Skip to main content
SpringerLink
Log in

Evaluation of Bone Fragility and Fracture Prevention

  • Chapter
  • First Online:
Fractures in the Elderly

Part of the book series: Aging Medicine ((AGME))

Abstract

Patients with osteoporotic fractures are much more likely to sustain ­additional fractures; therefore both appropriate treatment and prevention of future fractures (which takes into account the method of injury) need to be addressed. These patients are also much more likely to have underlying secondary causes for bone loss that need to be diagnosed and treated, as well as other multiple risk ­factors that should be uncovered and modified if possible. Finally, clinical pathways that unite orthopedic surgeons and medical specialists in osteoporosis care are necessary to target patients with osteoporotic fractures for evaluation and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. National Osteoporosis Foundation. America’s bone health: The state of osteoporosis and low bone mass in our nation. 2002; Washington, DC: National Osteoporosis Foundation.

    Google Scholar 

  2. Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995; 17:505S–11S.

    Article  CAS  PubMed  Google Scholar 

  3. Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES. Impact of recent fracture on health-related quality of life in postmenopausal women. J Bone Miner Res 2006; 21:809–16.

    Article  PubMed  Google Scholar 

  4. Klotzbuecher CM, Ross PD, Landsman PB, Abbott TA 3rd, Berger M. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res 2000; 15:721–39.

    Article  CAS  PubMed  Google Scholar 

  5. van Staa TP, Leufkens HG, Cooper C. Does a fracture at one site predict later fractures at other sites? A British cohort study. Osteoporos Int 2002; 13:624–9.

    Article  CAS  PubMed  Google Scholar 

  6. Bouxsein ML, Kaufman J, Tosi L, Cummings S, Lane J, Johnell O. Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture. J Am Acad Orthop Surg 2004; 12:385–95.

    PubMed  Google Scholar 

  7. Center JR, Bliuc D, Nguyen TV, Eisman JA. Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 2007; 297:387–94.

    Article  CAS  PubMed  Google Scholar 

  8. Siris ES, Bilezikian JP, Rubin MR, Black DM, Bockman RS, Bone HG, et al. Pins and ­plaster aren’t enough: a call for the evaluation and treatment of patients with osteoporotic fractures. J Clin Endocrinol Metab 2003; 88:3482–6.

    Article  CAS  PubMed  Google Scholar 

  9. Delmas PD, van de Langerijt L, Watts NB, Eastell R, Genant H, Grauer A, et al. Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res 2005; 20:557–63.

    Article  PubMed  Google Scholar 

  10. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 2000; 82-A:1063–70.

    CAS  PubMed  Google Scholar 

  11. Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 1995; 332:767–73.

    Article  CAS  PubMed  Google Scholar 

  12. Galabova V, Steiner E, Carson L, Schwab EP, Pignolo RJ. Spectrum of minimal trauma fractures. J Am Geriatr Soc 2004; 52:S23–24, Abstract.

    Google Scholar 

  13. Anonymous. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001; 285:785–95.

    Google Scholar 

  14. Robbins J, Aragaki AK, Kooperberg C, Watts N, Wactawski-Wende J, Jackson RD, et al. Factors associated with 5-year risk of hip fracture in postmenopausal women. JAMA 2007; 298:2389–98.

    Article  CAS  PubMed  Google Scholar 

  15. Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP. Evaluation of ­decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 2001; 286:57–63.

    Article  CAS  PubMed  Google Scholar 

  16. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ 2000; 162:1289–94.

    CAS  PubMed  Google Scholar 

  17. Geusens P, Hochberg MC, van der Voort DJ, Pols H, van der Klift M, Siris E, et al. Performance of risk indices for identifying low bone density in postmenopausal women. Mayo Clin Proc 2002; 77:629–37.

    Article  PubMed  Google Scholar 

  18. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care 1998; 4:37–48.

    CAS  PubMed  Google Scholar 

  19. Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, et al. A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 2001; 12:699–705.

    Article  CAS  PubMed  Google Scholar 

  20. Sedrine WB, Chevallier T, Zegels B, Kvasz A, Micheletti MC, Gelas B, et al. Development and assessment of the Osteoporosis Index of Risk (OSIRIS) to facilitate selection of women for bone densitometry. Gynecol Endocrinol 2002; 16:245–50.

    CAS  PubMed  Google Scholar 

  21. Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 1999; 353:878–82.

