title: Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action?
abstract: The burden of non-vertebral fractures is enormous. Hip fractures account for nearly 10% of all fractures (and a much greater proportion in the elderly), while wrist fractures may account for up to 23% of all limb fractures. The best available predictors of non-vertebral fracture risk are low BMD and a tendency to fall. Hip, forearm, proximal humerus and rib fractures have all been associated with low BMD, though ankle fracture is not strongly related to osteoporosis. Although clinical risk factors identify only about one-third of postmenopausal women at increased risk of osteoporotic fracture, the occurrence of one fracture commonly predicts a second fracture. Guidelines are presented for identifying and treating patients at risk of non-vertebral osteoporotic fractures, especially those with a previous fracture, based on the algorithm recently published by the Royal College of Physicians and the Bone and Tooth Society. Prevention of falls and use of external hip protectors may reduce the occurrence of hip fracture. Treatment options for patients presenting with hip fracture include HRT, bisphosphonates, and calcium plus vitamin D, and for Colles' fracture include general measures, HRT, bisphosphonates, or calcitonin plus calcium.
authors.affiliation: University of Sheffield Medical School, Sheffield, UK. r.eastell@sheffield.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Eastell
authors.forename: D M
authors.initials: DM
authors.lastname: Reid
authors.forename: J
authors.initials: J
authors.lastname: Compston
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: I
authors.initials: I
authors.lastname: Fogelman
authors.forename: R M
authors.initials: RM
authors.lastname: Francis
authors.forename: S M
authors.initials: SM
authors.lastname: Hay
authors.forename: D J
authors.initials: DJ
authors.lastname: Hosking
authors.forename: D W
authors.initials: DW
authors.lastname: Purdie
authors.forename: S H
authors.initials: SH
authors.lastname: Ralston
authors.forename: J
authors.initials: J
authors.lastname: Reeve
authors.forename: R G
authors.initials: RG
authors.lastname: Russell
authors.forename: J C
authors.initials: JC
authors.lastname: Stevenson
mesh_terms: D000058:Accidental Falls; D015519:Bone Density / Q000502:physiology; D016723:Bone Remodeling / Q000502:physiology; D002118:Calcium / Q000378:metabolism; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000628:therapy; D006620:Hip Fractures / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000503:physiopathology / Q000517:prevention & control*; D011482:Protective Devices; D011885:Radius Fractures / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D014458:Ulna Fractures / Q000209:etiology
chemical_list: D002118:Calcium