What is a Fragility Fracture?
A fragility fracture is a fracture sustained from a fall from standing height or lower that would not cause a fracture in most healthy persons, reflecting compromised bone strength and underlying skeletal fragility. 1
Core Definition
Fragility fractures (also called "low-energy" or "low-trauma" fractures) occur from minimal trauma—specifically, a fall from standing height or less—that would not typically break bone in healthy individuals. 1
These fractures are indicative of compromised bone strength and confirm the presence of skeletal fragility, even when bone mineral density (BMD) is relatively preserved. 1
Most fragility fractures actually occur in individuals with BMD T-scores higher than -2.5, meaning you don't need to meet the densitometric definition of osteoporosis to have a fragility fracture. 1, 2, 3
Common Sites
Major osteoporotic fractures (MOF) include fractures of the hip, spine, wrist, or shoulder. 1
However, fragility fractures can occur at other sites beyond these classic locations. 4, 5
Upper extremity fragility fractures, particularly distal radius fractures in the elderly, often present earlier than hip and vertebral fractures and represent an important opportunity for early intervention. 6
Clinical Significance in Older Adults with Osteopenia
In the context of an older adult with osteopenia (T-score between -1.0 and -2.5), a fragility fracture is particularly significant because:
The fracture itself confirms skeletal fragility and warrants pharmacologic treatment regardless of the BMD measurement. 2, 3
A history of fragility fracture is among the strongest risk factors for future fractures, with approximately 2-fold increased risk of subsequent fractures. 1, 7
The fracture risk is highest in the immediate 1-2 years following a fragility fracture, termed "imminent fracture risk." 1, 2, 3
Age is actually a stronger determinant of fracture risk than bone density alone—older adults have much higher fracture rates than younger adults with the same BMD due to declining bone quality and increased fall risk. 1
Critical Clinical Pitfall
Approximately 70% of patients who sustain fragility fractures are not evaluated or treated for underlying osteoporosis, representing a major care gap and patient safety crisis. 1, 2
Even when fragility fractures are diagnosed, evaluation and pharmacological intervention is only offered to a small percentage of these individuals. 1
Every patient with a fragility fracture requires systematic evaluation for underlying metabolic bone disease and treatment to prevent future fractures, regardless of their BMD T-score. 2, 3, 7
Vertebral Fractures: A Special Consideration
Most low-trauma vertebral fractures do not present with pain and are clinically silent, making dedicated vertebral imaging essential in high-risk patients to identify these fractures. 1