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Secondary Fracture Prevention : Consensus Clinical Recommendations from a Multistakeholder Coalition

Conley, Robert B. ; Adib, Gemma ; Adler, Robert A. ; Åkesson, Kristina E. LU ; Alexander, Ivy M. ; Amenta, Kelly C. ; Blank, Robert D. ; Brox, William Timothy ; Carmody, Emily E. and Chapman-Novakofski, Karen , et al. (2020) In Journal of Orthopaedic Trauma 34(4). p.125-141
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 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... (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 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).

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Journal of Orthopaedic Trauma
volume
34
issue
4
pages
125 - 141
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:32195892
ISSN
0890-5339
DOI
10.1097/BOT.0000000000001743
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English
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yes
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fe76189c-cdd8-4927-a624-a356c0d920a8
date added to LUP
2020-04-03 10:10:26
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2020-08-03 04:07:28
@article{fe76189c-cdd8-4927-a624-a356c0d920a8,
  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 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).</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         = {0890-5339},
  language     = {eng},
  number       = {4},
  pages        = {125--141},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Journal of Orthopaedic Trauma},
  title        = {Secondary Fracture Prevention : Consensus Clinical Recommendations from a Multistakeholder Coalition},
  url          = {http://dx.doi.org/10.1097/BOT.0000000000001743},
  doi          = {10.1097/BOT.0000000000001743},
  volume       = {34},
  year         = {2020},
}