Reviewed by
Dr Sam Joseph
MBBS | Accredited Orthopaedic Registrar
Fragility Fractures
- Osteoporosis = Bone mineral density T-score of <2.5
- Common fragility fractures
- Vertebrae
- proximal femur
- distal radius
- 1-year mortality after hip fracture between 15 & 33%
- Poor Prognostic Factors
- Age
- Comorbidities
- Time to surgery
- Subsequent Fracture risk as high as 45%
- Low initiation of osteoporosis treatment 1-9%
Evaluating Fracture Risk
- BMD is correlated to bone strength and is a predictor of future fracture risk
- WHO algorithm for assessing risk FRAX assessment tool
- National Osteoporosis Foundation (NOF) recommends treatment when 10 yr risk of hip fracture is >3%
Improving Bone Health & Reducing Fracture Risk
- Diet
- Calcium, Vitamin D (level 4 evidence)
- Smoking cessation
- Treating Alcoholism
- Fall Risk Factors
- Lighting, eyesight, postural hypotension
- Bisphosphonates
- Hormone replacement therapy
- physiotherapy / exercise
Osteoporosis Medications
- Bisphosphonates
- Acts on the osteoclast to prevent bone resporption
- Alendronate, risedronate, ibandronate and zoledronic acid have all been shown to reduce fracture risk (level III)
- Better compliance with less frequent dosing
HORIZON Study
- Multicentre RCT
- Hip fracture patients mean age 73
- N=2127
- IV zoledronic acid 5mg yearly vs placebo
- 5years
- Treatment group 8.6% subsequent fracture
- Placebo group 13.9% subsequent fracture
Safety of Bisphosphonates
- GI symptoms
- Osteonecrosis of the jaw
- Recommend dental examination
- <1/100,000 patient-years
- More common in patients with metastatic bone disease
- Bisphosphonate related fractures
Patient Preparation for Follow-up Care
- All patients with fragility fractures shoulder be accessed by physicians / endocrinologists for suitability of bisphosphonates
References
The Role of the Orthopaedic Surgeon in Minimizing Mortality and Morbidity Associated With Fragility Fractures, JAAOS 2010;18:278-285