Understanding What Fractures Are Most Common to Older Adults

An estimated one in two women and one in five men over the age of 50 will experience an osteoporosis-related fracture in their lifetime. Addressing this reality requires understanding what fractures are most common to older adults and how they can be prevented.

Quick Summary

Hip, vertebral compression, and wrist (distal radius) fractures are the most prevalent in older adults, often occurring from a low-energy fall and significantly impacted by underlying osteoporosis and related risk factors. Proactive prevention and swift medical treatment are crucial for recovery and maintaining independence.

Key Points

• Hip, Wrist, and Vertebral Fractures are Most Common: Fragility fractures most often occur in the hip, spine, and wrist in older adults, linked largely to osteoporosis and falls.

• Osteoporosis is the Primary Risk Factor: The loss of bone density with age makes bones brittle and susceptible to breaking from minimal trauma, often triggering these types of fractures.

• Falls are the Leading Cause of Injury: Most fractures in seniors result from a fall, highlighting the importance of prevention through exercise, balance training, and home safety.

• Surgical vs. Non-Surgical Treatment: Treatment options depend on the fracture's location and severity; surgery is often necessary for hip fractures, while non-surgical methods may be viable for stable wrist fractures.

• Rehabilitation is Critical for Recovery: Post-fracture physical and occupational therapy is essential for regaining strength, balance, and function to prevent long-term disability and loss of independence.

• Prevention is the Best Strategy: Addressing risk factors like low bone density, poor nutrition, medication side effects, and environmental hazards is key to preventing fractures in the first place.

Why Older Adults Are More Susceptible to Fractures

Age-related bone loss, a primary driver of fracture risk, is known as osteoporosis. This condition weakens bones, making them brittle and more likely to break from even minor incidents, often called fragility fractures. For older adults, many factors combine to increase this risk, including reduced muscle mass and strength (sarcopenia), impaired vision, balance problems, and slower reflexes, all of which increase the likelihood of falls. Furthermore, certain medications can cause dizziness or affect bone density, compounding the risk.

The Most Common Fractures in Older Adults

Hip Fractures

Regarded as one of the most serious fractures, hip fractures are most common in adults over 65, with 90% occurring in this age group. The vast majority are the result of a fall from a standing height. For those with severe osteoporosis, a hip fracture can happen with no fall at all, just by twisting the leg or standing awkwardly. Hip fractures often require major surgery and intensive rehabilitation, and carry a high rate of complications, impacting mobility and independence.

Symptoms of a hip fracture include:

• Severe pain in the hip or groin
• Inability to bear weight on the affected leg
• The injured leg may appear shorter or be externally rotated

Vertebral Compression Fractures

Vertebral compression fractures (VCFs) are breaks in the bones of the spine (vertebrae). These are also strongly linked to osteoporosis and can occur with minimal trauma, sometimes simply from coughing, sneezing, or lifting a light object. Because they can cause only mild or gradual back pain, about two-thirds of VCFs go undiagnosed. However, multiple VCFs over time can lead to significant height loss and a hunched posture known as kyphosis.

Symptoms of a VCF include:

• Sudden onset of back pain
• Increased pain when standing or walking, relieved by lying down
• Loss of height
• Stooped posture

Distal Radius (Wrist) Fractures

The distal radius fracture, or broken wrist, is particularly common in women over 50. It often happens when a person falls onto an outstretched hand (FOOSH). While generally less devastating than hip fractures, a wrist fracture can still lead to long-term issues, especially if alignment is not properly maintained during healing. This can significantly disrupt daily activities and a person's ability to live independently.

Symptoms of a wrist fracture include:

• Sudden pain and swelling
• Deformity, sometimes described as a “dinner fork” shape
• Difficulty moving the fingers or wrist

Fracture Risk Factors and Prevention Strategies

Preventing fractures in older adults involves a multi-pronged approach that addresses both bone density and fall risk.

For Healthy Bones:

• Proper Nutrition: Ensure adequate intake of calcium and vitamin D through diet and supplements. This is crucial for maintaining bone density.
• Regular Exercise: Engage in weight-bearing exercises like walking, jogging, and weightlifting to help build and maintain bone mass. Balance training, such as Tai Chi, is also highly effective at preventing falls.
• Medical Management: Undergo bone density screenings as recommended by a physician, especially for women over 65 and men over 70. Medications for osteoporosis may be necessary.

