Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Osteoporosis, frailty and fracture: implications for case finding and therapy

Abstract

In almost all patients with incident fractures, the absolute risk of subsequent fracture and mortality is highest immediately after the fracture is incurred; the risk is substantially increased in frail elderly patients. The risk factors for incident fractures, such as bone fragility, tendency to fall and the presence of metabolic bone disease, remain underdiagnosed and undertreated. Here, we review the evidence that demonstrates the influence of these risk factors on susceptibility to subsequent fracture and mortality after an incident fracture, and discuss the tools available to predict these outcomes. In this Review, we also propose a systematic, coordinator-based approach to assessment of risk, allocation of treatment and follow-up in all patients over 50 years of age who present with a fracture. The aim of this proposed multistep procedure is to improve the prevention of secondary fracture, decrease mortality rates and reduce patient undertreatment or overtreatment.

Key Points

  • Measurement of bone mineral density and diagnosis of concurrent vertebral fractures in patients with a recent fracture can contribute to selection of patients who might benefit from anti-osteoporotic therapy

  • Subsequent fracture risk is similar for men and women, and is highest immediately after a previous fracture; the increased risk has been observed for almost all clinical fractures

  • Mortality risk is highest in the first 5 years after fracture, depends on fracture location and severity, correlates with age at occurrence and is higher in males than females

  • Falls are a risk factor for fractures, however, no effect on fracture risk has been documented for fall prevention strategies that successfully reduce the risk of falls

  • 25% of patients over 50 years of age with a fracture had contributors to secondary osteoporosis, independent of sex, age, fracture type or bone mineral density

  • Anti-osteoporotic therapy is recommended for patients with a hip or vertebral fracture, or a nonhip, nonvertebral fracture and either a T-score ≤−2.5 or a high 10-year FRAX® fracture risk

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The relative risk of subsequent fracture after initial fracture is not constant over time.
Figure 2: Risk of mortality is highest immediately after fracture.
Figure 3: Mortality risk during follow-up subsequent to a recent fracture in men and women after correction for age and fracture location.
Figure 4: Contributors to SECOB in patients over the age of 50 years who presented with a fracture.
Figure 5: Newly diagnosed SECOB contributors (new SECOB) and vitamin D deficiency (serum 25(OH)D <50 nmol/l), according to gender, age, fracture location and skeletal status, in patients >50 years of age investigated after a recent fracture.
Figure 6: Secondary fracture prevention in patients over 50 years of age: a five-step approach.

Similar content being viewed by others

References

  1. van Staa, T. P., Dennison, E. M., Leufkens, H. G. & Cooper, C. Epidemiology of fractures in England and Wales. Bone 29, 517–522 (2001).

    Article  CAS  PubMed  Google Scholar 

  2. Kanis, J. A. & Johnell, O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos. Int. 16, 229–238 (2005).

    Article  CAS  PubMed  Google Scholar 

  3. Cauley, J. A. et al. Clinical risk factors for fractures in multi-ethnic women: the Women's Health Initiative. J. Bone Miner. Res. 22, 1816–1826 (2007).

    Article  PubMed  Google Scholar 

  4. Kanis, J. A. et al. International variations in hip fracture probabilities: implications for risk assessment. J. Bone Miner. Res. 17, 1237–1244 (2002).

    Article  PubMed  Google Scholar 

  5. Cummings, S. R. & Melton, L. J. Epidemiology and outcomes of osteoporotic fractures. Lancet 359, 1761–1767 (2002).

    Article  PubMed  Google Scholar 

  6. van den Bergh, J. P., Bours, S. P., van Geel, T. A. & Geusens, P. P. Optimal use of vitamin D when treating osteoporosis. Curr. Osteoporos. Rep. 9, 36–42 (2011).

    Article  PubMed  Google Scholar 

  7. Lyles, K. W. et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N. Engl. J. Med. 357, 1799–1809 (2007).

    Article  CAS  PubMed  Google Scholar 

  8. Stevenson, M. et al. A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis. Health Technol. Assess. 9, 1–160 (2005).

