Fragility fractures are breaks in bone resulting from low-energy trauma—an impact that would not typically cause a fracture in healthy bone. These fractures signal an underlying weakness in the skeletal system and are a significant public health concern, especially as populations age.
Understanding Fragility Fractures
Fragility fractures occur when bones break under minimal force, such as a fall from standing height or less, or even from everyday activities like coughing or bending over. The World Health Organization (WHO) defines low-energy trauma as forces equivalent to a fall from a standing height or less.
The underlying issue is often reduced bone mineral density, a measure of bone strength, along with changes in bone geometry and microstructure. The bone’s internal structure is compromised and weakened, making it susceptible to fractures from events that would pose no threat to robust bones.
Causes and Risk Factors
Osteoporosis is the primary cause of fragility fractures, characterized by decreased bone mass and deteriorating bone tissue. This condition makes bones porous and brittle, significantly increasing their susceptibility to fractures. Its prevalence rises sharply with age, affecting about 2% of women at 50 and over 25% by 80.
Other medical conditions can contribute to bone fragility, including hormonal imbalances like hyperthyroidism, certain cancers, and long-term use of specific medications such as corticosteroids. A predisposition to falls, stemming from poor balance or muscle weakness, also elevates fracture risk.
Risk factors are categorized into modifiable and non-modifiable types. Non-modifiable factors include advancing age, being female, and a family history of osteoporosis. Modifiable risk factors encompass lifestyle choices such as inadequate calcium and vitamin D intake, a sedentary lifestyle, smoking, and excessive alcohol consumption.
Diagnosis, Immediate Care, and Common Fracture Sites
Diagnosing fragility fractures typically involves medical imaging and a thorough review of the patient’s medical history. X-rays are commonly used, while more detailed imaging like CT scans or MRIs may be employed for complex cases or to assess soft tissue damage. The medical history helps determine if the trauma level was consistent with a fragility fracture.
Immediate care focuses on managing pain and stabilizing the injured area. Pain relief often involves medication, and stabilization might include splinting or casting to prevent further injury. Surgical intervention may be necessary to realign bones or implant hardware, while other fractures may be managed non-surgically.
Fragility fractures most commonly occur at three sites: the hip, spine, and wrist. Hip fractures often result from a fall from a standing position and frequently require hospitalization. Vertebral compression fractures in the spine can occur without a fall and may initially go unrecognized, causing significant back pain and spinal deformity. Wrist fractures are also common, typically occurring when an individual tries to break a fall with an outstretched hand.
Preventing Future Fractures and Long-Term Management
Preventing subsequent fragility fractures involves a multi-faceted approach, often referred to as secondary prevention. Medical interventions include medications designed to strengthen bones, such as bisphosphonates or denosumab, which can reduce bone loss and improve bone density. These medications are frequently prescribed, especially after an initial fragility fracture, as it significantly increases the risk of future fractures.
Lifestyle modifications play a considerable role in long-term management. Ensuring adequate intake of calcium and vitamin D, either through diet or supplements, supports bone health. Engaging in regular weight-bearing exercises, such as walking or dancing, helps to maintain bone density and improve muscle strength, reducing fall risk. Implementing fall prevention strategies, like home safety assessments to remove hazards and improve lighting, are also important.
Long-term management extends beyond fracture healing to encompass rehabilitation and ongoing pain management. Physical therapy and occupational therapy are often recommended to restore mobility and function after a fracture. Persistent pain may require specialized strategies. These fractures can have lasting consequences, including reduced independence and increased reliance on others, highlighting the importance of continuous care and support.