Subtrochanteric/femoral shaft fragility fractures can be due either to osteoporosis or to prior exposure to bisphosphonates. The assessment of such fractures is complicated and warrants referral to an osteoporosis specialist.

First Line Therapies with Evidence for Fracture Prevention in Postmenopausal Women



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First Line Therapies with Evidence for Fracture Prevention in Postmenopausal Women



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First Line Therapies with Evidence for Fracture Prevention in Postmenopausal Women



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Recommended biochemical tests for patients being assessed for osteoporosis as per the 2010 OC Guidelines: serum calcium corrected for albumin or ionized calcium, complete blood count (CBC), creatinine or eGFR, alkaline phosphatase, thyroid stimulating hormone (TSH). For patients with vertebral fractures, a serum protein electrophoresis is also recommended. Vitamin D (25-hydroxy vitamin D) should be measured after 3-4 months of adequate supplementation and should not be repeated if optimal level ≥ 75 nmol/L is achieved.

The IOF Best Practice Framework indicates that patients with any fragility fracture should be assessed for the presence of spine fractures. This requires a lateral view of the thoracic and lumbar spine, typically by conventional x-rays or, where available, by Vertebral Fracture Assessment (VFA) by DXA. If the initial presenting fracture is a vertebral fracture, it is important to ensure that the entire spine is imaged (e.g. if a T10 fracture is identified on a lateral chest x-ray, then a lateral view of the lumbar spine is also indicated).

Adequate vitamin D supplementation is important, not only for bone health, but also because it has been proven to reduce the risk of falls and fractures. Osteoporosis Canada recommends vitamin D supplementation of 800-2000 IU/day for adults ≥ 50 years of age.