Fragility Fractures
The presence of a fragility fracture is the best indicator of osteoporosis and future fragility fractures. Vertebral fractures are the most common fragility fracture (700,000 per year in the U.S.). Approximately two-thirds are asymptomatic and largely go undiagnosed. Approximately 19% of patients with vertebral fracture will have another in the next year. Patients with vertebral fracture have a three-fold increase in the risk of a hip fracture. Hip fractures are the most devastating fracture in the elderly with 25% of patients unable to live independently and a 20% higher than expected mortality. (13)
What to do after a suspected fragility fracture
Remember that fragility fractures are defined as fractures that occur at a low level of trauma (such as a fall from standing height or lower or no apparent trauma).
Rule out other causes of the fracture (mainly malignancy).
Lone vertebral fractures above T7 and posterior wedge fractures are less likely to be due to fragility alone.
When uncertain, consider risk factors and check BMD.
When certain, make the diagnosis of osteoporosis and discuss treatment with the patient.