Breaking a bone in unexpected circumstances like tripping and stumbling or having a standing-height fall can be frightening and upsetting. It could mean something more complex is happening with your bones. The Ohio State University Wexner Medical Center in Columbus, Ohio, is the right place to turn to for both immediate and preventive fracture and orthopedic trauma care.
As one of just 25 worldwide certified Geriatric Fracture Centers by The International Geriatric Fracture Society (IGFS), our orthopedic team treats your injury holistically and through a lens of cause and comprehensive prevention with strength training, nutrition and other proven methods.
What is a fragility fracture?
A fragility fracture happens when you break a bone from a trivial slip, trip or fall. This could happen while walking, climbing stairs or stumbling over the edge of a rug. Fragility fractures differ from other fractures by their underlying causes; fragility fractures happen because of an underlying weakness of the bones caused by a condition such as osteoporosis. In someone without osteoporosis or another bone-weakening condition, it would likely take more impact or force to fracture a bone.
What is osteoporosis?
Osteoporosis is the most common bone disease. It is a whole-body skeletal disease that slowly reduces bone mass and destroys bone structure so that bones become fragile and prone to fracture. The people most likely to develop osteoporosis or to experience a fragility fracture include:
- Older adults, especially postmenopausal women
- People of Caucasian and Asian descent
- People who have a family history of fragility fractures
- People who smoke, drink alcohol excessively, have poor nutrition and don’t exercise
- People who take certain medications, including corticosteroids and anticonvulsants, for a long time
What is osteopenia?
Osteopenia is a bone disease in which bone mass is reduced and bones are weakened, but not as much as they are in osteoporosis. Osteopenia will not necessarily lead to osteoporosis, but it can be seen as a warning sign and a call to prevention.
How are osteoporosis and osteopenia diagnosed?
Your doctor will use the FRAX®, or Fracture Risk Assessment tool, which evaluates your risk of fracture through measurements and health history. Doctors also typically order a DEXA scan, an X-ray that measures bone mineral density. The World Health Organization expresses bone density in T-scores, which compare your bone density to the peak density of a healthy 25-year-old person of the same sex and race as you.
- Normal is greater than -1.
- Osteopenia is between -1 and -2.5.
- Osteoporosis is equal or greater than -2.5 at the spine, hip or wrist.
If you’ve already had a low-impact fracture, that will also factor into your doctor’s treatment and prevention plan.
What are the most common sites for a fragility fracture?
While a fragility fracture can happen in most bones in the body, some areas are more prone to fractures associated with osteoporosis. Those areas include:
- Hips: Fragility fractures in the hip are the most serious because they can result in long hospital stays and rehabilitation, both of which can cause other physical and social health problems. In the United States, more than 350,000 hip fractures happen annually.
- Vertebrae (Spine): Vertebral fractures are the most common indication of osteoporosis. They can also be “silent,” because they may not cause any pain or the pain may be blamed on other causes.
- Wrists: There are more than 300,000 wrist fragility fractures every year in the United States. They are often painful and are sometimes treated surgically. If the fracture is not too severe, they often require splinting or casting to allow for healing.
Fragility fractures can also happen in the pelvis, ribs, ankles, collarbone, upper arms or thighs.
What are the signs of a fragility fracture?
Most fragility fractures will feel like common fractures. Those symptoms can include:
- Immediate pain that gets worse with movement or touch
- Swelling or bruising
- Difficulty moving or putting weight on the injured area
- Changes in the shape of the skin around the injury
- In rare cases, bone sticking out through the skin
If you have a vertebral fragility fracture, you may not feel any symptoms, or you may blame the symptoms on something else. Estimates suggest that as many as three in four vertebral fractures go undiscovered. If you feel no symptoms, the only way these fractures can be found is through imaging, such as X-rays.
How is a fragility fracture diagnosed?
To diagnose a fragility fracture, your doctor will consider how the injury happened and will assess your risk for, or diagnose you with, osteoporosis. If the injury was low-impact, happened in a vulnerable place on the body and you have low bone density, you probably experienced a fragility fracture rather than a common fracture.
How are fragility fractures different from other fractures?
A traumatic fracture happens when a bone comes under extreme pressure or force. These happen in falls, car accidents and sports.
A stress fracture results from repetitive movement that weakens muscles and places additional stress on the bone. These typically happen in athletes, particularly runners and gymnasts, or in soldiers in the military, particularly new recruits who are participating in greater physical activities in training.
A fragility fracture is influenced specifically by bone density, not activity intensity. In fact, these fractures can happen with relatively little movement.
What are the treatment options for fragility fractures?
The experts at the Ohio State Wexner Medical Center will treat your fracture with or without surgery, depending on your injury, your health and your lifestyle. Our Fragility Fracture Program goes beyond repairing your bones and helps you recover holistically and prevent future fractures. We offer:
- Nutrition counseling and education to help you get the nutrients you need to heal and become and stay stronger
- Activity recommendations, including balance and weight-bearing exercises and physical therapy that will improve strength and agility
- Screenings for vitamin and mineral levels to determine where you may benefit from supplements
- Clinical trials that give you access to promising treatments that aren’t yet available to the general public
Home, hospital and beyond – how we treat more than just broken bones
Carmen Quatman, MD, PhD, is an orthopedic surgeon who focuses on geriatric orthopedics, and she discusses Ohio State’s holistic approach to treating and preventing fragility fractures.
How can I prevent fragility fractures?
Prevention of another injury is a key function of Ohio State’s Fragility Fracture Program. Some or all these steps will be part of your recovery plan after a fragility fracture:
- Build strength: Strength-building exercise builds both bone density and muscle mass over time. Bones become stronger and more resistant to breakage, and larger, stronger, more capable muscles allow you to better stabilize your body to prevent falls. Balance exercises are also helpful for improving your agility and the ability to right your body when you trip over something.
- Eat a healthy diet for your bones: It’s important to eat enough calcium and vitamin D to preserve and improve bone strength. When your body doesn’t get enough calcium, it takes the nutrients from your bones. Vitamin D deficiency can hinder your body’s ability to heal fractures. Dietary protein is another essential nutrient for bone health. It affects bone mineral density and bone strength. Your doctor and nutrition counselor will work with you to find out how much of each nutrient you need every day, and the best ways for you to put them into your diet.
- Make your home safer: The Ohio State Wexner Medical Center has pioneered a program that combines trauma orthopedists’ knowledge and paramedics’ time in homes to pinpoint ways to help people with fragility fractures age in place at home. The program identifies physical obstacles, such as rugs and slippery surfaces, as well as process obstacles such as installing grab bars. You’ll also receive fall prevention education and screening in our Fall Prevention Clinic, including a home assessment.
Why choose Ohio State for treatment of fragility fractures?
The Ohio State Wexner Medical Center takes a comprehensive approach to fragility fractures. We are a certified Geriatric Fracture Center by the IGFS. This means we are recognized as a foremost authority on delivering evidence-based, patient-centered treatment for geriatric or fragility fractures and geriatric orthopedic care. In that spirit, our Fragility Fracture Program provides a holistic approach to care and education for you and your family, including:
- A team approach with fellowship-trained orthopedic surgeons, emergency medicine physicians, endocrinologists, physician assistants, nurses, nurse practitioners, physical therapists, occupational therapists and nutritionists
- Improved pain management strategies that reduce medical complications while prioritizing your comfort
- Surgery scheduled in less than 24 hours after your admission
- Fall risk analysis with balance training, designed to reduce the risk of future falls
- Follow-up outpatient visits that include a postsurgical visit, Bone Health Clinic or High-Risk Osteoporosis Clinic appointments and a bone density test, as needed