OSTEOPOROTIC FRACTURES IN OLDER ADULTS: RECOGNITION, IMMINENT RISK, SECONDARY PREVENTION AND MORTALITY

Abstract

Osteoporosis remains asymptomatic until a fragility fracture reveals it, and that fracture already signals a high risk of a further event and of premature death. This narrative review critically analysed the secondary prevention pathway in older adults, from risk recognition to survival after fracture, delimiting which interventions modify mortality and which modify fracture incidence alone. PubMed/MEDLINE, SciELO, the Virtual Health Library/LILACS and the Cochrane Library were searched, together with scientific society guidelines and official Brazilian and foreign documents; the last search was run on 25 July 2026. The analysis covered radiological underreporting of vertebral fractures, recalibration of the Brazilian FRAX model, the imminent risk window of the two years following a first fracture, the hierarchy of evidence for preventive measures, and the distance between efficacy and coverage of care. A 2026 systematic review of 69 trials reinterpreted the benefit of calcium and vitamin D supplementation as small, with absolute reductions of 1% for any fracture and 0.3% for hip fracture, below the clinical relevance thresholds set by its authors, in populations that were predominantly community dwelling and not receiving drug treatment for osteoporosis. Interventions with a demonstrated reduction in mortality remain few and narrowly defined. The priority is to shorten the interval between the sentinel fracture and the start of care.