Feature Article

Preventing the fracture cascade

Veronica Wong, Kirtan Ganda



People who experience a minimal trauma (or osteoporotic) fracture are at least twice as likely to sustain further fractures, with significant associated morbidity and mortality. There are a range of safe and effective nonpharmacological and pharmacological strategies to reduce the risk of recurrent fracture. Therefore, patients with an incident osteoporotic fracture should be identified and treated early to prevent the fracture cascade.

Key Points

  • A minimal trauma fracture at any site increases the risk of sustaining further fractures by at least twofold, whereas vertebral and hip fractures increase the risk by at least fourfold.
  • Minimal trauma fractures are associated with significant morbidity and premature mortality.
  • Both nonpharmacological and pharmacological strategies can be used to manage osteoporosis and fracture risk, and interventions should be tailored to the patient’s risk level, preference, compliance, comorbidities and medication side effects.
  • Denosumab and bisphosphonates are both excellent pharmacological options for patients at high risk of osteoporotic fracture.
  • The duration of pharmacotherapy should be determined by balancing the risk of further fracture with the risk of short-term and long-term medication side effects.

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