Fragility Fracture: 10 Commandments.

Area of Science:

• Gerontology
• Orthopedics
• Endocrinology

Background:

• Fragility fractures result from low-impact events due to weakened bones, commonly associated with osteoporosis.
• These fractures, prevalent in older adults and post-menopausal women, affect hips, spines, and wrists, indicating underlying bone fragility.
• Risk factors include age, gender, nutrition, physical activity, chronic kidney disease, smoking, alcohol, and certain medications like corticosteroids.

Purpose of the Study:

• To address underemphasized aspects of osteoporosis management and fragility fracture prevention.
• To provide a comprehensive framework for managing patients with a history of fragility fractures.
• To highlight key areas for intervention in preventing and combating fragility fractures.

Main Methods:

• Development of ten guiding principles for fragility fracture management.
• Consolidation of information into thematic headings covering risk factors, bone diseases, and therapeutic strategies.
• Focus on high and low turnover bone disease, gut dysbiosis, and inflammaging.

Main Results:

• The ten commandments cover risk factors, DEXA scans, bone turnover diseases, microbiota, inflammaging, hormonal factors, osteoporosis in younger adults, nutrient deficiencies, pharmacologic treatments, and monitoring.
• Key areas highlighted include high and low turnover bone disease, gut dysbiosis, and inflammaging.
• Therapeutic and monitoring strategies are emphasized within these areas.

Conclusions:

• Fragility fractures, also known as osteoporotic fractures, contribute to significant morbidity and mortality.
• While anti-resorptive and anabolic drugs improve osteoporosis management, long-term safety concerns exist.
• These ten commandments aim to guide management strategies toward targeted therapies for individuals at high risk of fragility fractures.