    Article  CAS  PubMed  Google Scholar 

  9. Silverman, S. L., Watts, N. B., Delmas, P. D., Lange, J. L. & Lindsay, R. Effectiveness of bisphosphonates on nonvertebral and hip fractures in the first year of therapy: the risedronate and alendronate (REAL) cohort study. Osteoporos. Int. 18, 25–34 (2007).

    Article  CAS  PubMed  Google Scholar 

  10. [No authors listed] Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ. Tech. Rep. Ser. 843, 1–129 (1994).

  11. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 285, 785–795 (2001).

  12. Writing Group for the ISCD Position Development Conference. Position statement: executive summary. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference. J. Clin. Densitom. 7, 7–12 (2004).

  13. Siris, E. S. et al. Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch. Intern. Med. 164, 1108–1112 (2004).

    Article  PubMed  Google Scholar 

  14. Bours, S. P. et al. Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture. J. Clin. Endocrinol. Metab. 96, 1360–1367 (2011).

    Article  CAS  PubMed  Google Scholar 

  15. van Helden, S. et al. Bone and fall-related fracture risks in women and men with a recent clinical fracture. J. Bone Joint Surg. Am. 90, 241–248 (2008).

    Article  PubMed  Google Scholar 

  16. Hegeman, J. H. et al. Effective tracing of osteoporosis at a fracture and osteoporosis clinic in Groningen; an analysis of the first 100 patients. Ned. Tijdschr. Geneeskd. 148, 2180–2185 (2004).

    CAS  PubMed  Google Scholar 

  17. Black, D. M. et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348, 1535–1541 (1996).

    Article  CAS  PubMed  Google Scholar 

  18. Black, D. M. et al. Fracture risk reduction with alendronate in women with osteoporosis: the Fracture Intervention Trial. FIT Research Group. J. Clin. Endocrinol. Metab. 85, 4118–4124 (2000).

    Article  CAS  PubMed  Google Scholar 

  19. Harris, S. T. et al. Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy With Risedronate Therapy (VERT) Study Group. JAMA 282, 1344–1352 (1999).

    Article  CAS  PubMed  Google Scholar 

  20. Meunier, P. J. et al. The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N. Engl. J. Med. 350, 459–468 (2004).

    Article  CAS  PubMed  Google Scholar 

  21. Ettinger, B. et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282, 637–645 (1999).

    Article  CAS  PubMed  Google Scholar 

  22. Goodman, R. L. The effect of risedronate on the risk of hip fracture in elderly women. N. Engl. J. Med. 344, 1720–1721 (2001).

    Article  CAS  PubMed  Google Scholar 

  23. Cummings, S. R. et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N. Engl. J. Med. 361, 756–765 (2009).

    Article  CAS  PubMed  Google Scholar 

  24. Kanis, J. A., Barton, I. P. & Johnell, O. Risedronate decreases fracture risk in patients selected solely on the basis of prior vertebral fracture. Osteoporos. Int. 16, 475–482 (2005).

    Article  CAS  PubMed  Google Scholar 

  25. Eastell, R. et al. Effect of once-yearly zoledronic acid five milligrams on fracture risk and change in femoral neck bone mineral density. J. Clin. Endocrinol. Metab. 94, 3215–3225 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. van Brussel, M. S. & Lems, W. F. Clinical relevance of diagnosing vertebral fractures by vertebral fracture assessment. Curr. Osteoporos. Rep. 7, 103–106 (2009).

    Article  PubMed  Google Scholar 

  27. Netelenbos, J. C. et al. Spine radiographs to improve the identification of women at high risk for fractures. Osteoporos. Int. 20, 1347–1352 (2009).

    Article  CAS  PubMed  Google Scholar 

  28. Koolhaas, W. et al. Efficient and improved diagnosis of osteoporosis by simultaneous bone density measurement and spinal morphometry. Ned. Tijdschr. Geneeskd. 152, 938–943 (2008).

    CAS  PubMed  Google Scholar 

  29. Greenspan, S. L., von Stetten, E., Emond, S. K., Jones, L. & Parker, R. A. Instant vertebral assessment: a noninvasive dual X-ray absorptiometry technique to avoid misclassification and clinical mismanagement of osteoporosis. J. Clin. Densitom. 4, 373–380 (2001).

