Secondary Fracture Prevention: Consensus Clinical Recommendations From a Multistakeholder Coalition

被引：7

作者：

Conley, Robert B. ^{[1
]}

Adib, Gemma ^{[2
]}

Adler, Robert A. ^{[3
]}

Akesson, Kristina E. ^{[4
,5
]}

Alexander, Ivy M. ^{[6
]}

Amenta, Kelly C. ^{[7
]}

Blank, Robert D. ^{[8
,9
]}

Brox, William Timothy ^{[10
]}

Carmody, Emily E. ^{[11
]}

Chapman-Novakofski, Karen ^{[12
]}

Clarke, Bart L. ^{[13
]}

Cody, Kathleen M. ^{[14
]}

Cooper, Cyrus ^{[15
]}

Crandall, Carolyn J. ^{[16
]}

Dirschl, Douglas R. ^{[17
]}

Eagen, Thomas J. ^{[18
]}

Elderkin, Ann L. ^{[19
]}

Fujita, Masaki ^{[20
]}

Greenspan, Susan L. ^{[21
]}

Halbout, Philippe ^{[22
]}

Hochberg, Marc C. ^{[23
,24
]}

Javaid, Muhammad ^{[25
]}

Jeray, Kyle J. ^{[26
]}

Kearns, Ann E. ^{[13
]}

King, Toby ^{[27
]}

Koinis, Thomas F. ^{[28
]}

Koontz, Jennifer Scott ^{[29
,30
]}

Kuzma, Martin ^{[31
]}

Lindsey, Carleen ^{[32
]}

Lorentzon, Mattias ^{[33
,34
,35
]}

Lyritis, George P. ^{[36
]}

Michaud, Laura Boehnke ^{[37
]}

Miciano, Armando ^{[38
]}

Morin, Suzanne N. ^{[39
]}

Mujahid, Nadia ^{[40
]}

Napoli, Nicola ^{[41
,42
]}

Olenginski, Thomas P. ^{[43
]}

Puzas, J. Edward ^{[11
]}

Rizou, Stavroula ^{[36
]}

Rosen, Clifford J. ^{[44
,45
]}

Saag, Kenneth ^{[46
]}

Thompson, Elizabeth ^{[47
]}

Tosi, Laura L. ^{[48
]}

Tracer, Howard ^{[49
]}

Khosla, Sundeep ^{[13
]}

Kiel, Douglas P. ^{[50
]}

机构：

[1] Ctr Med Technol Policy, Baltimore, MD USA

[2] Osteoporosis Ctr, Damascus, Syria

[3] McGuire VA Med Ctr, Richmond, VA USA

[4] Lund Univ, Lund, Scania, Sweden

[5] Skane Univ Hosp, Lund, Scania, Sweden

[6] Univ Connecticut, UConn Sch Nursing, Storrs, CT USA

[7] Mercyhurst Univ, Dept Phys Assistant Studies, Erie, PA USA

[8] Med Coll Wisconsin, Dept Endocrinol Metab & Clin Nutr, Milwaukee, WI 53226 USA

[9] Garvan Inst Med Res, Darlinghurst, NSW, Australia

[10] UCSF Fresno, Fresno, CA USA

[11] Univ Rochester, Med Ctr, Dept Orthopaed & Rehabil, Rochester, NY 14642 USA

[12] Univ Illinois, Div Nutr Sci, Urbana, IL 61801 USA

[13] Mayo Clin, Div Endocrinol Diabet Metab Nutr, Dept Internal Med, Rochester, MN USA

[14] Amer Bone Hlth, Raleigh, NC USA

[15] Univ Southampton, Southampton, Hants, England

[16] Univ Calif Los Angeles, Dept Med, Los Angeles, CA 90024 USA

[17] Univ Chicago Med, Dept Orthopaed Surg & Rehabil Med, Chicago, IL USA

[18] Natl Council Aging, New York, NY USA

[19] Amer Soc Bone & Mineral Res, Washington, DC USA

[20] Int Osteoporosis Fdn, Sci Dept, Nyon, Switzerland

[21] Univ Pittsburgh, Dept Med, Pittsburgh, PA USA

[22] Int Osteoporosis Fdn, Nyon, Switzerland

[23] Univ Maryland, Sch Med, Div Rheumatol, Baltimore, MD 21201 USA

[24] VA Maryland Hlth Care Syst, Baltimore, MD 21201 USA

[25] Univ Oxford, Nuffield Dept Orthopaed Rheumatol & Musculoskelet, Oxford, England

