Skip to main content
Top
Published in: Archives of Orthopaedic and Trauma Surgery 8/2013

01-08-2013 | Trauma Surgery

Surgeons save bones: an algorithm for orthopedic surgeons managing secondary fracture prevention

Authors: M. Gosch, C. Kammerlander, T. Roth, H. K. Doshi, R. W. Gasser, M. Blauth

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 8/2013

Login to get access

Abstract

Postmenopausal osteoporosis has a big impact on health care budget worldwide, which are expected to double by 2050. In spite of severe medical and socioeconomic consequences from fragility fractures, there are insufficient efforts in optimizing osteoporotic treatment and prevention. Undertreatment of osteoporosis is a well known phenomenon, particularly in elderly patients. Treatment rates remain low across virtually all patient, provider, and hospital-level characteristics, even after fragility fractures. In-hospital initiation is one of the options to increase treatment rates and improve osteoporosis management. However, multiple factors contribute to the failure of initiating appropriate treatment of osteoporosis in patients with fragility fractures. These include a lack of knowledge in osteoporosis and an absence of a comprehensive treatment guideline among family physicians and orthopedic surgeons. Furthermore, orthopedic surgeons are hardly willing to accept their responsibility for osteoporosis treatment due to the fact that they are usually not familiar with the initiation of specific drug treatments. The presented algorithm offers trauma surgeons and orthopedic surgeons a safe and simple guided pathway of treating osteoporosis in postmenopausal women appropriately after fragility fractures based on the current literature. From our point of view, this algorithm is useful for almost all cases and the user can expect treatment recommendations in more than 90 % of all cases. Nevertheless, some patients may require specialized review by an endocrinologist. The proposed algorithm may help to increase the rate of appropriate osteoporosis treatment hence reducing the rates of fragility fractures.
Literature
1.
go back to reference WHO (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. WHO, Geneva, p 59 WHO (1998) Guidelines for preclinical evaluation and clinical trials in osteoporosis. WHO, Geneva, p 59
3.
go back to reference Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38(2 Suppl 1):S4–S9PubMedCrossRef Reginster JY, Burlet N (2006) Osteoporosis: a still increasing prevalence. Bone 38(2 Suppl 1):S4–S9PubMedCrossRef
4.
go back to reference Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8(6):599–603PubMedCrossRef Oden A, Dawson A, Dere W, Johnell O, Jonsson B, Kanis JA (1998) Lifetime risk of hip fractures is underestimated. Osteoporos Int 8(6):599–603PubMedCrossRef
5.
go back to reference Häussler B, Gothe H, Göl D, Glaeske G, Pientka L, Felsenberg D (2007) Epidemiology, treatment and costs of osteoporosis in Germany—the Bone EVA Study. Osteoporos Int 18(1):77–84PubMedCrossRef Häussler B, Gothe H, Göl D, Glaeske G, Pientka L, Felsenberg D (2007) Epidemiology, treatment and costs of osteoporosis in Germany—the Bone EVA Study. Osteoporos Int 18(1):77–84PubMedCrossRef
6.
go back to reference Johnell K, Fastbom J (2009) Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people. Arch Osteoporos 4((1–2)):17–23 Epub 2009 Mar 19PubMedCrossRef Johnell K, Fastbom J (2009) Undertreatment of osteoporosis in the oldest old? A nationwide study of over 700,000 older people. Arch Osteoporos 4((1–2)):17–23 Epub 2009 Mar 19PubMedCrossRef
7.
go back to reference Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444PubMedCrossRef Kammerlander C, Gosch M, Kammerlander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444PubMedCrossRef
8.
go back to reference Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef Jennings LA, Auerbach AD, Maselli J, Pekow PS, Lindenauer PK, Lee SJ (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657PubMedCrossRef
9.
