News Reader.info

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 Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through

your institution Subscribe to this journal Receive 12 print issues and online access $209.00 per year only $17.42 per issue Learn more Buy this article * Purchase on SpringerLink * Instant

access to full article PDF Buy now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions *

Read our FAQs * Contact customer support SIMILAR CONTENT BEING VIEWED BY OTHERS RISK ANALYSIS FOR SUBSEQUENT FRACTURE OF OSTEOPOROTIC FRACTURES IN CHINESE WOMEN OVER AGE 60: A NATIONWIDE

CROSS-SECTIONAL STUDY Article Open access 10 June 2024 EVIDENCE-BASED GUIDELINE FOR THE MANAGEMENT OF OSTEOPOROSIS IN MEN Article 14 March 2024 A NEW CUT-OFF VALUE OF FRAX TOOLS AS AN

OSTEOPOROSIS SCREENING TOOL FOR THAI GERIATRIC POPULATION Article Open access 22 February 2025 REFERENCES * 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  * 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  * 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  * 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  * Cummings, S. R. & Melton, L. J. Epidemiology and outcomes of osteoporotic fractures.

_Lancet_ 359, 1761–1767 (2002). Article  PubMed  Google Scholar  * 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  * 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  * 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  * 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  * [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). * NIH Consensus Development Panel on Osteoporosis Prevention,

Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. _JAMA_ 285, 785–795 (2001). * 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). * 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  * 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  * 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  * 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  * 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  * 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  *

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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  *

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

  * 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  * 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  * 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  * 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  * 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  * 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  * 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  *

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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * Johnell, O. _ et al_. Mortality after osteoporotic fractures. _Osteoporos. Int._ 15, 38–42

(2004). Article  CAS  PubMed  Google Scholar  * 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  * 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  * 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  * 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. * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * [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). * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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  * 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). * 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). * 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  * 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  * 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  * 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  * 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  * National Osteoporosis Foundation. _Clinician's Guide to Prevention and Treatment of Osteoporosis_

(National Osteoporosis Foundation, Washington, DC, 2008). * Braun, J. & Pfeilschifter, J. Osteoporosis diagnosis and therapy according to the 2010 guidelines. _Z. Rheumatol._ 69, 327–339

(2010). Article  CAS  PubMed  Google Scholar  * 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  * 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  * 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  * 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  *

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  * 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  * 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). *

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  * 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  * 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  * Kanis, J. A. _ et al_.

Interpretation and use of FRAX in clinical practice. _Osteoporos. Int._ 22, 2395–2411 (2011). Article  CAS  PubMed  Google Scholar  * Abrahamsen, B. Screening: FRAX® in clinical practice.

_Nat. Rev. Rheumatol._ 7, 686–688 (2011). Article  PubMed  Google Scholar  * 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  * 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  * 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  * Werkgroep CBO.

_Richtlijn Osteoporose en Fractuurpreventie_, derde herziening [Dutch]. (CBO, Utrecht, 2011). * 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  * 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  * 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  * 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  * Dell, R. Fracture

prevention in Kaiser Permanente Southern California. _Osteoporos. Int._ 22 (Suppl. 3), 457–460 (2011). Article  PubMed  Google Scholar  * 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  * 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  * 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  * 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  * 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  * 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 * Department of Internal Medicine, VieCuri, Medical

Center Noord-Limburg, PO Box 1926, Venlo, 5900 BX, The Netherlands Joop P. van den Bergh * Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht

University, PO Box 616, Maastricht, 6200 MD, The Netherlands Tineke A. van Geel * Department of Internal Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO

Box 616, Maastricht, 6200 MD, The Netherlands Piet P. Geusens Authors * Joop P. van den Bergh View author publications You can also search for this author inPubMed Google Scholar * Tineke

A. van Geel View author publications You can also search for this author inPubMed Google Scholar * Piet P. Geusens View author publications You can also search for this author inPubMed 

Google Scholar 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: 17 January 2012 * Issue Date: March 2012 * DOI: https://doi.org/10.1038/nrrheum.2011.217 SHARE THIS ARTICLE Anyone you

share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the

Springer Nature SharedIt content-sharing initiative