Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Robert B Conley¹, Gemma Adib², Robert A Adler³, Kristina E Åkesson⁴, Ivy M Alexander⁵, Kelly C Amenta⁶, Robert D Blank^{7

8}, William Timothy Brox⁹, Emily E Carmody¹⁰, Karen Chapman-Novakofski¹¹, Bart L Clarke¹², Kathleen M Cody¹³, Cyrus Cooper¹⁴, Carolyn J Crandall¹⁵, Douglas R Dirschl¹⁶, Thomas J Eagen¹⁷, Ann L Elderkin¹⁸, Masaki Fujita¹⁹, Susan L Greenspan²⁰, Philippe Halbout²¹, Marc C Hochberg²², Muhammad Javaid²³, Kyle J Jeray²⁴, Ann E Kearns¹², Toby King²⁵, Thomas F Koinis²⁶, Jennifer Scott Koontz^{27

28}, Martin Kužma²⁹, Carleen Lindsey³⁰, Mattias Lorentzon^{31

32

33}, George P Lyritis³⁴, Laura Boehnke Michaud³⁵, Armando Miciano³⁶, Suzanne N Morin³⁷, Nadia Mujahid³⁸, Nicola Napoli^{39

40}, Thomas P Olenginski⁴¹, J Edward Puzas¹⁰, Stavroula Rizou³⁴, Clifford J Rosen^{42

43}, Kenneth Saag⁴⁴, Elizabeth Thompson⁴⁵, Laura L Tosi⁴⁶, Howard Tracer⁴⁷, Sundeep Khosla¹², Douglas P Kiel⁴⁸

Affiliations

¹ Center for Medical Technology Policy, Baltimore, MD, USA.
² Osteoporosis Centre, Damascus, Syria.
³ McGuire VA Medical Center, Richmond, VA, USA.
⁴ Lund University and Skåne University Hospital, Lund, Scania, Sweden.
⁵ UConn School of Nursing, University of Connecticut, Storrs, CT, USA.
⁶ Department of Physician Assistant Studies, Mercyhurst University, Erie, PA, USA.
⁷ Department of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
⁸ Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
⁹ UCSF Fresno, Fresno, CA, USA.
¹⁰ Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
¹¹ Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA.
¹² Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ American Bone Health, Raleigh, NC, USA.
¹⁴ University of Southampton, Southampton, UK.
¹⁵ Department of Medicine, University of California, Los Angeles, CA, USA.
¹⁶ Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA.
¹⁷ National Council on Aging, New York, NY, USA.
¹⁸ American Society for Bone and Mineral Research, Washington, DC, USA.
¹⁹ Science Department, International Osteoporosis Foundation, Nyon, Switzerland.
²⁰ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
²¹ International Osteoporosis Foundation, Nyon, Switzerland.
²² Division of Rheumatology, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD, USA.
²³ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, USA.
²⁴ Prisma Health - Upstate (formerly Greenville Health System), Greenville, SC, USA.
²⁵ US Bone and Joint Initiative, Rosemont, IL, USA.
²⁶ Duke Primary Care Oxford, Oxford, NC, USA.
²⁷ Orthopedics & Sports Medicine, Newton Medical Center, Newton, KS, USA.
²⁸ Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, KS, USA.
²⁹ 5th Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia.
³⁰ Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC, Bristol, CT, USA.
³¹ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
³² Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
³³ Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³⁴ Hellenic Osteoporosis Foundation, Athens, Greece.
³⁵ The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³⁶ Nevada Rehabilitation Institute, Las Vegas, NV, USA.
³⁷ Department of Medicine, McGill University, Montreal, Canada.
³⁸ Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
³⁹ Department of Nutrition and Metabolic Disorders, Campus Bio-Medico University of Rome, Rome, Italy.
⁴⁰ Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁴¹ HiROC Program/Rheumatology, Geisinger Health System, Danville, PA, USA.
⁴² Tufts University School of Medicine, Boston, MA, USA.
⁴³ Maine Medical Center Research Institute, Portland, ME, USA.
⁴⁴ Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴⁵ National Osteoporosis Foundation, Arlington, VA, USA.
⁴⁶ Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA.
⁴⁷ Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA.
⁴⁸ Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.

PMID: 32195892
DOI: 10.1097/BOT.0000000000001743

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Robert B Conley et al. J Orthop Trauma. 2020 Apr.

