Risk and Prevention of Fracture in Patients With Major Medical Illnesses: A Mini-Review

Patients with several medical conditions, including Parkinson's disease, recent stroke, HIV, and heart failure, have a high risk of hip fracture. These patients will also have more severe consequences of a hip fracture, including a greater chance of dying and more prolonged disability. Together, there are nearly as many patients with medical conditions that substantially increase the risk of hip fracture as there are people with osteoporosis by femoral neck bone mineral density (BMD). The contributions of falling and decreased bone mass to the increased risks with these conditions are not certain. Although there are few data about whether and what type of treatments these patients receive to prevent fracture, it is likely that few receive pharmacologic treatments that have been shown to reduce the risk of hip fracture. There is a need to show that drug treatments that strengthen bone also reduce fracture risk in patients whose risk may be owing in greater part to traumatic falls than osteoporosis. Assuming that treatments are efficacious in these patients, there is a major opportunity to substantially reduce the incidence and consequences of hip fracture by reaching more of them with drug treatments to reduce the risk of hip fracture. This will require engagement of specialists who have little expertise and perhaps limited interest in preventing fractures, or new approaches to delivering drug treatments to prevent fracture directly to the patients at risk. (c) 2016 American Society for Bone and Mineral Research.