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

Publication ,  Journal Article
Conley, RB; Adib, G; Adler, RA; Åkesson, KE; Alexander, IM; Amenta, KC; Blank, RD; Brox, WT; Carmody, EE; Chapman-Novakofski, K; Clarke, BL ...
Published in: J Orthop Trauma
April 2020

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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Published In

J Orthop Trauma

DOI

EISSN

1531-2291

Publication Date

April 2020

Volume

34

Issue

4

Start / End Page

e125 / e141

Location

United States

Related Subject Headings

  • Osteoporotic Fractures
  • Osteoporosis
  • Orthopedics
  • Humans
  • Diphosphonates
  • Consensus
  • Bone Diseases, Metabolic
  • Bone Density Conservation Agents
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
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Conley, R. B., Adib, G., Adler, R. A., Åkesson, K. E., Alexander, I. M., Amenta, K. C., … Kiel, D. P. (2020). Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Orthop Trauma, 34(4), e125–e141. https://doi.org/10.1097/BOT.0000000000001743
Conley, Robert B., Gemma Adib, Robert A. Adler, Kristina E. Åkesson, Ivy M. Alexander, Kelly C. Amenta, Robert D. Blank, et al. “Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.J Orthop Trauma 34, no. 4 (April 2020): e125–41. https://doi.org/10.1097/BOT.0000000000001743.
Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, et al. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Orthop Trauma. 2020 Apr;34(4):e125–41.
Conley, Robert B., et al. “Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.J Orthop Trauma, vol. 34, no. 4, Apr. 2020, pp. e125–41. Pubmed, doi:10.1097/BOT.0000000000001743.
Conley RB, Adib G, Adler RA, Åkesson KE, Alexander IM, Amenta KC, Blank RD, Brox WT, Carmody EE, Chapman-Novakofski K, Clarke BL, Cody KM, Cooper C, Crandall CJ, Dirschl DR, Eagen TJ, Elderkin AL, Fujita M, Greenspan SL, Halbout P, Hochberg MC, Javaid M, Jeray KJ, Kearns AE, King T, Koinis TF, Koontz JS, Kužma M, Lindsey C, Lorentzon M, Lyritis GP, Michaud LB, Miciano A, Morin SN, Mujahid N, Napoli N, Olenginski TP, Puzas JE, Rizou S, Rosen CJ, Saag K, Thompson E, Tosi LL, Tracer H, Khosla S, Kiel DP. Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition. J Orthop Trauma. 2020 Apr;34(4):e125–e141.

Published In

J Orthop Trauma

DOI

EISSN

1531-2291

Publication Date

April 2020

Volume

34

Issue

4

Start / End Page

e125 / e141

Location

United States

Related Subject Headings

  • Osteoporotic Fractures
  • Osteoporosis
  • Orthopedics
  • Humans
  • Diphosphonates
  • Consensus
  • Bone Diseases, Metabolic
  • Bone Density Conservation Agents
  • 3202 Clinical sciences
  • 1103 Clinical Sciences