Article reposted with permission from Dr. Lani Simpson: https://lanisimpson.com/blogs/news

What Fractures Tell About Our Bones

Article Summary:

• Fractures can be a sign of poor bone health, even though they are a common occurrence.

 • Bones are living tissue that require a balance between resorption and formation to remain healthy.

 • Factors that can contribute to poor bone health include age, gender, genetics, nutrition, and lack of physical activity.

 • Osteoporosis is a common condition that can lead to weakened bones and an increased risk of fractures, particularly in older women.

 • Maintaining good bone health throughout life is important to prevent fractures and other bone-related problems.

 • Tips for maintaining good bone health include getting enough calcium and vitamin D, engaging in weight-bearing exercises, and avoiding smoking and excessive alcohol consumption.

 • Regular bone density screenings can help assess one's risk of fractures.

Trauma Fractures

Fractures and Bone Health. Trauma fractures result from the direct, physical impact of an event such as tumbling off a ladder, being injured in a car accident, or falling while playing pickleball.

Unlike osteoporosis-related fractures, trauma fractures are not necessarily associated with an underlying weakness in the bones. They occur because the bones cannot withstand the amount of force exerted on them by the trauma event. Doctors and patients need to determine whether or not the health of the bone was adding to the extent of the fracture.

The fact that trauma was involved does not necessarily mean the bone is healthy.

Bottom-line

if you have any fractures of significance, you should get a bone density test (DXA).

Of course, there are gray areas. Osteoporosis may predispose some individuals to fracture a bone with less trauma than would be expected. It's important to tease out the details of any activities or life events that result in a fracture and bone health issues. This information can influence medical decisions and life activities.

Stress Fractures

Stress fractures are generally classified in the trauma category because the repetitive pounding of an activity. For example, running causes physical stress that can produce hairline breaks over time. But a stress fracture can also be a red flag for low bone density or poor bone quality (TBS test). It’s one thing if a stress fracture occurs in a person who trains for and runs a marathon. There could be other problems if it happens after a long walk.

Not Always Visible

Stress fractures are not always visible on x-rays. An MRI or CT scan may be required for confirmation. Seek this type of assessment if it seems the area in question has not healed after three to four weeks. If you or someone in your life experiences repeated stress fractures (or a fracture that seems to be of questionable origin), consider getting an accurate bone density test (DXA) to investigate the problem further.

Insufficiency Fracture

Note: “Insufficiency fracture” is a term you may see in medical reports. These are only seen in severe bone cases. Sometimes referred to as a ‘subtype’ of stress fracture, insufficiency fractures can happen without any trauma. These fractures occur due to loss of trabecular (porous) bone, and they are “caused by normal or physiologic stress upon weakened bone.” In other words, the bone is so weak it can collapse due to the mere stress of body weight. Insufficiency fractures are seen only in extreme cases of osteoporosis or some other bone pathology.

Osteoporosis-Related Fractures

Different terms are used to identify fractures caused by or related to osteoporosis. This can be confusing when you’re talking to your doctor or doing online research!

The following is a list of a few names for osteoporosis-related fractures.

Please note that all these terms basically mean the same thing:

• Fragility fracture
• Minimal or low-trauma fracture
• Low-impact fracture
• Osteoporotic fracture

World Health Organization

The World Health Organization describes all osteoporosis-related fractures as “fracture[s] caused by injury that would be insufficient to fracture a normal bone.” So, even though the above labels differ, they each describe bone breaks that fall under an ‘osteoporosis-related fracture’.

In other words, these fractures occur with minimal or no trauma from a standing height or lower.

This means if you have osteoporosis, you can fracture a bone if you trip and fall onto the floor or the street. That’s a fall from a standing height, and when there is no underlying pathology, most people can fall that far without breaking a bone. (Although certainly there are instances when falling from a standing height can have significant impact, which is why it is important to ask a lot of questions about a fracture).

Fall Examples

For instance, if someone falls hard from a standing height and breaks their wrist, it does not necessarily mean their bones are significantly weak. However, if the bones shatter in pieces or if surgery is necessary it certainly is possible that poor bone health was part of the reason the bone fracture, get a bone density test.

When my patients are unclear about whether a recent fracture could be due to osteoporosis, I sometimes ask them, “If this had happened when you were twenty-five years old, do you think you would have fractured?” Answering “no” to that question is one indication that their fractures may not be due to a specific trauma event and that further investigation is needed.

Your Bones Must Carry You Through a Lifetime

There is so much to know regarding your bones. Diagnosis is paramount, and if you have sustained a significant fracture, you can help yourself by learning all you can from reputable sources.

There is no osteoporosis specialty and most doctors of any persuasion are not specialists. If you have not sustained a fracture and you are diagnosed with osteoporosis with a bone density test(DXA), consider yourself lucky. Learn all you can to see if your fracture risk is of concern.

Treatment

Most medical doctors tend to “treat” the bone density test, and recommend a bone medication without doing proper lab work. Alternative doctors may recommend a simple supplement program, but they too are not experts in reading bone density reports and ordering proper lab work.

In both instances, your bones were not fully evaluated.