    Article  CAS  PubMed  Google Scholar 

  30. Gallacher, S. J., Gallagher, A. P., McQuillian, C., Mitchell, P. J. & Dixon, T. The prevalence of vertebral fracture amongst patients presenting with non-vertebral fractures. Osteoporos. Int. 18, 185–192 (2007).

    Article  CAS  PubMed  Google Scholar 

  31. van den Berg, M. et al. Vertebral fractures in women aged 50 years and older with clinical risk factors for fractures in primary care. Maturitas 70, 74–79 (2011).

    Article  PubMed  Google Scholar 

  32. Klotzbuecher, C. M., Ross, P. D., Landsman, P. B., Abbott, T. A. 3rd & Berger, M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J. Bone Miner. Res. 15, 721–739 (2000).

    Article  CAS  PubMed  Google Scholar 

  33. Mackey, D. C. et al. High-trauma fractures and low bone mineral density in older women and men. JAMA 298, 2381–2388 (2007).

    Article  CAS  PubMed  Google Scholar 

  34. Johnell, O., Oden, A., Caulin, F. & Kanis, J. A. Acute and long-term increase in fracture risk after hospitalization for vertebral fracture. Osteoporos. Int. 12, 207–214 (2001).

    Article  CAS  PubMed  Google Scholar 

  35. Lindsay, R. et al. Risk of new vertebral fracture in the year following a fracture. JAMA 285, 320–323 (2001).

    Article  CAS  PubMed  Google Scholar 

  36. von Friesendorff, M., Besjakov, J. & Akesson, K. Long-term survival and fracture risk after hip fracture: a 22-year follow-up in women. J. Bone Miner. Res. 23, 1832–1841 (2008).

    Article  PubMed  Google Scholar 

  37. Ryg, J., Rejnmark, L., Overgaard, S., Brixen, K. & Vestergaard, P. Hip fracture patients at risk of second hip fracture: a nationwide population-based cohort study of 169,145 cases during 1977–2001. J. Bone Miner. Res. 24, 1299–1307 (2009).

    Article  PubMed  Google Scholar 

  38. van Geel, T. A., van Helden, S., Geusens, P. P., Winkens, B. & Dinant, G. J. Clinical subsequent fractures cluster in time after first fractures. Ann. Rheum. Dis. 68, 99–102 (2009).

    Article  CAS  PubMed  Google Scholar 

  39. Center, J. R., Bliuc, D., Nguyen, T. V. & Eisman, J. A. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297, 387–394 (2007).

    Article  CAS  PubMed  Google Scholar 

  40. Center, J. R., Nguyen, T. V., Schneider, D., Sambrook, P. N. & Eisman, J. A. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353, 878–882 (1999).

    Article  CAS  PubMed  Google Scholar 

  41. Morin, S. et al. Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos. Int. 22, 2439–2448 (2011).

    Article  CAS  PubMed  Google Scholar 

  42. Abrahamsen, B., van Staa, T., Ariely, R., Olson, M. & Cooper, C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporos. Int. 20, 1633–1650 (2009).

    Article  CAS  PubMed  Google Scholar 

  43. Huntjens, K. M. et al. Risk of subsequent fracture and mortality within 5 years after a non-vertebral fracture. Osteoporos. Int. 21, 2075–2082 (2010).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Leblanc, E. S. et al. Hip fracture and increased short-term but not long-term mortality in healthy older women. Arch. Intern. Med. 171, 1831–1837 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  45. Johnell, O. et al. Mortality after osteoporotic fractures. Osteoporos. Int. 15, 38–42 (2004).

    Article  CAS  PubMed  Google Scholar 

  46. Bliuc, D. et al. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 301, 513–21 (2009).

    Article  CAS  PubMed  Google Scholar 

  47. Center, J. R., Bliuc, D., Nguyen, N. D., Nguyen, T. V. & Eisman, J. A. Osteoporosis medication and reduced mortality risk in elderly women and men. J. Clin. Endocrinol. Metab. 96, 1006–1014 (2011).

    Article  CAS  PubMed  Google Scholar 

  48. Hogan, D. B., MacKnight, C. & Bergman, H. Models, definitions, and criteria of frailty. Aging Clin. Exp. Res. 15 (3 Suppl.), 1–29 (2003).

