Integrating Bone Health into Fracture Management

Integrating bone health into fracture management has become imperative as untreated osteoporosis undermines surgical success and predisposes patients to secondary fractures.

Surgeons often focus on anatomical reduction and fixation, yet overlook the fragile substrate upon which implants and bone healing depend. Failure to address underlying bone fragility contributes to prolonged rehabilitation times and higher refracture rates, especially among older adults with osteoporotic bone.

Programs like Mount Sinai's innovative program embed comprehensive osteoporosis management into fracture care pathways, coupling early screening, pharmacotherapy initiation and coordinated follow-up to reduce secondary fracture incidence and enhance functional recovery.

This integrated model sets the stage for pharmacological advances that were previously relegated to primary osteoporosis clinics. Agents such as teriparatide and romosozumab deliver osteoanabolic effects that expedite callus formation and improve bone mineral density gains.

A recent analysis of innovations in osteoporosis pharmacotherapy demonstrated that these treatments can shorten time to consolidation and support earlier weight-bearing protocols compared with standard antiresorptive regimens.

The momentum behind these therapies highlights a broader need for proactive identification of at-risk patients. The latest call to reevaluate BMD screening guidelines—echoing considerations from the National Osteoporosis Foundation (NOF), the International Society for Clinical Densitometry (ISCD) and the Endocrine Society—argues for extending bone density assessment to younger adults who present with low-impact fractures or risk factors such as prolonged corticosteroid use, enabling intervention before catastrophic failure occurs.

For example, in one illustrative case of a 50-year-old male recreational athlete who sustained a low-energy distal radius fracture, combining early DEXA testing, initiation of teriparatide and a tailored loading program translated to near-normal bone density at six months and no refracture at 18 months, though individual outcomes may vary.

Looking ahead, the convergence of multidisciplinary fracture pathways and targeted osteoanabolic therapy requires surgeons to refine patient selection, establish rapid referral protocols for bone health evaluation and engage in continuous dialogue with endocrinology and rehabilitation teams to optimize long-term outcomes. Emerging questions around cost-effectiveness and the impact on patient quality of life will shape the next generation of practice standards.

Key Takeaways:

• Integrated programs like Mount Sinai's significantly enhance fracture outcomes by incorporating comprehensive osteoporosis management.
• Innovative treatments such as teriparatide and romosozumab accelerate healing in osteoporotic fractures.
• Updated BMD screening guidelines for younger adults could proactively mitigate fracture risks.
• As treatment approaches evolve, ongoing adaptation by clinicians is essential for optimal patient care.