Let's Talk About Bone Fractures Due to Osteoporosis
A bone break is often a sudden, painful indicator of osteoporosis. We explain what leads to a break, how fractures are treated, and potential complications to look out for.
It’s said that ounce for ounce, human bone is stronger than steel. If bones are that strong, how do they break? Much comes down to physics, force, and trauma. Even healthy bones can snap if hit with enough force. But for weakened bones, it doesn’t take much impact to cause a break. Due to age and other factors, bones may lose their denseness, become brittle, and break easily (say, from a stumble). The medical term is low bone mineral density or osteopenia, and it can be a stepping stone to osteoporosis—marked by extremely low bone density and a high risk of fracture. Following an osteoporosis diagnosis, you probably have questions about bone fractures. Here are the answers you need.
Our Pro Panel
We went to some of the nation’s top bone doctors for the most scientific and up-to-date information possible.
Stephen Liu, M.D.
Clinical Assistant Professor
UCLA School of Medicine
Los Angeles, CA
Eliana Cardozo, D.O.
Physiatrist and Assistant Professor
Rehabilitation and Physical Medicine at Mount Sinai Hospital
New York, NY
Kendall Moseley, M.D.
Johns Hopkins Metabolic Bone & Osteoporosis Center
Osteoporosis typically has no symptoms until you fracture a bone. And, yup, that can hurt a lot. But if your bones are especially brittle, you may experience little pain and not even know you have a fracture. In the case of a spinal compression fracture, a collapsed vertebra in your spine, your only indication may be a backache that gets worse after you’ve been sitting for a while.
Osteoporotic fractures typically occur in your wrist, hip, and spine, although they can happen in other spots like shoulders and ankles. Wrist fractures usually occur when you try to stop yourself from falling, breaking your fall with your hands. Hip and spine fractures can happen from falls, but when osteoporosis is severe, they can occur from simply bending the wrong way.
In a word: Nada! Fracture is the medical term for a broken bone and you may hear doctors and lay people alike use them interchangeably.
Without complications, you should have your range of motion back and be free of pain within six to eight weeks, but the full healing process can take a year or more. Long after your cast or splint comes off, your bones continue to “remodel,” the process of new bone forming and reshaping.
What is Osteoporosis? Let’s Recap!
Osteoporosis translates to porous, or soft, bones. Unlike healthy bones studded with tiny holes and a honeycomb-like appearance, the bones of those with osteoporosis have larger holes (picture Swiss cheese), leaving them brittle, weak and prone to breaking due to their low density.
How do bones get to this point? Bones are active and evolving from birth until death. We’re always building new bone and losing old bone, a process known as resorption. Mid-life is when the slide begins. You spend your first few decades building bone mass, and by age 30, you’ve hit peak bone mass: the max amount of bone you’ll have. For the next two decades, your bone mass stays fairly stable. You’ll lose bone, but also make new bone, known as remodeling.
Around age 50 and beyond though (earlier if you have certain health conditions) bone loss increases, especially if you’re a postmenopausal woman, because the loss of estrogen accelerates bone loss. For some people, bone loss outpaces bone growth, osteopenia sets in, and eventually leads to the more severe osteoporosis.
Aside from menopause and genetics, what makes some of us prone to osteoporosis? Other risk factors include:
Having a small-frame or being very thin
Being of Northern European descent
Skimping on calcium and vitamin D
A sedentary lifestyle
Underlying conditions such as diabetes, rheumatoid arthritis, undiagnosed celiac disease, cancer, etc. These diseases can interfere with bone development and calcium absorption, and often require medications that erode bones, too, such as corticosteroids.
With treatment (in the form of medication and lifestyle changes), you may improve your bone mass, or at least stave off further loss. But without treatment, bone loss and fragility put you at risk of--you guessed it--fractures, often from a slight movement.
What Causes Bones to Break?
First, fracture vs. break: What’s the difference? Nothing! Fracture is the medical term for a broken bone. They’re used interchangeably.
Fractures aren’t exclusive to folks with osteoporosis. Americans break a lot of bones—over 6 million annually—all sorts of ways. Here are the top three reasons bones fracture:
Trauma: Car accidents, a rough incident on the soccer field, a nasty fall of your bike—all of these traumatic injuries can have enough force behind them to snap even a bone.
Overuse: You’ve probably heard about a long-distance runner who had a foot fracture and didn’t even know it. Small cracks can occur in your bones over time from repetitive movements that put a lot of stress on the bone, like pounding the pavement every day.
Osteoporosis: When they are complications of osteoporosis, broken bones are known as pathological fractures, and they can be debilitating. It’s said that roughly 1.5 million fractures a year stem from osteoporosis. Someone with the condition can fracture a vertebra from simply twisting the wrong way, or experience a rib cage fracture from a bad cough.
