Geriatric Trauma Prevention

geriatrictraumaDouglas S. Tase, MD
Orthopaedic Surgeon
Cooper Bone and Joint Institute

A fragility fracture is a fracture resulting from a low trauma event such as a fall from standing height or less. These types of fractures are very common in older persons, affecting up to one half of women and one third of men after the age of 50 years.

Adults who have had any type of fracture are at an increased risk of having additional fractures. Fragility fractures are most commonly associated with osteoporosis. Therefore, optimal care of fragility fractures includes accurate diagnosis and treatment of the underlying osteoporosis to reduce the risk. The concern is that most patients with fragility fractures are not evaluated for osteoporosis, and often are not treated adequately to reduce future fracture risk.

Osteoporosis is a disease of the bones that leads to an increased risk of fracture. Osteoporosis literally means “porous bones.” In osteoporosis the bone mineral density (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of proteins in bone is altered. Osteoporosis is most common in women after menopause, when it is called postmenopausal osteoporosis, but may also develop in men, and may occur in anyone in the presence of particular hormonal disorders and other chronic diseases or as a result of medications, specifically glucocorticoids. Given its influence on the risk of fragility fracture, osteoporosis may significantly affect life expectancy and quality of life.

There are existing osteoporosis guidelines that universally recommend that all postmenopausal women who present with fractures be evaluated for osteoporosis, including measurement of Bone Mineral Density (BMD). Another important aspect is identifying a patient’s risk factors for osteoporosis and fragility fractures.

The American Orthopedic Association (AOA) recently took a leadership role by launching the Own the Bone Program, which Cooper is taking part in. The main focus of this program is identifying those at risk for fragility fractures and reducing their risk through the prevention and treatment of osteoporosis. There are many resources available to patients through this program, such as how to impact behavior and prevent fragility fractures. An equally important aspect is fall prevention. Identifying persons prone to recurrent and injurious falls is important for reducing fracture risks. Nearly all wrist fractures, 90 percent of hip fractures and up to 50 percent of vertebral fractures are associated with a fall.

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