There are several common fracture types recognized by expert committees as being due to osteoporosis. Other fractures that occur in adults and are clearly not traumatic in any way are called stress fractures. They are not traditionally said to be due to osteoporosis but remember that is simply an opinion not a fact. Common stress fractures occur in the metatarsal bones of the feet. These are the bones to connect the toes to the ankle. They can be quite troublesome.stress fractures in the metatarsal bones of the feet

Fragility Fracture DefinedOsteoporosis fractures are also called fragility fractures. They occur with very little bone. The fracture was unexpected given the trauma. The principal factor that differentiates a fracture due to osteoporosis and one due to trauma is the force that caused the fracture. The less force, the more likely it was osteoporosis. For example: 1) a fall from standing height = osteoporosis 2) a fall from a step latter = traumatic fracture.

Most fractures (75%) that occur in white adults over age 40 irrespective of the cause are contributed to by osteoporosis.

The most common osteoporotic fractures are of the spine, wrist, and hip. Fractures of the pelvic, ankle, humeral and femur can also be due to osteoporosis.

Hip Fractures

Hip FractureHip fractures are the most serious osteoporosis fracture

  • They are life threatening in the short term by blood clots, stroke, heart attack and infection
  • 20% of people with hip fracture die in the year after the fracture
  • 50% have to use a cane, walker of wheelchair post-fracture
  • 25% are not able to maintain their independence post-hip fracture and move to assisted living or a nursing home
  • Hip fractures are the second most common fracture due to osteoporosis after spine fractures

 

Hip FractureThey are the most expensive osteoporotic fracture, all requiring hospitalization, and most major surgery.

Hip fracture patients are usually old and frail. Most have one or more serious comorbid medical condition that makes them high risk for any major surgical procedure

A significant number of patients treated in hospital for hip fracture experience acute complications of the fracture or its treatment, some of which are life threatening.

Most hospitals and orthopedists are highly skilled at managing these patients. A team approach is used to rapidly and as safely possible move the patient from the ER to the OR to PT and out of the hospital. Today this process is accomplished in under a week compared with over two weeks 20 years ago. Outcomes are better, complications are fewer, and costs have not increased.

 

Spine Fractures

Vertebral Compression FractureSpine fractures, known as vertebral compression fractures

  • Are the most common fracture due to osteoporosis
  • 75% of spine fractures are silent
  • The pain due to a spine fracture usually occurs in the lower back and may radiate into the buttock
  • The pain is usually severe and the patient knows that something is different about the pain
  • OTC pain treatment is not very useful

 

 

 

Impact of Vertebral Compression Fractures on PostureSpine fractures cause shortening of the torso but your legs and arms remain the same length. This makes shopping for coats difficult and usually requires an alteration be made to the coat’s hem.

With conventional therapy of ice packs, pain medications and physical therapy the pain from spine fractures slowly resolves over 3 to 6 months in most people. In some, the pain becomes chronic but not severe.

Studies show that the presence of one spine fracture predicts the occurrence of future spine fractures. The more spine fractures someone has the higher the risk for follow-up fractures.

Patients who suffer symptomatic vertebral compression fractures experience a 20% excess mortality spread over the next five years from the date of the fracture compared with their peers who have not had a spine fracture.

Kyphoplasty Procedure

 

 

 

Kyphoplasty is an outpatient surgical technique where bone cement is injected into the broken vertebral body forming a stabilizing cast from within. Pain relief is immediate in 3 out of 4 patients. In half the others, it is improved and in the rest, there is no benefit.

 

 

 

 

Peripheral Fractures

  • Are less common than spine or hip fractures
  • Are not fatal
  • Are always painful
  • Can be temporarily disabling
  • May require surgery to repair
  • Surgical repair can be very expensive
  • Complex ankle, wrist and shoulder fractures may result in some degree of long-term disability
  • Wrist fractures are the most common peripheral osteoporotic fracture and typically occurs about a decade before the spine and two decades before hip fractures in women with the osteoporosis genetic complex. For this reason, wrist fractures are nick named the Herald Fracture of Osteoporosis.
osteoporotic fracture of the head of the radius

Typical osteoporotic fracture of the head of the radius that occurred in a 56 y/o white postmenopausal female who fell walking her dog. In the left panel he fracture line is clearly seen in the X-ray image in the running diagonally up from the outside of the wrist toward and extending into the middle of the wrist joint.

Since the fracture involved the joint, it was more complex than a simple crack that could be treated with a splint. She needed open reduction and internal fixation that required general anesthesia. A plate and screws were used to stabilize the loose bone fragment and keep radial head together. Surgery similar to that seen in the images below would have been performed by a skilled orthopedist.
Orthopedic Wrist Surgery    Orthopedic Wrist Surgery

The patient would remain in the hospital for a day or two post operatively. She would be in a case and sling and not able to use her arm for about 6 weeks or more depending on how quickly she healed.

After the case is removed, she will go to physical therapy. Her arm muscles have become very weak and are visibly shrunken as a result of being immobilized. It has been pretty difficult being dependent on others for so much during this past 6 weeks. She is so glad this part is over.

The total cost of her wrist fracture including hospitals, doctors, physical therapy and medications was $22,1450 all covered by insurance except her $6,000 deductible. She missed 3 weeks of work entirely and when she went back, well it was a joke. She really couldn’t get organized for at least another week. Anyway since she is self-employed, some of the lost business can be made up but she estimated that she lost about $10K easily in revenue that she would have booked in the month after the fracture. Fortunately she recovered completely, everything is fine. She sets the alarms off when she goes through security at the airport but that is her only complaint.
Reducing Risk