    Article  CAS  PubMed  Google Scholar 

  22. Fitzpatrick LA. Secondary causes of osteoporosis. Mayo Clin Proc 2002; 77:453–68.

    Article  PubMed  Google Scholar 

  23. Lawson J. Drug-induced metabolic bone disorders. Semin Musculoskelet Radiol 2002; 6:285–97.

    Article  PubMed  Google Scholar 

  24. Bannwarth B. Drug-induced musculoskeletal disorders. Drug Saf 2007; 30:27–46.

    Article  CAS  PubMed  Google Scholar 

  25. Canalis E, Mazziotti G, Giustina A, Bilezikian JP. Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 2007; 18:1319–28.

    Article  CAS  PubMed  Google Scholar 

  26. Cohen A, Shane E. Osteoporosis after solid organ and bone marrow transplantation. Osteoporos Int 2003; 14:617–30.

    Article  PubMed  Google Scholar 

  27. Green AD, Colon-Emeric CS, Bastian L, Drake MT, Lyles KW. Does this woman have osteoporosis? JAMA 2004; 292:2890–900.

    Article  CAS  PubMed  Google Scholar 

  28. Tannenbaum C, Clark J, Schwartzman K, Wallenstein S, Lapinski R, Meier D, et al. Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab 2002; 87:4431–7.

    Article  CAS  PubMed  Google Scholar 

  29. Jamal SA, Leiter RE, Bayoumi AM, Bauer DC, Cummings SR. Clinical utility of laboratory testing in women with osteoporosis. Osteoporos Int 2005; 16:534–40.

    Article  PubMed  Google Scholar 

  30. Benito M, Vasilic B, Wehrli FW, Bunker B, Wald M, Gomberg B, et al. Effect of testosterone replacement on trabecular architecture in hypogonadal men. J Bone Miner Res 2005; 20:1785–91.

    Article  CAS  PubMed  Google Scholar 

  31. Bellantonio S, Fortinsky R, Prestwood K. How well are community-living women treated for osteoporosis after hip fracture? J Am Geriatr Soc 2001; 49:1197–204.

    Article  CAS  PubMed  Google Scholar 

  32. Chevalley T, Hoffmeyer P, Bonjour JP, Rizzoli R. An osteoporosis clinical pathway for the medical management of patients with low-trauma fracture. Osteoporos Int 2002; 13:450–5.

    Article  CAS  PubMed  Google Scholar 

  33. McLellan AR, Gallacher SJ, Fraser M, McQuillian C. The fracture liaison service: success of a program for the evaluation and management of patients with osteoporotic fracture. Osteoporos Int 2003; 14:1028–34.

    Article  PubMed  Google Scholar 

  34. Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM. Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 2006; 88:25–34.

    Article  PubMed  Google Scholar 

  35. Elliot-Gibson VIM, Jain RJF, Beaton1 DE, Bogoch ER, Richie S, F. Samji F. Osteoporosis post-fracture screening program. J Bone Miner Res 2007; 22:S311, Abstract.

    Google Scholar 

  36. Nanci V, Berry G, Harvey E, Goltzman D, Morin SN. A novel integrated approach to the management of patients following hip fracture: The Hip Fracture Integrated Intervention Program (HIIP). J Bone Miner Res 2007; 22:S312, Abstract.

    Google Scholar 

  37. Glowacki J, Harris MB, Simon JB, Kolatkar NS, Thornhill TS, LeBoff MS. Osteoporosis care pathways for hospital patients with fragility fractures: a paradigm shift. J Bone Miner Res 2007; 22:S334, Abstract.

    Google Scholar 

  38. Skedros JG, Holyoak JD, Pitts TC. Knowledge and opinions of orthopaedic surgeons ­concerning medical evaluation and treatment of patients with osteoporotic fracture. J Bone Joint Surg Am 2006; 88:18–24.

    Article  PubMed  Google Scholar 

  39. Langridge CR, McQuillian C, Watson WS, Walker B, Mitchell L, Gallacher SJ. Refracture following fracture liaison service assessment illustrates the requirement for integrated falls and fracture services. Calcif Tissue Int 2007; 81:85–91.

    Article  CAS  PubMed  Google Scholar 

  40. Gloth FM 3rd, Gundberg CM, Hollis BW, Haddad JG Jr, Tobin JD. Vitamin D deficiency in homebound elderly persons. JAMA 1995; 274:1683–6.

    Article  PubMed  Google Scholar 

  41. Ooms ME, Lips P, Roos JC, van der Vijgh WJ, Popp-Snijders C, Bezemer PD, et al. Vitamin D status and sex hormone binding globulin: determinants of bone turnover and bone mineral ­density in elderly women. J Bone Miner Res 1995; 10:1177–84.

    Article  CAS  PubMed  Google Scholar 

  42. Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 2002; 23:552–9.

