Secondary Fracture Prevention: Consensus Clinical Recommendations from a Multistakeholder Coalition.

摘要: Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches patient care and discrepancies among treatment guidelines. To help bridge this gap improve outcomes, the American Society for Bone Mineral Research assembled a multistakeholder coalition develop clinical recommendations optimal prevention of secondary fractureamong people aged 65 years older with hip or vertebral fracture. The developed 13 (7 primary 6 secondary) strongly supported by empirical literature. recommends increased communication patients regarding fracture risk, mortality morbidity risk reduction. Risk assessment (including fall history) should occur at regular intervals referral physical and/or occupational therapy as appropriate. Oral, intravenous, andsubcutaneous pharmacotherapies efficaciousandcanreduce future fracture.Patientsneededucation,however, thebenefitsandrisks both not receiving treatment. Oral bisphosphonates alendronate risedronate first-line options generally well tolerated; otherwise, intravenous zoledronic acid subcutaneous denosumab can be considered. Anabolic agents expensive butmay beneficial selected high risk.Optimal duration pharmacotherapy is unknown but because second highest earlypost-fractureperiod,prompt recommended.Adequate dietary supplemental vitaminDand calciumintake shouldbe assured. Individuals beingtreatedfor osteoporosis reevaluated routinely, includingvia patienteducationabout osteoporosisandfracturesandmonitoringfor adverse effects.Patients shouldbestronglyencouraged avoid tobacco, consume alcohol inmoderation atmost, engage exercise strategies. Finally, endocrinologists other specialists may warranted individuals who experience repeated bone loss those complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease).