Assessment and management of fractures

The term fracture describes a loss of continuity of bone. It can occur when the force applied to the bone exceeds its strength. The microarchitecture, cortical shell thickness and bone density are important components of bone quality, which influence the risk of fracture. Bone quality, integrity and strength may be affected by diet, exercise, medication, and disease processes. Common pathologies affecting bone include tumours (primary or metastatic disease), infection, and conditions that directly affect the remodelling process, such as osteoporosis and Paget's disease (Stillwagon and Ostrum, 2021).

The prospect of a fracture occurring is determined by the quality and strength of the bone along with the mechanics of the force applied to it (Komisar and Robinovitch, 2021). The applied force may be a singular event (such as with a fall), or through repetitive overloading of the bone (e.g. when running). The force applied to the bone can be defined as high energy (e.g. a fall from a height or road traffic collision), or low energy (e.g. a fall from standing height, or less). Fractures that occur due to low energy forces are commonly referred to as fragility fractures. Approximately 549 000 new fragility fractures occur each year (National Osteoporosis Guideline Group (NOGG), 2021). Most fractures that occur in adults aged over 65 are due to a fall from a standing height or lower (Komisar and Robinovitch, 2021). The most common sites of fragility fractures are the hip, distal radius and vertebra (NOGG, 2021).