Secondary Fracture Prevention

Secondary fracture prevention refers to all the steps taken after an initial fragility fracture to prevent a second one. It is one of the most important and unfortunately one of the most neglected areas of osteoporosis care — but you can take an active role in making sure it happens for you.

Why Is a Second Fracture So Likely?

A first fracture is a clear signal that bone density is sufficiently reduced to allow a low-energy impact to break a bone. Without intervention:

• The underlying osteoporosis continues to progress
• Fall risk remains or increases
• The individual is now in the highest-risk category for a second fracture

The probability of a subsequent fracture after the first is high:

• A vertebral fracture increases the risk of a second vertebral fracture by 5 times in the following 12 months
• Any major fragility fracture approximately doubles subsequent fracture risk overall
• A hip fracture is associated with a 10% risk of a second hip fracture within 2 years

What Is a Fracture Liaison Service (FLS)?

A Fracture Liaison Service (FLS) is a systematic, coordinator-led service that identifies people who have had a fragility fracture and ensures they receive appropriate bone health assessment and treatment. FLS models have been shown to significantly increase the proportion of fracture patients who receive osteoporosis treatment and subsequent DXA scanning.

FLS in Ireland

Fracture Liaison Services in Ireland are growing but not yet universally available. Many major acute hospitals now have FLS programmes, primarily co-ordinated by specialist nurses working within orthopaedic or rheumatology departments.

The Irish Osteoporosis Society has been a strong advocate for the expansion of FLS services across Ireland. The International Osteoporosis Foundation (IOF) “Capture the Fracture” initiative recognises hospitals that have achieved best-practice FLS standards.

If Your Hospital Doesn't Have an FLS

If an FLS is not available at your hospital, the following steps should still happen — and you may need to initiate them:

1. Ask the orthopaedic team before discharge about bone health assessment
2. Follow up with your GP after discharge specifically to discuss osteoporosis assessment and treatment
3. Ask for a DXA scan if one has not been done recently
4. Ask for a FRAX score calculation to assess your 10-year fracture risk
5. Ask about starting bone-protective medication
6. Ask for referral to a rheumatologist or endocrinologist if your GP is unsure about management

Components of Secondary Prevention

Comprehensive secondary fracture prevention includes all of the following:

• Bone-protective medication: Started promptly after fracture — bisphosphonates, denosumab, or anabolic agents depending on clinical assessment
• Calcium and Vitamin D: Essential adjuncts to any medical treatment
• Falls prevention: Physiotherapy for balance and strength; home safety assessment; medication review; vision check
• Ongoing monitoring: DXA scan at 18–24 months after starting treatment to assess response
• Lifestyle: Weight-bearing exercise, adequate protein, smoking cessation, limited alcohol

Long-Term Follow-Up

Osteoporosis management is lifelong. Once treatment is started, regular follow-up with your GP is important to:

• Monitor treatment compliance and side effects
• Reassess bone density (DXA scan, typically every 1–2 years)
• Review medication — some medications are given for defined periods, then changed or paused
• Continue monitoring fall risk factors
• Adjust treatment if fractures occur despite therapy

Do not stop osteoporosis medication without discussing it with your GP. Treatment works — but only while you are taking it.