ASBMR's Updated Osteoporosis Guidelines Emphasize Communication to Avoid Secondary Fractures

The decline in fractures caused by osteoporosis has stagnated, leading bone experts to suspect a lack in osteoporosis diagnosis and treatment guideline adherence. To combat this, the American Society for Bone and Mineral Research (ASBMR) has added 5 clinical care recommendations to prevent secondary fractures in at-risk patients.

Osteoporosis is a debilitating disease that has alarmingly been ignored in both women and men, age 65 years or older, with hip or vertebral fractures. According to the National Osteoporosis Foundation, 96% of postmenopausal women who have experienced a fracture or break were not told by their doctors that it could be linked with osteoporosis. In fact, one-third of these women were also not referred for follow-up visits, despite the increased risk of an osteoporotic fracture after the first.

Osteoporosis has surprisingly poorer treatment prevention initiatives compared with other chronic diseases. Ninety-six percent of patients who suffer a heart attack receive a β-blocker to prevent the occurrence of another attack. However, only 23% of patients who suffer a hip fracture will receive a preventative osteoporosis medication to reduce the occurrence of a future fracture.

Using statins to reduce the risk of osteoporosis fractures.

In the United States alone, there are over 2 million fractures due to osteoporosis. Fractures of the hip and the spine are particularly devastating. Half of the patients with hip fractures never fully recover, and one-quarter of these patients will be sent to a nursing home. One-fourth of these patients will also die within 1 year.

To address the gap of care in the treatment of osteoporosis, the ASBMR has released 5 clinical recommendations in women and men, age 65 years or older, with a hip or vertebral fracture.

• The first recommendation emphasizes routine patient communication after the first fracture. One fracture will likely lead to more, especially over the next 1 to 2 years, and clinicians should take actions to reduce the risk for these patients.
• The second and third recommendations tie into communication and state that a patient’s primary healthcare provider should be made aware of the fractures and conduct regular assessments. Identifying a history of falls within the previous year, reducing the number of medications that can cause falls, and referring patients to a physical therapist or a physiatrist to improve impairments in mobility, gait, and balance, are many of the interventions that clinicians can offer their patients.
• The fourth guidance is to offer pharmacologic therapies to reduce the risk of additional fractures. Some of these medications involve bisphosphonates and denosumab, and the initiation of these medications should not be delayed even for bone mineral density testing.
• Finally, patients should receive regular counseling involving adherence, adverse events, treatment plans, and any other necessary changes.

Osteoporosis is a chronic condition that can severely affect patient lives. Fractures are a significant factor in osteoporosis and disability and should be monitored, treated, and communicated accordingly. Treatment of high-risk individuals is paramount and should be managed by all care givers with the highest vigilance.

Reference

Patients 65 years of age or older with hip or spine fracture should be treated for osteoporosis [news release]. Montreal, Quebec: American Society for Bone and Mineral Research; September 29, 2018. eurekalert.org/pub_releases/2018-09/b-p6y092418.php. Accessed October 5, 2018.