Interventions to improve treatment of osteoporosis following fracture

Objective: To review the approach to osteoporosis treatment following fracture. Methods: Review of the literature. Results: Despite the tremendous medical and economic impact of osteoporotic fractures, the majority of older patients with fragility fractures do not subsequently receive appropriate evaluation and therapy for osteoporosis. Relatively simple interventions can increase the likelihood that a patient who sustains a fracture will receive subsequent evaluation and therapy; however, the implementation of interdisciplinary approaches and coordination of fracture treatment among primary care providers, orthopedists, metabolic bone experts, dietitians, physical therapists, and other pertinent health care professionals has been a challenge for health care delivery systems. The comprehensive management of osteoporosis includes evaluation of bone mineral density, assessment for secondary causes of low bone density, initiation of nonpharmacologic therapies such as improved nutrition and physical activity, and selection of appropriate pharmacologic therapy. Effective pharmacologic options now include oral or intravenous bisphosphonates, anabolic therapy with parathyroid hormone, selective estrogen receptor modulator therapy with raloxifene, intranasal calcitonin, and estrogen therapy. Conclusion: Individual clinicians and health systems alike must minimize missed opportunities for meaningful secondary prevention of fractures, especially as the options expand for safe and efficacious treatment of osteoporosis.