Patients 65 years of age or older with hip or spine fracture should be treated for osteoporosis

September 29, 2018

MONTRÉAL (29 September 2018)--A coalition of the world's top bone health experts, physicians, specialists, and patient advocacy groups today released their clinical recommendations to tackle the public health crisis in the treatment of osteoporosis and the debilitating and often deadly hip and spine fractures caused by the disease.

The recommendations from the American Society for Bone and Mineral Research Secondary Fracture Prevention Initiative Coalition - more than 40 top U.S. and international bone health experts, health care professional organizations and patient advocacy organizations dedicated to reducing avoidable secondary fractures - were presented at the ASBMR 2018 Annual Meeting in Montréal, the premier global scientific meeting on bone, mineral and musculoskeletal science. The full recommendations and more data about the crisis in osteoporosis treatment are available on the Coalition's new website:

The Coalition's recommendations are the first to outline the best course of clinical care for women and men, age 65 years or older, with a hip or vertebral (spine) fracture. They were developed in response to growing evidence of an alarming trend of an increase in the expected number of hip fractures and high-risk osteoporosis patients who need treatment but are either not being prescribed appropriate medications, or if prescribed, are simply not taking them despite research showing their effectiveness in preventing fractures. Recent patient surveys also show that critical information about the connection between osteoporosis and fracture risk is not getting through to patients.

"I think many people are shocked to learn that these conversations are not happening and simple steps not being taken," said Michael Econs, M.D., ASBMR President and Division Chief of the Division of Endocrinology and Metabolism and Professor of Medicine at the Indiana University School of Medicine. "As doctors, it's our duty to help our patients and their loved ones understand what they can do to prevent another fracture. We must do a better job communicating with them and one another to help rein in this crisis."

According to a recent survey by the National Osteoporosis Foundation, 96 percent of postmenopausal women who say they have not been diagnosed with osteoporosis and have experienced a fracture or break were not told by their doctor it could be linked to osteoporosis. The survey also found that one-third of women in the survey with a fracture were not referred for follow-up visits by health care providers.

"Heart attack patients don't leave the hospital without beta blockers to prevent another one. But every day, patients hospitalized for hip or spine fractures are not receiving treatments that research shows help prevent a second fracture that could lead to disability or death," said Coalition Co-Chair Douglas P. Kiel, M.D., MPH, and past President of ASBMR, who serves as the Director of the Musculoskeletal Research Center at the Institute for Aging Research, Hebrew SeniorLife and a Professor of Medicine at Harvard Medical School. "We've joined forces to provide a roadmap to ensure all care givers from orthopedists to primary care doctors, and many other health professionals, understand what they need to be doing to prevent fractures and how they can partner with patients to make informed choices about osteoporosis treatment options."

The ProblemThe Costs: Human and Economic

While osteoporosis is a highly treatable disease, it is on the rise globally and responsible for more than two million fractures in the United States alone. It is also one of the 10 most costly chronic conditions to Medicare.Barriers to Care

Although there are many reasons for the "gap" in the treatment of osteoporosis, a major factor is physician and patient concerns over the risk of very rare side effects, especially atypical femur fractures (AFFs) related to the use of osteoporosis drugs called bisphosphonates.

"Patients who have suffered hip or vertebral fractures are at very high risk for suffering from serious and life-threatening fractures in the first one to two years after those fractures. These recommendations focus on actions they can take to reduce their risk of future fractures, that include medication, exercise, nutrition, and reducing their risk of falling," said Sundeep Khosla, M.D., co-chair of the Coalition and past President of ASBMR, who serves as Director of the Center for Clinical and Translational Science at the Mayo Clinic in Rochester, Minnesota. "The research shows that risks for atypical femur fractures are very rare and the benefits of taking bisphosphonates far outweigh the risks."

The following top recommendations for clinical care for women and men, age 65 years or older, with a hip or vertebral fracture, were developed by Coalition members through a consensus process.

The ASBMR Secondary Fracture Prevention Initiative Clinical Care Recommendations

An overarching principle for these recommendations is that women and men, age 65 years or older, with a hip or vertebral fracture, optimally should be managed in the context of a multi-disciplinary clinical system that includes case management, such as a fracture liaison service, to assure that they are appropriately evaluated and treated for osteoporosis and risk of future fractures.

1. Communicate three simple messages to patients and their family/caregivers throughout the fracture care and healing process: 2. Ensure that the patient's primary healthcare provider is made aware of the occurrence of the fracture. If unable to determine whether the patient's primary healthcare provider has been notified, take action to be sure the communication is made.

3. Regularly assess the risk of falling of women and men, age 65 or older, who have ever had a hip or vertebral fracture. 4. Offer pharmacologic therapy for osteoporosis to women and men, age 65 years or older, with a hip or vertebral fracture, to reduce their risk of additional fractures. 5. Because osteoporosis is a life-long chronic condition, routinely follow and re-evaluate women and men, age 65 years or older, with a hip or vertebral fracture, who are being treated for osteoporosis. Purposes include: "All patients with hip or vertebral fractures need to be told that their broken bone most likely means they have osteoporosis and they are at very high risk for breaking more bones. Our goal is for patients, families, and their health care professionals to understand this and take actions to prevent future fractures, said Dr. Econs."

To read the full recommendations and learn more about the ASBMR Secondary Fracture Prevention Initiative, go to:
The American Society for Bone and Mineral Research (ASBMR) is the leading professional, scientific and medical society established to bring together clinical and experimental scientists involved in the study of bone, mineral and musculoskeletal research. ASBMR encourages and promotes the study of this expanding field through annual scientific meetings, an official journal (Journal of Bone and Mineral Research®), the Primer on Metabolic Bone Diseases and Disorders of Mineral Metabolism, advocacy and interaction with government agencies and related societies. To learn more about upcoming meetings and publications, please visit

American Society for Bone and Mineral Research

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