Fracture in

elderly
(osteoporotic fracture)
Dr. Luthfi Hidayat, Sp.OT
 introduction
a diseases characterized by low bone mass
and micro architectural deterioration of
bone tissue, as a result of sub normal osteoid
production, excessive rate of
deossification and subnormal osteoid
mineralisation, leading to enhanced bone
fragility and consequent increase in fracture
risk.
 The World Health Organization defines osteoporosis
as a lumbar(L2-4) density level at least
25 standard deviations (SDs) below the
peak bone mass of a 25-year-old
individual; osteopenia is defined as a bone density
level 10 to 25 SDs below the peak bone mass of a
25-year-old individual
 Osteoporosis is a quantitative, not
qualitative, defect in bone; mineralization
of bone remains normal
 risk factors
Sedentary, thin Caucasian women of northern
European descent (fair skin and hair), particularly
smokers, heavy drinkers, and patients on
phenytoin (impairs vitamin D metabolism), with
diets low in calcium and vitamin D who
breast-fed their infants, are at the greatest risk
 Osteoporosis Management
Osteoporosis not reversible
Primary prevention most important

Uncontrolled Risk Controlled Risk

Age Alkoholism
Sex Low calcium and vit.D3
Hormonal Status intake
Race Immobilization
Family History Lack of exercise
Postmenopause Smoking
Osteoporosis Management
 Fracture in osteoporosis
Fragility fracture low energy trauma
Osteoporosis is a SILENT DISEASE until
fracture
Vertebral body > hip fracture > wrist
Problems:
o Weaken bone
o Prolong rehabilitation
o Comorbidity factors
o Compliance problems
 Vertebral body fracture
associated with 15% increase in 5-
year mortality
associated with increased
morbidity
o back pain, loss of height, poor
balance, respiratory
compromise, restrictive lung
disease, pneumonia
history of 1 vertebral fracture results
in 5 fold increased risk of 2nd
vertebral fracture and 5 fold
increased risk of hip fracture
 Vertebral body fracture
treatment
o Non operatif
Most get better within 6 to 8 weeks without specific treatment
short period of rest + limited use of pain medications
o Operatif
Kyphoplasty/vertebroplasty
 Hip fracture
associated with 20%
increase in mortality
o men have higher mortality rates
following hip fractures than
women
associated with increased
morbidity
o reduced quality of
lifeonly one third of
patients with hip fractures
return to their previous
level of function
history of 1 hip fracture
results in up to 10 fold
increased risk of 2nd hip
fracture
 Hip fracture
Treatment
o Consideration
patient's overall health and medical
condition
prior ambulation
o Non Surgery
Limited to non operable patients
In stable fracture pattern
complications from prolonged
immobilization. These include
infections, bed sores, pneumonia,
the formation of blood clots, and
nutritional wasting.
 Hip fracture
o Operative
Target : early weight bearing
Minimal soft tissue damage
Plate fixation (DHS)
Intramedulary nailing
Arthroplasty
 Hip fracture
Related to high complication incidence due
to prolong immobilization
o Decubitus ulcer
o Deep vein thrombosis
o Muscle atrophy (disuse)
o Disuse Osteoporosis
 Wrist fracture
high incidence of distal
radius fractures in women
>50
distal radius fractures are
a predictor of subsequent
fractures
 Wrist fracture
Treatment
o Nonoperative closed reduction and cast
immobilization
o Operative surgical fixation (CRPP, External Fixation,
ORIF)
 fall prevention
prevention of fall is better than treating
fracture
require holistic assessment of health status
and also environmental assessment
Intrinsic factors vs extrinsic factors
 Intrinsic factors
 Extrinsic factors
 summary
Osteoporosis is a silent disease
Fracture in osteoporosis is a complex
management
Fracture in osteoporosis may require
different management compared to normal
bone
Prevention is better than cure