boomers start their senior years they are encountering an unwelcome side effect of aging – more falls and more fractures. At the same time, orthopedic surgeons in underserved areas are retiring to enjoy their golden years. Soon, advocates worry, there will be too few surgeons left to treat the growing number of elderly people who will require expert help with their broken bones.

Though adults 60 or older comprise only 10 percent of the population in California, more than 40 percent of hospitalizations due to injuries are in the 60-plus age group. As people age, their bones can become brittle and fragile from a loss of tissue, which may result from hormonal changes, or deficiency of calcium or vitamin D.

Getting care may be become more difficult in rural communities and small towns a long drive from services in major care centers in larger urban centers.

But one small California city is responding aggressively with an approach that could be a model for the rest of the state and perhaps the nation. Faced with a dwindling number of doctors, Modesto, in the Central Valley between Sacramento and Fresno, created a new five-year training program for orthopedic surgeons as well as a program to help prevent falls in the first place.

Jill Erickson, manager of Stanislaus County Aging and Veterans Services, says exercise can help seniors avoid the need for surgeons. “People don’t have to settle for being weaker and more frail,” she said. “ They can do something about it.”

More Docs

Seven of Modesto’s orthopedic surgeons are older than 65 and recruitment of new surgeons to the valley is difficult, as it is generally in all rural areas. Many doctors prefer to practice in big urban areas. And many Modesto-area patients were already sent to medical centers at University of California at Davis, Stanford University and the University of California at San Francisco for their orthopedic surgeries.

“The Central Valley in general is lower in most specialties in physicians per capita,” said Peter Broderick, M.D. and CEO of the Valley Consortium of Medical Education. The consortium founded the new surgeon training program.to encourage doctors to build community ties that will keep them in the area once they finish their training.

The program is affiliated with Midwestern University and includes two first-year and two second-year residents. It’s a highly competitive program – 130 doctors applied for the most recent two openings. “They’re all stars,” Broderick said.

Eric Huish, M.D., one of the residents, said he chose to become an orthopedic surgeon because the surgeries can make a huge improvement on patients’ quality of life.

“Patients typically do well,” he said. “There’s a good amount of patients who do well and have improved quality of life.”

But he stressed that people can lessen their chances of ever needing his care by getting osteoporosis screenings in their 50s. “You want to start younger and catch it,” he said.

Prevention

Prevention programs are another way the county? is looking to reduce the need for orthopedic surgeons.

The Healthy Aging Association, a nonprofit that works for fall and disease prevention in seniors, offers 82 weekly exercise classes at 34 sites around town for people 50 and over or with a disability.  Most of the classes are led by volunteers. Getting seniors to show up hasn’t been hard, said Diana Olson, the director of the Healthy Aging Association. “They realize that in order to live independently and stay in their home – especially if they’re alone they have to do something.”

On a recent Wednesday morning, some 40 seniors showed up for a “Young at Heart” exercise class at the Modesto Senior Center. They performed gentle stretches and lunges to the music of 1950s doo wop music playing through a boom box as two teachers cheered them on.

“I’m here to try to get into better shape,” said Victor Montgomery, 68. “I’m pretty run down already. I’ve been going a month-and-a-half. The results are I have a little more energy and stamina”

Montgomery has never visited an orthopedic surgeon before, but his classmate Wanda Dominique, 79, has – and she doesn’t want to go back. Dominique, who had shoulder surgery, stays active and likes the classes because of the support she gets from the other seniors.

“We don’t do things that stretch our muscles and this does,” she said. “My whole body needs it. I’m going to start bringing my husband.”

The Healthy Aging Association also offers “A Matter of Balance” course, an 8-week program for seniors who have fallen and are afraid to do any activity or physical therapy. The evidence-based class is used throughout the United States.

Olson, the 68-year-old director of the association, has compassion because she has had her own falls. One time she was unloading boxes out of a pickup and slipped and landed on the cement on her knee. She was fortunately able to avoid surgery by wearing a brace. Just recently she tripped in a grocery store parking lot.

She encourages seniors to keep moving and enroll in her classes so they can enjoy their lives.

“If you do the strength training, it’s going to build your balance and your mobility,” Olson said. “We’ve had people in walkers and wheelchairs come in and pretty soon they don’t have to use their walker or wheelchair.”