title: Osteoporotic Fracture Care: Are We Closer to Gold Standards?
abstract: This review summarizes symposium presentations from the OTA's Basic Science Focus Forum on care for osteoporotic fractures. The limitations of diaphyseal osteoporotic animal bone models are discussed, together with the potential benefits of using metaphyseal models to study osteoporotic fracture fixation constructs. Metaphyseal bone repair models provide better simulation of the most common osteoporotic fractures. Selection of an osteoporotic model for mechanical testing is also challenging. One should always thoroughly define the clinical problem to be addressed. The selected model should then be validated for behavior matched to known clinical behavior with known fixation configurations. The medical management of osteoporosis is directed at enhancing bone mass, improving bone quality, and lowering fracture risk. Medical strategies to achieve these goals are discussed. The medical strategy should include provision of an adequate calcium and vitamin D environment to facilitate well-mineralized bone and improve bone quality, prevent excessive bone resorption, and provide an anabolic stimulus to enhance bone formation. Atypical femur fractures continue to be a serious issue for the orthopaedic community. Risk factors, treatment modalities, and prevention strategies are discussed. A comprehensive strategy for the improved treatment of osteoporotic fractures must address both biological and mechanical issues and includes 4 specific approaches: (1) removal of inhibitors to bone healing; (2) introduction of bone healing stimulants; (3) modification of fracture fixation constructs; and (4) application of bone augmentation or substitutes. There is currently no optimal bone substitute. Substitutes should be chosen based on the most critical need when treating a particular fracture.
authors.affiliation: *Department of Orthopaedic Surgery, San Francisco General Hospital Orthopaedic Trauma Institute, University of California, San Francisco, San Francisco, CA; †Department of Trauma, Hand and Reconstructive Surgery Giessen University Hospital Giessen-Marburg, Campus Giessen, Giessen, Germany; ‡Department of Orthopaedic Surgery, University of Miami, School of Medicine, Miami, FL; §Department of Orthopaedic Surgery, Hospital for Special Surgery, New Yore, NY; and ‖Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
authors.forename: Meir
authors.initials: M
authors.lastname: Marmor
authors.forename: Volker
authors.initials: V
authors.lastname: Alt
authors.forename: Loren
authors.initials: L
authors.lastname: Latta
authors.forename: Joseph
authors.initials: J
authors.lastname: Lane
authors.forename: Brian
authors.initials: B
authors.lastname: Rebolledo
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
authors.forename: Theodore
authors.initials: T
authors.lastname: Miclau
mesh_terms: D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D018786:Bone Substitutes / Q000592:standards / Q000627:therapeutic use*; D005593:Fracture Fixation, Internal / Q000592:standards*; D006801:Humans; D009985:Orthopedics / Q000592:standards; D058866:Osteoporotic Fractures / Q000175:diagnosis* / Q000628:therapy*; D010027:Osteotomy / Q000592:standards*; D017410:Practice Guidelines as Topic
chemical_list: D050071:Bone Density Conservation Agents; D018786:Bone Substitutes