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Osteoporotic Fracture – When Repairing the Fracture is not enough

Peter KK Wong and Grad Dip Clin Epi

Osteoporotic fractures are a major public health problem in most Western countries. Due to their ageing population, Asia and South America will soon feel the burden of this issue. Osteoporotic/low trauma fractures are associated with increased morbidity and mortality and are often followed by further fractures. Effective and welltolerated bone protective medication such as bisphosphonates and denosumab are readily available and has been shown to prevent further fractures. As the molecular biology of bone turnover is now well-characterised, more specific targeted therapies are currently undergoing clinical trial.

Despite these advances in pharmacotherapy secondary prevention of osteoporosis following low trauma fracture is often not implemented. Reasons for this include lack of appreciation of the importance of a low trauma fracture as a predictor of morbidity and mortality, lack of time on the part of treating clinicians and uncertainty regarding whose role it is to address secondary fracture prevention. However, many would suggest that best-practice surgical repair of an osteoporotic fracture also involves measures to prevent the next one. Such measures include bone mineral density assessment by dual x-ray absorptiometry, commencement of bone protective therapy and falls prevention strategies. This multi-faceted secondary prevention programme requires close cooperation between the orthopaedic surgical, nursing and physiotherapy team and a medical team with expertise in bone health. This occurs infrequently. The role of a Fracture Liaison Service built around a dedicated Fracture Liaison Coordinator will be discussed as this is probably the most effective strategy to ensure consistent secondary prevention of osteoporosis following low trauma fracture.