go back to reference Fonarow GC, Gheorghiade M, Abraham WT (2004) Importance of in-hospital initiation of evidence based medical therapies for heart failure-a review. Am J Cardiol 94(9):1155–1160PubMedCrossRef Fonarow GC, Gheorghiade M, Abraham WT (2004) Importance of in-hospital initiation of evidence based medical therapies for heart failure-a review. Am J Cardiol 94(9):1155–1160PubMedCrossRef
10.
go back to reference Muhlestein JB, Horne BD, Bair TL, Li Q, Madsen TE, Pearson RR, Anderson JL (2001) Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol 87(3):257–261PubMedCrossRef Muhlestein JB, Horne BD, Bair TL, Li Q, Madsen TE, Pearson RR, Anderson JL (2001) Usefulness of in-hospital prescription of statin agents after angiographic diagnosis of coronary artery disease in improving continued compliance and reduced mortality. Am J Cardiol 87(3):257–261PubMedCrossRef
11.
go back to reference Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394PubMedCrossRef Center JR, Bliuc D, Nguyen TV, Eisman JA (2007) Risk of subsequent fracture after low-trauma fracture in men and women. JAMA 297(4):387–394PubMedCrossRef
12.
go back to reference Queally JM, Kiernan C, Shaikh M, Rowan F, Bennett D (2012) Initiation of osteoporosis assessment in the fracture clinic results in improved osteoporosis management: a randomised controlled trial. Osteoporos Int. (Epub ahead of print) PubMed PMID: 23242431 Queally JM, Kiernan C, Shaikh M, Rowan F, Bennett D (2012) Initiation of osteoporosis assessment in the fracture clinic results in improved osteoporosis management: a randomised controlled trial. Osteoporos Int. (Epub ahead of print) PubMed PMID: 23242431
13.
go back to reference Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27(10):2039–2046PubMedCrossRef Eisman JA, Bogoch ER, Dell R, Harrington JT, McKinney RE Jr, McLellan A, Mitchell PJ, Silverman S, Singleton R, Siris E (2012) Making the first fracture the last fracture: ASBMR task force report on secondary fracture prevention. J Bone Miner Res 27(10):2039–2046PubMedCrossRef
14.
go back to reference Kammerlander C, Gosch M, Blauth M, Lechleitner M, Luger TJ, Roth T (2011) The tyrolean geriatric fracture center: an orthogeriatric co-management model. Z Gerontol Geriatr 44(6):363–367PubMedCrossRef Kammerlander C, Gosch M, Blauth M, Lechleitner M, Luger TJ, Roth T (2011) The tyrolean geriatric fracture center: an orthogeriatric co-management model. Z Gerontol Geriatr 44(6):363–367PubMedCrossRef
15.
go back to reference Gosch M, Roth T, Kammerlander C, Joosten-Gstrein B, Benvenuti-Falger U, Blauth M, Lechleitner M (2011) Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation: changes over the last decade. Z Gerontol Geriatr 44(6):381–386PubMedCrossRef Gosch M, Roth T, Kammerlander C, Joosten-Gstrein B, Benvenuti-Falger U, Blauth M, Lechleitner M (2011) Treatment of osteoporosis in postmenopausal hip fracture patients after geriatric rehabilitation: changes over the last decade. Z Gerontol Geriatr 44(6):381–386PubMedCrossRef
16.
go back to reference Premaor MO, Pilbrow L, Tonkin C, Adams M, Parker RA, Compston J (2010) Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a fracture liaison service. QJM 103(1):33–40PubMedCrossRef Premaor MO, Pilbrow L, Tonkin C, Adams M, Parker RA, Compston J (2010) Low rates of treatment in postmenopausal women with a history of low trauma fractures: results of audit in a fracture liaison service. QJM 103(1):33–40PubMedCrossRef
17.
go back to reference Kates SL, Mendelson DA, Friedman SM (2010) Co-managed care for fragility hip fractures (rochester model). Osteoporos Int 21(Suppl 4):S621–S625PubMedCrossRef Kates SL, Mendelson DA, Friedman SM (2010) Co-managed care for fragility hip fractures (rochester model). Osteoporos Int 21(Suppl 4):S621–S625PubMedCrossRef
18.
go back to reference Chakravarthy J, Ali A, Iyengar S, Porter K (2008) Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey. Int J Clin Pract 62(3):382–387PubMedCrossRef Chakravarthy J, Ali A, Iyengar S, Porter K (2008) Secondary prevention of fragility fractures by orthopaedic teams in the UK: a national survey. Int J Clin Pract 62(3):382–387PubMedCrossRef
