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Criteria vary between countries, with many requiring three or more previous fractures based on patient age and T-score.
Women with fractures were older, had more previous fractures, more cases of rheumatoid arthritis and also more osteoporosis on the baseline DXA.
However there is wide consensus on the pharmacological treatment of men with one or more previous fractures, in order to prevent further events.
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At least one osteoporotic fracture had already been diagnosed in 55.1 % of patients at baseline (70.2 % of these patients had vertebral fractures and 44.2 % had non-vertebral fractures), and 21.6%% of patients had two or more previous osteoporotic fractures.
Secondary prevention in patients with a history of one or more previous fragility fractures at major sites (hip or spine) or at minor sites plus T-score < − 3.
A total of three studies (12%) reported that one or more participants had previous fractures [ 10, 25, 29].
A descriptive comparison between the two studies (Table 1) suggests that women initiating treatment with teriparatide more recently (ExFOS) were relatively healthier, more active, exercised more frequently, could rise from a chair more easily and had fewer previous fractures than their counterparts from EFOS.
Strontium ranelate was prescribed more frequently in patients with previous fractures, perhaps reflecting a perception of superior efficacy in restoring bone mass.
Previous fractures and drug use were more prevalent in cases than in controls (table 1).
The Preventive Services panel recommends bone density screening for women starting at age 65, when osteoporosis becomes more common, or at age 60 if other risk factors are present, such as previous fractures.
Selective oestrogen receptor modulators were more likely to be prescribed to younger women, those without objectively demonstrated osteoporosis by densitometry and in those without previous fractures.
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