Bitterroot Orthopedics and Sports Medicine
A service of Marcus Daly Memorial Hospital
Michael Dolecki, MD
1200 Westwood Drive
Hamilton, MT 59840
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!