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Update on the Comprehensive Approach to Fragility Fractures
Matthew R Cohn1, Arianna L Gianakos2,3, Kirsten Grueter3
1Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Journal of Orthopaedic Trauma
|July 24, 2018
Summary
Effective fragility fracture care requires treating both the fracture and underlying osteoporosis. Fracture Liaison Services improve patient outcomes with coordinated care and modern treatments, including new anabolic agents.
Area of Science:
- Orthopedics
- Endocrinology
- Geriatrics
Background:
- Fragility fractures necessitate comprehensive care addressing both the acute injury and the chronic bone disease, osteoporosis.
- Despite available osteoporosis treatments, many patients with fragility fractures do not receive appropriate medication post-injury.
- Advances in diagnostics, pharmacotherapy, and Fracture Liaison Services (FLS) enhance fragility fracture management.
Purpose of the Study:
- To review current strategies and recent advances in the prevention and treatment of fragility fractures.
- To highlight the role of Fracture Liaison Services in coordinating comprehensive care for patients with osteoporosis and fractures.
- To discuss the evolving landscape of pharmacologic treatments for osteoporosis, including established and emerging anabolic agents.
Main Methods:
- Review of current literature on fragility fracture management, osteoporosis treatment, and Fracture Liaison Services.
- Description of the FLS model, emphasizing coordinated care including history, laboratory testing, bone density screening, and follow-up.
- Summary of current and novel therapeutic options for osteoporosis, including nonpharmacologic, antiresorptive, and anabolic agents.
Main Results:
- Fracture Liaison Services effectively coordinate care, improving treatment rates for osteoporosis after fragility fractures.
- Antiresorptive agents (bisphosphonates, denosumab) and anabolic agents (teriparatide) are key treatments for osteoporosis.
- Emerging anabolic agents, such as antisclerostin antibodies and parathyroid hormone-related protein analogs, show promise for increasing bone density.
Conclusions:
- Comprehensive management of fragility fractures requires addressing the underlying bone disease, primarily osteoporosis.
- Fracture Liaison Services represent a vital model for optimizing patient care and treatment adherence.
- The development of novel anabolic agents offers new therapeutic avenues for improving bone health and reducing fracture risk.
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