October 2019

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A coalition of the world's top bone health experts, physicians, specialists, and patient advocacy groups has published clinical care recommendations to tackle the public health crisis in the treatment of osteoporosis and the debilitating and often deadly hip and spine fractures caused by the disease The Secondary Fracture Prevention Consensus Recommendations from a Multistakeholder Coalition has been published online in the peer-reviewed Journal of Bone and Mineral Research.

The comprehensive recommendations are the first to outline the best course of clinical care for women and men, age 65 years or older, with a hip or vertebral (spine) fracture. Their publication in a peer-reviewed journal comes within days of a new report from the National Osteoporosis Foundation which found that older Americans covered by Medicare suffered one or more additional bone fractures—2.3 million total fractures—due to osteoporosis at a cost to Medicare of over $6.3 billion in 2015.
 
“Our message is even more urgent. The emotional and financial cost of osteoporotic fractures is unacceptable, as is the fact that most of these fractures go untreated when we have the means to improve lives,” said Bart Clarke, M.D., Immediate Past President of the American Society for Bone and Mineral Research (ASBMR) which led the coalition. Dr. Clarke is a clinician and researcher with the Division of Endocrinology, Metabolism, Diabetes, and Nutrition at the Mayo Clinic College of Medicine in Rochester, Minnesota. “These recommendations provide a guide for everyone involved with the care of a patient with a hip or vertebral fracture, from orthopedists to primary care doctors to caregivers.” 
 
Comprised of more than 40 top U.S. and international bone health experts, health care professional organizations and patient advocacy organizations (see full list below), the Coalition developed their recommendations in response to growing evidence of an alarming trend of increased hip fractures and high-risk osteoporosis patients who need treatment but are going untreated. Only 23 percent of elderly patients who suffer a hip fracture receive treatment to reduce future fracture risk compared to 96 percent of heart attack patients who receive beta blockers to prevent a future heart attack.
 
“We have the tools to both improve the treatment of osteoporosis and to prevent secondary fractures, including a national post-fracture registry in partnership with the AOA’s Own the Bone program ,” said W. Timothy Brox, MD, American Academy of Orthopaedic Surgeons member and coauthor of the recommendations published in JBMR. “Now we can use these resources to partner with patients, their caregivers and other health care professionals to make informed choices about the best treatment options and to provide greater standardization across the care continuum.”
 
An overarching principle for the Coalition’s recommendations is that fracture patients optimally should be managed in the context of a multi-disciplinary clinical system that includes case management, such as a fracture liaison service, to assure that they are appropriately evaluated and treated for osteoporosis and risk of future fractures.
 
“Orthopedists are on the front lines of fracture care,” said Paul A. Anderson, MD, FAOA, Chair of the American Orthopaedic Association’s Own the Bone Steering Committee and member of the AOA Executive Committee. These recommendations can help us all set the stage for better outcomes for patients, calling for hospitals, practices and other health care professionals to work together to help evaluate and treat these patients through care management and coordination, as with a fracture liaison service.”
 
Additionally, the Coalition outlined what hip and vertebral fracture patients and their families/caregivers need to know:

• Your broken bone likely means you have osteoporosis and are at high risk for breaking more bones, especially over the next 1-2 years;

• You may lose your independence, become walker-dependent/wheel chair-bound, have to move from your home to a residential facility, and will be at higher risk for dying prematurely; and,

• There are actions you can take to reduce your risk, including medication, exercise, nutrition, and reducing your risk of falling.

The complete Secondary Fracture Prevention Initiative: Consensus Clinical Recommendations and Rationales from a Multistakeholder Coalition are available at www.secondaryfractures.org. The document lists all Coalition's organizational members. The US Bone and Joint Initiative is a member.