Fragility Fractures: Causes, Prevention, and Treatment
Fragility fractures occur from low-impact trauma, such as a fall from a standing height or less. These fractures indicate weakened bone strength, often due to osteoporosis or other bone conditions.
Common Sites of Fragility Fractures
- Hip – The most serious fragility fracture, often requiring surgery.
- Spine (Vertebral Fractures) – Can cause height loss and chronic pain.
- Wrist (Distal Radius Fractures) – Common in postmenopausal women.
- Shoulder (Proximal Humerus Fractures) – Affects mobility and function.
Causes and Risk Factors
1. Osteoporosis
The leading cause of fragility fractures, characterized by reduced bone mineral density (BMD).
2. Aging and Hormonal Changes
Postmenopausal women and older adults experience increased bone loss and slower healing.
3. Vitamin D and Calcium Deficiency
Essential nutrients for bone strength and overall bone health.
4. Sedentary Lifestyle
Lack of weight-bearing exercise weakens bones and muscles, increasing fracture risk.
5. Medication-Induced Bone Loss
Certain medications, including corticosteroids, anticonvulsants, and some cancer treatments, can lead to weakened bones.
6. Falls and Poor Balance
Weak muscles, vision impairment, and poor coordination increase fall risk, contributing to fragility fractures.
Diagnosis of Fragility Fractures
1. Imaging Tests
X-rays confirm fracture location and severity, while DEXA (Dual-Energy X-ray Absorptiometry) Scan assesses bone mineral density (BMD). More complex fractures may require MRI or CT scans.
2. Blood Tests
Blood tests can check for vitamin D levels, calcium levels, and bone turnover markers to assess bone health.
Treatment Options
1. Immediate Management
- Pain Control: Acetaminophen, NSAIDs, or short-term opioids.
- Immobilization: Casting, bracing, or splinting for minor fractures.
- Surgical Intervention: Hip fractures often require total hip replacement or internal fixation.
2. Osteoporosis Management
If osteoporosis is the underlying cause, treatment may include:
- Bisphosphonates (Alendronate, Risedronate, Zoledronic Acid): Slow bone loss.
- Denosumab (Prolia®): Reduces bone resorption.
- Parathyroid Hormone Analogues (Teriparatide, Abaloparatide): Stimulate bone formation.
3. Calcium and Vitamin D Supplementation
Adequate intake is essential for fracture prevention and bone healing.
Recommended Daily Intake
- Calcium:
- Women 51+ years and men 70+ years: 1,200 mg/day
- Sources: Dairy, leafy greens, almonds, fortified foods.
- Vitamin D:
- Adults 19-70 years: 600 IU/day
- Adults 71+ years: 800 IU/day
- Sources: Sunlight, fatty fish, egg yolks, fortified dairy products.
4. Lifestyle and Fall Prevention Strategies
Exercise for Bone Strength
- Weight-bearing exercises: Walking, jogging, dancing.
- Resistance training: Weightlifting, resistance bands.
- Balance exercises: Tai Chi, yoga.
Home Safety Modifications
- Remove tripping hazards (e.g., loose rugs).
- Improve lighting at home.
- Use grab bars in bathrooms.
- Wear proper footwear with good grip.
5. Fracture Rehabilitation
Rehabilitation includes physical therapy to restore mobility, prevent future falls, and the use of assistive devices (e.g., canes, walkers) for stability.
Long-Term Outlook
Patients who suffer from a fragility fracture are at higher risk for additional fractures. Early intervention with osteoporosis treatment, supplementation, exercise, and fall prevention can reduce future fractures and maintain mobility.
Take Action for Bone Health
If you’ve had a fragility fracture or are concerned about osteoporosis and bone strength, speak with your primary care doctor or an endocrinologist about bone density testing and treatment options. Early detection and management can significantly reduce fracture risk and improve long-term bone health.