Osteoporotic fractures are one of the major problems facing healthcare systems worldwide. Undoubtedly, fragility fractures of the hip represent a far greater burden in terms of morbidity, mortality, and healthcare costs than other fracture sites. However, despite the significant impact on the health and quality of life of older adults, there is a general lack of awareness of osteoporosis, which results in suboptimal care. In fact, most high-risk individuals are never identified and do not receive adequate treatment, leading to further fragility fractures and worsening health status. Furthermore, considering the substantial treatment gap and the proven cost-effectiveness of fracture prevention programs such as Fracture Liaison Services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are adequately assessed and treated. Based on this evidence, the aim of our review was to (i) provide an overview and comparison of the burden and management of fragility fractures, highlighting the main gaps, and (ii) highlight the importance of using alternative approaches, both surgical and non-surgical, with the aim of implementing early prevention of osteoporotic fractures and improving the management of osteoporotic patients at imminent and/or very high risk of fracture.

骨质疏松性骨折是全球医疗保健系统面临的主要问题之一。毫无疑问，与其他骨折部位相比，髋部脆性骨折在发病率、死亡率和医疗费用方面的负担要大得多。然而，尽管对老年人的健康和生活质量产生了重大影响，但人们普遍缺乏对骨质疏松症的认识，从而导致护理不理想。事实上，大多数高危个体从未被识别出来，也没有得到足够的治疗，导致进一步的脆性骨折和健康状况恶化。此外，考虑到巨大的治疗差距和骨折预防计划（如骨折联络服务）已证明的成本效益，需要采取紧急行动，确保对所有处于脆性骨折高风险的个体进行充分评估和治疗。基于这些证据，我们审查的目的是 (i) 概述和比较脆性骨折的负担和管理，突出主要差距，以及 (ii) 强调使用替代方法的重要性，包括手术和非- 外科手术，旨在早期预防骨质疏松性骨折，并改善对即将发生和/或骨折风险非常高的骨质疏松症患者的管理。