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New strategies to prevent hip fracture should be investigated, experts say

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Osteoporosis patients who have a high risk of hip fracture should be assessed for preventive surgical intervention, according to a recent review published in Archives of Osteoporosis.

The review looked at the currently available approaches for prevention of hip fracture and at potential future approaches to address unmet needs in very high risk patients. It was authored by a working group from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Osteoporosis Foundation (IOF).

The researchers noted that hip fractures are the most severe type of fracture in osteoporosis patients, associated with premature death, and commonly leading to long-term physical disability, impaired capacity to perform daily activities and live independently, and reduced quality of life.

At present, prevention of hip fracture is based on pharmacological intervention together with regular physical activity, prevention of falls, and correction of nutritional deficiencies, including vitamin D supplementation.

However, these measures are only 50% successful at best and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporosis patients at imminent and/or at very high risk of hip fracture, the working group concluded that preventive surgical intervention to strengthen bone needs further investigation.

Procedures to test may include prophylactic nailing, femoroplasty with cement, and bone grafting with osteoconductive or osteoinductive materials, the panel said.

Professor René Rizzoli, lead author and chair of the ESCEO Scientific Advisory Board, commented:

“Given the very serious, indeed life-threatening, repercussions of hip fractures, we must do all we can to find effective strategies for prevention, including in the frail elderly. Notwithstanding the many challenges involved, the presently untapped potential of preventive surgical interventions for patients at imminent risk of hip fracture deserves further investigation by researchers in the field.”