A fragility fracture is when a bone breaks with minimal trauma — for instance, when you fall from standing height or even from sitting height. 

Bones are meant to withstand normal pressure experienced during daily living, but when they are weaker than normal, a fragility fracture can occur. These fractures typically happen during everyday activities that involve minor force: a simple fall while walking, stepping off a curb, or even coughing hard or twisting to reach for something. 

Spinal fragility compression fractures can be caused by the weight of the body itself, sometimes just from bending forward to pick something up. 

In healthy bone, these low-impact events wouldn't normally cause a break. This type of fracture therefore signals that the bone has become weakened and is more brittle than it should be. We call these types of fractures "fragility fractures" or "insufficiency fractures" because the bone is more frail than it is supposed to be and is not strong enough to withstand these normal loads. 

Related Media

How Does Menopause Affect Bone and Joint Health?

podcast

The most common sites for fragility fractures are the hip, spine (vertebrae), wrist, and shoulder. 

Hip fractures tend to be the most serious and can significantly impact quality of life. However, fragility fractures can occur in nearly any bone when bone density is severely compromised.

The key difference is the level of trauma required to cause the break. 

• A typical fracture occurs from high-energy trauma, such as a motor vehicle accident, sports injury, or significant fall (e.g., from the top of a ladder). 
• Fragility fractures occur with low-energy impacts that healthy bones would easily withstand, like a fall from standing height. When this happens, it is a sign of underlying bone weakness. 

This distinction is important. If the entire skeleton is likely weakened and therefore at risk for future breaks, treatment may need to go beyond repairing the fracture. Patients may need to work with their primary care doctor or other specialists to address their bone health. 

Additionally, the weakened bone may make repair of the current fracture more challenging or result in a longer rehabilitation period. For example, some patients may have limits placed on weightbearing. 

Identifying and treating the cause of the bone weakness can help to prevent a cascade of future fractures that can lead to disability and loss of independence and decrease your lifespan.

Bones constantly remodel throughout life, with old bone being broken down and new bone being formed, bones gradually lose density and become weaker and brittle. This imbalance weakens the bone's structure, making it at risk of breaking with minimal stress.

When doctors suspect weakness in the bones, they often order tests, which can include a bone density test (or a DEXA scan). The results of a DEXA scan are compared to a standardized value and also to age-matched and sex-matched standards.

• If bone density is very low, this is a condition called osteoporosis. 
• If bone density is somewhat low, this condition is called osteopenia.  
• Bone can also be found to be of normal density. 

This can be thought of as a "red light, yellow light, green light" scenario:

• Osteoporosis indicates the patient is at high risk of fracture and will likely need interventions. The "red light" should prompt evaluation and treatment discussions. 
• Osteopenia indicates that the patient is at risk of further bone density changes and may be at risk of fracture. A "yellow light" tells the patient that they should be aware of possible problems.   
• Normal bone density is a favorable finding, but there are many things patients can do or avoid to keep their bones healthy.  

There are often many lifestyle changes, nutritional changes, and medication treatments for osteopenia or osteoporosis. A medical doctor (such as your primary doctor, an endocrinologist, a rheumatologist, or another nonsurgical doctor) may make recommendations for you about lifestyle or medical changes. 

Things that can cause old bone to break down faster than new bone is formed, and risk factors for osteoporosis or osteopenia include:

• Hormonal changes (especially menopause)
• Aging
• Poor nutrition, particularly low vitamin D
• Certain medical conditions and medications

Absolutely. Bone loss is often called a "silent disease" because it typically causes no symptoms until a fracture occurs. Many people have their first fragility fracture without any prior diagnosis of osteoporosis or warning that their bones were weakening. This is why the fracture itself is an important red flag that you should not ignore.

While fragility fractures are most common in older adults, particularly postmenopausal women, they can affect younger people too. Even people who haven't been formally diagnosed with osteoporosis can have bone density low enough to sustain these fractures.

