Abstract
In almost all patients with incident fractures, the absolute risk of subsequent fracture and mortality is highest immediately after the fracture is incurred; the risk is substantially increased in frail elderly patients. The risk factors for incident fractures, such as bone fragility, tendency to fall and the presence of metabolic bone disease, remain underdiagnosed and undertreated. Here, we review the evidence that demonstrates the influence of these risk factors on susceptibility to subsequent fracture and mortality after an incident fracture, and discuss the tools available to predict these outcomes. In this Review, we also propose a systematic, coordinator-based approach to assessment of risk, allocation of treatment and follow-up in all patients over 50 years of age who present with a fracture. The aim of this proposed multistep procedure is to improve the prevention of secondary fracture, decrease mortality rates and reduce patient undertreatment or overtreatment.
Key Points
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Measurement of bone mineral density and diagnosis of concurrent vertebral fractures in patients with a recent fracture can contribute to selection of patients who might benefit from anti-osteoporotic therapy
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Subsequent fracture risk is similar for men and women, and is highest immediately after a previous fracture; the increased risk has been observed for almost all clinical fractures
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Mortality risk is highest in the first 5 years after fracture, depends on fracture location and severity, correlates with age at occurrence and is higher in males than females
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Falls are a risk factor for fractures, however, no effect on fracture risk has been documented for fall prevention strategies that successfully reduce the risk of falls
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25% of patients over 50 years of age with a fracture had contributors to secondary osteoporosis, independent of sex, age, fracture type or bone mineral density
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Anti-osteoporotic therapy is recommended for patients with a hip or vertebral fracture, or a nonhip, nonvertebral fracture and either a T-score ≤−2.5 or a high 10-year FRAX® fracture risk
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J. P. van den Bergh researched the data for the article, J. P. van den Bergh and P. P Geusens contributed equally to writing of the article, and all authors provided a substantial contribution to the discussion of the content and to review and/or editing of the manuscript before submission.
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van den Bergh, J., van Geel, T. & Geusens, P. Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol 8, 163–172 (2012). https://doi.org/10.1038/nrrheum.2011.217
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DOI: https://doi.org/10.1038/nrrheum.2011.217
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