19.
go back to reference Ringe JD, Doherty JG (2010) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatol Int 30(7):863–869PubMedCrossRef Ringe JD, Doherty JG (2010) Absolute risk reduction in osteoporosis: assessing treatment efficacy by number needed to treat. Rheumatol Int 30(7):863–869PubMedCrossRef
20.
go back to reference Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2013) On behalf of the scientific advisory board of the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) and the committee of scientific advisors of the international osteoporosis foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57PubMedCrossRef Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY (2013) On behalf of the scientific advisory board of the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO) and the committee of scientific advisors of the international osteoporosis foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 24(1):23–57PubMedCrossRef
21.
go back to reference Gates BJ, Sonnett TE, Duvall CA, Dobbins EK (2009) Review of osteoporosis pharmacotherapy for geriatric patients. Am J Geriatr Pharmacother 7(6):293–323PubMedCrossRef Gates BJ, Sonnett TE, Duvall CA, Dobbins EK (2009) Review of osteoporosis pharmacotherapy for geriatric patients. Am J Geriatr Pharmacother 7(6):293–323PubMedCrossRef
23.
go back to reference Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88(1):25–34PubMedCrossRef Bogoch ER, Elliot-Gibson V, Beaton DE, Jamal SA, Josse RG, Murray TM (2006) Effective initiation of osteoporosis diagnosis and treatment for patients with a fragility fracture in an orthopaedic environment. J Bone Joint Surg Am 88(1):25–34PubMedCrossRef
25.
go back to reference Brown EM, Hebert SC (1997) Calcium-receptor-regulated parathyroid and renal function. Bone 20(4):303–309PubMedCrossRef Brown EM, Hebert SC (1997) Calcium-receptor-regulated parathyroid and renal function. Bone 20(4):303–309PubMedCrossRef
26.
go back to reference Khairallah W, Fawaz A, Brown EM, El-Hajj Fuleihan G (2007) Hypercalcemia and diabetes insipidus in a patient previously treated with lithium. Nat Clin Pract Nephrol 3(7):397–404PubMedCrossRef Khairallah W, Fawaz A, Brown EM, El-Hajj Fuleihan G (2007) Hypercalcemia and diabetes insipidus in a patient previously treated with lithium. Nat Clin Pract Nephrol 3(7):397–404PubMedCrossRef
28.
go back to reference Chauvelier S, Péquignot R, Amzal A, Hanon O, Belmin J (2012) Comparison between the three most popular formulae to estimate renal function, in subjects 75 years of age or older. Drugs Aging 29(11):885–890PubMedCrossRef Chauvelier S, Péquignot R, Amzal A, Hanon O, Belmin J (2012) Comparison between the three most popular formulae to estimate renal function, in subjects 75 years of age or older. Drugs Aging 29(11):885–890PubMedCrossRef
29.
go back to reference Verbrugge FH, Gielen E, Milisen K, Boonen S (2012) Who should receive calcium and vitamin D supplementation? Age Ageing 41(5):576–580PubMedCrossRef Verbrugge FH, Gielen E, Milisen K, Boonen S (2012) Who should receive calcium and vitamin D supplementation? Age Ageing 41(5):576–580PubMedCrossRef
30.
go back to reference Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Endocrine society. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930PubMedCrossRef Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM (2011) Endocrine society. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930PubMedCrossRef
31.
go back to reference Sinha A, Cheetham TD, Pearce SH (2012) Prevention and treatment of vitamin D deficiency. Calcif Tissue Int. (Epub ahead of print) PubMed PMID: 23124916 Sinha A, Cheetham TD, Pearce SH (2012) Prevention and treatment of vitamin D deficiency. Calcif Tissue Int. (Epub ahead of print) PubMed PMID: 23124916
32.
go back to reference Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92(4):1415–1423PubMedCrossRef Boonen S, Lips P, Bouillon R, Bischoff-Ferrari HA, Vanderschueren D, Haentjens P (2007) Need for additional calcium to reduce the risk of hip fracture with vitamin D supplementation: evidence from a comparative metaanalysis of randomized controlled trials. J Clin Endocrinol Metab 92(4):1415–1423PubMedCrossRef
