Doctor María Jesús Rodríguez Macías, member of the Spanish Society of Spine (GEER), has warned that, in the face of a first osteoporotic fracture, specialists should not limit themselves to resolving the acute episode, since "it is necessary to study the patient, treat osteoporosis, and establish follow-up, because there is a risk of new fractures occurring."
As she has recalled, "osteoporosis is more common in women after menopause and its incidence increases with age," although "it also affects men and can appear in younger people with certain risk factors." In this context, secondary prevention is positioned as one of the pillars of the "National Consensus on the Management of Osteoporotic Vertebral Fracture," published in February in the specialized journal 'Archives of Osteoporosis.'
The disease can evolve for years without giving signals, gradually weakening the bone and raising the risk of fractures without the affected person noticing. The spine is one of the areas where these fragility fractures occur most frequently, which can also go unnoticed at first. Therefore, the scientific community insists on the complexity of diagnosis and emphasizes the need to identify the possible relationship between a vertebral fracture and osteoporosis and to intervene, once recognized, to prevent new events.
Doctor Juan Francisco Blanco Blanco, also a member of the GEER, has emphasized that the pathology is "systemic and silent" and "increases the fragility of bone tissue and, with it, the risk of fracture," so that "the patient may gradually lose bone mass and have an increasingly fragile skeleton without noticing any symptoms." Furthermore, he has pointed out that, "unlike fractures caused by traffic accidents, falls from height, or other high-energy trauma, osteoporotic vertebral fractures can occur from minimal trauma or low-intensity efforts."
In this line, he has noted that "this absence of an obvious trigger can make some initially go unnoticed or that, even when detected, they are not immediately related to possible bone fragility." Therefore, once it is confirmed that the fracture is linked to osteoporosis, the approach should be directed both to the specific injury and to the underlying disease.
Importance of Fracture Coordination Units
Ensuring continuity of care after initial treatment is key, and a reference model is the Fracture Coordination Units. These multidisciplinary structures are responsible for identifying those who have suffered a fragility fracture, assessing their bone health, facilitating the start of treatment when appropriate, and maintaining an evolutionary control in order to reduce the probability of new fractures.
A study based on the Spanish Registry of Osteoporotic Fractures, published in the journal 'Archives of Medical Research', analyzed 8,962 patients over 50 years old treated in 25 Spanish Units. The study compared two types of care devices —orthogeriatric units and bone metabolism units— and found that both models were effective in reducing the risk of recurrence. After 12 months, the rates of new fractures were 7.7 and 5.5 per 100 patients/year, respectively.
Finally, specialists have specified that treatment must be adapted to the characteristics of the fracture, its clinical consequences, and the individual situation of each person. They have also emphasized that assessment by a spine expert is especially relevant when pain persists despite initial therapy, a vertebral deformity appears or worsens, instability is observed, or signs of neurological compromise are identified. In their conclusions, they have highlighted that functional recovery constitutes an essential component of the management of osteoporotic vertebral fractures.