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Fragility Fracture – Causes, Symptoms & Treatment

A fragility fracture is a bone break caused by minimal force or impact – typically a sign of reduced bone density, most commonly associated with osteoporosis.

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Things worth knowing about "Fragility fracture"

A fragility fracture is a bone break caused by minimal force or impact – typically a sign of reduced bone density, most commonly associated with osteoporosis.

What Is a Fragility Fracture?

A fragility fracture is a bone fracture that results from mechanical loading that would not normally cause a break in healthy bone. It typically occurs after a fall from standing height or even spontaneously without any significant trauma. Fragility fractures are considered a hallmark sign of osteoporosis – a systemic skeletal disease characterized by reduced bone mass and deterioration of bone microarchitecture.

Causes

The most common underlying cause is osteoporosis, but several risk factors contribute to bone fragility:

Advanced age (especially from age 65 onwards)
Female sex and estrogen deficiency after menopause
Long-term corticosteroid therapy
Low body weight and nutritional deficiencies (calcium and vitamin D)
Physical inactivity and immobility
Smoking and excessive alcohol consumption
Chronic conditions such as rheumatoid arthritis, chronic kidney disease, or malabsorption syndromes

Common Sites of Fracture

Fragility fractures most often occur at specific skeletal locations:

Vertebral bodies: Often occurring without dramatic injury, frequently associated with back pain or height loss
Hip (proximal femur): Associated with significant consequences for mobility and quality of life
Wrist (distal radius): Common after falling on an outstretched hand
Proximal humerus (upper arm)
Pelvis and ribs

Symptoms

Symptoms depend on the location of the fracture and may include:

Sudden, severe pain at the fracture site
Swelling, bruising, or visible deformity
Reduced mobility or inability to bear weight
In vertebral fractures: gradual back pain, stooped posture (kyphosis), or loss of height

Diagnosis

Diagnosis of a fragility fracture typically involves:

X-ray imaging: First-line investigation to confirm the fracture
MRI or CT scan: For suspected vertebral fractures or detailed assessment
Bone density measurement (DXA scan): To confirm osteoporosis and assess fracture risk
Laboratory tests: Calcium, vitamin D, bone turnover markers, and exclusion of secondary causes
FRAX score: An internationally validated tool to calculate the 10-year probability of a major fracture

Treatment

Acute Management

Depending on the location and severity of the fracture, acute treatment may be conservative (immobilization, pain management) or surgical (e.g., hip replacement, vertebroplasty or kyphoplasty for vertebral fractures).

Osteoporosis Treatment

Since a fragility fracture is always an indication of underlying bone fragility, treatment of the root cause is essential:

Calcium and vitamin D: Basic supplementation to support bone mineralization
Bisphosphonates (e.g., alendronate, zoledronic acid): Inhibit bone resorption
Denosumab: A monoclonal antibody that reduces osteoclast activity
Teriparatide: An anabolic agent that stimulates bone formation
Romosozumab: A dual-action agent with both anabolic and antiresorptive effects

Rehabilitation and Prevention

Physiotherapy, fall prevention strategies, strength and balance training, and home safety modifications are crucial to reduce the risk of subsequent fractures. After a hip fracture, early mobilization is especially important, as this fracture type is associated with increased mortality.

Prognosis and Clinical Significance

A fragility fracture significantly increases the risk of further fractures. Hip fractures in particular are associated with elevated one-year mortality. Early diagnosis and consistent treatment of the underlying condition are therefore essential for long-term bone health.

References

Kanis JA et al. – European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International, 2019.
World Health Organization (WHO): Assessment of osteoporosis at the primary health care level. WHO Press, 2007.
Compston J et al. – UK clinical guideline for the prevention and treatment of osteoporosis. Archives of Osteoporosis, 2017.

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