Secondary fracture
Credit: Tatiana Ayazo

Osteoporosis is a condition that often occurs with age as you naturally start to lose bone mineral density and bone mass, which impacts the structure and strength of your bones. As a result, this condition increases the risk of broken or fractured bones. For some people, the first sign of osteoporosis is a bone fracture. Unfortunately, once you have one fracture, your chances of having another one increases. 

What Is Secondary Bone Fracture?

According to Claire Gill, CEO at the Bone Health and Osteoporosis Foundation, “a secondary bone fracture simply means that you’ve already had a first fracture.”  

To prevent a secondary bone fracture, it’s crucial to be proactive after the first one. Gill emphasizes that some people may think they’re fine after the first fracture, but it’s important to follow up to ensure that osteoporosis wasn’t the cause of the fracture. 

“You should be able to trip and fall and not break a bone,” says Gill. “If you broke the bone, after you get the bone treated, you need to get all the follow-up to make sure it wasn’t osteoporosis that caused the bone to break.”  

If osteoporosis did contribute to the first fracture, your risk of a secondary fracture can increase dramatically — up to seven-fold — making follow-up with your doctor crucial after a first fracture. 

The Dangers of Secondary Fractures

Unfortunately, many people do not receive the necessary care to prevent a secondary fracture from happening after their initial fracture. Bone fractures related to osteoporosis are becoming increasingly common. According to the International Osteoporosis Foundation, over 8.9 million osteoporosis-related fractures occur worldwide each year.  

Even after healing, these secondary fractures can result in the following:  

  • Reduced function: Secondary fractures can impact your ability to use the affected bone the same way that you used to. For example, a fracture to the wrist can impact your ability to write or type.  
  • Decreased mobility: Secondary fractures can make it harder to move around, particularly fractures that occur in the back or hip. 
  • Increased discomfort: Many people who have experienced secondary fractures are left with lingering, chronic pain at the fracture site. 
  • Lowered independence: Changes in function, mobility, and pain levels may mean you need to ask for help completing tasks you used to be able to do independently — all of which can also take a toll on your quality of life. 

The Importance of Osteoporosis Screening

If you’re 50 years old or older and have a bone fracture, it’s important to confirm (or rule out) osteoporosis. This can be done with a simple imaging test known as dual-energy X-ray absorptiometry (DEXA) scan.  

A DEXA scan is a type of imaging test that uses low-dose X-rays to measures your bone mineral density. Results can help determine whether you have osteoporosis or identify your risk of developing it. Tracking your results over time also helps measure bone loss. 

That’s why it’s equally essential to be proactive and undergo routine osteoporosis screening before experiencing a bone fracture.  

Women over the age of 65 and men over the age of 70 should undergo routine screening, and your doctor may suggest screening every one to two years or more frequently based on your overall health, family history, and medications that could affect bone health and contribute to osteoporosis. 

“Screening helps to identify those at high risk for a fracture so that one can focus on fracture prevention and treatment of bone disease,” says Deena Adimoolam, MD, an endocrinologist who specializes in bone disease at Summit Health in Clifton, New Jersey. 

Risk Factors of Secondary Fractures

There are several risk factors that can increase the likelihood of a secondary fracture in someone with osteoporosis, including:  

  • Age: Secondary fracture risk increases with age. 
  • Gender: Women are at a higher risk of secondary fractures than men. 
  • Family history: A family history of osteoporosis or secondary fractures may increase your risk. 
  • Medical history: Certain medical conditions and treatments, such as low body weight, celiac disease, rheumatoid arthritis, and long-term use of corticosteroids can impact your risk of osteoporosis and secondary fractures. 
  • Lifestyle factors: Smoking, excessive alcohol consumption, and a sedentary lifestyle are all things you can take steps to manage and reduce your risk.  

If you have any of these risk factors, or if you have already had a fracture, it’s important to speak with your doctor about your risk of a secondary fracture and what steps you can take to prevent it. 

The Role of Osteoporosis Treatment

If you’re diagnosed with osteoporosis, talk to your doctor about your treatment options. “We know that treatment of osteoporosis can prevent future fracture and the mortality and morbidity associated with these fractures,” says Adimoolam.  

