Fragility Fractures

Fragility Fractures - Defining the Snap

• Fractures resulting from low-energy trauma (e.g., fall from standing height or less), indicating compromised bone strength.
• Strongly associated with osteoporosis; may be the first sign.
• Common sites: Vertebrae (compression), hip (femoral neck), distal radius (Colles'), proximal humerus.
• Epidemiology: Incidence ↑ with age, particularly in postmenopausal women and men >50 years.
• Impact: Significant pain, disability, ↓ quality of life, ↑ mortality risk, and substantial healthcare costs.

⭐ A fragility fracture is defined by the WHO as a fracture caused by injury that would be insufficient to fracture a normal bone; the result of reduced compressive and/or torsional strength of bone.

Fragility Fractures - Why They Crumble

⭐ Osteoporosis is the most common underlying cause, characterized by low bone mass (T-score ≤ -2.5) and microarchitectural deterioration of bone tissue.

• Definition: Fracture from low-energy trauma (e.g., fall from standing height or less).
• Pathophysiology: Bone strength is compromised due to:
  • ↓ Bone Mineral Density (BMD).
  • Impaired bone quality (microarchitecture, turnover, mineralization).
• Key Underlying Causes:
  • Osteoporosis: Primary culprit.
  • Osteomalacia: Defective mineralization (often ↓ Vitamin D).
  • Hyperparathyroidism: ↑ PTH → ↑ bone resorption.
  • Paget's Disease: Disorganized, weak bone structure.
  • Medications: e.g., chronic corticosteroids.

• Common Sites: Vertebrae (compression), hip, distal radius (Colles'), proximal humerus.

Fragility Fractures - Spotting the Risk

Fragility fracture: results from low-energy trauma (e.g., fall from standing height or less).

• Key Risk Factors:

  • Age >50 yrs; Prior fragility fracture (strongest)
  • Glucocorticoid use (e.g., ≥5mg pred/day, ≥3 months)
  • Low BMI (<19 kg/m²); Parental hip fracture history
  • Current smoking; Alcohol ≥3 units/day
  • Secondary osteoporosis (e.g., RA, hypogonadism)

• Assessment Tools:

  • FRAX®: Estimates 10-yr major osteoporotic & hip fracture probability.

    ⭐ FRAX score predicting a 10-year probability of major osteoporotic fracture ≥ 20% or hip fracture ≥ 3% often warrants pharmacological intervention in many guidelines.

  • BMD (DXA): T-score ≤ -2.5 indicates osteoporosis.

Fragility Fractures - Sites & Fixes

• Definition: Fractures from low-energy trauma (e.g., fall from standing height) in weakened bone (osteoporosis).
• Common Sites:
  • Vertebrae (spine)
  • Hip (femoral neck, intertrochanteric)
  • Distal Radius (Colles' fracture)
  • Proximal Humerus

• Clinical Presentation:
  • Sudden onset pain, often after minimal trauma.
  • Deformity, swelling, ↓ range of motion.
  • Vertebral: Height loss, kyphosis, back pain.
• Diagnosis:
  • X-ray: Confirms fracture.
  • DEXA scan: T-score ≤ -2.5 indicates osteoporosis.
• Management Principles:
  • Acute Care: Pain relief (analgesics), immobilisation (splint/cast), DVT prophylaxis.
  • Fixation (Site-Specific):
    • Hip: ORIF (screws, plates, nails), hemiarthroplasty, total hip replacement (THR).
    • Vertebral: Conservative (bracing, analgesia); vertebroplasty/kyphoplasty for persistent pain.
    • Distal Radius: Closed reduction & casting; ORIF for unstable/displaced fractures.
  • Secondary Prevention (Crucial):
    • Calcium & Vitamin D supplementation.
    • Anti-osteoporotic meds: Bisphosphonates (alendronate), teriparatide, denosumab, SERMs (raloxifene).

⭐ Vertebral, hip (femoral neck, intertrochanteric), and distal radius (Colles') fractures are the most common sites for fragility fractures.

• Goal: Restore function, prevent future fractures, improve quality of life. 📌 FRAX tool estimates 10-year fracture probability.

High‑Yield Points - ⚡ Biggest Takeaways

• Fragility fractures result from low-energy trauma (e.g., fall from standing height).
• Common sites: vertebrae, hip (proximal femur), wrist (distal radius).
• Osteoporosis is the primary cause; DEXA T-score ≤ -2.5 is diagnostic.
• FRAX score estimates 10-year major osteoporotic fracture risk.
• Management: calcium, vitamin D, bisphosphonates, and fall prevention.
• Rule out secondary causes like long-term steroid use.
• A prior fragility fracture strongly ↑ risk of future fractures.