Chapter

Evaluation of Bone Fragility and Fracture Prevention

DOI: 10.1007/978-1-60327-467-8_16

ABSTRACT Patients with osteoporotic fractures are much more likely to sustain ­additional fractures; therefore both appropriate treatment
and prevention of future fractures (which takes into account the method of injury) need to be addressed. These patients are
also much more likely to have underlying secondary causes for bone loss that need to be diagnosed and treated, as well as
other multiple risk ­factors that should be uncovered and modified if possible. Finally, clinical pathways that unite orthopedic
surgeons and medical specialists in osteoporosis care are necessary to target patients with osteoporotic fractures for evaluation
and treatment.

KeywordsOsteoporosis-Risk factor assessment-Bone mineral density-Fragility fracture-Calcium-Vitamin D-Bisphosphonates-Prevention

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    ABSTRACT: Despite the availability of effective preventive and curative medications for osteoporosis, and guidelines for its diagnosis and management, few individuals are treated for osteoporosis, even among those who have already had a fracture. Our objective was to describe the patterns of use of medication for osteoporosis, i.e., calcium supplements, vitamin D supplements, and specific anti-osteoporotic drugs, such as bisphosphonates, in a large sample of French older women living at home, and to identify individual factors associated with use of these medications overall and in two specific clinical situations. Cross-sectional analysis of data from 4,221 women aged 75-85 years who participated in a balance and mobility examination as part of the screening procedure for the Ossébo study, a randomized controlled trial testing the effectiveness of exercise for the prevention of fall-related injuries. Electoral rolls were used to invite women in 16 towns to participate (participation rate 10.3 %). Information collected through questionnaires included current medication use and, in particular, use of osteoporosis medications (specific osteoporosis drugs, calcium and vitamin D supplementation) in the past 6 months, and history of fracture since the age of 50, including fracture locations. Fractures were categorized in three groups: no fracture, major osteoporotic fracture (hip, humerus, wrist, pelvis, and vertebra), and other fracture. Nearly 48 % of the participants reported they did not take calcium or vitamin D supplements or any specific osteoporosis drugs. Of the 2,133 women who reported using osteoporosis medication, 85 % used vitamin D supplements (25 % as the sole medication against this disease), 59 % calcium supplements, and 42 % a specific anti-osteoporotic drug (75 % of them combining it with vitamin D supplementation). The use of any osteoporosis medication was significantly associated (p < 0.001) with a history of a major osteoporotic fracture, lower weight, dual-energy X-ray absorptiometry (DXA) bone-density measurement in the past 5 years, a cancer-screening examination in the past 5 years, and a positive attitude toward medication use in general. Living alone was associated with a lower likelihood of using a specific anti-osteoporotic drug, and a higher education level was associated with a higher likelihood of vitamin D supplementation. Of the 1,553 women who had already had a major osteoporotic fracture, one-third (34.8 %) were not taking any osteoporosis medication. In this subgroup, use of this medication was associated with the same factors as in the overall study population. In particular, neither older age nor a history of falls in the previous 12 months was associated with a higher likelihood of using osteoporosis medication. Among the 909 women who reported using a specific osteoporosis drug, vitamin D use was associated with a higher educational level and a more frequent preventive attitude. In France, as in other western countries, women aged 75 years and over are not managed according to guidelines. Further studies should address the barriers encountered in improving quality of care in osteoporosis management.
    Drugs & Aging 10/2013; 30(12). DOI:10.1007/s40266-013-0121-9 · 2.50 Impact Factor