Conley RB1, Adib G2, Adler RA3, Åkesson KE4, Alexander IM5, Amenta KC6, Blank RD7,8, Brox WT9, Carmody EE10, Chapman-Novakofski K11, Clarke BL12, Cody KM13, Cooper C14, Crandall CJ15, Dirschl DR16, Eagen TJ17, Elderkin AL18, Fujita M19, Greenspan SL20, Halbout P21, Hochberg MC22, Javaid M23, Jeray KJ24, Kearns AE12, King T25, Koinis TF26, Koontz JS27,28, Kužma M29, Lindsey C30, Lorentzon M31,32,33, Lyritis GP34, Michaud LB35, Miciano A36, Morin SN37, Mujahid N38, Napoli N39,40, Olenginski TP41, Puzas JE10, Rizou S34, Rosen CJ42,43, Saag K44, Thompson E45, Tosi LL46, Tracer H47, Khosla S12, Kiel DP48.
J Orthop Trauma. 2020 Apr;34(4):e125-e141. doi: 10.1097/BOT.0000000000001743.
Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fractureamong people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies are efficaciousandcanreduce risk of future fracture.Patientsneededucation,however, about thebenefitsandrisks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk.Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the earlypost-fractureperiod,prompt treatment is recommended.Adequate dietary or supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis shouldbe reevaluated for fracture risk routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse treatment effects.Patients shouldbestronglyencouraged to avoid tobacco, consume alcohol inmoderation atmost, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).