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Q J Med 2001; 94: 575-597
© 2001 Association of Physicians

Review

Secondary prevention of osteoporosis: when should a non-vertebral fracture be a trigger for action?

R. Eastell1,, D.M. Reid2, J. Compston3, C. Cooper4, I. Fogelman5, R.M. Francis6, S.M. Hay7, D.J. Hosking8, D.W. Purdie9, S.H. Ralston2, J. Reeve3, R.G.G. Russell1 and J.C. Stevenson10

1 From the University of Sheffield Medical School, Sheffield, 2 University of Aberdeen, Aberdeen, 3 University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, 4 University of Southampton, Southampton, 5 Guy's Hospital, London, 6 Freeman Hospital, Newcastle upon Tyne, 7 The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, and the Royal Shrewsbury Hospital, Shrewsbury, 8 Nottingham City Hospital, Nottingham, 9 Hull Royal Infirmary, Hull, and 10 Imperial College of Science, Technology and Medicine, London, UK

The burden of non-vertebral fractures is enormous. Hip fractures account for nearly 10% of all fractures (and a much greater proportion in the elderly), while wrist fractures may account for up to 23% of all limb fractures. The best available predictors of non-vertebral fracture risk are low BMD and a tendency to fall. Hip, forearm, proximal humerus and rib fractures have all been associated with low BMD, though ankle fracture is not strongly related to osteoporosis. Although clinical risk factors identify only about one-third of postmenopausal women at increased risk of osteoporotic fracture, the occurrence of one fracture commonly predicts a second fracture. Guidelines are presented for identifying and treating patients at risk of non-vertebral osteoporotic fractures, especially those with a previous fracture, based on the algorithm recently published by the Royal College of Physicians and the Bone and Tooth Society. Prevention of falls and use of external hip protectors may reduce the occurrence of hip fracture. Treatment options for patients presenting with hip fracture include HRT, bisphosphonates, and calcium plus vitamin D, and for Colles' fracture include general measures, HRT, bisphosphonates, or calcitonin plus calcium.

Address correspondence to Professor R. Eastell, University of Sheffield Medical School, Northen General Hospital, Herries Road, Sheffield S5 7AU. e-mail: r.eastell{at}sheffield.ac.uk


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