What You Need to Know About Osteoporosis and Fragility Fractures

Fragility fractures, also known as osteoporotic fractures, are caused by minimal, low-energy trauma such as falling from a standing height or lower. This type of fracture is typically an underlying symptom of osteoporosis, a condition that causes bones to become weak and brittle. Fragility fractures often occur in the hip, spine, or wrist. Many people with osteoporosis don't realize they have this disease until their first fragility fracture.

This article explains the basics of fragility fractures. It discusses why osteoporotic fractures are one of the key symptoms of osteoporosis, how they occur, risk factors, and various treatment options.

Osteoporosis and Bone Health

Osteoporosis means "porous bone disease" in Latin. It is also called "brittle bone disease." A lifetime of low calcium intake can contribute to the loss of bone mineral density (BMD) observed in people with osteoporosis. Calcium is a mineral that keeps bones healthy and strong. Over 99% of the body's total calcium is found in the bones and teeth.

The amount of calcium you need to offset the risk of osteoporosis and maintain bone health depends on your age and sex. For example, the average daily recommended amount of calcium for postmenopausal adult women (ages 51–70) is 1,200 milligrams (mg), whereas men of the same age only require 1,000 mg/day. Children and teenagers (ages 9–18) need about 1,300 mg of calcium per day to keep their bones healthy.

The body typically absorbs less calcium after menopause, which makes postmenopausal women more susceptible to progressive bone thinning, osteoporosis, and fragility fractures.

Vitamin D, the "sunshine vitamin" helps the body absorb calcium and plays a vital role in bone health and offsetting the risk of osteoporosis and fragility fractures. Vitamin D deficiency can increase your risk of osteoporotic fractures because the calcium someone consumes isn't absorbed properly and can't make bones stronger.

Weight-bearing activities such as walking or climbing stairs help keep bones healthy and strong. Resistance-training exercises such as lifting weights or doing push-ups also boost bone mass and help to prevent osteoporosis. On the other hand, inactivity and sitting too much make bones weaker and increases the risk of both osteoporosis and fragility fractures, especially in postmenopausal women.

What Is a Fragility Fracture?

A fragility fracture, also known as an osteoporotic fracture or low-impact fracture, is a bone fracture that typically occurs when someone with fragile bones falls from a standing height or less. These fractures occur spontaneously as someone is going about daily activities and has a minor, low-energy impact with a hard surface that typically wouldn't cause a fracture in a healthy adult with stronger bones.

Unlike bone fractures caused by high-energy trauma, such as being in an automobile accident, fragility fractures are caused by low-energy bumps and falls that typically wouldn't be forceful enough to fracture a healthy bone. Fragility fractures are most commonly attributed to osteoporosis and a lack of bone mineral density.

Where Fractures Commonly Occur

Fragility fractures most commonly occur in these areas:

• Proximal femur (hip)
• Vertebral body (spine)
• Distal radius (wrist)
• Proximal humerus (shoulder)

Fragility Fracture Risk Factors

In addition to low bone mineral density and osteoporosis, some other clinical risk factors associated with fragility fractures are listed below:

• Increased age
• Family history of osteoporosis
• Age-related hormonal changes (e.g., menopause)
• Recent falls
• Previous fragility fractures
• Insufficient calcium intake
• Vitamin D deficiency
• Cigarette smoking
• Alcohol use disorder

Fixed Factors

Increased age among all people and the hormonal changes associated with menopause, such as lower estrogen, are fixed risk factors that are almost guaranteed to increase fragility fracture risk. Genetic susceptibility to osteoporotic fractures is another fixed risk factor.

Variable Factors

Variable factors that affect fragility fracture risk include physical activity, weight-bearing exercise, dietary habits, Vitamin D levels, daily calcium intake, cigarette smoking, and alcohol consumption.

Symptoms and Diagnosis

Osteoporosis can occur without symptoms, which is why it is called a "silent disease." Many people don't know they have osteoporosis or that their bones have become weak and brittle until they've had a low-impact mishap that causes a bone to break. The lack of symptoms before experiencing a fragility fracture makes progressive bone thinning easy to miss.

Bone mineral density assessment using dual-energy X-ray absorptiometry, known as a DEXA scan, is the gold standard for diagnosing osteoporosis. Calcaneal quantitative ultrasonography (QUS) is another screening tool for assessing bone health.

After a fracture has occurred, a healthcare provider or orthopedic specialist can diagnose an osteoporotic fracture during a physical exam along with imaging techniques such as X-ray, magnetic resonance imaging (MRI), CT scan, or bone scan.

Treatment

After a fragility fracture, calcium and vitamin D supplementation are key parts of treatment. Patients with osteoporosis are also encouraged to make lifestyle changes such as staying physically active (e.g., sitting less, moving more), eating a nutritious diet, drinking less alcohol, and not smoking. Bisphosphonates are the most commonly prescribed medication for treating osteoporosis and slowing bone loss.

Caring for the Fracture and Related Complications

Fragility fractures are cared for by stabilizing the broken bone so that it can heal after it's set in place. Most fractures heal without surgery using a cast, brace, or sling for stabilization. If surgery is required to reposition and stabilize bones, an orthopedic surgeon may also implant screws, rods, or plates to stabilize the bone and let it heal.

Managing the Underlying Condition

In addition to calcium and vitamin D supplementation, lifestyle habits such as regular exercise, eating a healthy diet, drinking less, and avoiding cigarettes are effective ways to manage the underlying condition (osteoporosis) that increases fragility fracture risk.

Bisphosphonate medications are also used for the prevention and treatment of osteoporosis. Bisphosphonates are prescribed under different brand names and have different delivery methods:

• Actonel (risedronate): Pill taken once a week or monthly
• Fosamax (alendronate): Pill taken once a week
• Boniva (ibandronate): Monthly pill or intravenous (IV) infusion quarterly
• Aredia (pamidronate): IV infusion monthly
• Reclast (zoledronic acid): IV infusion annually

For those who can't tolerate the side effects of bisphosphonates, denosumab medications (Prolia, Xgeva) are often prescribed to manage osteoporosis and reduce the risk of fragility fractures.

Preventing Future Fractures

Fragility fractures typically occur as people are going about their day-to-day activities and have a minor accident that wouldn't normally break a bone. Taking extra care when it's slippery or icy outside is a practical way to avoid slips and falls, thus avoiding future fractures. However, the best way to prevent future fractures is to make your bones stronger by treating or preventing osteoporosis.

Summary

Fragility fractures are also called osteoporotic fractures. When someone's bones have become weak and brittle from osteoporosis, even the slightest impact can cause a fragility fracture. Increased age, hormonal changes women experience after menopause, and genetics can increase someone's risk of osteoporosis and fragility fractures. Not getting enough calcium and vitamin D also increases risk. Smoking cigarettes and drinking too much alcohol deteriorates bone health and makes people more prone to fragility fractures over time.

Making healthier lifestyle choices and eating a nutritious diet can help keep bones healthy and strong, which offsets the risk of fragility fractures. When healthy habits aren't enough, bisphosphonates are the first-line medication for treating and preventing osteoporosis.

A Word From Verywell

As you get older, your bones will get weaker and more brittle. The best way to prevent fragility fractures is to keep your bones healthy and strong. Most people don't realize they've lost bone mineral density until they have a minor mishap and feel a bone snap. Therefore, it's important to be proactive and talk to a healthcare provider about prescreening for osteoporosis around ages 45–55 or during menopause.