    PubMed  Google Scholar 

  49. Theou, O. et al. The effectiveness of exercise interventions for the management of frailty: a systematic review. J. Aging Res. http://dx.doi.org/10.4061/2011/569194.

  50. Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56, M146–M156 (2001).

    Article  CAS  PubMed  Google Scholar 

  51. Bandeen-Roche, K. et al. Phenotype of frailty: characterization in the women's health and aging studies. J. Gerontol. A Biol. Sci. Med. Sci. 61, 262–266 (2006).

    Article  PubMed  Google Scholar 

  52. Ensrud, K. E. et al. Frailty and risk of falls, fracture, and mortality in older women: the study of osteoporotic fractures. J. Gerontol. A Biol. Sci. Med. Sci. 62, 744–751 (2007).

    Article  PubMed  Google Scholar 

  53. Ensrud, K. E. et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch. Intern. Med. 168, 382–389 (2008).

    Article  PubMed  Google Scholar 

  54. Chen, J. S. et al. A selection strategy was developed for fracture reduction programs in frail older people. J. Clin. Epidemiol. 63, 679–685 (2010).

    Article  PubMed  Google Scholar 

  55. Chen, J. S. et al. Fracture risk assessment in frail older people using clinical risk factors. Age Ageing 37, 536–541 (2008).

    Article  PubMed  Google Scholar 

  56. Ensrud, K. E. et al. A comparison of frailty indexes for the prediction of falls, disability, fractures, and mortality in older men. J. Am. Geriatr. Soc. 57, 492–498 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  57. Chen, J. S. et al. Low-trauma fractures indicate increased risk of hip fracture in frail older people. J. Bone Miner. Res. 26, 428–433 (2011).

    Article  PubMed  Google Scholar 

  58. [No authors listed] The prevention of falls in later life. A report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan. Med. Bull. 34 (Suppl. 4), 1–24 (1987).

  59. Stalenhoef, P. A., Diederiks, J. P., Knottnerus, J. A., Kester, A. D. & Crebolder, H. F. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J. Clin. Epidemiol. 55, 1088–1094 (2002).

    Article  CAS  PubMed  Google Scholar 

  60. Graafmans, W. C. et al. Falls in the elderly: a prospective study of risk factors and risk profiles. Am. J. Epidemiol. 143, 1129–1136 (1996).

    Article  CAS  PubMed  Google Scholar 

  61. Tromp, A. M., Smit, J. H., Deeg, D. J., Bouter, L. M. & Lips, P. Predictors for falls and fractures in the Longitudinal Aging Study Amsterdam. J. Bone Miner. Res. 13, 1932–1939 (1998).

    Article  CAS  PubMed  Google Scholar 

  62. Stel, V. S., Smit, J. H., Pluijm, S. M. & Lips, P. Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing 33, 58–65 (2004).

    Article  PubMed  Google Scholar 

  63. Tinetti, M. E. & Williams, C. S. The effect of falls and fall injuries on functioning in community-dwelling older persons. J. Gerontol. A Biol. Sci. Med. Sci. 53, M112–M119 (1998).

    Article  CAS  PubMed  Google Scholar 

  64. Youm, T., Koval, K. J., Kummer, F. J. & Zuckerman, J. D. Do all hip fractures result from a fall? Am. J. Orthop. (Belle Mead, N. J.) 28, 190–194 (1999).

    CAS  Google Scholar 

  65. Parkkari, J. et al. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif. Tissue Int. 65, 183–187 (1999).

    Article  CAS  PubMed  Google Scholar 

  66. Schwartz, A. V., Nevitt, M. C., Brown, B. W., Jr. & Kelsey, J. L. Increased falling as a risk factor for fracture among older women: the study of osteoporotic fractures. Am. J. Epidemiol. 161, 180–185 (2005).

    Article  PubMed  Google Scholar 

  67. La Grow, S. J., Robertson, M. C., Campbell, A. J., Clarke, G. A. & Kerse, N. M. Reducing hazard related falls in people 75 years and older with significant visual impairment: how did a successful program work? Inj. Prev. 12, 296–301 (2006).