A number of factors can also impact bone health and increase fragility fracture risk regardless of a person's age. These include:

• Long-term corticosteroid use
• Thyroid disorders
• Rheumatoid arthritis
• Vitamin D deficiency
• Excessive alcohol consumption
• Smoking
• Certain cancer treatments
• Eating disorders or being underweight
• Gastrointestinal conditions that affect nutrient absorption
• Being sedentary (not active) 
• Not bearing weight (example if a leg is paralyzed, its bones will lose bone density)
• Family history of osteoporosis or fractures
• Early menopause 

Yes. Having one fragility fracture approximately doubles your risk of having another fracture. This risk is highest in the first 1 to 2 years after the initial fracture. 

Without intervention to improve bone health, many patients experience multiple fractures over time. This creates a domino effect, with each subsequent fracture further affecting the person's mobility, health, and independence.

In particular, hip (and also spine) fractures can dramatically alter a person's life trajectory. 

• Hip fractures often result in loss of independent living, with many patients unable to return home or walk without assistance. 
• Spine fractures can cause chronic pain, loss of height, stooped posture, and reduced lung capacity. 
• Beyond physical limitations, these fractures increase risk of depression, social isolation, and death.

The immediate priority is managing pain and coming up with a treatment plan to stabilize the fracture and prevent further injury. A quick evaluation by trained medical professionals and keeping the affected body part still (immobilized) help reduce the risk of complications and patient suffering.  

This depends on specifics related to the fracture, including location and patient-specific factors.  Surgery is sometimes recommended if:

• The fracture is displaced (the pieces of bone are not in their normal alignment)
• The fracture involves a joint surface
• The fracture is unstable and unlikely to heal properly with non-operative treatment
• Surgical fixation would enable earlier movement and better long-term function 

It is almost always recommended that people with hip fractures have surgery. Wrist or spine fractures may be managed nonsurgically, depending on how severe they are. The goals are to:

• Restore stability and function
• Minimize possible complications from not being able to move around 

Rehabilitation often begins as soon as it is medically safe. For example, for most hip fractures in older patients, the goal is to get the patient moving as soon as it is both possible and safe. 

Physical and occupational therapy help restore strength, mobility, and function while helping to prevent complications like blood clots and muscle loss. 

This is also when your doctor will start to evaluate your bone health to address the underlying cause of the fragility fracture and prevent future fractures. 

A fracture may prompt a bone health evaluation, because a fragility fracture means you likely have underlying bone weakness that can put you at high risk for future fractures. Early identification and treatment of low bone density can reduce your future fracture risk by 50% or more.

The health evaluation is most often accomplished by having a discussion with your primary care doctor.

Does poor bone quality affect how fractures are treated or how they heal? 

Poor bone quality can affect both surgical options and healing potential. 

• Screws and plates may not hold as securely in weak bone, sometimes requiring special implants or techniques designed for osteoporotic bone. 
• Fractures may take longer to heal. There is also increased risk of the fracture not healing properly or the hardware failing. This is why addressing bone health during the healing process is crucial.

Recovery varies significantly depending on the fracture location and severity. 

• Wrist fractures may take 6 to 8 weeks to heal, with return to more normal activities in 3 to 4 months
• Hip fractures often require 3 to 6 months for substantial recovery, and it is expected that almost all patients never fully return to their pre-fracture function. 
• Spine compression fractures may cause pain for several weeks to months but often improve with time. However, you may have some permanent loss of height, meaning you are shorter than before you suffered the fracture.

Many patients can return to active, fulfilling lives after fragility fractures, especially with proper treatment of both the fracture and underlying bone health. 

However, some modifications may be wise — focusing on balance and strength training, fall prevention, and avoiding high-risk activities that increase fall risk. The goal is to safely lead an active lifestyle rather than not being active at all. Inactivity actually worsens bone health and increases future fracture risk.

