Skip to main content

Advertisement

SpringerLink
Log in

Osteoporosis Diagnosis, Management, and Referral Practice After Fragility Fractures

  • Orthopedic Management of Fractures (R Natoli and L Gerstenfeld, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this manuscript is to review the current diagnosis, management, and referral practices of patients with osteoporosis after a fragility fracture from the orthopedic surgeon’s perspective.

Recent Findings

Effective treatments are available for osteoporosis that significantly decrease the risk of additional fractures. Despite recommendations for improved post-fragility fracture osteoporosis management, the rate of diagnosis and treatment is still unacceptably low.

Summary

Patients sustaining a low-energy fracture should be evaluated for osteoporosis with discussion of beginning pharmacological treatment. Antiresorptive and anabolic agents are available treatment options. Fracture Liaison Services can help to coordinate the care of these patients and improve the rate of diagnosis and initiation of therapy. Dartmouth-Hitchcock is working to improve the bone health for our patients utilizing a multidisciplinary team-based approach. This process is intended to lead to increased recognition of osteoporosis within our institution and close the capture gap between hospital discharge and initiation of osteoporosis pharmacotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tosi LL, Lane JM. Osteoporosis prevention and the orthopaedic surgeon: when fracture care is not enough. J Bone Joint Surg Am. 1998;80:1567–9.

    Article  CAS  Google Scholar 

  2. American Orthopaedic Association. Leadership in orthopaedics: taking a stand to own the bone. American Orthopaedic Association position paper. J Bone Joint Surg Am. 2005;87(6):1389–91. https://doi.org/10.2106/JBJS.E.00449.

  3. Anderson PA, Jeray KJ, Lane JM, et al. Bone health optimization: beyond own the bone: AOA Critical Issues. J Bone Joint Surg Am. 2019;101:1413–9. AOA critical issues article describes the current bone health crisis, and the importance of including osteoporosis evalaution in the preoperative assessment of elective orthopedic procedures

    Article  Google Scholar 

  4. Levitt EB, Patch DA, Ponce BA, Razi AE, Kates SL, Patt JC. Barriers and Resources to Optimize Bone Health in Orthopaedic Education: Own the Bone (OTB): Bone Health Education in Residency. JB & JS Open Access. 2021;6:e21.00026.

    Google Scholar 

  5. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res: the official journal of the American Society for Bone and Mineral Research. 2007;22:465–75.

    Article  Google Scholar 

  6. Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. PMID: 20945569.

  7. Carlson BC, Robinson WA, Wanderman NR, Nassr AN, Huddleston PM III, Yaszemski MJ, Currier BL, Jeray KJ, Kirk KL, Bunta AD, Murphy S, Patel B, Watkins CM, Sietsema DL, Edwards BJ, Tosi LL, Anderson PA, Freedman BA. The American Orthopaedic Association's Own the Bone® database: a national quality improvement project for the treatment of bone health in fragility fracture patients. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2018;29:2101–9.

    Article  CAS  Google Scholar 

  8. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. Jama. 2007;297:387–94.

    Article  CAS  Google Scholar 

  9. Bawa HS, Weick J, Dirschl DR. Anti-osteoporotic therapy after fragility fracture lowers rate of subsequent fracture: analysis of a large population sample. J Bone Joint Surg Am. 2015;97:1555–62.

    Article  Google Scholar 

  10. Liu SK, Munson JC, Bell J-E, Zaha RL, Mecchella JN, Tosteson ANA, Morden NE. Quality of osteoporosis care of older Medicare recipients with fragility fractures: 2006 to 2010. J Am Geriatr Soc. 2013;61:1855–62.

    Article  Google Scholar 

  11. Camacho PM, Petak SM, Binkley N, Diab DL, Eldeiry LS, Farooki A, Harris ST, Hurley DL, Kelly J, Lewiecki EM, Pessah-Pollack R, McClung M, Wimalawansa SJ, Watts NB. American Association of Clinical Endocrinologists/American College of Endocrinology Clinical Practice Guidelines for the diagnosis and treatment of postmenopausal osteoporosis- 2020 update executive summarY. Endocr Pract: official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. 2020;26:564–70.

    Article  Google Scholar 

  12. Curry SJ, Krist AH, Owens DK, et al. Screening for osteoporosis to prevent fractures: US preventive services task force recommendation statement. JAMA. 2018;319:2521–31.

    Article  Google Scholar 

  13. Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R, National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2014;25:2359–81.

    Article  CAS  Google Scholar 

  14. Schnell S, Friedman SM, Mendelson DA, Bingham KW, Kates SL. The 1-year mortality of patients treated in a hip fracture program for elders. Geriatr Orthop Surg Rehabil. 2010;1:6–14.

    Article  Google Scholar 

  15. Adler RA. Osteoporosis in men: a review. Bone Res. 2014;2:14001.

    Article  Google Scholar 

  16. Namkung-Matthai H, Appleyard R, Jansen J, Hao Lin J, Maastricht S, Swain M, Mason RS, Murrell GAC, Diwan AD, Diamond T. Osteoporosis influences the early period of fracture healing in a rat osteoporotic model. Bone. 2001;28:80–6.