For Fall Prevention:

• Home Safety Modifications: Secure or remove loose rugs, install grab bars in bathrooms, and ensure adequate lighting in hallways and stairwells.
• Regular Health Check-ups: Have vision and hearing checked regularly and discuss any medications that may cause dizziness or imbalance with a doctor.
• Choose Proper Footwear: Wear sturdy, low-heeled shoes with good traction and avoid walking in socks or flimsy slippers.

Treatment Options Comparison

While specific treatment varies by the type and severity of the fracture, here is a general comparison of surgical versus non-surgical options, especially relevant for distal radius and hip fractures where choices exist.

Feature	Non-Surgical Treatment	Surgical Treatment
Application	Suitable for stable fractures with minimal displacement. Often involves a cast, splint, or brace.	Necessary for unstable, displaced, or complex fractures. Common for most hip fractures.
Speed of Recovery	Can take longer to regain full function due to prolonged immobilization.	Can lead to faster return to daily activities and better early-stage function, especially for wrist fractures.
Accuracy of Reduction	Risk of malunion (improper healing), which can cause cosmetic deformity and potentially long-term functional issues.	Allows for precise realignment and stabilization of bone fragments using pins, plates, or screws.
Risks	Lower risk of complications associated with anesthesia and infection.	Potential risks include infection, nerve injury, and complications from anesthesia.
Best for	Lower-demand patients or those with stable, simple fractures.	High-demand patients, those with complex fractures, or if rapid recovery of function is a priority.

Rehabilitation is Key to Recovery

After initial treatment, rehabilitation is a critical step for older adults to regain strength, balance, and independence. For hip fractures, rehabilitation begins almost immediately in the hospital to prevent complications and restore mobility as quickly as possible. Physical therapy focuses on gait training and strengthening exercises. For wrist and vertebral fractures, a regimen of physical and occupational therapy helps improve range of motion, build muscle strength, and adapt to any functional limitations.

Successful recovery also depends on addressing the underlying causes of the fracture. For example, if osteoporosis is a factor, a comprehensive care plan will include medication, nutrition counseling, and ongoing fall prevention strategies to reduce the risk of future breaks. Family physicians and caregivers play a vital role in identifying risk factors and ensuring that older adults receive appropriate preventative care and follow-up.

In conclusion, older adults are at increased risk for several specific types of fractures due to reduced bone density and a higher incidence of falls. Hip, vertebral, and wrist fractures are the most common and can have a significant impact on quality of life. By focusing on robust bone health and active fall prevention, older adults and their caregivers can significantly reduce the risk of these debilitating injuries and maintain long-term independence. For more information, the National Institute on Aging offers comprehensive resources on falls and fracture prevention.

Frequently Asked Questions

What is a fragility fracture?

A fragility fracture is a bone break that occurs from a fall from standing height or less, or from another form of low-energy trauma. These fractures are typically a result of weakened bones due to conditions like osteoporosis.

Why are hip fractures so dangerous for older adults?

Hip fractures are particularly dangerous for older adults because they often lead to serious complications, including blood clots, pneumonia, and significant loss of independence. The one-year mortality rate following a hip fracture is also notably high.

Can you walk with a fractured hip?

While it is possible in some rare, non-displaced cases, most people cannot walk with a fractured hip due to severe pain and instability. Attempting to bear weight is extremely painful and often impossible.

What are the first signs of a vertebral compression fracture?

The first signs of a vertebral compression fracture often include the sudden onset of back pain that worsens with standing or walking. For some, a gradual collapse may cause only mild pain or go unnoticed until height loss or a hunched posture becomes apparent.

What kind of exercises can prevent common fractures?

Weight-bearing exercises, such as walking, jogging, and climbing stairs, help strengthen bones. Balance exercises like Tai Chi or yoga are highly effective at improving stability and coordination to prevent falls.

What can be done at home to prevent falls?

Simple home modifications can significantly reduce fall risk. These include removing throw rugs, securing electrical cords, installing grab bars in bathrooms, and ensuring all areas are well-lit.

Is surgery always the best option for a wrist fracture?

No, surgery is not always the best option for a wrist fracture, especially in older adults with stable, minimally displaced breaks. For these individuals, non-surgical treatment with a cast or splint can yield comparable functional outcomes over the long term.