Fighting the fracture cascade: evaluation and management of osteoporotic fractures

Osteoporosis is a bone disorder characterized by compromised bone strength and increased susceptibility to fractures. In the United States, osteoporosis accounts for approximately 2 million fractures and medical costs of $17 billion each year. As the proportion of the elderly population increases, the prevalence of osteoporosis and related fractures is expected to rise. In addition to the socioeconomic costs, osteoporotic fractures often cause significant morbidity and disability. Although low bone mineral density and fragility fractures of the hip or spine are commonly used to diagnose osteoporosis, they do not identify all patients at risk. Wrist fractures are often overlooked as an early sign of reduced bone strength and should prompt immediate and careful evaluation. Improving the identification of patients at risk for osteoporosis and optimizing management of the condition will reduce the socioeconomic and individual burdens of the disease. This article illustrates the importance of osteoporosis screening, diagnosis, and management in patients who have sustained a fragility fracture, with particular emphasis on fractures beyond the spine and hip.