Fragility fracture

This is defined as a fracture from standing height or less and includes vertebral fracture that may result in spinal deformity.

• fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or 'low energy') trauma. The World Health Organization (WHO) has quantified this as forces equivalent to a fall from a standing height or less.

A previous fragility fracture is a strong independent risk factor for further fracture and is considered an indication for osteoporosis treatment without the need for bone mineral density measurement.

Reduced bone density is a major risk factor for fragility fracture. Other factors that may affect the risk of fragility fracture include the use of oral or systemic glucocorticoids, age, sex, previous fractures and family history of osteoporosis. Because of increased bone loss after the menopause in women, and age related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years in women. As the longevity of the population increases, so will the incidence of osteoporosis and fragility fracture.

Fragility fractures occur most commonly in the spine (vertebrae), hip (proximal femur) and wrist (distal radius)

• may also occur in the arm (humerus), pelvis, ribs and other bones

Osteoporotic fractures are defined as fractures associated with low bone mineral density (BMD) and include clinical spine, forearm, hip and shoulder fractures

• osteoporotic fragility fractures can cause substantial pain and severe disability, often leading to a reduced quality of life, and hip and vertebral fractures are associated with decreased life expectancy
• hip fracture nearly always requires hospitalisation, is fatal in 20% of cases and permanently disables 50% of those affected; only 30% of patients fully recover
  • projections suggest that, in the UK, hip fracture incidence will rise from 70,000 per year in 2006 to 91,500 in 2015 and 101,000 in 2020

Reference:

• NICE (February 2017). Osteoporosis: assessing the risk of fragility fracture