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Departments: Guest Editorial

Strong Bones Prevent Fractures

Editor(s): Pearce, Angela N. MS, RN, FNP-C, ONP-C; Trauma/Orthopaedic Nurse Practitioner, Parkland Health and Hospital System, Dallas, TX.

Author Information
doi: 10.1097/NOR.0000000000000659
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“We are only as strong as we are united, as weak as we are divided.”

—J. K. Rowling, Harry Potter and the Goblet of Fire (2005)

Angela N. Pearce, MS, RN, FNP-C, ONP-C,
Angela N. Pearce, MS, RN, FNP-C, ONP-C,:
Trauma/Orthopaedic Nurse Practitioner, Parkland Health and Hospital System, Dallas, TX.

We have a global crisis in the treatment of osteoporosis. This highly treatable disease is responsible for more than 2 million fractures per year in the United States alone and on the rise globally. Worldwide, osteoporosis causes more than 8.9 million fractures per year.

The disease burden of osteoporosis far exceeds that incurred by noncommunicable diseases; yet, the care gap from this deadly and debilitating disease is staggering and continues to grow (Adler et al., 2016).

Did you know that this year marks 50 years since the seminal discovery of bisphosphonates, a potent class of osteoporosis therapies, and cornerstone of therapy to date? Dual-energy x-ray absorptiometry (DXA) machines became available 35 years ago and densitometry-based definition of osteoporosis was coined 25 years ago. (T scores −2.5 standard deviations below a healthy 25-year-old woman.) FRAX launched 11 years ago to give a 10-year fracture risk for major fractures and hip fractures. Antiresorptive and anabolic bone-building pharmaceuticals are now increasingly available to treat these diagnoses.

Prevention of the second fracture is multifactorial. Patients and the public often have a poor understanding of osteoporosis and the fracture risk and therapies available. Healthcare providers need to stay current on available therapies and find the time to discuss prevention of falls and fracture risk. Healthcare systems need to be willing to support endeavors that prevent fractures and promote healthy lifestyles.

In September 2019, The American Society of Bone Mineral Research coalition of 39 healthcare organizations developed a series of consensus clinical recommendations for secondary fracture prevention (see Table 1). These recommendations pertain to people 65 years or older with hip or vertebral fractures. They are directed to all healthcare professionals who participate in the care of these patients (including, but not limited to, orthopaedic surgeons, rheumatologists, endocrinologists, family physicians and primary care providers, fracture liaison service coordinators, geriatricians, occupational therapists, physical therapists, rehabilitation therapists, emergency department physicians, gynecologists, hospitalists, infusion nurses, internists, neurosurgeons, nurse practitioners, dentists, oral and maxillofacial surgeons, pharmacists, physician assistants, radiologists, registered dietitian nutritionists, and chiropractors).

Table 1
Table 1:
Summary of Consensus Recommendations

The use of a Fracture Liaison Service ensures that the patient is appropriately evaluated and treated for osteoporosis and promotes the prevention of the second fracture.

We must stop this public health crisis by advocating for our vulnerable patients, provide frontline teaching, and find that “teachable moment” that prevents the second fracture and stops the revolving hospital door of untreated or undertreated osteoporotic fractures.

“Together we can make a difference.”

References

Adler R. A., El-Hajj Fuleihan G., Bauer D. C., Camacho P. M., Clarke B. L., Clines G. A., Compston J. E., Drake M. T., Edwards B. J., Favus M. J., Greenspan S. L., McKinney R. Jr., Pignolo R. J., Sellmeyer D. E. (2016). Managing osteoporosis in patients on long term bisphosphonate treatment: Report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research, 31(1), 16–35.
Conley R. B., Adib G., Adler R. A., Åkesson K. E., Alexander I. M., Amenta K. C., Blank R. D., Brox W. T., Carmody E. E., Chapman-Novakofski K., Clarke B. L., Cody K. M., Cooper C., Crandall C. J., Dirschl D. R., Eagen T. J., Elderkin A. L., Fujita M., Greenspan S. L., Halbout P., Kiel D. P. (2020). Secondary fracture prevention: Consensus clinical recommendations from a multistakeholder coalition. Journal of Bone and Mineral Research, 35(1), 36–52.

Suggested Readings

Compston J. E., McClung M. R., Leslie W. D. (2019). Osteoporosis. The Lancet, 393(10169), 364–376.
Eastell R., Rosen C. J., Black D. M., Cheung A. M., Murad H. M., Shoback D. (2019). Pharmacological management of osteoporosis in postmenopausal women: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 104(5), 1595–1622.
Harvey N. C., McCloskey E. V., Mitchell P. J., Dawson-Hughes B., Pierroz D. D., Reginster J. Y., Rizzoli R., Cooper C., Kanis J. A. (2017). Mind the (treatment) gap: A global perspective on current and future strategies for prevention of fragility fractures. Osteoporosis International, 28(5), 1507–1529.
Kanis J. A., Cooper C., Rizzoli R., Abrahamsen B., Al-Daghri N. M., Brandi M. L., Cannata-Andia J., Cortet B., Dimai H. P., Ferrari S., Hadji P., Harvey N. C., Kraenzlin M., Kurth A., McCloskey E., Minisola S., Thomas T., Reginster J. Y., & European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). (2017). Identification and management of patients at increased risk for osteoporotic fracture: Outcomes of an ESCEO expert consensus meeting. Osteoporosis International, 28(7), 2023–2034.
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