    Article  CAS  PubMed  Google Scholar 

  43. Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (randomised evaluation of calcium or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005; 365:1621–8.

    Article  CAS  PubMed  Google Scholar 

  44. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized ­controlled trials. JAMA 2005; 293:2257–64.

    Article  CAS  PubMed  Google Scholar 

  45. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007; 370:657–66.

    Article  CAS  PubMed  Google Scholar 

  46. Hannan MT, Tucker KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP. Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000; 15:2504–12.

    Article  CAS  PubMed  Google Scholar 

  47. Dawson-Hughes B, Harris SS. Calcium intake influences the association of protein intake with rates of bone loss in elderly men and women. Am J Clin Nutr 2002; 75:773–9.

    CAS  PubMed  Google Scholar 

  48. Carter JD, Vasey FB, Valeriano J. The effect of a low-carbohydrate diet on bone turnover. Osteoporos Int 2006; 17:1398–403.

    Article  CAS  PubMed  Google Scholar 

  49. Delmi M, Rapin CH, Bengoa JM, Delmas PD, Vasey H, Bonjour JP. Dietary supplementation in elderly patients with fractured neck of the femur. Lancet 1990; 335:1013–6.

    Article  CAS  PubMed  Google Scholar 

  50. Rico H, Revilla M, Villa LF, Hernandez ER, Fernandez JP. Crush fracture syndrome in senile osteoporosis: a nutritional consequence? J Bone Miner Res 1992; 7:317–9.

    Article  CAS  PubMed  Google Scholar 

  51. Bastow MD, Rawlings J, Allison SP. Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial. Br Med J (Clin Res Ed) 1983; 287:1589–92.

    Article  CAS  Google Scholar 

  52. Barger-Lux MJ, Heaney RP, Stegman MR. Effects of moderate caffeine intake on the ­calcium economy of premenopausal women. Am J Clin Nutr 1990; 52:722–5.

    CAS  PubMed  Google Scholar 

  53. Heaney RP, Rafferty K. Carbonated beverages and urinary calcium excretion. Am J Clin Nutr 2001; 74:343–7.

    CAS  PubMed  Google Scholar 

  54. Lyles KW, Colon-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med 2007; 357:1799–809.

    Article  CAS  PubMed  Google Scholar 

  55. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin Endocrinol Metab 2005; 90:1294–301.

    Article  CAS  PubMed  Google Scholar 

  56. Ott SM. Long-term safety of bisphosphonates. J Clin Endocrinol Metab 2005; 90:1897–9.

    Article  CAS  PubMed  Google Scholar 

  57. Goh SK, Yang KY, Koh JS, Wong MK, Chua SY, Chua DT, et al. Subtrochanteric insufficiency fractures in patients on alendronate therapy: a caution. J Bone Joint Surg Br 2007; 89:349–53.

    Article  PubMed  Google Scholar 

  58. Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, et al. Ten years’ experience with alendronate for osteoporosis in postmenopausal women. N Engl J Med 2004; 350:1189–99.

    Article  CAS  PubMed  Google Scholar 

  59. Rodan G, Reszka A, Golub E, Rizzoli R. Bone safety of long-term bisphosphonate ­treatment. Curr Med Res Opin 2004; 20:1291–300.

    Article  CAS  PubMed  Google Scholar 

  60. Black DM, Schwartz AV, Ensrud KE, Cauley JA, Levis S, Quandt SA, et al. Effects of ­continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006; 296:2927–38.

    Article  CAS  PubMed  Google Scholar 

  61. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002; 288:321–33.

    Article  CAS  PubMed  Google Scholar 

  62. Cauley JA, Robbins J, Chen Z, Cummings SR, Jackson RD, LaCroix AZ, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. JAMA 2003; 290:1729–38.

    Article  CAS  PubMed  Google Scholar 

  63. Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004; 291:1701–12.

    Article  CAS  PubMed  Google Scholar 

  64. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282:637–45.

    Article  CAS  PubMed  Google Scholar 

  65. Delmas PD, Ensrud KE, Adachi JD, Harper KD, Sarkar S, Gennari C, et al. Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial. J Clin Endocrinol Metab 2002; 87:3609–17.

    Article  CAS  PubMed  Google Scholar 

  66. Grady D, Ettinger B, Moscarelli E, Plouffe L Jr, Sarkar S, Ciaccia A, et al. Safety and adverse effects associated with raloxifene: multiple outcomes of raloxifene evaluation. Obstet Gynecol 2004; 104:837–44.

    Article  CAS  PubMed  Google Scholar 

  67. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344:1434–41.

    Article  CAS  PubMed  Google Scholar 

  68. Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM. The effects of ­parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 2003; 349:1216–26.

