Recommendations for Secondary Fracture Prevention in Elderly Patients

The American Society for Bone and Mineral Research developed 13 clinical recommendations (7 primary and 6 secondary) to address the undertreatment of osteoporosis-related fractures and prevent secondary fracture among persons aged ≥65 years with hip or vertebral fractures.

The American Society for Bone and Mineral Research assembled an international group of experts to develop clinical recommendations for optimal prevention of secondary fracture among patients aged ≥65 years with a hip or vertebral fracture. These consensus guidelines were published in the Journal of Bone and Mineral Research.

Although there have been remarkable advances in understanding the pathogenesis of and treatment for osteoporosis, many untreated patients may warrant pharmacologic treatment to prevent fractures. The goal of this consensus document was to develop recommendations for the optimal prevention of secondary fractures among elderly patients with a history of hip or vertebral fracture.

A multidisciplinary clinical system that includes case management is recommended to ensure patients are appropriately evaluated and treated for osteoporosis.

The document includes 7 fundamental recommendations and 6 secondary recommendations that are intended for patients aged ≥65 years with a prior hip or vertebral fracture.

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Communication and Assessment

As most elderly patients with a prior hip or vertebral fracture do not realize they are at risk for another fracture, it is recommended to include in the discussion with the patients and their family members/caregivers the following:

· Explain that their fracture history is likely an indication they have osteoporosis and have a high risk for additional fractures, especially in the following 1 to 2 years.

· Inform the patients they are at increased risk for premature death secondary to complications related to fracture-related immobility.

· Stress the importance of steps to reduce these risks.

It is also recommended that the usual healthcare provider of the patients be informed of the occurrence of the fracture.

The incidence of fall increases steadily until age 80 years, and about one-third of patients aged ≥65 years sustain a fall each year; thus, it is recommended that the risk of falling be regularly assessed and minimized.

Pharmacologic Therapy

Pharmacologic therapy for osteoporosis reduces the risk for fracture in elderly patients with a prior hip or vertebral fracture at all levels of bone mineral density. For patients after repair of hip fracture or patients who are hospitalized for vertebral fracture, oral pharmacologic therapy can be started during the hospitalization. Intravenous and subcutaneous agents are possible after ≥2 weeks of the surgery, as they are associated with possible complications, including hypocalcemia and influenza-like symptoms that can limit their use in the perioperative period.