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Chapter 41 Video 2: What Constitutes Orthopaedic Management When a Patient Presents with a Fragility Fracture?

January 05, 2018

Contributors: Joseph M Lane, MD

Bone strength is determined by bone quality and bone mineral density, and the probability of future fractures increases after an initial fracture. It is important for orthopaedists and trauma teams to assume responsibility in the prevention of future fractures in fracture patients, especially since osteoporotic fractures pose a lifetime risk of death comparable to breast cancer. Agents against osteoporosis are categorized as either antiresorption (bisphosphonates, Denosumab, selective estrogen receptor modulators) or as bone stimulating (PTH, strontium ranelate). Bisphosphonates maintain bone mass and increase mineralization, but do not increase bone mass. Denosumab has a short half-life and does increase bone density. PTH is the only real anabolic agent for bone, increasing bone mass, decreasing fracture rates, and enhancing fracture healing and spine fusion. It is important to talk to family members regarding medication adherence as many fracture patients may also suffer from dementia.

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