Table 3.

Management Options That Need to Be Considered for Patients at Risk of Fragility Fractures

Management for “at risk” of fracture group is holistic and includes recommendation of Engaging in discussion and informing the patient appropriately (via conversation and leaflets) Smoking cessation interventions where appropriate. It may be an additional encouragement for some to stop smoking Recommendation to increase activity (especially weight-bearing exercise) Offering referral to pulmonary rehabilitation (if not attended in the last year) Dietary optimisation Falls risk ± falls programme where applicable Frailty assessments ± optimisation where applicable Pharmacological elements: Medicines review Optimising inhaled corticosteroid dose Reviewing and monitor oral corticosteroid rescue courses Keeping any maintenance oral corticosteroids to a minimum Bisphosphonates but bearing in mind Adherence Side effects – especially gastro-oesophageal reflux disease and osteonecrosis. Combined with oral calcium and vitamin D – adequate vitamin D levels prior to initiating bisphosphonates reduce the risk of secondary hyperparathyroidism and increases the effectiveness of anti-resorptive medications Given for a certain duration but then drug holiday usually required Specialist Review required prior to anabolics and intravenous preparations