Appropriate antiosteoporotic medication, regular encouragement to ensure compliance with medication and participation in resistance and balance exercises are components of the effective management of individuals with recurrent osteoporotic fractures.
- Following a single fracture in an individual with osteoporosis, the risk of further fracture is increased, resulting in the ‘fracture cascade’.
- The effective management of individuals with osteoporosis should include not only the prescribing of an antiosteoporotic agent but also regular encouragement to ensure persistence and adherence with taking their medications.
- Antiosteoporotic agents reduce the risk of subsequent fractures rather than prevent them. Unfortunately, this means that there will be a number of individuals who comply with therapy and continue to fracture.
- Factors influencing recurrent fracturing while on antiosteoporotic therapy include the antiosteoporotic agent being used and compliance with taking it, calcium and vitamin D status, smoking, alcohol consumption, secondary causes of osteoporosis, trauma due to falls and abnormal bone remodelling due to long-term (more than five years) use of antiresorptive osteoporotic agents.
- People who fracture recurrently usually require detailed evaluation and appropriate treatment, and specialist referral is recommended.
- Resistance and balance training exercise programs improve reflexes and muscle strength and reduce the risk of falls.
- The atypical peripheral fractures reported to be associated with long-term bisphosphonate therapy should not detract from prescribing bisphosphonates. However, caution and avoidance of indefinite long-term exposure to these medications must be considered in all patients.