Fragility Fractures in Older Adults

Epidemiology

Fragility fractures are a major public health problem with significant impact on quality of life for patients and their families, with approximately 325,000 hip fractures occurring annually in the United States, and a mean age of 77 years 1
Hip fractures are associated with excess short-term and long-term all-cause mortality, with mortality in the first year three times higher than expected in the general geriatric population 1

Osteoporosis is the most common underlying cause of fragility fractures, according to the European League Against Rheumatism 2
Age-related factors including decreased bone mineral density, impaired balance, and reduced muscle strength contribute to fracture risk, as reported by the European League Against Rheumatism 3

Fragility fractures should be managed in a multidisciplinary clinical system with adequate preoperative assessment, pain relief, appropriate fluid management, and surgery within 48 hours of injury, as recommended by the European League Against Rheumatism 3
Orthogeriatric comanagement significantly improves functional outcomes, reduces length of hospital stay, and decreases mortality, according to the European League Against Rheumatism 4
Early surgery (within 24-48 hours) significantly reduces short-term and mid-term mortality rates and reduces medical complications due to immobility, as reported by the European League Against Rheumatism 3
Systematic evaluation for future fracture risk should be performed in all patients over 50 years with a recent fracture, as recommended by the European League Against Rheumatism 4

Stable non-displaced femoral neck fractures can be addressed with cannulated fixation, according to the European League Against Rheumatism 5
Displaced femoral neck fractures in healthy, active older individuals are best treated by total hip replacement, as recommended by the European League Against Rheumatism 5
In frail patients, hemiarthroplasty is often preferred due to shorter operative time and lower dislocation risk, according to the European League Against Rheumatism 5
For stable intertrochanteric fractures, a sliding hip screw is favored; unstable intertrochanteric fractures are treated with an antegrade cephalomedullary nail, as reported by the European League Against Rheumatism 5

An appropriate rehabilitation program should include early post-fracture physical training, muscle strengthening, and long-term balance training, as recommended by the European League Against Rheumatism 4
Pharmacological treatment should use medications demonstrated to reduce vertebral, non-vertebral, and hip fracture risk, according to the European League Against Rheumatism 4

Delay in surgical intervention beyond 48 hours increases mortality risk and complications, as reported by the European League Against Rheumatism 3
Inadequate pain management can delay mobilization and rehabilitation, according to the European League Against Rheumatism 3
Overlooking the need for secondary fracture prevention increases the risk of subsequent fractures, as recommended by the European League Against Rheumatism 4