Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts

Management of Vertebral Fragility Fracture in Older People: Recommendations from a Spanish Consensus of Experts

A Spanish Consensus of Experts developed 22 recommendations intended to facilitate the appropriate diagnosis, treatment, and follow-up of older people suffering from Vertebral Fragility Fracture. 


Specialists in osteoporosis belonging to different scientific societies reviewed the main clinical practice guidelines published in Spain in 2014. Thirty-five recommendations for the management of VFF were evaluated by seven experts using an anonymous survey. Consensus was achieved in 22 recommendations:
• Need for anamnesis, clinical assessment, and laboratory tests, including erythrocyte sedimentation rate, proteinography, and the assessment of levels of calcium, vitamin D, alkaline phosphatase, and thyroid-stimulating hormone. Optional tests, such as bone turnover markers (BTMs), magnetic resonance imaging, bone scintigraphy, or using a fracture risk assessment tool (FRAX®) didn’t achieve consensus.
• Administration of calcium/vitamin D supplements, withdrawal of toxic habits, and personalized physical exercise. 
• Administration of teriparatide for 24 months and then a switch to denosumab or bisphosphonates in patients at high risk of fracture. 
• Specialists in osteoporosis, primary care physicians, and geriatricians should be involved in the follow-up of patients with VFF. 
• Therapeutic objectives should be individualized for every patient.

According to the authors: ‘Interesting aspects of this project include the consideration of osteoporosis from a multidisciplinary approach, the focus of the survey on VFF only, and the differentiation of older people into the three categories of “robust”, “frail” and “severely disabled”, based on their physiological vulnerability, functional and mental capacity, and family/social support.

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