Secondary Fracture Prevention
Summary of Consensus Recommendations
The following recommendations pertain to people aged 65 years or older with a hip or vertebral fracture. They are directed to all health care professionals who participate in the care of these patients (including, but not limited to, orthopedic surgeons, rheumatologists, endocrinologists, family physicians and primary care providers, fracture liaison service coordinators, geriatricians, occupational therapists, physical therapists, rehabilitation therapists, emergency department physicians, gynecologists, hospitalists, infusion nurses, internists, neurosurgeons, nurse practitioners, dentists, oral and maxillofacial surgeons, pharmacists, physician assistants, radiologists, registered dietitian nutritionists, and chiropractors).
An important overarching principle for the recommendations is that people aged 65 years or older with a hip or vertebral fracture optimally should be managed in the context of a multidisciplinary clinical system that includes case management (one example is a fracture liaison service) to assure that they are appropriately evaluated and treated for osteoporosis and risk of future fractures.
|1. Communicate three simple messages to people aged 65 years or older with a hip or vertebral fracture (as well as to their family/caregivers) consistently throughout the fracture care and healing process:
|2. Ensure that the usual health care provider for a person aged 65 years or older with a hip or vertebral fracture is made aware of the occurrence of the fracture. If unable to determine whether the patient's usual health care provider has been notified, take action to be sure the communication is made.|
|3. Regularly assess the risk of falling of people aged 65 years or older who have ever had a hip or vertebral fracture.
|4. Offer pharmacologic therapy for osteoporosis to people aged 65 years or older with a hip or vertebral fracture to reduce their risk of additional fractures.
|5. Initiate a daily supplement of at least 800 IU vitamin D per day for people aged 65 years or older with a hip or vertebral fracture.|
|6. Initiate a daily calcium supplement for people aged 65 years or older with a hip or vertebral fracture who are unable to achieve an intake of 1200 mg/d of calcium from food sources.|
|7. Because osteoporosis is a life-long chronic condition, routinely follow and reevaluate people aged 65 years or older with a hip or vertebral fracture who are being treated for osteoporosis. Purposes include:
|8. Consider referring people aged 65 years or older with a hip or vertebral fracture who have possible or presumed secondary causes of osteoporosis to the appropriate subspecialist for further evaluation and management.|
|9. Counsel people aged 65 years or older with a hip or vertebral fracture:
|10. When offering pharmacologic therapy for osteoporosis to people aged 65 years or older with a hip or vertebral fracture, discuss the benefits and risks of therapy, including, among other things:
11. First-line pharmacologic therapy options for people aged 65 years or older with a hip or vertebral fracture, include:
For patients at high risk of fracture, particularly those with vertebral fractures, anabolic agents may be useful, although consultation with or referral to a specialist would also be appropriate.
|12. The optimal duration of pharmacologic therapy for people aged 65 years and older with a hip or vertebral fracture is not known.
|13. Primary care providers who are treating people aged 65 years and older with a hip or vertebral fracture may want to consider referral to an endocrinologist or osteoporosis specialist for those patients who, while on pharmacotherapy, continue to experience fractures or bone loss without an obvious cause, or who have comorbidities or other factors that complicate management (eg, hyperparathyroidism, chronic kidney disease).|
Secondary Fracture Prevention
September 20, 2019
External Publication Status
Country of Publication
Female, Male, Older adult
Health Care Settings
Ambulatory, Hospital, Long term care, Operating and recovery room, Outpatient, Radiology services
Radiology technologist, physical therapist, occupational therapist, dietician nutritionist, dentist, clinical researcher, nurse, nurse practitioner, physician, physician assistant
D010024 - Osteoporosis, D058866 - Osteoporotic Fractures
osteoporosis, Osteoporosis, Secondary Fracture, vertebral fracture.