Basic principles for organizing secondary fracture prevention in patients hospitalized with proximal femoral fracture

To reduce the incidence of osteoporotic fractures, Fracture Liaison Services are being established worldwide, which have demonstrated high clinical and cost-effectiveness. However, in patients hospitalized with a fracture of the proximal femur, the implementation of this system presents a number of specific features and difficulties. This is due to the severity of the condition and multimorbidity of the patients, as well as difficulties in accessing medical services due to reduced mobility and dependence on external assistance. The most effective approach to organizing secondary fracture prevention in these patients is the implementation of measures for the diagnosis and initiation of osteoporosis therapy within the framework of orthogeriatric care already at the inpatient treatment stage. Furthermore, it is necessary to establish a system for transferring patient information to primary care physicians and engaging them in the active management of these patients. The article also discusses controversial issues regarding the need for bone densitometry, prevention of hypocalcemia, correction of possible vitamin D deficiency, active identification of vertebral fractures, as well as ensuring active monitoring and education of patients who have sustained a proximal femoral fracture. The opinion is expressed on the necessity of developing unified standards for the organization of secondary fracture prevention services and establishing quality criteria for evaluating their performance at the national level.