Risks and Harms of Implementing this Recommendation
A hip fracture is a sign of osteoporosis, but most patients with hip fractures are not currently evaluated and treated for their underlying osteoporosis. Patients who have fractured a hip are at high risk for subsequent fracture and increased mortality. There are very effective osteoporosis therapies that lower the risk of fractures. There are potential benefits for identification of secondary causes of osteoporosis with no known harm associated with this osteoporosis evaluation. There is the potential for “atypical femur fractures” that may be associated with prolonged bisphosphonate therapy. All medications including osteoporosis therapies have potential harms.
Cost-effectiveness research on use of a fracture liaison service in open health care systems would be helpful for evaluation and treatment of osteoporosis and to test whether a fracture liaison service reduces the risk of hip fracture readmission rates after a hip fracture. Further investigations of the long term patient specific outcomes of bisphosphonate therapies are also appropriate, including assessment of alternative osteoporosis treatments. In addition, the relative roles of the orthopaedic surgeon and the patient's primary care provider in evaluating and treating low bone mass after hip fracture, and how these compare to the use of a fracture liaison service, should be studied.
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