    Article  CAS  Google Scholar 

  17. Tran EY, Uhl RL, Rosenbaum AJ. Vitamin D in Orthopaedics. JBJS Rev. 2017;5:e1.

    Article  Google Scholar 

  18. Doetsch AM, Faber J, Lynnerup N, Wätjen I, Bliddal H, Danneskiold–Samsøe B. The effect of calcium and vitamin D3 supplementation on the healing of the proximal humerus fracture: a randomized placebo-controlled study. Calcif Tissue Int. 2004;75:183–8.

    Article  CAS  Google Scholar 

  19. Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, Della Rocca GJ, Mehta S, McKinley T, Wang Z, Steen RG. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg. 2016;151:e162775.

    Article  Google Scholar 

  20. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005;293:2257–64.

    Article  CAS  Google Scholar 

  21. Banefelt J, Åkesson KE, Spångéus A, Ljunggren O, Karlsson L, Ström O, Ortsäter G, Libanati C, Toth E. Risk of imminent fracture following a previous fracture in a Swedish database study. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2019;30:601–9.

    Article  CAS  Google Scholar 

  22. Duckworth AD, McQueen MM, Tuck CE, et al. Effect of alendronic acid on fracture healing: a multicenter randomized placebo-controlled trial. J Bone Miner Res Off J Am Soc Bone Miner Res. 2019;34:1025–32.

    Article  CAS  Google Scholar 

  23. Cho YJ, Chun YS, Rhyu KH, Kang JS, Jung GY, Lee JH. Does the time of postoperative bisphosphonate administration affect the bone union in osteoporotic intertrochanteric fracture of femur? Hip Pelvis. 2015;27:258–64.

    Article  Google Scholar 

  24. Lyles KW, Colón-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799–809. Large randomized, double-blind, placebo-controlled trial that found a 35% risk reduction with zoledronic acid started within 90 days after low-trauma hip fracture

    Article  CAS  Google Scholar 

  25. Curtis JR, Silverman SL. Commentary: the five Ws of a fracture liaison service: why, who, what, where, and how? In osteoporosis, we reap what we sow. Curr Osteoporos Rep. 2013;11:365–8.

    Article  Google Scholar 

  26. Bunta AD, Edwards BJ, Macaulay WB Jr, et al. Own the bone, a system-based intervention, improves osteoporosis care after fragility fractures. J Bone Joint Surg Am. 2016;98:e109.

    Article  Google Scholar 

  27. Ross BJ, Lee OC, Harris MB, et al. Rates of Osteoporosis management and secondary preventative treatment after primary fragility fractures. JBJS Open Access. 2021;6:e20.00142. Large database study showed that the rate of pre- and post-fragility fracture osteoporosis evaluation and management is unacceptably low

    Article  Google Scholar 

  28. Patel JN, Klein DS, Sreekumar S, Liporace FA, Yoon RS. Outcomes in multidisciplinary team-based approach in geriatric hip fracture care: a systematic review. J Am Acad Orthop Surg. 2020;28:128–33.

    Article  Google Scholar 

  29. Simonelli C, Killeen K, Mehle S, Swanson L. Barriers to osteoporosis identification and treatment among primary care physicians and orthopedic surgeons. Mayo Clin Proc. 2002;77:334–8.

    Article  Google Scholar 

  30. Bernatz JT, Brooks AE, Squire MW, Illgen RI II, Binkley NC, Anderson PA. Osteoporosis is common and undertreated prior to total joint arthroplasty. J Arthroplast. 2019;34:1347–53.

    Article  Google Scholar 

  31. Bjerke BT, Zarrabian M, Aleem IS, Fogelson JL, Currier BL, Freedman BA, Bydon M, Nassr A. Incidence of osteoporosis-related complications following posterior lumbar fusion. Global Spine J. 2018;8:563–9.

    Article  Google Scholar 

  32. Aro HT, Nazari-Farsani S, Vuopio M, Löyttyniemi E, Mattila K. Effect of denosumab on femoral periprosthetic BMD and early femoral stem subsidence in postmenopausal women undergoing cementless total hip arthroplasty. JBMR Plus. 2019;3:e10217.

    Article  Google Scholar 

  33. Khatod M, Inacio MCS, Dell RM, Bini SA, Paxton EW, Namba RS. Association of bisphosphonate use and risk of revision after THA: outcomes from a US total joint replacement registry. Clin Orthop Relat Res. 2015;473:3412–20.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA

    Phillip Snodgrass, Anthony Zou & Ida Leah Gitajn

  2. Department of Medicine, Division of Endocrinology, Dartmouth Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH, 03766, USA

    Ugis Gruntmanis

Authors
  1. Phillip Snodgrass
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anthony Zou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ugis Gruntmanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ida Leah Gitajn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Phillip Snodgrass.

Ethics declarations

Conflicts of Interest

Dr. Gitajn serves as a paid consultant to Stryker and DePuy Synthes for teaching and lectures. Dr. Snodgrass declares no conflict of interest. Dr. Zou declares no conflict of interest. Dr. Gruntmanis declares no conflict of interest. No external funding was received for any aspect of this work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Orthopedic Management of Fractures

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snodgrass, P., Zou, A., Gruntmanis, U. et al. Osteoporosis Diagnosis, Management, and Referral Practice After Fragility Fractures. Curr Osteoporos Rep 20, 163–169 (2022). https://doi.org/10.1007/s11914-022-00730-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11914-022-00730-1

Keywords

Search

Navigation