. 2020 Apr;34(4):e125-e141.

doi: 10.1097/BOT.0000000000001743.

Authors

Affiliations

¹ Center for Medical Technology Policy, Baltimore, MD, USA.
² Osteoporosis Centre, Damascus, Syria.
³ McGuire VA Medical Center, Richmond, VA, USA.
⁴ Lund University and Skåne University Hospital, Lund, Scania, Sweden.
⁵ UConn School of Nursing, University of Connecticut, Storrs, CT, USA.
⁶ Department of Physician Assistant Studies, Mercyhurst University, Erie, PA, USA.
⁷ Department of Endocrinology, Metabolism and Clinical Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA.
⁸ Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.
⁹ UCSF Fresno, Fresno, CA, USA.
¹⁰ Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
¹¹ Division of Nutritional Sciences, University of Illinois, Urbana, IL, USA.
¹² Division of Endocrinology, Diabetes, Metabolism, Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
¹³ American Bone Health, Raleigh, NC, USA.
¹⁴ University of Southampton, Southampton, UK.
¹⁵ Department of Medicine, University of California, Los Angeles, CA, USA.
¹⁶ Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA.
¹⁷ National Council on Aging, New York, NY, USA.
¹⁸ American Society for Bone and Mineral Research, Washington, DC, USA.
¹⁹ Science Department, International Osteoporosis Foundation, Nyon, Switzerland.
²⁰ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
²¹ International Osteoporosis Foundation, Nyon, Switzerland.
²² Division of Rheumatology, University of Maryland School of Medicine and VA Maryland Health Care System, Baltimore, MD, USA.
²³ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, USA.
²⁴ Prisma Health - Upstate (formerly Greenville Health System), Greenville, SC, USA.
²⁵ US Bone and Joint Initiative, Rosemont, IL, USA.
²⁶ Duke Primary Care Oxford, Oxford, NC, USA.
²⁷ Orthopedics & Sports Medicine, Newton Medical Center, Newton, KS, USA.
²⁸ Department of Family and Community Medicine, University of Kansas School of Medicine, Wichita, KS, USA.
²⁹ 5th Department of Internal Medicine, University Hospital, Comenius University, Bratislava, Slovakia.
³⁰ Bones, Backs and Balance, LLC, Bristol Physical Therapy, LLC, Bristol, CT, USA.
³¹ Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
³² Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
³³ Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³⁴ Hellenic Osteoporosis Foundation, Athens, Greece.
³⁵ The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³⁶ Nevada Rehabilitation Institute, Las Vegas, NV, USA.
³⁷ Department of Medicine, McGill University, Montreal, Canada.
³⁸ Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA.
³⁹ Department of Nutrition and Metabolic Disorders, Campus Bio-Medico University of Rome, Rome, Italy.
⁴⁰ Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
⁴¹ HiROC Program/Rheumatology, Geisinger Health System, Danville, PA, USA.
⁴² Tufts University School of Medicine, Boston, MA, USA.
⁴³ Maine Medical Center Research Institute, Portland, ME, USA.
⁴⁴ Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴⁵ National Osteoporosis Foundation, Arlington, VA, USA.
⁴⁶ Department of Orthopaedic Surgery and Sports Medicine, Children's National Hospital, Washington, DC, USA.
⁴⁷ Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, USA.
⁴⁸ Harvard Medical School, Musculoskeletal Research Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA.

PMID: 32195892
DOI: 10.1097/BOT.0000000000001743

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 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).

PubMed Disclaimer

References

1. Khosla S, Shane E. A crisis in the treatment of osteoporosis. J Bone Miner Res. 2016;31(8):1485–7.
1. Khosla S, Cauley JA, Compston J, et al. Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res. 2017; 32(3):424–30.
1. Weaver J, Sajjan S, Lewiecki EM, Harris ST, Marvos P. Prevalence and cost of subsequent fractures among U.S. patients with an incident fracture. J Manag Care Spec Pharm. 2017;23(4): 461–71.
1. Eisman JA, Bogoch ER, Dell R, et al. Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res. 2012;27(10):2039–46.
1. Lems WF, Dreinhofer KE, Bischoff-Ferrari H, et al. EULAR/EFORT recommendations for management of patients older than 50 years with a fragility fracture and prevention of subsequent fractures. Ann Rheum Dis. 2017;76(5):802–10.

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Affiliations

Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Authors

Affiliations

Abstract

References

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous