WCO-IOF-ESCEO 2026: Updates on Fracture & Orthogeriatrics

Integrating Biology, Behavior, Function, and Environment: A 4-Pillar Framework Driving Comprehensive Bone Health Optimization

Presenter: N. Koumontzis

The Optimal Clinical Paradigm is a structured, reproducible clinical process designed to comprehensively assess and manage bone health. It is built around a 4‑Pillar Assessment encompassing biological, behavioral, functional, and environmental factors. The biological pillar addresses physiological drivers of bone loss through risk assessment, examinations, investigations, and specialist input.

The behavioral pillar evaluates lifestyle factors and barriers to treatment adherence, supporting sustainable behavior change. The functional pillar assesses movement, balance, strength, and fall risk, with targeted physical therapy interventions. The environmental pillar focuses on optimizing home safety through occupational therapy input and modifications, aiming to reduce falls and support long‑term independence and mobility.

A successful clinical process of Bone Health Optimization needs to be based upon inherent assessment and treatment algorithms that involves all these pillars into the clinical framework.

Early Initiation of Osteoporosis Treatment After Fracture Reduces Secondary Fractures in Adults Aged ≥75 Years

Presenter: M. Tsukamoto

This large observational study evaluated whether early and sustained osteoporosis treatment after fracture reduces secondary fracture risk in adults aged 75 years or older. Using Japanese claims data and a target trial emulation approach, over 53,000 matched participants were analysed.

Initiating osteoporosis medication within three months of fracture and continuing treatment for at least six months significantly lowered the risk of subsequent fractures, with greater risk reduction seen with longer treatment duration. Hip fracture risk was substantially reduced in both men and women, with similar benefits across sexes.

These findings strongly support prompt initiation and sustained continuation of osteoporosis therapy after a fracture for secondary fracture prevention in older adults.

Evidence-Based Strategies for Improving Bone Health in Older Adults Through Orthogeriatric Care and Risk Communication

Presenter: F. Kamberi

This study assessed risk perception, chronic pain, and bone health behaviors among older adults with chronic conditions in Albanian primary healthcare settings, focusing on barriers and facilitators to orthogeriatric care.

Using cross‑sectional and observational data from 2017–2024, it found high prevalence of chronic back and joint pain, frequent falls, fractures, and multiple osteoporosis risk factors. Fractures, particularly hip fractures, were more common in men and were mainly fall-related. Patient education relied on individual counseling and family support, while barriers included poor risk communication, limited resources, and weak documentation.

Improved interdisciplinary collaboration, communication, training, and access to screening and rehabilitation were identified as key to reducing fracture risk and improving bone health outcomes.

Impact of Anti-osteoporotic Therapy Post-Hip Fracture on Mortality: A Real-World Study

Presenter: E. Monleón Acosta

This retrospective study of 1,068 patients with osteoporotic hip fractures evaluated the impact of post‑fracture osteoporosis management on mortality. Only a small proportion received osteoporosis treatment before or after fracture.

Post‑fracture anti‑osteoporotic therapy and calcium/vitamin D supplementation were both significantly associated with reduced mortality. Mortality was lowest among patients treated with denosumab, followed by bisphosphonates and teriparatide. Patients managed by a bone metabolism expert also had significantly better survival.

Despite clear benefits, treatment rates remained low, supporting the value of a coordinated fracture unit led by a bone metabolism specialist.

Single Dose of Zoledronate After Hip and Vertebral Fracture on Long-Term Mortality: A Real-World Evidence Study

Presenter: C.-H. Wu

This nationwide retrospective cohort study in Taiwan evaluated whether a single dose of zoledronate after major osteoporotic fracture is associated with long-term survival benefits.

Among propensity-matched patients hospitalized for first hip or vertebral fractures, those receiving one dose of zoledronate had a significantly lower 10‑year all‑cause mortality than untreated patients. Over follow‑up, mortality was 46.7% in the zoledronate group versus 50.0% in controls, corresponding to a modest but significant risk reduction.

These real‑world findings extend trial evidence and support early zoledronate use, even as a single dose, for improving long‑term survival after osteoporotic fractures.

WCO-IOF-ESCEO Congress, April 16-19, 2026, Prague, Czech Republic.