Pathophysiology of Fractures

  • Michael R. McClung


  • There are multiple determinants of fractures, many of which are related to each other by virtue of their increased prevalence with aging.

  • Osteoporosis (or low bone mass) is a major risk factor for fractures, but it is not the only factor.

  • Appropriate strategies for decreasing fracture frequency include both pharmacologic and non-pharmacologic approaches, which address the wide variety of risk factors for fracture with which our patients present.

Fractures are the complication of osteoporosis, much as strokes are the complication and result of hypertension. It is only through fractures that osteoporosis manifests its clinical effects or has clinical relevance. Fractures occur in patients with decreased bone strength and who experience an injury. Thus, the pathophysiology of fractures encompasses a multitude of factors that determine bone strength (bone mass, bone quality, age, skeletal geometry) and the frequency, nature, and effects of injuries (Figure 4.1).Each of these factors becomes more prevalent with advancing age, resulting in the exponential increase in the prevalence of fractures related to osteoporosis in elderly individuals. Understanding the determinants of fracture risk provides the basis of appropriate and effective interventions to reduce fracture frequency and the complications of osteoporosis.


Bone Loss Bone Mass Fracture Risk Bone Density Anorexia Nervosa 
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Further Reading

  1. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7: 221–227.PubMedCrossRefGoogle Scholar
  2. Cummings SR, Nevitt MC, Browner WS, et al. (1995) Risk factors for hip fracture in white women. N Engl J Med 332: 767–773.PubMedCrossRefGoogle Scholar
  3. Faulkner KG, Cummings SR, Nevitt MC, Pressman A, Jergas M, Genant HK (1995) Hip axis length and osteoporotic fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 10: 506–508.PubMedCrossRefGoogle Scholar
  4. Greenspan SL, Myers ER, Maitland LA, Resnick NM, Hayes WC (1994) Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. J Am Med Assoc 271: 128–133.CrossRefGoogle Scholar
  5. Hui SL, Slemenda CW, Johnston CC jr (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81: 1804–1809.Google Scholar
  6. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319: 1701–1707.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2004

Authors and Affiliations

  • Michael R. McClung

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