Fragility Fractures
Although definitions vary, fragility fractures are commonly defined as any fracture in an adult over age 50 that occurs by an injury mechanism of a fall from a standing height or less. Normal bones in healthy people should be able to withstand this amount of trauma without sustaining a fracture. Any bone of the body may be affected, but the most common involve fractures of the distal radius, proximal humerus, spine, pelvis, and proximal femur. Of special concern are fractures of the femoral neck and intertrochanteric/ subtrochanteric regions of the proximal femur, or “hip” fractures.
Fragility fractures are increasing in incidence because of an aging baby boomer population. The current pace of 2 million fragility fractures per year is expected to increase to 3 million by 2025. Fragility fractures outnumber heart attack, stroke, and breast cancer combined.
Fifty percent of women and twenty-five percent of men over age 50 will experience at least one fragility fracture in their lifetime.
Hip fractures present a particular problem for patients. Surgery is almost always indicated for fractures of the proximal femur because of the high complication rate of non-operative treatment. Mortality rates for non-operative care approach 80 to100%, secondary to prolonged immobility. Even with surgical treatment, permanent reductions in mobility, function, and independence are common. Additionally, death rates after hip fracture surgery are 1-3% in hospital, 5-10% at 30 days, and 20-25% at 1 year. Currently, a 50-year-old woman has an equal risk of death in her lifetime from a hip fracture as she does from breast cancer.
Preventing Fragility Fractures
The best way to prevent fragility fractures is to prevent falls. One third of people over age 65 fall each year. Simple solutions to prevent falls include:
- Removing loose thresholds, area rugs, and other tripping hazards from the home. Non-slip mats can be placed in the kitchen and bath or other wet areas. Banisters or other mobility aids can be installed for stairways, and night lights illuminating paths to the restroom can help prevent falls at night.
- Especially in New England, falls on ice in winter are very common. Walkways around the house should be diligently cleared of ice.
- Shoe wear should be appropriate for the weather conditions. I often recommend crampons for my patients, which can easily be strapped onto shoes for use in snow and ice. Yaktrax is a widely available brand. Similar devices can be purchased to fit over the ends of canes and walkers to prevent slippage.
- Regular exercise is important to improve strength, balance, flexibility, coordination, and stamina. When lacking, these are important contributors to the circumstances of all falls.
Osteoporosis As a Risk Factor
Osteoporosis causes fragility fractures, and often goes undiagnosed until the first fracture occurs. Eighty percent of fragility fracture patients go untreated for their underlying condition. Women over 65 and men over 70 should get a screening DEXA scan. Patients with other risk factors for osteoporosis, such as a strong family history, chronic steroid use, any prior fragility fracture, or renal disease, should be screened as early as 50. Good bone health should be recommended for all patients. Smoking and heavy alcohol use negatively affect bone quality. Vitamin D, which is vital for bone formation, is a common deficiency and can be prevented with vitamin D supplementation. Regular weight-bearing exercise is important for maintaining bone mass.
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Fragility fractures are a common cause of pain, loss of function, and even death. Many are preventable with simple measures to prevent falls. Finally, diagnosis and treatment of osteoporosis can also help prevent fractures and their life-altering consequences.