Post-fracture patient follow-up

Background

Are we missing opportunities to prevent future fractures in patients with BMD T scores > -2.5?   

As Dr. Adachi mentioned in his video clip, advancing age and bone mineral density (BMD) are important risk factors contributing to future fragility fractures.¹ But we need to also be aware that many fragility fractures occur in those with a BMD in the non-osteoporotic range (T-score higher than -2.5).²

About 80% of fragility fractures in those over the age of 50 occur in women with BMD in the “osteopenia” range.^2. 

All patients with low trauma hip or vertebral fractures (regardless of BMD) are at high risk for future fracture and warrant initiation of therapy to prevent future fractures.²

If patients are on therapy when they experience a fragility fracture, re-evaluation of therapy should occur along with an assessment for secondary causes for bone loss or reduced bone quality (ie: low vitamin d levels, glucocorticoid use, smoking.

Patient education on the consequences of osteoporotic fractures and appropriate therapy is crucial to secondary preventative therapies:

Osteoporotic fractures are associated with loss of independence, reduced quality of life, admission to long term care, and death.³

When patients understand the facts of the disease and the available pharmaceutical therapies, they are more likely to adhere to appropriate therapy.³

Post-fracture patient follow-up for assessment of adherence is crucial to ensure efficacy of therapy and re-fracture rate reduction:

Patients often don’t tolerate oral therapy nor are they aware of the necessity of long-term therapy.⁴ Patients on denosumab therapy must be educated about the importance of consistent adherence required for therapeutic efficacy.⁴ Physicians must be made aware that “drug holidays” do not exist for this therapy in high-risk patients.⁴

Consistent follow up with post-fracture patients can improve therapeutic adherence along with the rate of re-fracture in these patients.⁴

About Expert

Jodie M. Reis BHK, MD, FRCPC

Dr. Jodie Reis is passionate about managing her patients bone health, including osteoporosis! She completed her medical school at the University of British Columbia and then went on to pursue a residency in both internal medicine and rheumatology, at the University of Saskatchewan. She has been mentored by international, osteoporosis experts Dr David Kendler, Dr Rick Adachi, Dr Aliya Khan and Dr Wojciech Olszynski, just to name a few. Dr Jodie Reis has a busy community rheumatology practice which focuses on various aspects of bone health along with inflammatory rheumatologic conditions. She is the physician lead for the Saskatoon Fracture Liaison Service (FLS) and has a devoted team of nurses who help her aid in secondary fracture prevention. She is committed to teaching both her patients and her medical colleagues. Along with her business partner, Dr Keltie Anderson, she is the associate program director for the rheumatology residency program at the University of Saskatchewan. Alongside all of this, she spends time with her husband, running around with their 4 busy children!

References

1. Adachi J, Brown J, Schemitsch E, et al. Fragility fracture identifies patients at imminent risk for subsequent fracture: real-world retrospective database study in Ontario, Canada. BMC Musculoskeletal Disorders 2021;22:224-33.
2. Camacho PM, Petak SM, Binkley N et al. American Association of Clinical Endocrinologists / American College of Endocrinology Clinical Practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis – 2020 update. Endo Pract 2020; 26 (Suppl 1):
3. https://osteoporosis.ca/about-the-disease/ Accessed April 13, 2022
4. https://fls.osteoporosis.ca/fls-tools-and-resources/educational-resources-for-healthcare-professionals-and-patients/ Accessed April 13, 2022