Treatment options include:  

  • Anabolic agents: These medications stimulate bone formation and are recommended for severe osteoporosis.
  • Anti-resorptive drugs: These medications help prevent bone loss by blocking the action of osteoclasts, which are cells responsible for breaking down bone tissue.
  • Bisphosphonates: This class of drugs is the gold standard treatment for osteoporosis. Available as an oral pill or IV infusion, they work to reduce bone loss and increase bone density. Options include Actonel (risedronate), Boniva (ibandronate), Fosamax (alendronate), and Reclast (zoledronic acid).
  • Calcitonin: These medications contain calcitonin, a hormone that helps increase bone density, reduce the risk of spinal fracture, and reduce fracture-related pain. Options include Calcimar (an injection), Fortical and Miacalcin (both nasal sprays).
  • Hormone therapy: While not recommended for prevention or treatment of osteoporosis in menopausal women, hormone therapy can benefit bones in women who take it to relieve menopausal symptoms. It’s also appropriate for premenopausal women whose ovaries don’t make enough estrogen normally.
  • Parathyroid hormone (PTH): This medication contains hormones that increase bone formation and reduce bone resorption. Options include Forteo (teriparatide) and Tymlos (abaloparatide), which are often prescribed for people who have a high risk of fracture, have tried other osteoporosis medications without success, or have experienced side effects while taking other medication options.
  • Parathyroid (PTH1) agonist: These medications work by increasing bone formation and decreasing bone resorption. Options include Prolia (denosumab) and Xgeva (denosumab), which are both injection-only medications indicated for those at risk of fracture or with advanced breast cancer, respectively.
  • Selective estrogen receptor modulators (SERMS): This category includes one medication, Evista (raloxifene), which has protective estrogen-like effects on the bones but doesn’t carry the risk of hormone replacement therapy (HRT), which is no longer used to treat osteoporosis.
  • Sclerostin inhibitors: This new treatment option is available for postmenopausal women who have osteoporosis and are at a high risk of fracture. Evenity (romosozumab) primarily helps increase bone formation and somewhat helps decrease resorption.

Each of these treatments come with different pros, cons, and side effects. Talk to your doctor to determine which osteoporosis medication is best for you. 

How Lifestyle Changes Can Help

In addition to receiving osteoporosis treatment, incorporating these strategies into your daily routine can help strengthen your bones and prevent secondary fractures. 

  • Consider your eating habits: Focus on getting more calcium and vitamin D in your diet,” recommends Adimoolam. These essential nutrients work together to promote bone health: Calcium strengthens bones, and vitamin D helps your body absorb calcium. Eating plenty of fruits, vegetables, dairy, and fish can also help build strong bones. 
  • Stay active: Regular exercise can help prevent bone loss. It can also help reduce fall risk by improving coordination and balance. Weight-bearing (jogging, hiking, stair climbing, dancing) and resistance exercises (weightlifting, squats, lunges, and push-ups) in particular can help strengthen the bones and the muscles surrounding them, emphasizes Gill. 
  • Quit smoking: Cigarette smoking is known to weaken bone density and increase your risk of osteoporosis. It’s never too late to quit. Even quitting later in life is thought to help reduce bone loss related to smoking — which can in turn help prevent secondary fractures.  
  • Drink alcohol in moderation: Keep it to one drink a day for women, and two for men — any more than that may contribute to your risk of developing osteoporosis in the first place.  
  • Take steps to prevent falls: “Eliminate anything from your home that could cause unnecessary falls,” says Gill. That includes securing loose cords, adding non-slip pads under throw rugs, and re-arranging furniture to ensure clear pathways. “Be careful when you’re outside stepping off curbs, or walking on ice in the wintertime,” advises Gill.   

“The good news is you can make these lifestyle changes,” says Gill, “and there are very effective medications that can prevent you from having a second fracture.” 

This article was made possible with support from Amgen. 

American Bone Health. How Often Should I Get Tested?  

Bone Health & Osteoporosis Foundation. Bone Density Testing.  

Bone Health & Osteoporosis Foundation. Nutrition.  

International Osteoporosis Foundation. Falls Prevention.  

Mayo Clinic. Bone health: Tips to keep your bones healthy.  

Mayo Clinic. Osteoporosis treatment: Medications can help.  

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoporosis.  

National Library of Medicine. Calcium, vitamin D, and your bones.  

NIH Osteoporosis and Related Bone Diseases National Resource Center. Exercise for Your Bone Health.  

NIH Osteoporosis and Related Bone Diseases National Resource Center. Smoking and Bone Health.  

Interview with Deena Adimoolam, MD, an endocrinologist who specializes in bone disease at Summit Health in Clifton, New Jersey. 

Interview with Claire Gill, CEO at the Bone Health and Osteoporosis Foundation.  

Theodore MD, Miclau. Secondary fracture prevention: global approaches. OTA International. June 2022.  


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