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Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition

Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition
Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition
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 fracture among 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, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks 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 but may 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 early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be re‐evaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, 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 (e.g., hyperparathyroidism, chronic kidney disease).
0884-0431
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Conley, Robert B., Adib, Gemma, Adler, Robert A., Akesson, Kristina E., Alexander, Ivy M., Amenta, Kelly C., Blank, R.D., Brox, William T., Carmody, Emily E., Chapman-Novakofski, Karen, Clarke, Bart L., Cooper, Cyrus, Cody, Kathleen M., Crandall, Carolyn J., Dirschi, Douglas R., Eagen, Thomas J., Elderkin, Ann L., Fujita, Masaki, Greenspan, Susan L., Halbout, Philippe, Hochberg, Marc C., Javaid, Muhammad, Jeray, Kyle J., Kearnes, Ann E., King, Toby, Koinis, Thomas F., Koontz, Jennifer Scott, Kuzma, Martin, Lindsey, Carleen, Lorentzen, Mattias, Lyritis, George P., Michaud, Laura B., Miciano, Armado, Morin, Suzanne N, Mujahid, Nadia, Napoli, Nicola, Olenginski, Thomas P., Puzas, J. Edward, Rizou, Stavroula, Rosen, Clifford J., Saag, Kenneth G., Thompson, Elizabeth, Tosi, Laura L., Tracer, Howard, Khosla, Sundeep and Kiel, Douglas R. (2019) Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition. Journal of Bone and Mineral Research. (doi:10.1002/jbmr.3877).

Record type: Article

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 fracture among 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, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks 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 but may 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 early post‐fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calcium intake should be assured. Individuals being treated for osteoporosis should be re‐evaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, 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 (e.g., hyperparathyroidism, chronic kidney disease).

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Conley - Accepted Manuscript
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Accepted/In Press date: 11 September 2019
e-pub ahead of print date: 20 September 2019

Identifiers

Local EPrints ID: 435182
URI: http://eprints.soton.ac.uk/id/eprint/435182
ISSN: 0884-0431
PURE UUID: 17edd5e5-284d-48af-8b47-8907f7981b0f
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 25 Oct 2019 16:30
Last modified: 26 Nov 2021 05:36

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Contributors

Author: Robert B. Conley
Author: Gemma Adib
Author: Robert A. Adler
Author: Kristina E. Akesson
Author: Ivy M. Alexander
Author: Kelly C. Amenta
Author: R.D. Blank
Author: William T. Brox
Author: Emily E. Carmody
Author: Karen Chapman-Novakofski
Author: Bart L. Clarke
Author: Cyrus Cooper ORCID iD
Author: Kathleen M. Cody
Author: Carolyn J. Crandall
Author: Douglas R. Dirschi
Author: Thomas J. Eagen
Author: Ann L. Elderkin
Author: Masaki Fujita
Author: Susan L. Greenspan
Author: Philippe Halbout
Author: Marc C. Hochberg
Author: Muhammad Javaid
Author: Kyle J. Jeray
Author: Ann E. Kearnes
Author: Toby King
Author: Thomas F. Koinis
Author: Jennifer Scott Koontz
Author: Martin Kuzma
Author: Carleen Lindsey
Author: Mattias Lorentzen
Author: George P. Lyritis
Author: Laura B. Michaud
Author: Armado Miciano
Author: Suzanne N Morin
Author: Nadia Mujahid
Author: Nicola Napoli
Author: Thomas P. Olenginski
Author: J. Edward Puzas
Author: Stavroula Rizou
Author: Clifford J. Rosen
Author: Kenneth G. Saag
Author: Elizabeth Thompson
Author: Laura L. Tosi
Author: Howard Tracer
Author: Sundeep Khosla
Author: Douglas R. Kiel

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