From the Guidelines
A fragility fracture is defined as a bone break that occurs from minimal trauma, such as falling from standing height or less, that would not normally cause a fracture in a healthy bone, and is a significant predictor of future fractures, requiring further evaluation and treatment of the underlying osteoporosis. These fractures typically occur in individuals with osteoporosis or other conditions that weaken bone structure. Common sites for fragility fractures include the hip, spine, wrist, and shoulder. They are significant because they indicate underlying bone weakness and substantially increase the risk of subsequent fractures. Fragility fractures are clinically important as they often serve as the first indication of osteoporosis, prompting evaluation of bone mineral density and consideration of treatment options such as bisphosphonates, denosumab, teriparatide, or romosozumab 1.
Key Points
- Fragility fractures are associated with significant morbidity and mortality, and require a comprehensive evaluation to identify underlying metabolic bone disease and reduce the incidence of future fractures 1.
- A fragility fracture in an adult is an important predictor of future fractures, and most fragility fractures occur in patients with bone mineral density T scores higher than 2.5, confirming the presence of skeletal fragility even in the presence of a well-maintained bone mineral density 1.
- Dedicated vertebral imaging and review of past imaging is useful in identifying fractures in patients at high risk for vertebral fractures, as most low-trauma vertebral fractures do not present with pain 1.
- Early identification of fragility fractures is crucial, as appropriate treatment can reduce the risk of subsequent fractures by 30-70%, and it is recommended that an established classification system be used for fracture identification and reporting 1.
Evaluation and Treatment
The evaluation of fragility fractures should include exclusion of contributing factors for osteoporosis and assessment of clinical risk factors for fracture, followed by appropriate pharmacological intervention designed to reduce the risk of future fracture 1.
Risk Factors
Risk factors for osteoporosis include age, low body weight, weight loss, physical inactivity, use of oral corticosteroids, and previous fragility fracture 1.
Diagnosis
The standard for measuring bone mineral density and diagnosing osteoporosis is DXA, however, it is not universally available, and other non-DXA osteoporosis tests that are sensitive, inexpensive, and easily implemented should be evaluated 1.
From the FDA Drug Label
Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture Fractures, usually of the spine, hip, and wrist, are the common consequences
A fragility fracture is a fracture that occurs due to osteoporosis, characterized by low bone mass and an increased risk of fracture, often confirmed by evidence of fracture on x-ray, history of osteoporotic fracture, or height loss or kyphosis. Common sites of fragility fractures include the spine, hip, and wrist 2.
From the Research
Definition of Fragility Fracture
- A fragility fracture is a fracture that occurs from a low-impact event, such as a fall from standing height or less, typically due to weakened bones 3.
- These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to fracture 3, 4.
- Fragility fractures often occur in older adults, including post-menopausal women, and commonly affect areas such as the hip, spine, and wrist 3, 4.
Risk Factors for Fragility Fractures
- History of a fragility fracture is among the strongest risk factors for future fracture 4.
- Other risk factors include age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease 3.
- Additional risk factors include smoking, excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, which can overtime result in osteoporosis 3.
Prevention and Treatment of Fragility Fractures
- Bisphosphonates have been found to be effective in preventing fragility fractures, with zoledronate being the most effective treatment in preventing vertebral fractures 5.
- Antiresorptive drugs, such as bisphosphonates and the RANKL inhibitor denosumab, increase bone mineral density and reduce the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis 6, 7.
- Anabolic therapy with teriparatide and the sclerostin antibody romosozumab have also been shown to be effective in preventing vertebral and clinical fractures in postmenopausal women with osteoporosis 6.