A low-energy fracture in an older adult is a diagnosis of osteoporosis until proven otherwise, and the moment of greatest risk for the next fracture is the months immediately after this one. Yet secondary prevention is routinely deferred to a clinic the patient may never reach.
Do the three things that can be done on the ward. Check calcium, vitamin D and renal function; request a DXA or record why it is not available; and either start bone protection or write in the discharge summary who is to start it and when. Naming the person closes the loop that a generic 'for bone health review' leaves open.
Where DXA access is the constraint — much of India outside large centres — a fragility fracture at the hip or vertebra is itself sufficient to diagnose osteoporosis and to treat. Waiting for a scan that will not happen is how the second fracture arrives.
- Check calcium, vitamin D and renal function before discharge
- Name the clinician responsible for starting bone protection in the discharge summary
- Treat a hip or vertebral fragility fracture as diagnostic — do not wait for DXA to start
- Review falls risk and medications in the same admission
- Tell the patient plainly that this fracture predicts the next one
Why it matters
The highest-risk window for the next fracture is the one in which nothing usually gets started.
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