Fragility Fracture: 10 Commandments

Abstract

Background: Fragility fractures are a major health concern. It is a fracture that occurs from a low-impact event, such as a fall from standing height or less typically due to weakened bones. These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to get fractured. Fragility fractures often occur in older adults including post-menopausal women and commonly affect areas, such as the hip, spine, and wrist. These fractures reflect the underlying bone fragility, and following first fragility fracture, there is increased risk of getting further fractures. Apart from osteoporosis, the contributing factors have also to be considered like age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease. The other risk factors like smoking, and excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, can overtime result into osteoporosis.

Methods: Fragility fractures basically revolve around the terminal management of osteoporosis and many issues have not been over emphasized. Hence, these 10 commandments have been crafted to focus on the areas which can help prevent fragility fractures or combat those cases who come with a history of fragility fractures.

Results: The ten commandments have crystallized into various headings, including fragility fracture-the risk factors & DEXA, subnormal turnover bone diseases, microbiota & microbiome, inflammaging including obesity, parathyroid, thyroid & testosterone, dilemmas in the management of osteoporosis in younger adults, vitamin D, calcium & albumin, pharmacologic treatment options, associated medications & alternative therapies, and monitoring. High and low turnover bone disease, dysbiosis in gut, and inflammaging are the highlights including therapy and monitoring.

Conclusion: Fragility fracture also known as osteoporotic fracture has significant morbidity and mortality. Management of osteoporosis has been emboldened with the existing basket of both anti-resorptive and anabolic drugs. Safety concerns on long-term use of these drugs are emerging. These ten commandments will help management strategies to concentrate on targeting therapy to persons most "at risk" of getting these fractures.

Keywords: Collagen; Cortical bone; Fragility fracture; Frailty; Inflammaging; Microbiome; Osteoporosis; Parathyroid; Sarcopenia.