The primary test is a dual-energy X-ray absorptiometry, or DEXA scan. A DEXA scan is a quick, painless, low-radiation scan that measures bone mineral density at the hip and spine. 

Your doctor may also order blood tests to check your calcium and vitamin D levels, thyroid function, and other markers that could indicate underlying causes of bone loss. This is usually done by a medical doctor rather than your surgeon, since you will need a comprehensive look at your overall health.

Some patients may need additional testing to rule out secondary causes of osteoporosis.

This often depends on the complexity of the case and the types of specialists you have access to.

Most commonly, these conditions are managed by primary care physicians (PCP) or other medical specialties such as endocrinologists or rheumatologists 

Often, an orthopaedic surgeon identifies the need for evaluation, and you then work with your physician — PCP, OB/GYN, endocrinologist, or rheumatologist — to manage your long-term bone health. However, depending on the availability of specialists where you live and other factors, like which type of insurance you have, your care might be managed solely by one doctor.

Treatment options include bisphosphonates, denosumab (Prolia), anabolic agents like teriparatide (Forteo), and hormone-replacement therapies (HRT), depending on individual circumstances. 

These medications can reduce fracture risk by 30 to 70%, with the greatest benefits seen in preventing spine and hip fractures. Taking the medications consistently is key, as stopping treatment can lead to rapid bone loss in some cases.

• Bisphosphonates are the most commonly prescribed first-line treatment.
• Medications like alendronate, risedronate, ibandronate, and zoledronic acid work by inhibiting osteoclasts (cells that break down bone), thereby reducing bone resorption. They can be taken by mouth or given with an intravenous (IV) infusion depending on the specific medication.
• RANK ligand inhibitors, specifically denosumab (Prolia), block the protein RANKL that is essential for osteoclast formation and function. This also reduces bone breakdown. It is given as a subcutaneous (under the skin) injection every six months.
• Anabolic agents actually stimulate new bone formation rather than just preventing loss: 
  
  • Teriparatide (Forteo) and abaloparatide are synthetic forms of parathyroid hormone that promote bone building when given in daily injections. 
  • Romosozumab (Evenity) is a newer option that works by both increasing bone formation and decreasing bone resorption (the breakdown of bone) by inhibiting sclerostin.
•  Selective estrogen receptor modulators (SERMs) like raloxifene (Evista) mimic estrogen's beneficial effects on bone while avoiding some of estrogen's effects on other tissues. These are particularly used in postmenopausal women.
• Hormone replacement therapy with estrogen (sometimes combined with progestin) can prevent bone loss in postmenopausal women.
• Calcitonin is an older treatment that modestly reduces bone resorption (breakdown) but is less commonly prescribed today given more effective options.

Speak to your doctor to understand more about these medications and which one might be right for you. 

Adequate calcium (1,000 to 1,200 mg daily) and vitamin D (800 to 1000 IU daily, or more if you have a deficiency) are helpful for bone health.  

Learn more: Calcium, Nutrition, and Bone Health
Learn more: Vitamin D for Good Bone Health

Weightbearing exercise and resistance training help maintain and even build bone density while improving balance and muscle strength, which reduces fall risk. 

While nutrition and exercise alone may not be enough to treat established osteoporosis, they are essential parts of any fracture prevention strategy.

It means things you can do to make your environment safer. Even seemingly small steps can go a long way in preventing future falls.

• Avoid throw rugs.
• Do not wear shoes that are unstable, like very high heels or flip-flops. If you wear socks or slippers around the house, choose ones with gripper bottoms or non-slip designs.
• Pick up common household items that may be on the ground and lead to falls, like cords, dog and kid toys, and decorations. 
• Always have a well-lit path to the bathroom.
• Use the handrails when going up and down steps.
• If possible, install handrails near toilet and bathtub/shower.
• Consider putting a seat in the shower.

Learn more: Guidelines for Preventing Falls