Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices

Khan AA, Slart RH, Ali DS, Bock O, Carey JJ, Camacho P, Engelke K, Erba PA, Harvey NC, Lems WF, Morgan S, Moseley KF, O'Brien C, Probyn L, Punda M, Richmond B, Schousboe JT, Shuhart C, Ward KA, Lewiecki EM (2024)

Publication Type: Journal article, Review article

Publication year: 2024

Journal

Book Volume: 99

Pages Range: 1127-1141

Journal Issue: 7

DOI: 10.1016/j.mayocp.2024.01.011

Abstract

Osteoporotic fractures, also known as fragility fractures, are reflective of compromised bone strength and are associated with significant morbidity and mortality. Such fractures may be clinically silent, and others may present clinically with pain and deformity at the time of the injury. Unfortunately, and even at the time of detection, most individuals sustaining fragility fractures are not identified as having underlying metabolic bone disease and are not evaluated or treated to reduce the incidence of future fractures. A multidisciplinary international working group with representation from international societies dedicated to advancing the care of patients with metabolic bone disease has developed best practice recommendations for the diagnosis and evaluation of individuals with fragility fractures. A comprehensive narrative review was conducted to identify key articles on fragility fractures and their impact on the incidence of further fractures, morbidity, and mortality. This document represents consensus among the supporting societies and harmonizes best practice recommendations consistent with advances in research. A fragility fracture in an adult is an important predictor of future fractures and requires further evaluation and treatment of the underlying osteoporosis. It is important to recognize that most fragility fractures occur in patients with bone mineral density T scores higher than −2.5, and these fractures confirm the presence of skeletal fragility even in the presence of a well-maintained bone mineral density. Fragility fractures require further evaluation with exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture followed by appropriate pharmacological intervention designed to reduce the risk of future fracture. Because most low-trauma vertebral fractures do not present with pain, dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures. Given the importance of fractures in confirming skeletal fragility and predicting future events, it is recommended that an established classification system be used for fracture identification and reporting.

Authors with CRIS profile

Involved external institutions

McMaster University Canada (CA) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) Inselspital, Universitätsspital Bern Switzerland (CH) University of Galway (NUIG) / Ollscoil na Gaillimhe Ireland (IE) Loyola University Chicago United States (USA) (US) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB Italy (IT) MRC Lifecourse Epidemiology Unit (LEU) United Kingdom (GB) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra Netherlands (NL) University of Alabama at Birmingham (UAB) United States (USA) (US) Johns Hopkins University (JHU) United States (USA) (US) Brant Community Healthcare System Canada (CA) Sunnybrook Health Sciences Centre Canada (CA) Sisters of Charity Hospital / Klinički Bolnički Centar Sestre Milosrdnice (KBCSM) Croatia (HR) Cleveland Clinic United States (USA) (US) University of Minnesota (UMN) United States (USA) (US) New Mexico Clinical Research & Osteoporosis Center United States (USA) (US)

How to cite

APA:

Khan, A.A., Slart, R.H., Ali, D.S., Bock, O., Carey, J.J., Camacho, P.,... Lewiecki, E.M. (2024). Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices. Mayo Clinic Proceedings, 99(7), 1127-1141. https://doi.org/10.1016/j.mayocp.2024.01.011

MLA:

Khan, Aliya A., et al. "Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices." Mayo Clinic Proceedings 99.7 (2024): 1127-1141.

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