minimal trauma (pathologic, osteoporotic, fragility, insufficiency) fracture
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Etiology
- osteoporosis
- hyperparathyroidism (in the absence of osteoporosis)[6]
- malasborption syndrome(s) with vitamin D deficiency
- multiple myeloma
- renal insufficiency (stage 3 or 4, ESRD)
- hypogonadism in men[7]
- rheumatoid arthritis & other chronic inflammatory rheumatic diseases[10]
- fracture risk increase by higher dosed of proton pump inhibitor & duration of use > 1 year[6]
Includes:
- fracture from a fall from standing height or less
- vertebral fractures without known trauma
- foot fractures in patients with rheumatoid arthritis without known trauma
Pathology
- 44% of patients with pathological foot fractures have multiple fractures[10]
Laboratory
Radiology
- X-ray detects 25% of foot fractures
- magnetic resonance imaging[10]
- subchondral hypointensity with adjacent bone marrow edema of the medial femoral condyle seen with an osteoporotic fracture of the knee
- dual energy X-ray absorptiometry (DEXA) scan[11] even if result will not affect management[12]
Complications
- associated with increased mortality[5]
- a minimal-trauma fracture predicts risk for another fracture within a year, with concomitant adverse effects on quality of life[4]
- predictive value of minimal trauma fracture:
relative risk of hip fracture after 1st fracture
| 1st fracture | RR women | RR men |
|---|---|---|
| wrist | 1.5 | 3.0 |
| vertebral | 2.0 | - |
| hip | 2.0 | 3.0 |
| any | 1.5 | - |
RR: relative risk
Differential diagnosis
Management
- bisphosphonate may be of some benefit
- bisphosphonates do not interfere with long bone fracture healing[9]
- Ca+2 & vitamin D may (or may not) be of benefit[2][3]
- parathyroidectomy for hyperparathyroidism[6]
More general terms
More specific terms
Additional terms
References
- ↑ Greendale, GA: UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 2.0 2.1 Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005 May 11;293(18):2257-64. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15886381
- ↑ 3.0 3.1 Journal Watch 25(13):106, 2005 Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, Donaldson C, Gillespie WJ, Robinson CM, Torgerson DJ, Wallace WA; RECORD Trial Group. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo- controlled trial. Lancet. 2005 May 7;365(9471):1621-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15885294
Sambrook P. Vitamin D and fractures: quo vadis? Lancet. 2005 May 7;365(9471):1599-600. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15885279 - ↑ 4.0 4.1 Cooper C et al, Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: The Observational Study of Severe Osteoporosis (OSSO). Osteoporos Int 2008 Apr; 19:493. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17968611
- ↑ 5.0 5.1 Bliuc D et al Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. AMA 2009 Feb 4; 301:513. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19190316
- ↑ 6.0 6.1 6.2 6.3 Medical Knowledge Self Assessment Program (MKSAP) 16, 19 American College of Physicians, Philadelphia 2012, 2022
- ↑ 7.0 7.1 Bours SP, van Geel TA, Geusens PP et al Contributors to secondary osteoporosis and metabolic bone diseases in patients presenting with a clinical fracture. J Clin Endocrinol Metab. 2011 May;96(5):1360-7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21411547
- ↑ Friedman SM, Mendelson DA. Epidemiology of fragility fractures. Clin Geriatr Med. 2014 May;30(2):175-81. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24721358
- ↑ 9.0 9.1 Thorne TJ et al. No increased risk of nonunion with bisphosphonate use in a Medicare claims cohort following operatively treated long-bone fractures. J Bone Joint Surg Am 2023 Apr 5; 105:549. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36753557 https://journals.lww.com/jbjsjournal/Abstract/2023/04050/No_Increased_Risk_of_Nonunion_with_Bisphosphonate.6.aspx
- ↑ 10.0 10.1 10.2 10.3 Buehring B et al. High prevalence of foot insufficiency fractures in patients with inflammatory rheumatic musculoskeletal diseases. J Rheumatol 2023 Aug; 50:1071. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36521920 https://www.jrheum.org/content/50/8/1071
- ↑ 11.0 11.1 Camacho PM, Petak SM, Binkley N et al AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS-2020 UPDATE. Endocr Pract. 2020 May;26(Suppl 1):1-46. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32427503
- ↑ 12.0 12.1 Kline GA, Morin SN, Feldman S et al. Diminishing value from multiple serial bone densitometry in women receiving antiresorptive medication for osteoporosis. J Clin Endocrinol Metab 2021 Sep; 106:2718. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33784384 https://academic.oup.com/jcem/article-abstract/106/9/2718/6204740