For the first fracture to be the last

Abstract

Increased longevity has made progression in the number of fractures increasingly significant. Because hip fractures give rise to high morbidity and mortality rates and have high treatment costs, their occurrence is the most important marker of effectiveness in relation to osteoporosis treatment. In countries and systems that, especially over the last decade, have been investing in the prevention of osteoporosis and its consequences, the number of hip fractures has been decreasing. What these countries have in common is secondary prevention of fractures, i.e. to avoid subsequent fractures. Given that half of the patients who present hip fractures have had a previous fracture and that the treatments available have proven to be extremely efficient for decreasing subsequent fractures, a good proportion of hip fractures are preventable. It is within this scenario that orthopedists play a leading role.

Primary and secondary osteoporotic fractures prophylaxis: evaluation of a prospective cohort

“…Bone fragility fractures can be considered a public health problem, with an estimated annual incidence of 3% in women aged at least 85 years, in the proportion of 3:1 compared to men, 11 , 12 with a direct cost to Brazil's Public Health System of approximately 30 million dollars annually. 3 , 13 This disease prevention is of paramount importance, since it can improve a patient's quality of life, as well as reduce morbidity and mortality. 14 In addition, the epidemiological transition to the Brazilian population, with the increase in the number of elderly people, implies the need to create strategies to control the risk of primary and secondary fractures.…”

“…We observed a low frequency of indication of secondary fracture prophylaxis (beginning of treatment after the first fracture) in our cohort. Stolnicki and Oliveira 13 say that a second episode of fracture may occur within a short interval, especially during the first year. The earlier the secondary drug prophylaxis is established, the better, because the risk of recurrence decreases 30% to 60%.…”

“…The earlier the secondary drug prophylaxis is established, the better, because the risk of recurrence decreases 30% to 60%. 13 Initially, the aim of the study was to identify possible factors related to the eventual failure of this indication. For this, we calculated a sample of 100 patients and a follow-up of one year.…”

“…In our hospital, the measures included a series of educational lectures for orthopedists and residents involved, as well as the creation of a reference clinic for the prevention of secondary fractures, inspired by programs such as Prevfrat. 13 The impacts of these measures will be evaluated in future studies. Nevertheless, we have decided to publish our findings, because we believe that this scenario is probably present in several hospitals in the country.…”

Consensus statement: osteoporosis prevention and treatment in Latin America—current structure and future directions

“…A recent prospective observational study of > 60,000 women aged ≥ 55 years, recruited from 723 primary physician practices in 10 countries, reported that less than 20% of women with new fractures received an osteoporosis diagnosis and treatment [ 27 ]. There is a paucity of data about this situation among LA countries, but, at least in the Brazilian experience, the majority of patients with fractures due to fragility are neither evaluated nor treated for osteoporosis or for the prevention of subsequent falls [ 28 ].…”