Fractures Related to Osteoporosis
Osteoporosis is a loss of bone density and structural quality that makes bone fragile. It runs silently; often the first sign is a fracture. A fracture caused by a low-energy injury — for example a fall from standing height — is an important warning that calls for assessment of bone health.
The Most Common Fractures
- Vertebral compression fractures: can sometimes occur without an obvious fall, on bending forwards or lifting
- Hip fractures: the group that most affects independence in older patients
- Wrist fractures: from falling onto an outstretched hand; often the first fracture
- Shoulder (upper arm) and rib fractures
There is a chain between these fractures: having had one fracture markedly increases the risk of a second. Assessing bone health after the first fracture is therefore as important as treating the fracture itself.
Risk Factors
- Older age and the post-menopausal period
- A family history of hip fracture
- Low body weight, inadequate nutrition, vitamin D deficiency
- Smoking and excessive alcohol use
- Inactivity
- Long-term corticosteroid use and certain conditions (rheumatological, endocrine, malabsorption)
- Conditions that increase the risk of falling: balance problems, poor vision, multiple medications, hazards in the home
Symptoms
Osteoporosis itself does not cause pain. Symptoms generally appear when a fracture occurs. In vertebral compression fractures the picture can be insidious:
- Loss of height (several centimetres over the years)
- Increasing forward curvature of the upper back
- Back pain beginning without an obvious injury and increasing with movement
- Being unable to stand for long
Diagnosis
- History and examination: history of low-energy fracture, height loss, medication use, assessment of falls risk.
- Bone density measurement (DEXA): the principal method for diagnosis and monitoring.
- X-ray: to show the fracture and assess vertebral compression.
- MRI / CT: where the age of a fracture needs to be determined or uncertain findings clarified.
- Laboratory tests: vitamin D, calcium and investigation of other causes of bone loss.
Management of osteoporosis is often multidisciplinary; assessment together with endocrinology, physical medicine and internal medicine may be needed.
Treatment
Treating the fracture
Depending on the site and type of fracture, bone quality and the patient’s general condition, treatment may be a cast or splint with follow-up, or surgical fixation. In hip fractures the general approach is a treatment plan that allows the patient to be got up early; prolonged bed rest brings other problems with it.
A significant proportion of vertebral compression fractures are managed without surgery: pain control, gradual mobilisation and, where needed, a brace. In selected resistant cases interventional methods may be considered.
Treating the bone — the real issue
Fixing the fracture is not enough on its own; to prevent a second fracture, bone health must be addressed.
- Assessment and correction of calcium and vitamin D status
- Bone-protective drug treatment in suitable patients — the choice and duration determined by the relevant physician
- Weight-bearing exercise and balance work — affecting both bone and the risk of falling
- Stopping smoking and excessive alcohol
- Reducing the risk of falls: adjustments in the home, vision checks, review of medication
Preventing Falls: What You Can Do at Home
- Remove or secure loose rugs; do not leave cables across the floor
- Fit grab rails in the bathroom and toilet and use a non-slip mat
- Keep a light that shows the way at night
- Prefer enclosed, non-slip shoes to slippers
- Review your spectacle prescription and any medicines that can cause dizziness
- Add balance and strength work to your weekly programme
When Should You Seek Assessment?
- If you have had a fracture from a low-energy injury such as a fall from standing height
- If you have noticed marked loss of height or curvature of the upper back
- If you have back pain beginning without injury and increasing with movement
- If you are post-menopausal and have never had a bone density measurement
- If you are on long-term steroid treatment
When to Seek Medical Help Without Delay
- Inability to bear weight on the hip after a fall, with the leg appearing short and rotated outwards (suspected hip fracture)
- Loss of strength in the legs, numbness or a change in bladder or bowel control (there may be pressure on the spinal cord)
- Severe back pain together with fever, weight loss or a history of cancer
- Coldness, colour change or absence of a pulse at the fracture site
These findings require urgent assessment. Outside office hours, go to the nearest emergency department.
Frequently Asked Questions
Does osteoporosis cause pain?
Osteoporosis itself does not cause pain; it runs silently. Pain generally appears when a fracture occurs. For that reason assessment is recommended in people at risk without waiting for symptoms.
I have had one fracture — will there be another?
Having had a fracture markedly increases the risk of a second. Assessing bone health and reducing the risk of falls alongside treating the fracture is therefore important.
Are calcium and vitamin D enough?
They are part of treatment but are generally not sufficient on their own. In suitable patients bone-protective drug treatment is considered; the choice and duration are determined by the relevant physician.
What exercises should I do?
Weight-bearing exercise and balance work are recommended; walking, controlled strength work and balance exercises are examples. In patients with vertebral compression, forward bending and trunk twisting are planned with care.
Does a hip fracture always need surgery?
In the great majority of hip fractures the aim is to get the patient up early, and this is generally achieved with surgical fixation. The decision weighs the type of fracture, bone quality and the patient’s general health together.
Can a vertebral compression fracture heal without surgery?
A significant proportion of these fractures are managed without surgery, with pain control, gradual mobilisation and a brace where needed. Where pain is resistant or neurological findings are present, other options are considered.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of trauma surgery and fracture care and related areas. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Trauma and Fracture Treatment
- Lumbar Disc Herniation
- Spinal Stenosis (Narrowing of the Spinal Canal)
- Hip Osteoarthritis (Coxarthrosis)
- Spinal Disorders and Scoliosis
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any treatment or surgical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.