title: Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture.
abstract: This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture.
  
  
  
  Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered.
  
  
  
  A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions.
  
  
  
  Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation.
  
  
  
  Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.
authors: Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland.
authors: Serge
authors: S
authors: Ferrari
authors: Bone and Cartilage Metabolism Unit, University of Liège, Liège, Belgium.
authors: Jean-Yves
authors: JY
authors: Reginster
authors: Section of Endocrinology, Unit of Bone and Mineral Metabolism, Department of Surgery and Translational Medicine, Florence, Italy.
authors: Maria Luisa
authors: ML
authors: Brandi
authors: Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia.|University of Sheffield Medical School, Sheffield, UK.
authors: John A
authors: JA
authors: Kanis
authors: Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Jean-Pierre
authors: JP
authors: Devogelaer
authors: Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.
authors: Jean-Marc
authors: JM
authors: Kaufman
authors: Orthopaedic and Trauma Department, Saint Antoine Hospital, UPMC-Sorbonne Universities, Paris, France.
authors: Jean-Marc
authors: JM
authors: Féron
authors: Department of Orthopaedic Surgery, Themistocles Gluck Hospital, Dusseldorf, Germany.
authors: Andreas
authors: A
authors: Kurth
authors: Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, 1211, Geneva 14, Switzerland. rene.rizzoli@unige.ch.
authors: René
authors: R
authors: Rizzoli
mesh_terms: D000368:Aged; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000145:classification / Q000627:therapeutic use; D019468:Disease Management; D005260:Female; D006620:Hip Fractures / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D058866:Osteoporotic Fractures / Q000517:prevention & control*; D011315:Preventive Medicine / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents
keywords: BMD; Bone strength; Fracture; Osteoporosis; Surgical treatment; Treatment