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Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review

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Abstract

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.

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Funding

This work was supported by F.I.R.M.O. Foundation through a grant from AgNovos.

Author information

Authors and Affiliations

  1. Department of Clinical Sciences and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133, Rome, Italy

    Umberto Tarantino, Ida Cariati & Chiara Greggi

  2. Department of Orthopaedics and Traumatology, “Policlinico Tor Vergata” Foundation, Viale Oxford 1, 00133, Rome, Italy

    Umberto Tarantino, Riccardo Iundusi & Elena Gasbarra

  3. PhD in Medical-Surgical Biotechnologies and Translational Medicine, “Tor Vergata” University of Rome, Via Montpellier 1, 00133, Rome, Italy

    Ida Cariati & Chiara Greggi

  4. Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Caserta, Italy

    Giovanni Iolascon

  5. Department of Orthopaedic and Trauma Surgery, Community Clinics Middle Rhine, Campus Kemperhof, Koblenz, Germany

    Andreas Kurth

  6. Department of Clinical Sciences Malmö, Lund University and Department of Orthopedics, Skane University Hospital, Malmö, Sweden

    Kristina E. Akesson

  7. Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Harvard Medical School, BIDMC, Boston, MA, USA

    Mary Bouxsein

  8. Orthopaedic Department, University of Sassari, Sassari, Italy

    Paolo Tranquilli Leali

  9. Department of Surgical Science, University of Florence, Florence, Italy

    Roberto Civinini

  10. Orthopaedic and Traumatology Department, S. Spirito Hospital, Rome, Italy

    Francesco Falez

  11. FIRMO Foundation, 50141, Florence, Italy

    Maria Luisa Brandi

Authors
  1. Umberto Tarantino
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  2. Ida Cariati
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  3. Chiara Greggi
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  4. Riccardo Iundusi
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  5. Elena Gasbarra
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  6. Giovanni Iolascon
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  7. Andreas Kurth
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  8. Kristina E. Akesson
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  9. Mary Bouxsein
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  10. Paolo Tranquilli Leali
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  11. Roberto Civinini
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  12. Francesco Falez
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  13. Maria Luisa Brandi
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Corresponding author

Correspondence to Maria Luisa Brandi.

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Conflicts of interest

K-E. Akesson reports consultations and lecture fees from Amgen, Astellas Pharma, Chugai, RenaPharma, and UCB. M. Bouxsein serves on the Advisory Board for Keros Therapeutics and Beryl Health. M-L. Brandi has received honoraria from Amgen, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, and UCB; reports grants and/or speaker for Abiogen, AgNovosAlexion, Amgen, Bruno Farmaceutici, Echolight, Eli Lilly, Kyowa Kirin, SPA, Theramex, and UCB; and reports consultations for Aboca, Alexion, Amolyt, Bruno Farmaceutici, Calcilytix, Kyowa Kirin, and UCB. I. Cariati has no disclosures. R. Civinini reports personal fees and consultancy or lecture fees from Orthofix, Smith &Nephew, and Microport. F. Falez reports consultations for Lima, Microport, Adler, G21, and external collaborations for Menarini. E. Gasbarra has no disclosures. C. Greggi has no disclosures. G. Iolascon serves on the Advisory Board for UCB pharma, AMGEN, Eli-Lilly. R. Iundusi has no disclosures. A. Kurth serves on the advisory board for UCB, Amgen, and AgNovos; speaker fees from Amgen, Alexion, UCB, Eli-Lilly, Theramex, Ratiopharm, and AgNovos. P. Tranquilli Leali has no disclosures. U. Tarantino serves on the Advisory Board for Abiogen, AMGEN, Eli-Lilly.

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Tarantino, U., Cariati, I., Greggi, C. et al. Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review. Osteoporos Int 33, 2467–2478 (2022). https://doi.org/10.1007/s00198-022-06482-z

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