    Article  CAS  PubMed  Google Scholar 

  68. Gillespie, L. D. et al. Interventions for preventing falls in older people living in the community. Cochrane Database Systemic Reviews, Issue 2. Art. No.: CD007146 doi: 10.1002/14651858.CD007146.pub2 (2009).

  69. Cameron, I. D. et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Systemic Reviews, Issue 1. Art. No.: CD005465 doi: 10.1002/14651858.CD005465.pub2. (2010).

  70. Cummings, S. R. et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N. Engl. J. Med. 332, 767–773 (1995).

    Article  CAS  PubMed  Google Scholar 

  71. Kannus, P., Sievänen, H., Palvanen, M., Järvinen, T. & Parkkari, J. Prevention of falls and consequent injuries in elderly people. Lancet 366, 1885–1893 (2005).

    Article  PubMed  Google Scholar 

  72. Chang, J. T. et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 328, 680 (2004).

    Article  PubMed  PubMed Central  Google Scholar 

  73. Compston, J. et al. Guidelines for the diagnosis and management of osteoporosis in postmenopausal women and men from the age of 50 years in the UK. Maturitas 62, 105–108 (2009).

    Article  CAS  Google Scholar 

  74. Kanis, J. A. et al. Case finding for the management of osteoporosis with FRAX—assessment and intervention thresholds for the UK. Osteoporos. Int. 19, 1395–1408 (2008).

    Article  CAS  PubMed  Google Scholar 

  75. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis (National Osteoporosis Foundation, Washington, DC, 2008).

  76. Braun, J. & Pfeilschifter, J. Osteoporosis diagnosis and therapy according to the 2010 guidelines. Z. Rheumatol. 69, 327–339 (2010).

    Article  CAS  PubMed  Google Scholar 

  77. Tannenbaum, C. et al. Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J. Clin. Endocrinol. Metab. 87, 4431–4437 (2002).

    Article  CAS  PubMed  Google Scholar 

  78. Deutschmann, H. A. et al. Search for occult secondary osteoporosis: impact of identified possible risk factors on bone mineral density. J. Intern. Med. 252, 389–397 (2002).

    Article  CAS  PubMed  Google Scholar 

  79. Johnson, B. E., Lucasey, B., Robinson, R. G. & Lukert, B. P. Contributing diagnoses in osteoporosis. The value of a complete medical evaluation. Arch. Intern. Med. 149, 1069–1072 (1989).

    Article  CAS  PubMed  Google Scholar 

  80. Dumitrescu, B. et al. Evaluation of patients with a recent clinical fracture and osteoporosis, a multidisciplinary approach. BMC Musculoskelet. Disord. 9, 109 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  81. Becker, C. et al. Characteristics of elderly patients admitted to an urban tertiary care hospital with osteoporotic fractures: correlations with risk factors, fracture type, gender and ethnicity. Osteoporos. Int. 17, 410–416 (2006).

    Article  PubMed  Google Scholar 

  82. Edwards, B. J., Langman, C. B., Bunta, A. D., Vicuna, M. & Favus, M. Secondary contributors to bone loss in osteoporosis related hip fractures. Osteoporos. Int. 19, 991–999 (2008).

    Article  CAS  PubMed  Google Scholar 

  83. Kanis, J. A., on behalf of the World Health Organization Scientific Group (2008). Assessment of osteoporosis at the primary health care level. Technical Report. WHO Collaborating Centre. University of Sheffield, UK. http://www.shef.ac.uk/FRAX/ (2008).

  84. Nguyen, N. D., Frost, S. A., Center, J. R., Eisman, J. A. & Nguyen, T. V. Development of a nomogram for individualizing hip fracture risk in men and women. Osteoporos. Int. 18, 1109–1117 (2007).

    Article  CAS  PubMed  Google Scholar 

  85. Nguyen, N. D., Frost, S. A., Center, J. R., Eisman, J. A. & Nguyen, T. V. Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks. Osteoporos. Int. 19, 1431–1444 (2008).

