Geriatric Fragility Fractures: Diagnostic Barriers and Multimodal Management Strategies

Abstract

Fragility fractures, which occur due to low-impact trauma like a fall from standing height, pose a significant health risk for older adults. These fractures mainly affect the hip, spine, and distal radius, leading to considerable morbidity, mortality, and long-term disability. Annually, up to 37 million fragility fractures occur worldwide in individuals aged 55 and older, translating to an average of 70 fractures every minute. Their development is influenced by multiple factors, including osteoporosis, sarcopenia, frailty, and mechanical decline. Contributing risk factors consist of advanced age, being female, a history of past fractures, vitamin D insufficiency, the use of multiple medications, and specific treatments. In this review, we outline the diagnostic process, which involves evaluating bone mineral density using dual-energy X-ray absorptiometry (DEXA), conducting assessment for vertebral fracture, and applying risk stratification tools such as FRAX. While immediate surgical care remains a cornerstone, the optimal timing and approach are often debated in complex geriatric patients with multimorbidity. Notably, the implementation of integrated ortho-geriatric models, though proven effective, faces significant logistical and financial barriers globally.

Keywords: Fragility fractures, low-impact trauma, hip