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Having a prior fracture is a major predictor of future fractures.
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There is strong evidence to support the rationale for postfracture secondary prevention programs.
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It is believed that a systems approach, with dedicated personnel, bone mineral density (BMD) testing within a program, or both, performs better whereas programs offering only education, awareness, and medication coverage are less effective.
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Gaps in care still exist despite the improvements demonstrated by postfracture secondary
Secondary Prevention After an Osteoporosis-Related Fracture: An Overview
Section snippets
Key points
Burden of fragility fractures
One in 2 women and 1 in 5 men have a fragility (sometimes referred to as a low trauma or osteoporotic) fracture after age 50.1, 2, 3 The risk of fracture in a 1-year period for women over age 50 is higher than the risk of any cardiovascular disease event in that year.4 Having a prior fracture, whether it is a confirmed fragility fracture5, 6, 7 or not,8, 9, 10 is a major predictor of future fracture,5, 6, 7, 8, 9, 10 especially in the first 5 years after the initial fracture.8, 10 According to
The evidence for pharmacologic and nonpharmacologic agents on fracture risk reduction
Evidence gained from rigorous study designs, such as randomized controlled trials, supports the use of both pharmacologic and nonpharmacologic agents in preventing fractures.
The concept of fracture risk is replacing a diagnosis of OP and osteopenia
Since 1994, clinical practice guidelines worldwide have relied on a diagnosis of OP for bone health treatment recommendations.48 A fundamental shift from a diagnosis of OP to absolute fracture risk has become a worldwide phenomenon, with tools such as the Fracture Risk Assessment Tool49 translated and available across 19 countries.50
A recent systematic review identified 12 fracture risk assessment tools for women.51 Between 1 and 31 risk factors were considered in the algorithms of these tools,
Clinical practice guidelines acknowledge the need to intervene in patients who are at risk for future fracture
There has been a movement for clinical practice guidelines to recommend fracture risk assessment in advance of making treatment recommendations,26, 54, 55 with some guidelines recommending pharmacotherapy for patients who are at high risk for future fracture.54
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According to the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada, all individuals 50 years of age and older who have had a hip or vertebral fragility fracture or who have had more than 1
The Introduction of Postfracture Secondary Prevention Programs
Despite the knowledge that prior fractures are a major predictor of future fractures,5, 8, 9, 10 it is well documented that fracture patients often do not undergo BMD testing or initiate bone health treatment after a fragility fracture.15, 56, 57, 58, 59, 60 For example, Papaioannou and colleagues57 reported that the proportion of fracture patients who received an OP diagnostic test or physician diagnosis ranged from 1.7% to 50%. Given that approximately half of hip fracture patients have had a
The Scope of Postfracture Secondary Prevention Programs
Postfracture secondary prevention programs are currently established worldwide. Although most programs typically screen all fragility fracture patients over age 50, some have reported data on older adults, ages 65 and older.65, 66 The International Osteoporosis Foundation Capture the Fracture report describes several coordinator-based models of care that have a systematic approach to fragility fracture prevention in Australia, Canada, Singapore, the Netherlands, the United Kingdom, and the
Reduction in Health Care Costs
The effects of postfracture secondary prevention programs on several outcomes have been reported. Some programs have been shown at least cost effective or even cost saving.77, 78, 79, 80
Improved Investigation and Treatment Rates
According to several recent systematic reviews, these programs have had positive effects on BMD testing63, 76 and bone health treatment initiation.63, 76, 81 Little and Eccles81 showed that based on postintervention differences between the intervention and control groups of randomized controlled trials, a
Potential reasons for these gaps in bone health still exist despite postfracture secondary prevention programs
There are opportunities for improvement at several stages in postfracture bone secondary prevention, from identifying patients at risk for future fracture to promoting patients to follow treatment recommendations. For example:
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Chevalley and colleagues86 reported that 72 patients were given recommendations for medication but only 45 patients were prescribed medication by their family physicians and only 30 patients were still on medication at 6 months.
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In Sale and colleagues’63 systematic review,
Future research directions in postfracture secondary prevention
Postfracture secondary prevention programs have had considerable positive effects on bone health. Despite these successes, there are several opportunities for improvement:
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There is a need for consistent information to be relayed to patients beyond the orthopedic environment so that health care providers can promote long-term adherence to treatment recommendations.94
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Because the concept of fracture risk is relatively new, health care providers need to be aware of revisions to clinical practice
Summary
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Adults who have had a fragility fracture should be assessed for fracture risk and treated for bone health if indicated.
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Postfracture secondary prevention programs that aim to improve bone health after a fracture exist worldwide and programs that are coordinator based are endorsed by the International Osteoporosis Foundation.
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Opportunities to improve the success of these programs include facilitating patients’ understanding of bone health recommendations and the connection between their fracture
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Epidemiologic characteristics of traumatic fractures during the outbreak of coronavirus disease 2019 (COVID-19) in China: A retrospective & comparative multi-center study
2020, InjuryCitation Excerpt :The fracture sites were recorded as proximal, shaft and distal fracture for each limb long-bone (humerus, ulnar and radius, femur, tibia and fibula), pelvic and acetabular fracture, scapula, clavicle, patella, cervical vertebra, thoracolumbar fracture, hand and wrist fracture, foot and ankle fractures. The patients who met the following three criteria were considered as having sustained osteoporotic fracture: ① occurred in one of the four sites (hip, thoracic and lumbar vertebra, distal radius and proximal humerus) ②≥65 years old, ③ low energy injury [7-11]. The injury mechanism included fall from standing height, fall from a low height (<1 m, e.g. bed, chair, stool), fall from a height >1 m (e.g. roof or tree), bicycle injury, motor vehicle injury (including electronic bike), and others.
Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography
2019, Journal of Orthopaedic TranslationCitation Excerpt :Some studies have shown that patients with vertebral body fractures experience loss of body function, back pain and height loss, as well as difficulties in social interaction [5]. Other research studies have shown that osteoporotic fracture of vertebral body can reduce life expectancy in patients and may worsen the mortality and permanent disability rates of long-term bedridden patients [6]. Despite the prevalence of vertebral fractures, only a small number of people with fractures are found early, especially with atraumatic fractures, the aetiology of which is still relatively unknown, and vertebral fractures are often delayed in treatment compared with limb bone fractures.
Activation of JNK signaling in osteoblasts is inversely correlated with collagen synthesis in age-related osteoporosis
2018, Biochemical and Biophysical Research CommunicationsCitation Excerpt :Notably, with the increased transcription of MAP3K4, COL12A1, COL5A1, COL5A3, COL8A1 and COL8A2 levels decreased (Supplement 5), further supporting the notion that dysregulated JNK signaling may contribute to abnormal collagen synthesis in aged osteoblasts. Several studies have revealed that the bone density decreases in some degree in the elderly [2,30–33]. The rate of bone formation is largely determined by the number and functionality of osteoblasts [34,35].
Initial experiences of an orthogeriatric unit
2015, Revista Espanola de Cirugia Ortopedica y Traumatologia