Osteoporosis and Compression Fracture Management

Introduction to Management

• The American College of Rheumatology recommends that patients with osteoporosis and compression fractures should be managed through a coordinated multidisciplinary approach, with orthopedic surgery handling acute fracture care and either endocrinology or rheumatology managing long-term osteoporosis treatment, coordinated by a designated lead clinician or fracture liaison service 1, 2, 3

Immediate Orthopedic Surgery Referral Required

• Patients with hip fractures requiring surgical intervention should be referred to orthopedic surgery immediately 1, 3, 6
• The European League Against Rheumatism (EULAR) guidelines recommend immediate referral to orthopedic surgery or neurosurgery for patients with neurological deficits, such as weakness, numbness, bowel/bladder dysfunction 4, 5

Conservative Management First (No Immediate Referral)

• For neurologically intact patients with osteoporotic compression fractures, the American Academy of Orthopaedic Surgeons recommends conservative management for the first 3 months, including calcitonin for pain control and analgesics and activity modification 3, 6, 7

Delayed Orthopedic Referral (After 3 Months)

• The American College of Rheumatology recommends referring patients to orthopedic surgery or interventional radiology if they experience severe worsening pain despite 3 months of conservative management 4, 5

Endocrinology/Rheumatology Referral for Osteoporosis Management

• The National Osteoporosis Foundation guidelines recommend that all patients aged 50+ with fragility fractures require systematic evaluation for osteoporosis and future fracture risk, including DXA scan, clinical risk factors, vertebral imaging, falls assessment, and screening for secondary osteoporosis 1, 2, 3, 6
• The European League Against Rheumatism (EULAR) guidelines emphasize that a designated coordinator should liaise between surgeons, rheumatologists/endocrinologists, geriatricians, and primary care to ensure comprehensive secondary fracture prevention 1, 2, 3, 6

Geriatrics Co-Management

• The American Geriatrics Society recommends that elderly patients with hip fractures should receive orthogeriatric co-management on dedicated wards, which provides shortest time to surgery, shortest hospital stay, and lowest inpatient and 1-year mortality 1, 3

Common Pitfalls

• The American College of Rheumatology guidelines highlight that failing to systematically evaluate all fragility fractures and missing secondary osteoporosis causes are common pitfalls in osteoporosis management 1, 2, 3, 6