33.
go back to reference Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692. doi:10.1136/bmj.b3692 PubMedCrossRef Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, Wong JB, Egli A, Kiel DP, Henschkowski J (2009) Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomised controlled trials. BMJ 339:b3692. doi:10.​1136/​bmj.​b3692 PubMedCrossRef
34.
go back to reference Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, Colon-Emeric C, Kilgore ML, Morrisey MA, Saag KG, Safford MM, Warriner A, Delzell E (2010) Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc 11(8):584–591PubMedCrossRef Curtis JR, Arora T, Matthews RS, Taylor A, Becker DJ, Colon-Emeric C, Kilgore ML, Morrisey MA, Saag KG, Safford MM, Warriner A, Delzell E (2010) Is withholding osteoporosis medication after fracture sometimes rational? A comparison of the risk for second fracture versus death. J Am Med Dir Assoc 11(8):584–591PubMedCrossRef
35.
go back to reference Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251PubMedCrossRef Charlson M, Szatrowski TP, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251PubMedCrossRef
36.
go back to reference Mahoney FI, Barthel DW (1965) Functional evaluation: the barthel index. Md State Med J 14:61–65PubMed Mahoney FI, Barthel DW (1965) Functional evaluation: the barthel index. Md State Med J 14:61–65PubMed
37.
go back to reference Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Jt Surg Br Vol 75(5):797–798 Parker MJ, Palmer CR (1993) A new mobility score for predicting mortality after hip fracture. J Bone Jt Surg Br Vol 75(5):797–798
38.
go back to reference Nakazawa A, Nakamura K, Kitamura K, Yoshizawa Y (2012) Association between activities of daily living and mortality among institutionalized elderly adults in Japan. J Epidemiol 22(6):501–507PubMedCrossRef Nakazawa A, Nakamura K, Kitamura K, Yoshizawa Y (2012) Association between activities of daily living and mortality among institutionalized elderly adults in Japan. J Epidemiol 22(6):501–507PubMedCrossRef
39.
go back to reference Kammerlander C, Gosch M, Kammelrander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444PubMedCrossRef Kammerlander C, Gosch M, Kammelrander-Knauer U, Luger TJ, Blauth M, Roth T (2011) Long-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg 131(10):1435–1444PubMedCrossRef
40.
go back to reference Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, for the HORIZON Recurrent fracture trial (2007) Zoledronic acid in reducing clinical fracture and mortality after hip fracture. N Engl J Med 357:nihpa40967PubMedCrossRef Lyles KW, Colón-Emeric CS, Magaziner JS, Adachi JD, Pieper CF, Mautalen C, Hyldstrup L, Recknor C, Nordsletten L, Moore KA, Lavecchia C, Zhang J, Mesenbrink P, Hodgson PK, Abrams K, Orloff JJ, Horowitz Z, Eriksen EF, Boonen S, for the HORIZON Recurrent fracture trial (2007) Zoledronic acid in reducing clinical fracture and mortality after hip fracture. N Engl J Med 357:nihpa40967PubMedCrossRef
41.
go back to reference Boonen S, Black DM, Colón-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, Mesenbrink P, Haentjens P, Lyles KW (2010) Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc 58(2):292–299PubMedCrossRef Boonen S, Black DM, Colón-Emeric CS, Eastell R, Magaziner JS, Eriksen EF, Mesenbrink P, Haentjens P, Lyles KW (2010) Efficacy and safety of a once-yearly intravenous zoledronic acid 5 mg for fracture prevention in elderly postmenopausal women with osteoporosis aged 75 and older. J Am Geriatr Soc 58(2):292–299PubMedCrossRef
42.