What Fractures Are Associated With Osteoporosis?
Osteoporosis is a silent disease; there aren’t obvious symptoms. Most people don’t know they have the condition until they fracture a bone. Certain breaks are red flags for a bone-thinning condition. Osteoporotic fractures often occur in the wrist, hip, and spine, although they can happen in shoulders and ankles, too. What are the most common types? Let’s take a look:
Compression fracture: This is a break (or several) in the vertebra, small bones that make up your spine. When these bones fracture, they compress or collapse together. This can cause back pain or shortening in height. It can even create a curvature of the spine. These are twice as common as other osteoporotic fractures, with nearly 700,000 patients experiencing them a year, according to the American Academy of Orthopaedic Surgeons (AAOS).
Hip fracture: A broken hip is usually due to a fall in someone with low bone density. In severe osteoporosis cases, it can happen simply from bending or twisting.
Colles fracture: This is a break in the radius, an arm bone. You may also hear it referred to as a distal radius fracture. It typically happens when someone tries to stop their fall, and it’s a common break for those with low bone density and osteoporosis.
Fragility fracture: This is defined as any fracture incurred from a standing height or lower—like a little stumble over a curb. Healthy, strong bones should be able to withstand these types of falls, but low-density bones may break.
Hairline fracture: This is also referred to as a stress fracture. It’s a hairline crack in your bone, most likely from overuse and repetitive impact. In addition to those with osteoporosis, it’s common in extreme athletes, especially women, who tend to have low hormone levels affecting their menstrual cycles, low body weight, and low bone density, a.k.a., the female triad. Often, the only signs are a nagging pain that doesn’t go away, swelling, or bruising.
What Are Other Common Types of Fractures?
Other breaks are brought on by high-force and traumatic injuries, rather than osteoporosis. These are the most common:
Spiral fracture: This typically happens with a twisting injury with a lot of force. Spiral fractures are most common in the lower body or the long bones in the arm, and almost always require surgery to repair.
Buckle fracture: This break tends to be more common in children because their bones are still somewhat soft. The bone buckles, but doesn’t actually break all the way through. It’s also known as an incomplete fracture.
Greenstick fracture: This is another break commonly seen in kids. It’s also an incomplete fracture. Picture the bone as a bow and arrow. It bends on one side with little cracks, but the other side of the bone stays intact.
Displaced fracture: With this break, the two ends of the bone don’t line up, so healing requires some amount of intervention or surgery to line it up bone-to-bone again. With non-displaced fractures, the broken ends match up, keeping the bone in alignment.
Compound fracture: This is a high-energy break that’s also known as an open fracture. Here, the bone protrudes through the skin.
Chip fracture: This happens when the muscles and ligaments around a bone actually chip a piece off; it occurs in the ankle, foot, elbow, and hip from high-energy and sport-related injuries.
What Are Symptoms of a Fracture?
If you’ve ever broken a bone, or been on a sports field with someone who has, the first sign is usually, as you may have guessed, pain. It hurts when you apply pressure or try to move the affected limb. You may also experience swelling, bruising, nausea and dizziness. In some cases, the limb may even look bent or deformed. And if a bone broke through the skin, well, you’re going to see that (and feel it).
What about osteoporotic fractures that don’t happen as a result of falling? The signs can be a bit more subtle. Here’s what to watch out for:
Hairline crack symptoms may include soreness during weight-bearing exercise that gets worse over time.
Spinal compression fractures may cause a backache that gets worse after you’ve been sitting for a while and attempt to get up. You might even notice you’re shrinking in height. While it’s normal to lose some height with age, two inches or more is suspect and should be checked out.
A curve in your spine that creates a hunched posture is also a sign of collapsed vertebrae.
What Kind of Doctor Treats Fractures?
An orthopaedist (or orthopedic) is your go-to for bone fractures. Depending on the severity of your break and the recommended course of treatment, you may need to see an orthopedic surgeon or trauma surgeon. During your recovery, you may also need to make appointments with a physical therapist or a physiatrist, who specializes in rehabilitation medicine.
You’ll also want to start on a treatment plan for the osteoporosis that spurred the fracture. Doctors who diagnose and treat osteoporosis include: endocrinologists, rheumatologists, gynecologists, and geriatric medicine physicians.
How Are Fractures Diagnosed?
The doctor doctor will want to know all about your injury, your pain level, and any other symptoms you’re experiencing, as well as your medical history. To confirm your fracture, you’ll likely have an X-ray.
However, some fractures, such as hairline stress fractures, are too small for even an X-ray to pick up. In that case, your doctor might order another type of imaging test such as:
Computed tomography scan (CT scan)
Magnetic resonance imaging (MRI)
How Are Bone Fractures Treated?