[26] Prisma Hlth Upstate, Greenville, SC USA

[27] US Bone & Joint Initiat, Rosemont, IL USA

[28] Duke Primary Care Oxford, Oxford, NC USA

[29] Newton Med Ctr, Orthoped & Sports Med, Newton, KS USA

[30] Univ Kansas, Sch Med, Dept Family & Community Med, Wichita, KS 67214 USA

[31] Comenius Univ, Univ Hosp, Dept Internal Med 5, Bratislava, Slovakia

[32] Bones Backs & Balance LLC, Bristol Phys Therapy LLC, Bristol, CT USA

[33] Australian Catholic Univ, Mary MacKillop Inst Hlth Res, Melbourne, Vic, Australia

[34] Sahlgrens Univ Hosp, Dept Geriatr Med, Molndal, Sweden

[35] Univ Gothenburg, Sahlgrenska Acad, Inst Med, Geriatr Med, Gothenburg, Sweden

[36] Hellen Osteoporosis Fdn, Athens, Greece

[37] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[38] Nevada Rehabil Inst, Las Vegas, NV USA

[39] McGill Univ, Dept Med, Montreal, PQ, Canada

[40] Brown Univ, Dept Med, Warren Alpert Med Sch, Providence, RI 02912 USA

[41] Campus Biomed Univ Rome, Dept Nutr & Metab Disorders, Rome, Italy

[42] Washington Univ, Sch Med, Dept Med, St Louis, MO 63110 USA

[43] Geisinger Hlth Syst, HiROC Program Rheumatol, Danville, PA USA

[44] Tufts Univ, Sch Med, Boston, MA 02111 USA

[45] Maine Med Ctr Res Inst, Portland, ME USA

[46] Univ Alabama Birmingham, Div Clin Immunol & Rheumatol, Birmingham, AL 35294 USA

[47] Natl Osteoporosis Fdn, Arlington, VA USA

[48] Childrens Natl Hosp, Dept Orthopaed Surg & Sports Med, Washington, DC USA

[49] Agcy Healthcare Res & Qual, Ctr Evidence & Practice Improvement, Rockville, MD 20857 USA

[50] Harvard Med Sch, Musculoskeletal Res Ctr, Marcus Inst Aging Res, Hebrew SeniorLife, 1200 Ctr St, Boston, MA 02131 USA

来源：

ORTHOPAEDIC NURSING | 2020年 / 39卷 / 03期

关键词：

AGING; ANABOLICS; ANTIRESORPTIVES; OSTEOPOROSIS; SECONDARY FRACTURE PREVENTION;

D O I：

10.1097/NOR.0000000000000672

中图分类号：

R47 [护理学];

学科分类号：

1011 ;

摘要：

Osteoporosis-related fractures are undertreated, due in part to misinformation about recommended approaches to patient care and discrepancies among treatment guidelines. To help bridge this gap and improve patient outcomes, the American Society for Bone and Mineral Research assembled a multistakeholder coalition to develop clinical recommendations for the optimal prevention of secondary fracture among people aged 65 years and older with a hip or vertebral fracture. The coalition developed 13 recommendations (7 primary and 6 secondary) strongly supported by the empirical literature. The coalition recommends increased communication with patients regarding fracture risk, mortality and morbidity outcomes, and fracture risk reduction. Risk assessment (including fall history) should occur at regular intervals with referral to physical and/or occupational therapy as appropriate. Oral, intravenous, and subcutaneous pharmacotherapies are efficacious and can reduce risk of future fracture. Patients need education, however, about the benefits and risks of both treatment and not receiving treatment. Oral bisphosphonates alendronate and risedronate are first-line options and are generally well tolerated; otherwise, intravenous zoledronic acid and subcutaneous denosumab can be considered. Anabolic agents are expensive butmay be beneficial for selected patients at high risk. Optimal duration of pharmacotherapy is unknown but because the risk for second fractures is highest in the early post-fracture period, prompt treatment is recommended. Adequate dietary or supplemental vitamin D and calciumin take should be assured. Individuals being treated for osteoporosis should be reevaluated for fracture risk routinely, including via patient education about osteoporosis and fractures and monitoring for adverse treatment effects. Patients should be strongly encouraged to avoid tobacco, consume alcohol in moderation at most, and engage in regular exercise and fall prevention strategies. Finally, referral to endocrinologists or other osteoporosis specialists may be warranted for individuals who experience repeated fracture or bone loss and those with complicating comorbidities (eg, hyperparathyroidism, chronic kidney disease). (c) 2019 American Society for Bone and Mineral Research.

引用

页码：145 / 161

页数：17

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