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Secondary Fracture Risk Reduction

Posted October 10, 2019

A multi-stakeholder coalition assembled by the American Society for Bone and Mineral Research (ASBMR) has issued clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture—the most serious complication associated with osteoporosis.

Douglas Kiel, professor of medicine at Harvard Medical School and director of the Musculoskeletal Research Center in the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife, is senior author on the report and served as co-leader of the project.

Image credit:, CC0 Public Domain

The recommendations were published in the Journal of Bone and Mineral Research to coincide with the annual meeting of ASBMR, where Kiel was honored with the 2019 Frederic C. Bartter Award. This prestigious award is presented to an ASBMR member in recognition of outstanding clinical investigation in disorders of bone and mineral metabolism.

Approximately 10 million Americans have osteoporosis, and 44 million have low bone density, placing them at risk of developing the disease. This means half of all adults over age 50 are at risk of fracture or should be concerned about bone health.

Bone fractures are painful and debilitating, and they pose a serious health threat to older adults. Despite remarkable advances in treatment, osteoporosis‐related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines.

To help address this problem and improve patient outcomes, ASBMR engaged the Center for Medical Technology Policy to help develop a consensus by a broad multi-stakeholder coalition regarding several aspects of osteoporosis treatment. The aim of this consensus is to promote more effective treatment for patients with osteoporosis and prevention of secondary fracture in patients who have already suffered a fracture.

The coalition was made up of representatives from 42 professional organizations from the United States and abroad, including the American College of Physicians, American Association of Nurse Practitioners, American Geriatrics Society and International Osteoporosis Foundation.

The coalition developed 13 recommendations strongly supported by the empirical literature and recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction.

Several key recommendations are:

  • An individual over age 65 who breaks a bone likely has osteoporosis and is at high risk for breaking more bones, especially one to two years following the break.
  • Breaking bones means patients may suffer declines in mobility or independence and be at higher risk of premature death.
  • Physicians should talk with patients who have already sustained a hip or vertebral fracture about the available medications to prevent second fractures.
  • Patients with these fractures should undergo fall-risk assessment and fall-prevention interventions where appropriate, and they should get adequate exercise and calcium and vitamin D.

“The value of our secondary fracture prevention efforts is that it will be used to initiate an action plan to improve the current practice of not treating many patients who have sustained a hip or vertebral fracture,” said Kiel. “We are pursuing a multitude of activities such as improving awareness, educating physicians in practice, creating national fracture registries, and meeting with CMS [Centers for Medicare and Medicaid Services] to set financial and quality of care-related reimbursement to care for older adults who have sustained a fracture.”

Source: HMS

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