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ABSTRACT: The incidence of hip fracture is expected to increase as the population ages. One in five persons dies in the first year after sustaining a hip fracture, and those who survive past one year may have significant functional limitation. Although surgery is the main treatment for hip fracture, family physicians play a key role as patients' medical consultants. Surgical repair is recommended for stable patients within 24 to 48 hours of hospitalization. Antibiotic prophylaxis is indicated to prevent infection after surgery. Thromboprophylaxis has become the standard of care for management of hip fracture. Effective agents include unfractionated heparin, low-molecular-weight heparin, fondaparinux, and warfarin. Optimal pain control, usually with narcotic analgesics, is essential to ensure patient comfort and to facilitate rehabilitation. Rehabilitation after hip fracture surgery ideally should start on the first postoperative day with progression to ambulation as tolerated. Indwelling urinary catheters should be removed within 24 hours of surgery. Prevention, early recognition, and treatment of contributing factors for delirium also are crucial. Interventions to help prevent future falls, exercise and balance training in ambulatory patients, and the treatment of osteoporosis are important strategies for the secondary prevention of hip fracture.
ABSTRACT: Family physicians will frequently encounter patients with osteoporosis, a condition that is often asymptomatic until a fracture occurs. Treatment of the fracture can be initiated without further diagnostic testing. Thereafter, treatment of osteoporosis includes (1) prevention of further bone loss through weight-bearing exercise, tobacco and alcohol avoidance, hormone replacement therapy in women, and raloxifene and calcium supplementation; (2) treatment of fracture-related pain with analgesics and calcitonin; (3) building bone mass when feasible with alendronate; and (4) modifying behaviors that increase the risk of falls. Patients without fracture who are at risk for osteoporosis can also benefit from these preventive measures. Furthermore, women of all ages should be encouraged to maintain a daily calcium intake of 1,000 to 1,500 mg and to participate in weight-bearing exercise for 30 minutes three times weekly to reduce their risk of falls and fractures. Persons at risk should avoid medications known to compromise bone density, such as glucocorticoids, thyroid hormones and chronic heparin therapy.
NIH Releases Statement on Osteoporosis Prevention, Diagnosis, and Therapy - Practice Guidelines
Postmenopausal Hormone Replacement Therapy for the Primary Prevention of Chronic Conditions - U.S. Preventive Services Task Force
Hormone Therapy: Continuing Discussion and Debate - Editorials
Predicting Hip Fracture Risk in Older Women - Point-of-Care Guides
Osteoporosis in Men - Article
ABSTRACT: Osteoporosis is an important and often overlooked problem in men. Although the lifetime risk of hip fracture is lower in men than in women, men are twice as likely to die after a hip fracture. Bone mineral density measurement with a T-score of -2.5 or less indicates osteoporosis. The American College of Physicians recommends beginning periodic osteoporosis risk assessment in men before 65 years of age and performing dual-energy x-ray absorptiometry for men at increased risk of osteoporosis who are candidates for drug therapy. All men diagnosed with osteoporosis should be evaluated for secondary causes of bone loss. The decision regarding treatment of osteoporosis should be based on clinical evaluation, diagnostic workup, fracture risk assessments, and bone mineral density measurements. Pharmacotherapy is recommended for men with osteoporosis and for high-risk men with low bone mass (osteopenia) with a T-score of -1 to -2.5. Bisphosphonates are the first-line agents for treating osteoporosis in men. Teriparatide (i.e., recombinant human parathyroid hormone) is an option for men with severe osteoporosis. Testosterone therapy is beneficial for men with osteoporosis and hypogonadism. Adequate intake of calcium and vitamin D should be encouraged in all men to maintain bone mass. Men should be educated regarding lifestyle measures, which include weight-bearing exercise, limiting alcohol consumption, and smoking cessation. Fall prevention strategies should be implemented in older men at risk of falls.
Monitoring Osteoporosis Treatment: DXA Should Not Be Routinely Repeated - Editorials: Controversies in Family Medicine