Jha S S
Patna, India.
Indian J Orthop. 2025 Mar 27;59(3):244-255. doi: 10.1007/s43465-025-01356-y. eCollection 2025 Mar.
Fragility fractures are a major health concern. It is a fracture that occurs from a low-impact event, such as a fall from standing height or less typically due to weakened bones. These fractures are most commonly associated with conditions like osteoporosis, where the bone density is reduced, making the bones more susceptible to get fractured. Fragility fractures often occur in older adults including post-menopausal women and commonly affect areas, such as the hip, spine, and wrist. These fractures reflect the underlying bone fragility, and following first fragility fracture, there is increased risk of getting further fractures. Apart from osteoporosis, the contributing factors have also to be considered like age, gender, nutritional deficiencies, physical activities, and medical conditions like chronic kidney disease. The other risk factors like smoking, and excessive alcohol consumption, and certain medications such as corticosteroids and anti-convulsants like sodium valproate, can overtime result into osteoporosis.
Fragility fractures basically revolve around the terminal management of osteoporosis and many issues have not been over emphasized. Hence, these 10 commandments have been crafted to focus on the areas which can help prevent fragility fractures or combat those cases who come with a history of fragility fractures.
The ten commandments have crystallized into various headings, including fragility fracture-the risk factors & DEXA, subnormal turnover bone diseases, microbiota & microbiome, inflammaging including obesity, parathyroid, thyroid & testosterone, dilemmas in the management of osteoporosis in younger adults, vitamin D, calcium & albumin, pharmacologic treatment options, associated medications & alternative therapies, and monitoring. High and low turnover bone disease, dysbiosis in gut, and inflammaging are the highlights including therapy and monitoring.
Fragility fracture also known as osteoporotic fracture has significant morbidity and mortality. Management of osteoporosis has been emboldened with the existing basket of both anti-resorptive and anabolic drugs. Safety concerns on long-term use of these drugs are emerging. These ten commandments will help management strategies to concentrate on targeting therapy to persons most "at risk" of getting these fractures.
脆性骨折是一个重大的健康问题。它是指因低冲击力事件（如从站立高度或更低处跌倒）导致的骨折，通常是由于骨骼变弱引起的。这些骨折最常与骨质疏松症等疾病相关，骨质疏松症会导致骨密度降低，使骨骼更容易骨折。脆性骨折常发生在老年人，包括绝经后女性，并且通常影响髋部、脊柱和手腕等部位。这些骨折反映了潜在的骨骼脆性，首次发生脆性骨折后，再次发生骨折的风险会增加。除了骨质疏松症外，还需要考虑其他促成因素，如年龄、性别、营养缺乏、身体活动以及慢性肾病等疾病状况。其他风险因素，如吸烟、过量饮酒以及某些药物，如皮质类固醇和丙戊酸钠等抗惊厥药物，长期使用可能会导致骨质疏松症。
脆性骨折基本上围绕骨质疏松症的终末管理展开，许多问题并未被过度强调。因此，制定了这十条原则，以关注有助于预防脆性骨折或应对有脆性骨折病史患者的领域。
这十条原则已归纳为不同的主题，包括脆性骨折——风险因素与双能X线吸收法（DEXA）、骨转换异常的骨疾病、微生物群与微生物组、包括肥胖在内的炎症衰老、甲状旁腺、甲状腺与睾酮、年轻成年人骨质疏松症管理中的困境、维生素D、钙与白蛋白、药物治疗选择、相关药物与替代疗法以及监测。高转换和低转换骨疾病、肠道菌群失调以及炎症衰老，包括治疗和监测，都是重点内容。
脆性骨折也称为骨质疏松性骨折，具有显著的发病率和死亡率。现有的抗吸收和促合成药物使骨质疏松症的管理更有信心。长期使用这些药物的安全性问题正在出现。这十条原则将有助于管理策略集中于针对最“有风险”发生这些骨折的人群进行靶向治疗。
