Postoperative bone mineral health optimization in the geriatric patient

Osteoporosis is a silent condition and often goes undiagnosed until the sequela of fracture occurs. The occurrence of a fragility fracture is diagnostic of osteoporosis, regardless of bone mineral density (BMD). Hip fracture is the most devastating consequence of osteoporosis and associated with prolonged hospitalizations, loss of independence, diminished quality of life, and increased mortality. Hip fractures are important not only due to their immediate consequences, but because their occurrence is associated with future fractures. Despite recommendations to treat osteoporosis in patients who have sustained a fragility fracture, including a hip fracture, rates of treatment remain low. Because of the morbidity, mortality, cost, and risk of future fractures, secondary prevention of hip fractures is critical. Initial assessment for all patients presenting with hip fracture should include a medical history, physical examination for signs of conditions associated with bone loss, risk factor evaluation, and laboratory evaluation. Lifestyle interventions such as smoking cessation, limiting alcohol intake, resistance and balance exercises, and adequate calcium and vitamin D intake should be reinforced in all patients. Pharmacologic treatment is recommended in all patients with an osteoporotic fracture to prevent subsequent fractures. Pharmacologic options include anti-resorptive medications, which decrease bone resorption by inhibiting osteoclast activity, and anabolic agents, which promote bone formation by activating osteoblasts. Both classes of medications have been shown to decrease the risk of fractures and improve BMD.