Secondary Fracture Prevention : Consensus Clinical Recommendations from a Multistakeholder Coalition
(2020) In Orthopaedic Nursing 39(3). p.145-161- 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... (More)
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 offuture 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 riskfor 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 reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring foradverse 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 (eg, hyperparathyroidism, chronic kidney disease). (c) 2019 American Society for Bone and Mineral Research.
(Less)
- author
- organization
- publishing date
- 2020-05-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- aging, anabolics, antiresorptives, osteoporosis, secondary fracture prevention
- in
- Orthopaedic Nursing
- volume
- 39
- issue
- 3
- pages
- 17 pages
- publisher
- Lippincott Williams & Wilkins
- external identifiers
-
- pmid:32443087
- scopus:85085537840
- ISSN
- 0744-6020
- DOI
- 10.1097/NOR.0000000000000672
- language
- English
- LU publication?
- yes
- id
- 402adee6-67f8-4bcc-add2-ec7e98977e60
- date added to LUP
- 2021-01-14 14:12:16
- date last changed
- 2024-05-16 02:28:04
@article{402adee6-67f8-4bcc-add2-ec7e98977e60,
abstract = {{<p>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 offuture 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 riskfor 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 reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring foradverse 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 (eg, hyperparathyroidism, chronic kidney disease). (c) 2019 American Society for Bone and Mineral Research.</p>}},
author = {{Conley, Robert B. and Adib, Gemma and Adler, Robert A. and Åkesson, Kristina E. and Alexander, Ivy M. and Amenta, Kelly C. and Blank, Robert D. and Brox, William Timothy and Carmody, Emily E. and Chapman-Novakofski, Karen and Clarke, Bart L. and Cody, Kathleen M. and Cooper, Cyrus and Crandall, Carolyn J. and Dirschl, Douglas R. and Eagen, Thomas J. and Elderkin, Ann L. and Fujita, Masaki and Greenspan, Susan L. and Halbout, Philippe and Hochberg, Marc C. and Javaid, Muhammad and Jeray, Kyle J. and Kearns, Ann E. and King, Toby and Koinis, Thomas F. and Koontz, Jennifer Scott and Kužma, Martin and Lindsey, Carleen and Lorentzon, Mattias and Lyritis, George P. and Michaud, Laura Boehnke and Miciano, Armando and Morin, Suzanne N. and Mujahid, Nadia and Napoli, Nicola and Olenginski, Thomas P. and Puzas, J. Edward and Rizou, Stavroula and Rosen, Clifford J. and Saag, Kenneth and Thompson, Elizabeth and Tosi, Laura L. and Tracer, Howard and Khosla, Sundeep and Kiel, Douglas P.}},
issn = {{0744-6020}},
keywords = {{aging; anabolics; antiresorptives; osteoporosis; secondary fracture prevention}},
language = {{eng}},
month = {{05}},
number = {{3}},
pages = {{145--161}},
publisher = {{Lippincott Williams & Wilkins}},
series = {{Orthopaedic Nursing}},
title = {{Secondary Fracture Prevention : Consensus Clinical Recommendations from a Multistakeholder Coalition}},
url = {{http://dx.doi.org/10.1097/NOR.0000000000000672}},
doi = {{10.1097/NOR.0000000000000672}},
volume = {{39}},
year = {{2020}},
}