Osteoporotic Insufficiency or Fragility Fractures

Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
(406) 375-4868

Osteoporotic Insufficiency or Fragility Fractures
In recognition of Osteoporosis month, the topic for discussion is a fracture that can occur as a result of osteoporosis or "thinning of the bones." Osteoporosis literally means "porous bone" which is a reduction in the density of bone. This is thought to be a normal aging process but in some patients it can become so severe that broken bones or fractures can occur. The best way to check the density of bones is a DEXA scan which measures the density of bones from various anatomic areas such as the wrist, spine, and hip. That density is then compared to a population of patients of similar age. If your score fall 2 standard deviations outside the normal range, osteoporosis is diagnosed. Appropriate treatment of calcium, vitamin D, and agents such as Fosamax can be given to prevent further loss of bone and in some cases even help restore some bone density.

If osteoporosis goes untreated, fractures can occur spontaneously without injury. These fractures are called insufficiency or fragility fractures. The names are derived for the fact that bones are too "fragile" or "insufficient" to support one's weight for simple daily activities such as standing or walking. The most common area for this type of fracture is the pelvis. The pelvis is formed into a ring to help transfer weight from our legs into our spine and torso. The pelvic ring can break anywhere but most commonly occurs in the front pubic area called the superior or inferior ramus. The second area of breakage is the sacrum or back of the pelvis. These fragility pelvic fractures can be painful and are treated with rest, minimizing weight bearing with a walker or crutches, and treating the patient with supplemental calcium and vitamin D. These fractures can take 3 to 4 months to heal.

Another area of a fragility fracture is the hip or more specifically the proximal femur. The weakest area of the femur is where it forms a bend to meet the hip joint, called the femoral neck. Fractures here usually require surgery to stabilize the bone with screws, plates, or rods. Another area for a fragility fracture is the spine. Each segment of the spine is made up of a square block of bone called a vertebral body. In the case of a fragility fracture, the square block of bone compresses or flattens into a wedge or triangle. This fracture's treatment is usually a back brace but sometimes requires a procedure called a vertebroplasty where cement is injected into the bone to help stabilize it.

The take home message is to prevent these fractures before they occur. Have your bone density measured with a DEXA scan and take the appropriate measures to prevent your bones from weakening to the point where they can break spontaneously. As the old saying goes, an ounce of prevention is worth a pound of cure.

Questions and or comments regarding this week's health column please contact Michael Dolecki, MD at Bitterroot Orthopedics and Sports Medicine, a service of Marcus Daly Memorial Hospital, 1200 Westwood Drive, Hamilton, MT 59840. Working together to build a healthier community!


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