Initial Management of Closed Complete Middle-Distal Third Humerus Fracture

Patient Assessment and Management

The American College of Rheumatology recommends glucocorticoid exposure assessment, including current dose, duration, and cumulative exposure, to define glucocorticoid-induced osteoporosis risk 2, 3
The American College of Cardiology recommends anticoagulation status assessment, including specific agent, dose, indication, and last dose timing, for surgical planning and bleeding risk assessment 1
The National Osteoporosis Foundation recommends prior fracture history assessment, including any previous fragility fractures, age at occurrence, and asymptomatic vertebral fractures, to guide osteoporosis management 2, 4
The American Geriatrics Society recommends functional status assessment, including baseline mobility, independence in ADLs, and living situation, to guide management decisions 1

The National Osteoporosis Foundation recommends calcium and vitamin D supplementation for all patients, with a target serum 25(OH)D level of ≥30 ng/mL 2, 3, 4, 1
The American College of Rheumatology recommends risk stratification for treatment intensity, including age, prior fractures, T-score, and FRAX score, to guide pharmacologic management 4
The National Osteoporosis Foundation recommends teriparatide or romosozumab as first-line treatment for very high-risk patients, with mandatory transition to bisphosphonate or denosumab after completion 4
The American College of Rheumatology recommends oral bisphosphonates as first-line treatment for high-risk patients, with denosumab as a second-line option 3, 4, 1

The American Geriatrics Society recommends fall prevention strategies, including home safety assessment, medication review, and vision and hearing assessment, to reduce fall risk 1
The National Osteoporosis Foundation recommends exercise prescription, including weight-bearing exercises, resistance training, and balance exercises, to improve bone density and reduce fall risk 3, 1
The American Heart Association recommends lifestyle modifications, including smoking cessation, alcohol reduction, and nutrition counseling, to improve overall health and reduce osteoporosis risk 2, 3, 1

The American Academy of Orthopaedic Surgeons recommends multidisciplinary coordination, including orthopedic surgery, rheumatology or endocrinology, nephrology, cardiology, primary care, and physical therapy, to provide comprehensive care 1
The National Osteoporosis Foundation recommends follow-up protocol, including fracture healing assessment, osteoporosis monitoring, and medication adherence assessment, to ensure optimal management 2, 1