The prevention and treatment of fragility fractures continuously evolves. Adequate fracture care should involve treating the fracture itself as well as the underlying bone disease. Although effective treatments of osteoporosis are available, a large proportion of patients with fragility fractures are not prescribed anti-osteoporotic medications after their injury. Recent advances in diagnostic tools, medications, and implementation of Fracture Liaison Services (FLS) allow for more effective and comprehensive treatment or fragility fractures. In the FLS model, a physician and physician extenders coordinate care. This includes a thorough medical and surgical history, metabolic bone disease labs, dual-energy x-ray absorptiometry screening, treatment, and long-term follow up. Treatment options include nonpharmacologic treatment with calcium and Vitamin D as well as antiresorptive and anabolic agents. Antiresorptive agents such as bisphosphonates and denosumab are first-line treatments for osteoporosis and anabolic agents such as Teriparatide are effective in reducing bone density loss and have implications in fracture healing. In addition, new anabolic agents including anti-sclerostin antibodies and parathyroid hormone-related protein show promise as potential treatments to increase bone density.





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