Management of proximal femoral fracture patiens and secondary prevention of fractures. II. Secondary antiosteoporotic care. Position Paper of the Czech Rheumatology Society, the Czech Society for Metabolic Bone Diseases, and Czech Society for Orthopedics and Traumatology
Abstract
Hip fractures disproportionately affect elderly male and female patients, and may result in impairment of mobility, loss of quality of life, increased health resource utilization and even in death. Despite strong evidence indicating that the occurrence of a hip fracture increases the risk of other osteoporotic fractures including recurrent hip fractures, secondary prevention of fractures in older patients with hip fractures is not adequately provided.
One explanation for this decrease is the perception that it is too late to alter the course of the disease in its late stage. The management of such patients should include assessing clinical diagnosis, treating osteoporosis and preventing falls.
Based on clinical trials and experience, this collective position of professional societies reviews the anti-fracture measures and efficacy and safety of antiosteoporotic agents in this high-risk elderly population of patients with recent low trauma hip fractures. Available pharmacological therapies for the treatment of osteoporosis include calcium and vitamin D, antiresorptive drugs such as bisphosphonates and denosumab, and the bone forming drug teriparatide.
Many elderly patients with established osteoporosis have multiple comorbid conditions, and demonstrated drug safety in this frail population is critically important.