Fragility Fractures in Older Adults: Diagnosis, Treatment, and Surgical Considerations in Modern Orthopedic Care
As life expectancy increases globally, the burden of osteoporotic fractures continues to rise. Among these, fragility fractures are a leading cause of hospitalization, loss of independence, and long-term disability in older adults. A single low-impact fracture, particularly in weight-bearing bones, significantly increases the risk of subsequent fractures within 1–2 years, often referred to as the "fracture cascade." Prompt and appropriate management of these injuries is critical to improving functional outcomes, reducing morbidity and mortality, and preserving quality of life in this vulnerable population.
Common Sites of Fragility Fractures
Hip Fractures: Most clinically significant due to the high rate of postoperative complications and functional impairment.
Distal Radius (Wrist) Fractures: Frequently the first indicator of underlying bone fragility.
Vertebral Compression Fractures: Often asymptomatic initially, these can lead to chronic back pain and postural deformity.
Proximal Humerus Fractures: Impacts shoulder mobility, particularly in the elderly with poor bone quality.
Diagnostic Approach
Evaluation begins with a thorough clinical assessment and appropriate imaging.
Plain Radiographs remain the initial imaging modality for most fracture sites.
MRI is especially useful in detecting occult hip fractures or evaluating vertebral fractures when X-rays are inconclusive.
Bone Density Testing (DEXA scan) is essential for confirming osteoporosis and planning secondary fracture prevention.
Laboratory Workup may include serum calcium, vitamin D, thyroid function, and renal profile to evaluate for secondary causes of bone loss.
Surgical Management and Considerations
The decision for operative versus non-operative treatment depends on fracture type, displacement, bone quality, comorbid conditions, and the patient’s functional status.
Hip Fractures
Surgical fixation (e.g., cannulated screws or intramedullary nails) is indicated for non-displaced femoral neck fractures.
Hemiarthroplasty or Total Hip Replacement is preferred for displaced fractures in active, independent older adults.
Wrist Fractures
Closed reduction and casting may suffice for stable fractures.
Open reduction with internal fixation (ORIF) using volar locking plates is considered for unstable or intra-articular fractures in high-functioning elderly patients.
Spinal Compression Fractures
Conservative therapy with bracing and analgesia is first-line.
Vertebroplasty or kyphoplasty may be used in cases of severe pain or progressive vertebral collapse.
Shoulder (Proximal Humerus) Fractures
Non-operative treatment is feasible for minimally displaced fractures.
Surgical fixation or reverse total shoulder arthroplasty may be indicated in displaced fractures with poor bone stock.
Postoperative Rehabilitation and Secondary Prevention
Rehabilitation is critical in restoring mobility, preventing deconditioning, and reducing the risk of complications such as deep vein thrombosis (DVT), pneumonia, and pressure ulcers.
Early mobilization post-surgery is associated with better outcomes.
Physical therapy focuses on strength, balance, and fall prevention.
Pharmacologic interventions such as bisphosphonates, denosumab, or teriparatide should be initiated to improve bone density and reduce future fracture risk.
Nutritional optimization, especially ensuring adequate calcium and vitamin D intake, must be emphasized as part of a comprehensive care plan.
Role of Multidisciplinary Care
An integrated orthogeriatric model, involving orthopedic surgeons, internists, physical therapists, and geriatricians, is associated with improved outcomes and lower mortality. Patients with fragility fractures benefit from:
Preoperative optimization of comorbidities
Standardized surgical protocols
Structured rehabilitation pathways
Ongoing osteoporosis management
At MedTravel, we understand the urgency and complexity of fragility fracture care in older adults. We partner with board-certified orthopedic surgeons in Seattle who specialize in osteoporotic fracture repair, minimally invasive techniques, and geriatric trauma management. Through our coordinated medical tourism services, patients can access timely surgery, expert rehabilitation, and long-term follow-up.
