For fracture risk in older adults on osteoporosis or glucocorticoid therapy, which two signs should prompt urgent referral?

For fracture risk in older adults on osteoporosis or glucocorticoid therapy, which two signs should prompt urgent referral?

• A. Severe focal tenderness on palpation and history of osteoporosis or glucocorticoid use
• B. Mild tenderness with no trauma
• C. Pain worsened by movement but no focal tenderness
• D. Normal mood and energy

Answer: (A)

Recognize red flags for fracture in older adults at high risk. Severe focal tenderness on palpation points to a localized bone injury, which is a classic sign of a fracture. When this is combined with a history of osteoporosis or glucocorticoid use, the likelihood of a fracture from minimal or no trauma is high, so urgent imaging and evaluation are needed to prevent complications. The other scenarios describe diffuse or non-specific or non-tender pain, which is less suggestive of an acute fracture in this high-risk group. Normal mood and energy don’t indicate fracture risk. So the presence of severe focal bone tenderness with a risk factor history should trigger urgent referral.