A fragility fracture is a broken bone that occurs from a seemingly minor incident, an event that would not typically cause a fracture in a young, healthy adult. These injuries represent a significant public health challenge, particularly as the global population ages. They signal an underlying weakness in the skeletal structure, often resulting from low-energy trauma, such as a simple fall from a standing height or less. Understanding these injuries is important for maintaining bone health and preventing severe consequences.
What Defines a Fragility Fracture
A fragility fracture is defined by the minimal mechanical force required to cause the break, quantified by the World Health Organization as trauma equivalent to falling from a standing height. In some cases, especially in the spine, a fracture may occur spontaneously from everyday movements like coughing or bending. The injury is a symptom of a compromised skeletal system that can no longer withstand normal stresses. The direct cause is typically osteoporosis, a condition characterized by low bone mineral density and the deterioration of bone tissue. This lowered density means the bone’s load-bearing capacity is easily exceeded, and a patient who experiences one fracture is at a significantly higher risk of sustaining a second one within the first two years.
High-Risk Locations and Susceptibility Factors
Fragility fractures occur most commonly at three skeletal sites: the hip, the vertebrae of the spine, and the wrist (distal forearm). Hip fractures, involving the proximal femur, are considered the most serious due to the extensive surgery and recovery required. Vertebral fractures may not be diagnosed immediately but can lead to chronic back pain, loss of height, and a stooped posture. Wrist fractures are frequently the first type of fragility fracture, often occurring when a person attempts to break a fall with an outstretched hand.
An individual’s susceptibility is determined by a combination of non-modifiable and modifiable risks. Non-modifiable factors include advancing age, female sex (due to accelerated bone loss following menopause), and a history of a previous fragility fracture or parental hip fracture. Modifiable risk factors relate to lifestyle choices and certain medical conditions. For example, a low body mass index (BMI) of less than 18.5 kg/m² is associated with increased fracture risk. Smoking, excessive alcohol consumption, and long-term use of certain medications, such as oral glucocorticoids, also significantly increase fragility.
Long-Term Health and Quality of Life Consequences
The outcomes following a fragility fracture, especially a hip fracture, significantly impact a person’s life expectancy and independence. Approximately one in five seniors who suffer a hip fracture will die within one year of the injury, often due to complications arising from surgery or prolonged immobility. For those who survive, the fracture frequently results in a substantial loss of autonomy and mobility. Many patients do not regain their pre-injury level of function, with about 50% becoming permanently disabled. This loss of independence often necessitates long-term care, leading to a decline in overall quality of life.
Comprehensive Prevention and Management Strategies
Lifestyle Prevention
Preventing fragility fractures involves a dual approach focusing on lifestyle modifications and medical intervention to improve skeletal strength. To support bone health, adults over the age of 50 should aim for a daily intake of 1,200 milligrams of calcium and between 800 to 1,000 international units (IU) of Vitamin D. Vitamin D is necessary for the body to absorb calcium effectively. Physical activity is another component, specifically weight-bearing exercise, which stimulates bone growth by applying force against gravity. Resistance training, which includes lifting weights or using body weight exercises, also provides tension to the bone to increase density.
Medical Management
Medical prevention centers on identifying and treating the underlying bone weakness before a fracture occurs. A Dual-Energy X-ray Absorptiometry (DEXA) scan is the standard non-invasive test used to measure bone mineral density. The result is reported as a T-score, where a score of -2.5 or lower is diagnostic of osteoporosis, indicating a need for pharmacological treatment. These medications, often prescribed by a physician, work to slow bone loss or increase bone formation, substantially reducing the risk of a future fracture.
When a fracture does occur, effective management begins with acute care, which often involves surgical stabilization, especially for hip fractures. Following this, post-acute care and rehabilitation are critical steps to restore mobility and function. The most important management strategy after a first fragility fracture is to initiate a comprehensive plan to prevent a subsequent one, including fall prevention measures and treatment for osteoporosis.