Addressing the Epidemic: Fragility Fractures on the Rise Among Aging Americans

Between 2022 and 2050, the United States is projected to see a 47% increase in the number of Americans aged 65 and older.1   This progressive aging trend will have public health implications too, because older adults are at a higher risk of developing chronic health problems like diabetes, Alzheimer’s disease, and osteoporosis.2

As we age, bone mass and bone density decrease, making our bones more susceptible to fractures. Every year, 1 in every 4 older adults sustains a fall, making falls the leading cause of injury for those 65 and older. 3   Women are about twice as likely to sustain a fracture versus men.

According to Dr. Stephen Davis, orthopedic trauma surgeon and fracture specialist, anyone over the age of 60 is at risk for a fragility fracture after a fall because of reduced bone density. Reduced bone density is the primary feature of osteoporosis, which has multiple causes.

What is a fragility fracture?

When an older adult falls from a standing position and sustains a fracture, they are considered to have a fragility fracture. Every year in the United States more fragility fractures occur than heart attacks, stroke, and breast cancer combined.4

According to Dr. Davis, upper extremity fractures, spinal compression fractures, and hip fragility fractures are the most common fragility fractures. Hip fragility fractures are considered the most dangerous and worrisome amongst orthopedic fracture specialists because they have a higher morbidity and mortality rate, and treatment is most often surgical.

A deeper look at hip fragility fractures

Dr. Davis reports that a fragility hip fracture usually occurs at the top end of the femur near the hip joint. This is a tremendously painful and immobilizing experience. Surgery is recommended as soon as possible after the injury occurs. The goal of surgery is to stabilize the fracture, control pain, and allow the patient to be mobile (to get up and out of bed) as soon as possible after surgery. Depending on the fracture pattern, a hip replacement may be required.

Dr. Davis informs us that around 50% of fragility hip fracture patients will ultimately require a cane, walker, or some walking aid permanently after their surgery. In addition, 30-50% of those who were living independently before their injury will no longer be able to live independently. Despite proper care, up to 20% of patients will die within 1 year of a hip fracture, typically due to complications of other medical problems and reduced mobility. Therefore, we at OAH and the Bone and Joint Institute strive to perform surgery within the first 24 hours of injury, as multiple studies have shown reduced complications and improved outcomes with early surgical treatment.

Bone density and osteoporosis

Peak bone mass is attained in our early to mid-thirties. Bone density decreases as we age, and can be exacerbated by certain lifestyle choices, medical problems, and medications. Smoking and excessive alcohol negatively affect bone, as do medical problems such as diabetes, lupus, rheumatoid arthritis, and bowel diseases. Medications like steroids can also worsen bone health.

Osteoporosis is defined by low bone density. This is more common in women due to hormonal changes associated with menopause and also lower peak bone mass compared to men. Osteoporosis is a completely silent disease and has no symptoms. Most often, patients are diagnosed with osteoporosis only after they have sustained a fracture. Talk to your doctor and ask if you are at risk and whether you should be tested. Osteoporosis is easily diagnosed by a simple X-ray test called a DEXA scan which is painless and fast. Treatments are available that can help prevent fractures before they occur.

Fragility fracture prevention

According to Dr. Davis, it is estimated that as many as 50% of women and 25% of men will suffer from a fragility fracture in their lifetime. Although aging cannot be avoided, we can become more educated in how to care for ourselves as we age, to avoid experiencing a fragility fracture.

Falls prevention
• Weight-bearing exercises to work on flexibility, strength, and coordination.
Remove tripping hazards around the home such as eliminating thresholds, loose extension cords, and area rugs.
• Wearing slip-resistant footwear instead of socks at home to avoid slips and falls.

Routine medical evaluation. For those over the age of 50, talk to your primary care doctor or an orthopedic specialist about bone density exams and osteoporosis screenings. This applies to:
• Anyone over the age of 50 who has had a fracture.
Women over age 50.
• Anyone with other chronic health problems that can compromise bone health such as diabetes, autoimmune diseases, digestive conditions, etc.

Fragility fracture expertise

As orthopedic specialists, we are committed to the safety and well-being of our patients and community and are constantly learning how to educate and treat our patients in informed scientifically-driven ways.

Fragility Fracture Program
With fragility fracture rates increasing nationally as well as worldwide, a group of orthopedic specialists have come together to form The Fragility Fracture Program at the Bone and Joint Institute in Hartford, Connecticut to provide better osteoporosis treatment and education, prevent fragility fractures, and improve acute fragility fracture care. Learn more about the fragility fracture program.

Fragility Fracture Research
Bones are highly vascular, so patients with fragility fractures bleed a lot after injury and during surgery and will sometimes require blood transfusions. According to Dr. Davis, around 40-50% of patients with hip fragility fractures require a transfusion. Transfusion, for a variety of reasons, contributes to complications after surgery. A recent medical study by Dr. Davis and peers Matthew Solomito, PhD, and Mandeep Kumar, MD was published in early 2024 in the Journal of Orthopedic Trauma. This research studies medications that can be administered that will reduce the amount of blood loss during surgery, therefore improving surgical outcomes and improved mortality rates. Learn more about this study.

Conclusion

Experiencing a fall as an older adult is serious. Reduced bone density and muscle mass contribute to a higher risk of fracture and more serious complications. Loss of walking ability and functional independence is unfortunately all too common. Recovering from injury as an older adult is also a slower process and can reduce quality of life, especially for those who were more independent pre-injury.

Learning about fall prevention and taking an active role in your health can help prevent falls and fragility fractures from occurring. As orthopedic specialists, we strive to educate our community and continue to learn ways to reduce fragility fractures and improve outcomes for patients who sustain them. At OAH, we have an expert team of joint replacement, trauma, and fracture specialists who are available for consultation on any musculoskeletal or fracture concern.

Sources

1 Population Reference Bureau
2 U.S. Department of Health and Human Services
3 Centers for Disease and Control and Prevention Falls Data
4 National Library of Medicine (NIH)

Additional Resources
The American Orthopaedic Association’s Own the Bone program

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