Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition

Robert B. Conley, Gemma Adib, Robert A. Adler, Kristina E. Åkesson, Ivy M. Alexander, Kelly C. Amenta, Robert D. Blank, William Timothy Brox, Emily E. Carmody, Karen Chapman-Novakofski, Bart L. Clarke, Kathleen M. Cody, Cyrus Cooper, Carolyn J. Crandall, Douglas R. Dirschl, Thomas J. Eagen, Ann L. Elderkin, Masaki Fujita, Susan L. Greenspan, Philippe HalboutMarc C. Hochberg, Muhammad Javaid, Kyle J. Jeray, Ann E. Kearns, Toby King, Thomas F. Koinis, Jennifer Scott Koontz, Martin Kužma, Carleen Lindsey, Mattias Lorentzon, George P. Lyritis, Laura Boehnke Michaud, Armando Miciano, Suzanne N. Morin, Nadia Mujahid, Nicola Napoli, Thomas P. Olenginski, J. Edward Puzas, Stavroula Rizou, Clifford J. Rosen, Kenneth Saag, Elizabeth Thompson, Laura L. Tosi, Howard Tracer, Sundeep Khosla, Douglas P. Kiel

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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).

Original languageEnglish (US)
Pages (from-to)E125-E141
JournalJournal of orthopaedic trauma
Issue number4
StatePublished - Apr 1 2020



ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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