A low-trauma fracture in an adult over 50 — wrist, hip, vertebra, humerus — is itself the clearest signal of underlying osteoporosis and a strong predictor of the next fracture. The established gap in care is not diagnosis but follow-through: most such patients leave hospital without bone-health treatment.
After a fragility fracture, assess bone health, start calcium and vitamin D, and begin an anti-resorptive agent where indicated — for a hip or vertebral fragility fracture you need not wait for a DXA scan to start. Add a falls assessment, because the next fracture usually needs both weak bone and a fall.
In India, where osteoporosis is widely undertreated and fracture-liaison services are scarce, making this a reflex after every fragility fracture is one of the highest-value, lowest-cost things an orthopaedic team can do.
- Treat any low-trauma fracture in an over-50 as presumed osteoporosis and act before discharge.
- Start calcium and vitamin D, and an anti-resorptive where indicated; a hip or vertebral fragility fracture need not wait for DXA.
- Arrange a falls assessment — the next fracture needs both fragile bone and a fall.
- Document the bone-health plan so it is not lost at handover to primary care.
Why it matters
The fracture already made the diagnosis; the failure is in acting on it, which is where most patients are lost.
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