Tibial plateau fracture secondary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rohan A. Bhimani, M.B.B.S., D.N.B., M.Ch.[2]

Effective measures for the secondary prevention of tibial plateau fracture include early detection and management of osteoporosis.

• Effective measures for the secondary prevention of tibial plateau fracture includes early detection and management of osteoporosis and osteopenia.
• Post-menopausal women over the age of 65 have osteoporosis, putting them at greater risk for fractures.
• Measures to detect osteoporosis include:^{[1][2][3] [4]}
  • DEXA(dual-energy x-ray absorptiometry) scan
  • Serum calcium and vitamin D levels
  • Ultrasonography of the calcaneus

• Measures for the secondary prevention of osteoporosis include pharmacological therapy and also lifestyle modification.

• The primary goal for the treatment of osteoporosis is to reduce longtime fracture risk in patients. Increasing bone mineral density (BMD) in response to the treatment is far less important than improvement of clinical aspects of osteoporosis, i.e., osteoporotic fracture. Therefore, most of the drugs efficacy is measured by the extent they improve the fracture risk instead of increasing BMD.^[5]
• During the treatment, if a single fracture happens, it does not necessarily indicate treatment failure or the need to be started on an alternative treatment or patient referral to a specialist.^[6]
• Calcium and vitamin D supplementation have been found to be effective in reducing the long term fracture risk, significantly. In order to suggest the people to use vitamin D and calcium supplements, the physician needs to make sure that patient is not able to obtain the nutrients through the daily intake. The available supplemental ions of calcium include calcium carbonate, calcium citrate, and vitamin D3 in various dosage forms.^[7]

• Exercise: Exercise promotes the mineralization of bone and bone accumulation particularly during growth. High impact exercise, in particular, has been shown to prevent the development of osteoporosis. However, it can have a negative effect on bone mineralization in cases of poor nutrition, such as anorexia nervosa and celiac disease.
• Nutrition: A diet high in calcium and vitamin D prevents bone loss. Patients at risk for osteoporosis, such as persons with chronic steroid use are generally treated with vitamin D and calcium supplementation. In renal disease, more active forms of vitamin D, such as 1,25-dihydroxycholecalciferol or calcitriol are used; as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol), which is the storage form of vitamin D.
• By quitting smoking, osteoporosis as well as other diseases can be prevented.
• Avoiding excessive alcohol intake or drinking only in moderation (1–2 alcoholic beverages/day).
• Taking least possible dosages of certain medications that are associated with osteoporosis (anticonvulsants or corticosteroids).^[8]

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