    Article  CAS  PubMed  Google Scholar 

  69. Kurland ES, Cosman F, McMahon DJ, Rosen CJ, Lindsay R, Bilezikian JP. Parathyroid hormone as a therapy for idiopathic osteoporosis in men: effects on bone mineral density and bone markers. J Clin Endocrinol Metab 2000; 85:3069–76.

    Article  CAS  PubMed  Google Scholar 

  70. Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, et al. The effect of teriparatide human parathyroid hormone (1-34) therapy on bone density in men with ­osteoporosis. J Bone Miner Res 2003; 18:9–17.

    Article  CAS  PubMed  Google Scholar 

  71. Black DM, Greenspan SL, Ensrud KE, Palermo L, McGowan JA, Lang TF, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal ­osteoporosis. N Engl J Med 2003; 349:1207–15.

    Article  CAS  PubMed  Google Scholar 

  72. Black DM, Bilezikian JP, Ensrud KE, Greenspan SL, Palermo L, Hue T, et al. One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis. N Engl J Med 2005; 353:555–65.

    Article  CAS  PubMed  Google Scholar 

  73. Cosman F, Nieves J, Woelfert L, Shen V, Lindsay R. Alendronate does not block the anabolic effect of PTH in postmenopausal osteoporotic women. J Bone Miner Res 1998; 13:1051–5.

    Article  CAS  PubMed  Google Scholar 

  74. Cosman F, Nieves J, Zion M, Woelfert L, Luckey M, Lindsay R. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 2005; 353:566–75.

    Article  CAS  PubMed  Google Scholar 

  75. Cosman F, Nieves J, Woelfert L, Formica C, Gordon S, Shen V, et al. Parathyroid hormone added to established hormone therapy: effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal. J Bone Miner Res 2001; 16:925–31.

    Article  CAS  PubMed  Google Scholar 

  76. Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int 2005; 16:510–6.

    Article  CAS  PubMed  Google Scholar 

  77. Lane NE, Sanchez S, Modin GW, Genant HK, Pierini E, Arnaud CD. Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: results of a randomized controlled clinical trial. J Bone Miner Res 2000; 15:944–51.

    Article  CAS  PubMed  Google Scholar 

  78. Lindsay R, Scheele WH, Neer R, Pohl G, Adami S, Mautalen C, et al. Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med 2004; 164:2024–30.

    Article  PubMed  Google Scholar 

  79. Kurland ES, Heller SL, Diamond B, McMahon DJ, Cosman F, Bilezikian JP. The importance of bisphosphonate therapy in maintaining bone mass in men after therapy with teriparatide. Osteoporos Int 2004; 15:992–7.

    Article  CAS  PubMed  Google Scholar 

  80. Rittmaster RS, Bolognese M, Ettinger MP, Hanley DA, Hodsman AB, Kendler DL, et al. Enhancement of bone mass in osteoporotic women with parathyroid hormone followed by alendronate. J Clin Endocrinol Metab 2000; 85:2129–34.

    Article  CAS  PubMed  Google Scholar 

  81. Lindsay R, Nieves J, Formica C, Henneman E, Woelfert L, Shen V, et al. Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 1997; 350:550–5.

    Article  CAS  PubMed  Google Scholar 

  82. Deal C, Omizo M, Schwartz EN, Eriksen EF, Cantor P, Wang J, et al. Combination ­teriparatide and raloxifene therapy for postmenopausal osteoporosis: results from a 6-month double-blind placebo-controlled trial. J Bone Miner Res 2005; 20:1905–11.

    Article  CAS  PubMed  Google Scholar 

  83. Gold DT, Pantos BS, Masica DN, Misurski DA, Marcus R. Initial experience with ­teriparatide in the United States. Curr Med Res Opin 2006; 22:703–8.

    Article  CAS  PubMed  Google Scholar 

  84. Harper KD, Krege JH, Marcus R, Mitlak BH. Osteosarcoma and teriparatide? J Bone Miner Res 2007; 22:334.

    Article  PubMed  Google Scholar 

  85. Dalsky GP, Stocke KS, Ehsani AA, Slatopolsky E, Lee WC, Birge SJ Jr. Weight-bearing exercise training and lumbar bone mineral content in postmenopausal women. Ann Intern Med 1988; 108:824–8.

    CAS  PubMed  Google Scholar 

  86. Smith EL, Gilligan C, McAdam M, Ensign CP, Smith PE. Deterring bone loss by exercise intervention in premenopausal and postmenopausal women. Calcif Tissue Int 1989; 44:312–21.

