Fracture in the Elderly

by Dr. Tan Boon Cheong

MBBS (MU),. MS Ortho (MU)

Not too long ago, I remember writing an article regarding osteoporosis for this column. Thus, I find it appropriate to bring up the topic regarding fragility fractures in the elderly. A fragility fracture is defined as a fracture that takes place due to a fall from a standing height or less.

Domestic falls in the elderly happen rather frequently when they get out of bed in the middle of the night to go to the toilet. Several reasons could have attributed to the fall, for example, giddiness, poor lighting, poor balance or a slippery floor. Fragility fractures are most common in three places, namely the wrist, spine and hip.

A wrist fracture is a common fracture seen in an osteoporotic bone. This fracture occurs more commonly in women compared to men with a ratio of 10:1 at the age of 70. This fracture usually occurs due to a fall on an outstretched hand (trying to stop a forward fall). Most of the time this fracture can be managed with casting, but occasionally surgical fixation might be necessary. 

In the spine, a vertebral body compression fracture can take place with an individual landing in a sitting position after a slip. In some patients, this fracture might even occur when driving at high speed across a road bump. The main symptom of a compression fracture is severe back pain. You will be surprised that some patients might not even know that they have a compression fracture, as they present with mild symptoms and it is only picked up during some other routine check-up. Majority of patients with this compression fracture are treated conservatively with medication, rest and physiotherapy. Some patients will choose to undergo procedures such as percutaneous vertebroplasty (injecting bone cement into the vertebral body) or kyphoplasty (jacking up the compression segment) for pain management. It is rare for the need of an open surgery unless there are obvious neurological deficits that require decompression of the spinal cord. 

Lastly, is the hip fracture. This is a fracture that will compromise the quality of life and shorten the life expectancy of a person. It has been shown that older patients have five to eight times higher risk of dying within the first three months of a hip fracture compared to those without a hip fracture. The two most common places at the hip which are most susceptible to fractures are the intertrochanteric (extra-capsular) and neck of femur (intra-capsular). Almost all hip fractures require surgical intervention. Without surgery, complications such as pressure ulcers or orthostatic pneumonia might occur.

A fragility fracture is something that is important to prevent and treat irrespective of where the fracture occurs. This fracture can bring about depression, loss of function, loss of mobility, loss of independence and loss of quality of life. Thus, screening and treatment for osteoporosis should be emphasized on. It is essential to make sure one has healthy and strong bones and not regret only after a fracture has taken place.