Osteoporosis, characterised by a low bone mineral density and decreased bone quality, occurs frequently in the elderly. It is estimated that due to the ageing of the population, the number of fractures may rise 30—40% in Europe in the coming 15 years.
For the primary prevention of fractures (in patients without a recent fracture) it is crucial to select those patients at high risk for fractures. Apart from ageing, low body mass, familary osteoporosis, elevated fall risk, and immobility, comorbidity (including inflammatory rheumatic diseases) and comedication (among which glucocorticoids) are also important risk factors. With FRAX it might useful to calculate the 10-years major- and hipfracture risk in individual patients. Primary prevention can be limited by suboptimal selection of patients, while adherence to treatment is another serious issue.
The risk of a subsequent fracture is increased after an incident fracture; unfortunately the routinely performing of investigations to underlying osteoporosis (DXA) occurs only in minority of patients. This is even more striking since effective, relatively safe, and non-expensive drugs are available.
One of the most attractive options is to start with a fracture liaison service, in with all patients 50 years and over with a recent fracture will be systematically investigated for low BMD and other risk factors for future fractures, such as elevated fall risk, secondary osteoporosis and vertebral fractures.
Currently a working group is formulating a combined set of EULAR-EFORT recommendations not only on the surgical treatment of fractures, but also on the diagnosis and treatment of osteoporosis in patients 50 years and over with a recent fracture. We hope that these recommendations are helpful in daily practice for orthopaedics, reumatologists and others who are trying to optimalize the care of fracture patients
Disclosure of Interest W. Lems Speakers bureau: Amgen, Eli Lilly, Merck, Servier, Will Pharma, Novartis.