    Article  CAS  PubMed  Google Scholar 

  87. Feskanich D, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA 2002; 288:2300–6.

    Article  PubMed  Google Scholar 

  88. Wiswell RA, Hawkins SA, Dreyer HC, Jaque SV. Maintenance of BMD in older male ­runners is independent of changes in training volume or VO(2)peak. J Gerontol A Biol Sci Med Sci 2002; 57:M203–8.

    PubMed  Google Scholar 

  89. Srinivasan S, Weimer DA, Agans SC, Bain SD, Gross TS. Low-magnitude mechanical ­loading becomes osteogenic when rest is inserted between each load cycle. J Bone Miner Res 2002; 17:1613–20.

    Article  PubMed  Google Scholar 

  90. Rubin C, Turner AS, Bain S, Mallinckrodt C, McLeod K. Anabolism. Low mechanical ­signals strengthen long bones. Nature 2001; 412:603–4.

    Article  CAS  PubMed  Google Scholar 

  91. Helge EW, Kanstrup IL. Bone density in female elite gymnasts: impact of muscle strength and sex hormones. Med Sci Sports Exerc 2002; 34:174–80.

    Article  PubMed  Google Scholar 

  92. Pfeifer M, Sinaki M, Geusens P, Boonen S, Preisinger E, Minne HW. Musculoskeletal ­rehabilitation in osteoporosis: a review. J Bone Miner Res 2004; 19:1208–14.

    Article  PubMed  Google Scholar 

  93. Johnell O, Eisman J. Whole lotta shakin’ goin’ on. J Bone Miner Res 2004; 19:1205–7.

    Article  PubMed  Google Scholar 

  94. Bloomfield SA. Changes in musculoskeletal structure and function with prolonged bed rest. Med Sci Sports Exerc 1997; 29:197–206.

    CAS  PubMed  Google Scholar 

  95. LeBlanc A, Marsh C, Evans H, Johnson P, Schneider V, Jhingran S. Bone and muscle ­atrophy with suspension of the rat. J Appl Physiol 1985; 58:1669–75.

    CAS  PubMed  Google Scholar 

  96. Hulley SB, Vogel JM, Donaldson CL, Bayers JH, Friedman RJ, Rosen SN. The effect of supplemental oral phosphate on the bone mineral changes during prolonged bed rest. J Clin Invest 1971; 50:2506–18.

    Article  CAS  PubMed  Google Scholar 

  97. Mackey DC, Lui LY, Cawthon PM, Bauer DC, Nevitt MC, Cauley JA, et al. High-trauma fractures and low bone mineral density in older women and men. JAMA 2007; 298:2381–8.

    Article  CAS  PubMed  Google Scholar 

  98. Feldstein AC, Vollmer WM, Smith DH, Petrik A, Schneider J, Glauber H, et al. An outreach program improved osteoporosis management after a fracture. J Am Geriatr Soc 2007; 55:1464–9.

    Article  PubMed  Google Scholar 

  99. Kiel DP, Magaziner J, Zimmerman S, Ball L, Barton BA, Brown KM, et al. Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized ­controlled trial. JAMA 2007; 298:413–22.

    Article  CAS  PubMed  Google Scholar 

  100. Faucett S, Genuario J, Tosteson A, Koval KJ. Is prophylactic fixation a cost-effective method for prevention of secondary hip fracture? Orthopaedic Trauma Association Meeting 2007; Scientific Poster #137.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Medicine and Orthopaedic Surgery, University of Pennsylvania School of Medicine, 424B Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104-6081, USA

    Robert J. Pignolo

Authors
  1. Robert J. Pignolo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert J. Pignolo .

Editor information

Editors and Affiliations

  1. School of Medicine, Ralston-Penn Clinic for Osteoporosis &, University of Pennsylvania, 36th Street & Hamilton Walk, Philadelphia, 19104-6160, Pennsylvania, USA

    Robert J. Pignolo

  2. Dept. Orthopaedic Surgery, University of Pennsylvania, Spruce St. 3400, Philadelphia, 19104, Pennsylvania, USA

    Mary Ann Keenan

  3. , Department of Orthopaedic Surgery, University of Pennsylvania School of Med, 51 N 39th Street, Philadelphia, 19104, USA

    Nader M. Hebela

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Pignolo, R.J. (2011). Evaluation of Bone Fragility and Fracture Prevention. In: Pignolo, R., Keenan, M., Hebela, N. (eds) Fractures in the Elderly. Aging Medicine. Humana Press. https://doi.org/10.1007/978-1-60327-467-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-467-8_16

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-466-1

  • Online ISBN: 978-1-60327-467-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation