The clinical pathway for fracture prevention consists of a 5-step approach: case finding, risk evaluation, differential diagnosis, treatment and follow up. For each of these steps new insights have emerged during the last year.
Epidemiologic studies have shown that not only fracture risk, but also mortality is increased after fracture, and that adequate therapy can not only decrease fracture risk but also increase survival.
Fracture risk is not constant over time. It is highest the years following a fracture, and immediately increases in some instances, such as after starting glucocorticoids or androgen deprivation therapy. This has raised the concept of “imminent” fracture risk, in contrast to long-term fracture risk as included in FRAX. In this context, we present the the EULAR initiative, in collaboration with EFORT, that published recommendations for multidisciplinary acute fracture care, including orthogeriatric care after hip fracture, and subsequent fracture prevention at the Fracture Liaison Service.
The presence, number and severity of vertebral fractures contribute to fracture risk, independent of BMD. Most vertebral fractures are subclinical and can therefore only be diagnosed by imaging of the spine. The role of vertebral fracture assessment (VFA) using DXA will be discussed.
New treatment insights will be reviewed, including for glucocorticoid users, combined and sequential treatments with anti-resorptive and bone forming drugs, real world data and the role of fall prevention.
Prescription of and adherence to treatment are still major issues. In patients adherent to therapy, new insights and recommendations will be reviewed on the need for early treatment, duration of treatment and the clinical approach when considering stopping drug therapy.
Disclosure of Interest P. Geusens Grant/research support from: Pfizer, Abbott, Lilly, Amgen, MSD, Will, Roche, UCB, BMS, Novartis, Consultant for: Amgen