Recovery depends on the type of fracture, what bone has been broken, age, and overall well-being. A typical healing period is six to eight weeks, but underlying issues such as osteoporosis can slow the process and cause complications (more on that below). The most common ways of treating a fracture are:
Resetting the bone and stabilizing it with a brace, splint or cast
Traction to set the bone back into alignment
Many fractures heal with just a brace, splint or cast. Others require traction, a system of using weights, pulleys and ropes to adjust a broken bone back into alignment. (If you’re getting a visual of someone laid up in a hospital bed with their leg suspended in the air, you’re not wrong.) It looks straight out of a dramatic hospital scene from a movie, but it may be necessary to stabilize and elongate your bones so they can heal correctly. Traction can also ease pain while waiting for surgery.
Spinal compression fractures and hip fractures are, as impossible to cast and may only require bed rest, pain mediation, cold and hot therapy, and a brace. In some cases, they will need surgery.
If the broken bone is particularly difficult to reset, like a hip fracture, or there are bone fragments involved, it may need surgery and screws, pins, plates, or rods to hold it in place. A hip fracture may require a partial or full hip replacement. Even still, the loss of mobility associated with these breaks can lead to depression, financial strain, infections such as pneumonia, and even death. The one-year-post-surgery mortality rate after a hip fracture is 22 percent, a study in the World Journal of Orthopedics suggests.
If spinal fractures don’t heal on their own, they may require kyphoplasty, a procedure that involves using small balloons to expand the space between the collapsed vertebra. The balloons are removed and those spaces are cemented. A similar technique, called vertebroplasty, uses cement without the balloons, but a study in the British Medical Journal suggested that it isn’t effective and doesn’t improve quality of life.
How Do Bone Fractures Heal?
Bones don’t miraculously recover due to a cast, traction or surgery alone. Changes need to take place within them to bring about healing. What’s going on inside those bones as they’re repairing? Five things need to happen for a bone to heal properly:
Inflammation: When you first fracture a bone, your body sends out an SOS, calling inflammatory cells to the scene of the accident. This inflammatory cascade is what causes redness, swelling, and warmth around the injury.
Hematoma: A break disrupts the lining of the bone, which brings blood supply to the area. You’ll have a lot of clotting around the broken bone, and a flood of stem cells. This stage lasts about a week.
Callus: Now your body forms a callus over the bone’s ends. First a soft callus that’s later replaced by a hard callus.
Consolidation: During this stage, the bone starts to firm up. Consolidation occurs three to four weeks after your break and continues for a couple of months.
Remodeling: The new bone continues to form, replacing the hard callus until it eventually returns to the size and shape it was before the break. You might be up and moving six weeks after a break, but this process goes on for at least a year.
Of course, life doesn’t always go according to plan, and that goes for the repair process, too. When a break doesn’t heal properly (a malunion or nonunion) or takes a while (a delayed union), you may be left with chronic pain, reduced range of motion, or the loss of independence that accompanies these complications. Your break may require surgery to correct, which comes with its own set of risks: bleeding, infection, and blood clots.
Risk of infection after a fracture is rare, but possible. It’s more likely to happen with an open fracture, when the bone breaks through the skin. When the skin barrier is compromised, bacteria can get into the bone and cause trouble. One such infection is osteomyelitis, which causes inflammation of the bone and bone marrow. Treatment includes antibiotics and surgery to drain the infected area and remove diseased bone and tissue. In some cases, the limb will need to be amputated.
Osteoporosis Facts and Figures: National Osteoporosis Foundation. (n.d.) cdn.nof.org/wp-content/uploads/2015/12/Osteoporosis-Fast-Facts.pdf
Compression Fracture and Osteoporosis: American Academy of Orthopaedic Surgeons. (n.d.) “Osteoporosis and Spinal Fractures.” orthoinfo.org/en/diseases--conditions/osteoporosis-and-spinal-fractures/
The Female Triad and Bone Fracture: BMJ Open. (2012). “Risk Factors for Stress Fracture in Female Endurance Athletes: A Cross Sectional Study.” ncbi.nlm.nih.gov/pmc/articles/PMC3533057/
Vertebroplasty and Pain Relief: British Medical Journal. (2018). “Vertebroplasty Versus Sham Procedure For Painful Acute Osteoporotic Vertebral Compression Fractures.” bmj.com/content/361/bmj.k1551
Hip Fracture Mortality Rate: World Journal of Orthopedics. (2019). “Changing Trends in the Mortality Rate at 1-Year Post Hip Fracture.” wjgnet.com/2218-5836/full/v10/i3/166.htm