Fractures associated with bone fragility are frequent, particularly in elderly women. They occur as a result of a moderate trauma such as a fall from standing height or in the absence of any obvious trauma, most often in the femur, the vertebrae or the forearm bones. Fractures often cause loss of autonomy, chronic pain, depression, and are associated with increased mortality.

Contributory causes of these fractures include advanced age, female gender, falls, history of fractures associated with bone fragility, prolonged treatment with corticosteroids, family history of hip fractures, active smoking, certain conditions such as hyperthyroidism or chronic renal failure. In cases of  overweight, intentional weight loss also increases the risk of fracture, especially post menopause. Other risk factors  have been identified in the elderly, such as visual impairment, urinary incontinence, functional disability, orthostatic hypotension and alcohol consumption. Various medications expose patients to the risk of falls, including opioid analgesics and sedatives.

Treatment is based firstly on fall prevention and an appropriate lifestyle: regular physical activity, exposure to the sun, sufficient calcium intake, reduced consumption of tobacco, alcohol and caffeine. For elderly people living in institutions, calcium and vitamin D supplements reduce the risk of fracture of the femoral neck by about 25%. In postmenopausal women with a history of fractures and osteoporosis, a bisphosphonate such as alendronic acid is the first-choice treatment, as long as vital  precautions are taken. Raloxifene is an alternative for a minority of patients.

©Prescrire 1 April 2017

"Fractures related to bone fragility: prevention" Prescrire Int 2017; 26 (181): 103-106. (Pdf, subscribers only).