Primary prevention
High-energy trauma is best prevented by promoting safety among motor vehicle drivers and passengers (e.g., proper seatbelt use, safe driving), in the workplace, and in the home (e.g., falling precautions for older people, appropriate window and balcony guards to prevent falls from heights).[47]
Fall-prevention programs (e.g., exercise, physical therapy) for older people and those with neuromuscular disorders can be useful. There is some evidence that multifaceted interventions in hospital inpatients may reduce the relative risk for number of falls; this may be more likely in a subacute setting.[48][49] These interventions include risk assessment, risk-factor assessment, care planning, medical/diagnostic approaches, changes in the physical environment, education programs, medication review, hip protectors, removal of physical restraints, and exercise.[49] Primary prevention and/or appropriate treatment of osteoporosis can reduce the incidence of osteoporotic fractures. See Osteoporosis.
Appropriate safety gear can decrease the incidence of acute fractures in athletes. Proper training techniques, correct technique, adequate rest, avoidance of over-training, and proper footwear may decrease the incidence of stress fractures in athletes.[23] Screening for and treatment of eating disorders and female athlete triad (disordered eating, menstrual dysfunction, and decreased bone mineral density) may similarly decrease the risk of stress fractures in these populations.[22][23]
Appropriate calcium and vitamin D supplementation can help to decrease the effects of chronic corticosteroid use on bone mineral density among those with corticosteroid-dependent chronic inflammatory conditions.[50] Weight-bearing exercise and resistance training is recommended to help prevent osteoporosis. It is not clear whether teriparatide (recombinant parathyroid hormone) decreases the risk of long bone fractures; however, it is being studied in select patients to improve healing of fractures.[51][52]
Secondary prevention
In an older patient (e.g., 65 years or older) with a fracture resulting from a fall, consider an underlying condition such as osteoporosis, which would put the patient at higher risk of a subsequent fracture. See Osteoporosis.
Patients who are at a high risk of developing a stress fracture (e.g., female long-distance runner with a history of a prior stress fracture) should be followed up and encouraged to report any pain to their physician immediately. There is no secondary prevention for acute fractures of long bones.
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