Osteoporosis, Frailty and Fracture: Implications for Case Finding and Therapy

Overview

Journal Nat Rev Rheumatol

Specialty Rheumatology

Date 2012 Jan 18

PMID 22249162

Citations 76

Authors

Joop P van den Bergh

Tineke A van Geel

Piet P Geusens

Affiliations

Soon will be listed here.

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.

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References

Ensrud K, Ewing S, Taylor B, Fink H, Stone K, Cauley J . Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J Gerontol A Biol Sci Med Sci. 2007; 62(7):744-51. DOI: 10.1093/gerona/62.7.744. View

Siris E, Chen Y, Abbott T, Barrett-Connor E, Miller P, Wehren L . Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004; 164(10):1108-12. DOI: 10.1001/archinte.164.10.1108. View

Lindsay R, Silverman S, Cooper C, Hanley D, Barton I, Broy S . Risk of new vertebral fracture in the year following a fracture. JAMA. 2001; 285(3):320-3. DOI: 10.1001/jama.285.3.320. View

Nguyen N, Frost S, Center J, Eisman J, Nguyen T . Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos Int. 2007; 18(8):1109-17. DOI: 10.1007/s00198-007-0362-8. View

. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001; 285(6):785-95. DOI: 10.1001/jama.285.6.785. View

Cauley J, Wu L, Wampler N, Barnhart J, Allison M, Chen Z . Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative. J Bone Miner Res. 2007; 22(11):1816-26. DOI: 10.1359/jbmr.070713. View

van Geel T, van Helden S, Geusens P, Winkens B, Dinant G . Clinical subsequent fractures cluster in time after first fractures. Ann Rheum Dis. 2008; 68(1):99-102. DOI: 10.1136/ard.2008.092775. View

van Helden S, Wyers C, Dagnelie P, van Dongen M, Willems G, Brink P . Risk of falling in patients with a recent fracture. BMC Musculoskelet Disord. 2007; 8:55. PMC: 1933426. DOI: 10.1186/1471-2474-8-55. View

Kanis J, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby A . International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res. 2002; 17(7):1237-44. DOI: 10.1359/jbmr.2002.17.7.1237. View

10.

Dumitrescu B, van Helden S, Ten Broeke R, Nieuwenhuijzen-Kruseman A, Wyers C, Udrea G . Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskelet Disord. 2008; 9:109. PMC: 2529301. DOI: 10.1186/1471-2474-9-109. View

11.

Huntjens K, van Geel T, Blonk M, Hegeman J, van der Elst M, Willems P . Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos Int. 2010; 22(7):2129-35. PMC: 3106159. DOI: 10.1007/s00198-010-1442-8. View

12.

Hegeman J, Willemsen G, van Nieuwpoort J, Kreeftenberg H, van der Veer E, Slaets J . [Effective tracing of osteoporosis at a fracture and osteoporosis clinic in Groningen; an analysis of the first 100 patients]. Ned Tijdschr Geneeskd. 2004; 148(44):2180-5. View

13.

Greenspan S, von Stetten E, Emond S, Jones L, Parker R . Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J Clin Densitom. 2001; 4(4):373-80. DOI: 10.1385/jcd:4:4:373. View

14.

Ettinger B, Black D, Mitlak B, Knickerbocker R, Nickelsen T, Genant H . Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA. 1999; 282(7):637-45. DOI: 10.1001/jama.282.7.637. View

15.

. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994; 843:1-129. View

16.

. The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull. 1987; 34 Suppl 4:1-24. View

17.

Klotzbuecher C, Ross P, Landsman P, Abbott 3rd T, Berger M . Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. 2000; 15(4):721-39. DOI: 10.1359/jbmr.2000.15.4.721. View

18.

Meunier P, Roux C, Seeman E, Ortolani S, Badurski J, Spector T . The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med. 2004; 350(5):459-68. DOI: 10.1056/NEJMoa022436. View

19.

Kanis J, Johnell O . Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int. 2004; 16(3):229-38. DOI: 10.1007/s00198-004-1811-2. View

20.

Braun J, Pfeilschifter J . [Osteoporosis diagnosis and therapy according to the 2010 guidelines]. Z Rheumatol. 2010; 69(4):327-39. DOI: 10.1007/s00393-010-0623-3. View