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J Bone Miner Res. 2019 Sep 20. doi: 10.1002/jbmr.3877. [Epub ahead of print]

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.

Author information

1
Center for Medical Technology Policy.
2
Osteoporosis Centre, Damascus-Syria.
3
McGuire VA Medical Center.
4
Lund University and Skane University Hospital.
5
UConn School of Nursing.
6
Mercyhurst University Physician Assistant Department.
7
Medical College of Wisconsin, Garvan Institute of Medical Research.
8
UCSF Fresno.
9
University of Rochester Medical Center.
10
University of Illinois.
11
Mayo Clinic.
12
American Bone Health.
13
University of Southampton, UK.
14
University of California, Los Angeles.
15
University of Chicago Medicine.
16
National Council on Aging.
17
American Society for Bone and Mineral Research.
18
International Osteoporosis Foundation.
19
University of Pittsburgh, Pittsburgh, PA.
20
University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD.
21
University of Oxford.
22
Prisma Health - Upstate (formerly Greenville Health System).
23
US Bone and Joint Initiative.
24
Duke Primary Care Oxford, Oxford, NC.
25
Department of Family and Community Medicine, Newton Medical Center; Clinical Assistant Professor University of Kansas School of Medicine-Wichita.
26
5th department of Internal Medicine, University Hospital, Comenius University Faculty of Medicine, Bratislava, Slovakia.
27
Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC.
28
Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden, Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia, Region Västra Götaland, Sweden.
29
Hellenic Osteoporosis Foundation, Athens, Greece.
30
The University of Texas MD Anderson Cancer Center.
31
Nevada Rehabilitation Institute.
32
Department of Medicine, McGill University.
33
Brown University of the Wares Alpert Medical School.
34
Campus Bio-Medico University of Rome and Washington University in St Louis.
35
Geisinger Health System - HiROC Program/Rheumatology.
36
Department of Orthopaedics.
37
Tufts University School of Medicine.
38
University of Alabama at Birmingham.
39
National Osteoporosis Foundation.
40
Children's National Health System.
41
Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality.
42
Mayo Clinic College of Medicine.
43
Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife.

Abstract

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 fracture among 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, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks 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 but may 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 early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be re-evaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, 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 (e.g., hyperparathyroidism, chronic kidney disease). This article is protected by copyright. All rights reserved.

KEYWORDS:

Aging; Anabolics; Antiresorptives; Osteoporosis; Secondary Fracture Prevention

PMID:
31538675
DOI:
10.1002/jbmr.3877

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