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The American Society for Bone and Mineral Research has developed multistakeholder consensus clinical recommendations for the prevention of secondary fractures for those aged 65 years and older after an initial hip or vertebral fracture.
Overall they have promoted 13 recommendations (7 primary and 6 secondary) strongly supported medical evidence.
Highlights include recommendations for:
- Increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction.
- Risk assessments (including fall history) should be done 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.
- Patient education about the benefits and risks of both treatment and not receiving treatment.
- First‐line options: oral bisphosphonates alendronate and risedronate; if contraindicated intravenous zoledronic acid and subcutaneous denosumab can be considered.
- Anabolic agents are expensive but may be beneficial for selected high risk patients.
- 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.
- Osteoporosis patients should be re‐evaluated for fracture risk routinely
- Lifestyle: patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies.
- 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)