go back to reference Reid IR, Black DM, Eastell R, Bucci-Rechtweg C, Su G, Hue TF, Mesenbrink P, Lyles KW, Boonen S (2013) For the HORIZON pivotal fracture trial HORIZON recurrent fracture trial steering committees. Reduction in the risk of clinical fractures after a single dose of zoledronic acid 5 milligrams. J Clin Endocrinol Metab (Epub ahead of print) PubMed PMID: 23293335 Reid IR, Black DM, Eastell R, Bucci-Rechtweg C, Su G, Hue TF, Mesenbrink P, Lyles KW, Boonen S (2013) For the HORIZON pivotal fracture trial HORIZON recurrent fracture trial steering committees. Reduction in the risk of clinical fractures after a single dose of zoledronic acid 5 milligrams. J Clin Endocrinol Metab (Epub ahead of print) PubMed PMID: 23293335
43.
go back to reference Akehurst R, Brereton N, Ariely R, Lusa T, Groot M, Foss P, Boonen S (2011) The cost effectiveness of zoledronic acid 5 mg for the management of postmenopausal osteoporosis in women with prior fractures: evidence from Finland, Norway and the Netherlands. J Med Econ 14(1):53–64PubMedCrossRef Akehurst R, Brereton N, Ariely R, Lusa T, Groot M, Foss P, Boonen S (2011) The cost effectiveness of zoledronic acid 5 mg for the management of postmenopausal osteoporosis in women with prior fractures: evidence from Finland, Norway and the Netherlands. J Med Econ 14(1):53–64PubMedCrossRef
44.
go back to reference Goldhahn J, Féron JM, Kanis J, Papapoulos S, Reginster JY, Rizzoli R, Dere W, Mitlak B, Tsouderos Y, Boonen S (2012) Implications for fracture healing of current and new osteoporosis treatments: an ESCEO consensus paper. Calcif Tissue Int 90(5):343–353PubMedCrossRef Goldhahn J, Féron JM, Kanis J, Papapoulos S, Reginster JY, Rizzoli R, Dere W, Mitlak B, Tsouderos Y, Boonen S (2012) Implications for fracture healing of current and new osteoporosis treatments: an ESCEO consensus paper. Calcif Tissue Int 90(5):343–353PubMedCrossRef
45.
go back to reference Eriksen EF, Lyles KW, Colón-Emeric CS, Pieper CF, Magaziner JS, Adachi JD, Hyldstrup L, Recknor C, Nordsletten L, Lavecchia C, Hu H, Boonen S, Mesenbrink P (2009) Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 24(7):1308–1313PubMedCrossRef Eriksen EF, Lyles KW, Colón-Emeric CS, Pieper CF, Magaziner JS, Adachi JD, Hyldstrup L, Recknor C, Nordsletten L, Lavecchia C, Hu H, Boonen S, Mesenbrink P (2009) Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res 24(7):1308–1313PubMedCrossRef
46.
go back to reference Amanat N, McDonald M, Godfrey C, Bilston L, Little D (2007) Optimal timing of a single dose of zoledronic acid to increase strenght in rat fracture repair. J Bone Miner Res 22:867–876PubMedCrossRef Amanat N, McDonald M, Godfrey C, Bilston L, Little D (2007) Optimal timing of a single dose of zoledronic acid to increase strenght in rat fracture repair. J Bone Miner Res 22:867–876PubMedCrossRef
48.
go back to reference Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr (2012) American college of chest physicians. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, American college of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl) 9th edn: e278S–e325S Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr (2012) American college of chest physicians. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, American college of chest physicians evidence-based clinical practice guidelines. Chest 141(2 Suppl) 9th edn: e278S–e325S
49.
go back to reference Diez-Perez A, Adachi JD, Agnusdei D, Bilezikian JP, Compston JE, Cummings SR, Eastell R, Eriksen EF, Gonzalez-Macias J, Liberman UA, Wahl DA, Seeman E, Kanis JA, Cooper C (2012) IOF CSA inadequate responders working group treatment failure in osteoporosis. Osteoporos Int 23(12):2769–2774PubMedCrossRef Diez-Perez A, Adachi JD, Agnusdei D, Bilezikian JP, Compston JE, Cummings SR, Eastell R, Eriksen EF, Gonzalez-Macias J, Liberman UA, Wahl DA, Seeman E, Kanis JA, Cooper C (2012) IOF CSA inadequate responders working group treatment failure in osteoporosis. Osteoporos Int 23(12):2769–2774PubMedCrossRef
Metadata
Title
Surgeons save bones: an algorithm for orthopedic surgeons managing secondary fracture prevention
Authors
M. Gosch
C. Kammerlander
T. Roth
H. K. Doshi
R. W. Gasser
M. Blauth
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 8/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1774-x

Other articles of this Issue 8/2013

Archives of Orthopaedic and Trauma Surgery 8/2013 Go to the issue