Osteoporosis Evaluation and Treatment in Proximal Humerus Fracture

Acute Fracture Management

Conservative therapy is appropriate for most proximal humerus fractures, as acute symptoms subside over 6-8 weeks as the fracture heals, according to the American College of Neurointerventional Surgery 1, 2

The American College of Radiology recommends obtaining a DXA scan of spine and hip to measure bone mineral density, and calculating 10-year fracture risk using FRAX, for patients with proximal humerus fractures 3, 4
Vertebral imaging should be performed to identify silent vertebral compression fractures, as recommended by the American College of Radiology 3, 4

Pharmacologic treatment is indicated if T-score ≤ -2.5 at spine or hip, or FRAX 10-year risk ≥20% for major osteoporotic fracture OR ≥3% for hip fracture, according to the American College of Radiology 3, 4
The American College of Radiology also recommends pharmacologic treatment for patients with a history of fragility fracture 3, 4

First-line pharmacologic therapy is oral bisphosphonate (alendronate or risedronate), as recommended by the American College of Rheumatology 5, 6
Alternative therapies include IV bisphosphonates (zoledronic acid), teriparatide, and denosumab, in order of preference, according to the American College of Rheumatology 5, 6
All patients require calcium 1,000-1,200 mg/day, vitamin D 600-800 IU/day, weight-bearing exercise as tolerated, smoking cessation, and alcohol limitation, as recommended by the American College of Rheumatology 5, 6

Establishing a Fracture Liaison Service (FLS) approach with a dedicated coordinator can ensure osteoporosis evaluation is completed, treatment is initiated, and primary care physician is notified, as recommended by the European League Against Rheumatism 7, 4

Delaying osteoporosis evaluation can increase the risk of subsequent fracture, with a 20% risk of another vertebral fracture within 12 months, according to the American College of Neurointerventional Surgery 1, 2, 4
Prolonged bed rest should be avoided, as it can cause significant loss of lower extremity strength and aerobic capacity, equivalent to a decade of age-related decline, according to the American College of Neurointerventional Surgery 1, 2