Bone health

5 ASBMR recommendations on secondary osteoporotic fractures


New recommendations on preventing secondary osteoporotic fractures have been released by the American Society for Bone and Mineral Research (ASBMR).

The recommendations are part of a new initiative launched at the ASBMR 2018 Annual Meeting in Montréal that aims to ensure all people who have an osteoporotic hip or vertebral fracture are provided with appropriate treatments to prevent further fractures.

They were developed in response to concerns that people who have osteoporotic fractures are not being advised about preventive treatments or not being prescribed them.

Only 23% of elderly patients who suffer a hip fracture receive osteoporosis medication to reduce future fracture risk, noted Professor Douglas P. Kiel, past President of ASBMR.

“Heart attack patients don’t leave the hospital without beta blockers to prevent another one. But every day, patients hospitalized for hip or spine fractures are not receiving treatments that research shows help prevent a second fracture that could lead to disability or death,” he told the meeting.

The ASBMR Secondary Fracture Prevention Initiative Clinical Care Recommendations are:

  1. Communicate three simple messages to patients and their family/caregivers throughout the fracture care and healing process:
  • their broken bone likely means they have osteoporosis and are at high risk for breaking more bones, especially over the next 1-2 years;
  • breaking bones means they may, for example, have to use a walker, cane, or wheelchair, or move from their home to a residential facility) and will be at higher risk for dying prematurely;
  • most importantly, there are actions they can take to reduce their risk.
  1. Ensure that the patient’s primary healthcare provider is made aware of the occurrence of the fracture. If unable to determine whether the patient’s primary healthcare provider has been notified, take action to be sure the communication is made.
  2. Regularly assess the risk of falling of women and men, age 65 or older, who have ever had a hip or vertebral fracture.
  • At a minimum, take a history of their falls within the last year.
  • Minimise use of medications associated with an increased risk for falls.
  • Evaluate patients for conditions associated with an increased risk for falls.
  • Strongly consider referring patients to physical and/or occupational therapy or a physiatrist for evaluation and interventions to improve impairments in mobility, gait, and balance, and to reduce the risk for falls.
  1. Offer pharmacologic therapy for osteoporosis to women and men, age 65 years or older, with a hip or vertebral fracture, to reduce their risk of additional fractures.
  • Pharmacologic therapy (oral or intravenous) can begin in the hospital and be included in their discharge orders, although some practitioners prefer to delay intravenous zoledronic acid for a few weeks.
  • Do not delay initiation of therapy for bone mineral density (BMD) testing. Although BMD testing may be performed to monitor responses to treatment, therapy should be offered regardless of BMD levels.
  • Consider patients’ oral health before starting therapy with bisphosphonates or denosumab.
  1. Because osteoporosis is a life-long chronic condition, routinely follow and re-evaluate women and men, age 65 years or older, with a hip or vertebral fracture, who are being treated for osteoporosis. Purposes include:
  • reinforcing key messages about osteoporosis and associated fractures
  • identifying any barriers to treatment adherence;
  • assessing the risk of falling;
  • evaluating the effectiveness of the treatment plan;
  • monitoring for adverse effects;
  • determining whether any changes in treatment should be made, including whether any osteoporosis pharmacotherapy should be changed or discontinued.

To read the full recommendations and learn more about the ASBMR Secondary Fracture Prevention Initiative, go to: http://www.secondaryfratures.org

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