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fragility fractures

Risk Assessment, Prevention, and Treatment in Osteoporosis-Related Fractures

Teaser: 

Yan Gabriel Morais David Silva, MD,1 Ramon Guerra Barbosa, MD,2 Martin Kotochinsky, MD,3Lara Barbosa de Souza Moura Canas Lara, MS,4 Cloud Kennedy Couto de Sa, MD, PhD,5 Lucas Leal Varjão, MD,6 Kaike Lobo, MS,7 Eshita Sharma, MS,8Yasmin Picanço Silva, MD,9 Luis Fernando Weber de Oliveira, MD,10 Walter Fagundes, MD, PhD,11 Newton Godoy Pimenta, MD, PhD,12

1Spine Surgery - Hospital Ortopédico do Estado (Soc. Ben. Israelita Albert Einstein), Salvador, Bahia, Brazil.
2 Department of Neurosurgery, Hôpital de Chicoutimi, Quebec, Canada.

3 Department of Medicine, National University of Cuyo, Mendoza, Argentina.

4 State University of Feira de Santana (UEFS), Feira de Santana, Brazil.

5 Hospital Ortopédico do Estado (Soc. Ben. Israelita Albert Einstein), Salvador, Bahia, Brazil.
6 Hospital Ortopédico do Estado (Soc. Ben. Israelita Albert Einstein), Salvador, Bahia, Brazil.
7 State University of Pará, Belém, Brazil.
8 David Geffen School of Medicine at UCLA, Los Angeles, USA.
9 Healthcare Institution of South Iceland, Selfoss, Iceland.
10 Spine Surgery - Hospital Ortopédico do Estado (Soc. Ben. Israelita Albert Einstein), Salvador, Bahia, Brasil.
11 Department of Neurosurgery, Federal University of Espírito Santo, Espírito Santo, Vitória, Brazil.
12 Neurosurgery Division, University of Sherbrooke, Sherbrooke, Canada.

CLINICAL TOOLS

Abstract: Osteoporosis-related fractures represent a growing global health burden, requiring comprehensive strategies that span risk assessment, prevention, pharmacologic therapy, and surgical care. Dual-energy X-ray absorptiometry (DEXA) remains the diagnostic standard. However, fracture prediction improves when combined with clinical risk models, such as the Fracture Risk Assessment Tool (FRAX), QFracture, Garvan Risk Calculator, or a simplified assessment created by the Canadian Association of Radiologists and Osteoporosis Canada (CAROC). Effective prevention should be approached across the lifespan, maximizing peak bone mass in youth and attenuating later loss through lifestyle modifications. Pharmacologic therapy remains central to proper management while the treatment sequence, duration, and adverse effects necessitate individualized decision-making. In primary care, targeted screening of at-risk populations, systematic use of fracture risk calculators, prompt initiation of secondary prevention after sentinel fractures, and integration of multidisciplinary models are paramount.
Key Words: Osteoporosis, fragility fractures, DEXA, fracture risk calculators, pharmacologic therapy.

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Pre-test CME Quiz Post-test CME Quiz
Hip fractures in the elderly lead to a 17–30% one-year mortality.
The DEXA scan is the gold standard for identifying osteoporosis but fracture risk tools assist management.
Prevention includes early bone mass optimization; lifestyle measures and fall prevention in elderly.
Bisphosphonates are the first-line pharmacologic treatment.
Most vertebral fractures are treated conservatively; vertebroplasty/kyphoplasty should only be used for persistent pain.
About two thirds of vertebral fractures are silent so screening at-risk patients is important.
Calcium plus Vitamin D is more effective than calcium alone.
Fall-prevention strategies in the elderly such as balance, strength and environment modification reduce fracture risk more than drugs do.
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Related Terms: Back Health, osteoporosis, fragility fractures, DEXA, fracture risk calculators, pharmacologic therapy