    Article  CAS  PubMed  Google Scholar 

  86. van den Bergh, J. P., van Geel, T. A., Lems, W. F. & Geusens, P. P. Assessment of individual fracture risk: FRAX and beyond. Curr. Osteoporos. Rep. 8, 131–137 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  87. Kanis, J. A. et al. Interpretation and use of FRAX in clinical practice. Osteoporos. Int. 22, 2395–2411 (2011).

    Article  CAS  PubMed  Google Scholar 

  88. Abrahamsen, B. Screening: FRAX® in clinical practice. Nat. Rev. Rheumatol. 7, 686–688 (2011).

    Article  PubMed  Google Scholar 

  89. Dawson-Hughes, B. A revised clinician's guide to the prevention and treatment of osteoporosis. J. Clin. Endocrinol. Metab. 93, 2463–2465 (2008).

    Article  CAS  PubMed  Google Scholar 

  90. Kanis, J. A. & Reginster, J. Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women—what is the current message for clinical practice? Pol. Arch. Med. Wewn. 118, 538–540 (2008).

    PubMed  Google Scholar 

  91. Papaioannou, A. et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 182, 1864–1873 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  92. Werkgroep CBO. Richtlijn Osteoporose en Fractuurpreventie, derde herziening [Dutch]. (CBO, Utrecht, 2011).

  93. Kanis, J. A. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos. Int. 19, 399–428 (2008).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  94. McLellan, A. R. et al. Fracture liaison services for the evaluation and management of patients with osteoporotic fracture: a cost-effectiveness evaluation based on data collected over 8 years of service provision. Osteoporos. Int. 22, 2083–2098 (2011).

    Article  CAS  PubMed  Google Scholar 

  95. Majumdar, S. R. et al. Osteoporosis case manager for patients with hip fractures: results of a cost-effectiveness analysis conducted alongside a randomized trial. Arch. Intern. Med. 169, 25–31 (2009).

    Article  PubMed  Google Scholar 

  96. Sander, B., Elliot-Gibson, V., Beaton, D. E., Bogoch, E. R. & Maetzel, A. A coordinator program in post-fracture osteoporosis management improves outcomes and saves costs. J. Bone Joint Surg. Am. 90, 1197–1205 (2008).

    Article  PubMed  Google Scholar 

  97. Dell, R. Fracture prevention in Kaiser Permanente Southern California. Osteoporos. Int. 22 (Suppl. 3), 457–460 (2011).

    Article  PubMed  Google Scholar 

  98. Marsh, D. et al. Coordinator-based systems for secondary prevention in fragility fracture patients. Osteoporos. Int. 22, 2051–2065 (2011).

    Article  CAS  PubMed  Google Scholar 

  99. Che, M., Ettinger, B., Liang, J., Pressman, A. R. & Johnston, J. Outcomes of a disease-management program for patients with recent osteoporotic fracture. Osteoporos. Int. 17, 847–854 (2006).

    Article  CAS  PubMed  Google Scholar 

  100. Majumdar, S. R. et al. Multifaceted intervention to improve diagnosis and treatment of osteoporosis in patients with recent wrist fracture: a randomized controlled trial. CMAJ 178, 569–575 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  101. van Helden, S. et al. Risk of falling in patients with a recent fracture. BMC Musculoskelet. Disord. 8, 55 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  102. Huntjens, K. M. et al. Implementation of osteoporosis guidelines: a survey of five large fracture liaison services in the Netherlands. Osteoporos. Int. 22, 2129–2135 (2011).

    Article  CAS  PubMed  Google Scholar 

  103. Lewiecki, E. M. Risk communication and shared decision making in the care of patients with osteoporosis. J. Clin. Densitom. 13, 335–345 (2010).

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

J. P. van den Bergh researched the data for the article, J. P. van den Bergh and P. P Geusens contributed equally to writing of the article, and all authors provided a substantial contribution to the discussion of the content and to review and/or editing of the manuscript before submission.

Corresponding author

Correspondence to Joop P. van den Bergh.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van den Bergh, J., van Geel, T. & Geusens, P. Osteoporosis, frailty and fracture: implications for case finding and therapy. Nat Rev Rheumatol 8, 163–172 (2012). https://doi.org/10.1038/nrrheum.2011.217

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2011.217

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing