Jul 2026· International science journal· 0 citations· 3 references
TL;DR
Modern orthogeriatric care, based on multidisciplinary collaboration, timely surgical management, individualized rehabilitation, nutritional optimization, osteoporosis treatment, and secondary fracture prevention, consistently improves mobility, functional independence, postoperative outcomes, and long-term quality of life.
Abstract
Fragility fractures have become one of the most significant health challenges associated with global population aging, generating substantial consequences for functional independence, healthcare systems, and quality of life. This review aimed to analyze the current scientific evidence regarding the epidemiology, pathophysiology, risk factors, modern orthogeriatric management, and functional recovery of older adults sustaining fragility fractures. A structured literature review was conducted using international scientific databases and evidence-based clinical guidelines published by recognized organizations. The available evidence demonstrates that fragility fractures are multifactorial conditions resulting from the interaction of osteoporosis, sarcopenia, frailty syndrome, multimorbidity, nutritional deficits, and age-related physiological decline. Contemporary orthogeriatric care, based on multidisciplinary collaboration, Comprehensive Geriatric Assessment, timely surgical management, individualized rehabilitation, nutritional optimization, osteoporosis treatment, and secondary fracture prevention, consistently improves mobility, functional independence, postoperative outcomes, and long-term quality of life. Early rehabilitation and coordinated follow-up through structured fracture prevention programs were also associated with lower complication rates and reduced risk of recurrent fractures. Furthermore, the findings emphasize the growing importance of integrating orthopedic surgery, geriatrics, rehabilitation medicine, nutrition, and preventive care into patient-centered management strategies. As demographic aging continues to accelerate worldwide, particularly in Latin America, strengthening orthogeriatric services and implementing evidence-based multidisciplinary models represent essential strategies for preserving autonomy, reducing disability, and improving long-term clinical outcomes among older adults with fragility fractures.
ABSTRACT Hip fractures pose a serious threat to the quality of life among older adults and impose a heavy burden on both society and families. Although current surgical techniques for hip fractures have become increasingly refined, postoperative quality of life and overall function in older adult populations often steeply decline. This decline is marked by “secondary debilitation,” characterized by exacerbated sarcopenia, functional impairment, and physiological reserve depletion—a process that becomes a risk factor for recurrent fractures, creating a “vicious cycle” with hip fractures. This article provides a comprehensive overview of the pathophysiological mechanisms underlying “secondary debilitation,” discusses the clinical application of risk assessment tools, and presents a phased, stepwise intervention strategy aimed at interrupting the “vicious cycle.” The strategy includes early rapid rehabilitation, nutritional support, and prevention of complications; a mid‐phase multimodal approach involving multidisciplinary management, comanaged wards, fracture liaison services, and systematic rehabilitation; and, finally, late‐phase exploration of emerging pharmacotherapies and treatment methods. This review seeks to offer an evidence‐based foundation for optimizing clinical risk assessment and developing precise interventional strategies.
Wenyang Xu, Fan Xu, Maoqiang Fan et al.· Orthopaedic Surgery· 0 citations
An Aging Spine Surgical Host framework is proposed that integrates frailty, sarcopenia, osteoporosis, nutrition, cognition, mobility, and surgical magnitude into four actionable grades: robust, vulnerable, high-risk, and prohibitive or modifiable high-risk.
N. X· International Journal of Sci...· 0 citations
Vertebral compression fractures (VCFs) represent the most prevalent osteoporotic fracture and constitute a growing cause of morbidity, mortality, and healthcare utilization worldwide. Although often considered benign, VCFs are associated with chronic pain, progressive spinal deformity, functional impairment, decreased pulmonary capacity, and increased short- and long-term mortality, especially in older adults. Despite their high prevalence, key challenges persist regarding appropriate diagnostic evaluation, optimal treatment selection, and integration of osteoporosis management following fracture. This narrative review consolidates current evidence on the epidemiology, pathophysiology, diagnostic evaluation, management strategies, and public health implications of VCFs, with a focus on emerging spine-focused care models. VCFs predominantly result from compromised vertebral strength secondary to osteoporosis-related deterioration of trabecular microarchitecture, although traumatic and pathologic etiologies should also be considered. Diagnosis involves careful clinical assessment combined with imaging, with magnetic resonance imaging serving as a key modality for distinguishing acute fractures from chronic deformities or malignancy. Despite advances in diagnostic techniques, VCFs remain underrecognized and undertreated, contributing to avoidable disability and recurrent fractures. This narrative review synthesizes contemporary evidence, highlighting practical considerations for clinical decisionmaking in VCF care. Particular emphasis is placed on differentiating acute symptomatic fractures from chronic deformities or pathologic collapse, identifying patients most likely to benefit from vertebral augmentation, and defining surgical indications in the setting of neurologic compromise, instability, or progressive deformity. Conservative management, incorporating analgesia, early mobilization, and rehabilitation, remains the first-line approach for most stable fractures. Vertebroplasty and balloon kyphoplasty may provide short-term pain relief in carefully selected patients with persistent symptoms. However, the long-term benefits of augmentation and optimal patient selection criteria remain under investigation. Treatment options range from conservative measures—including analgesia, bracing, mobilization, rehabilitation, and osteoporosis-directed pharmacotherapy—to minimally invasive vertebral augmentation procedures such as vertebroplasty and balloon kyphoplasty. Vertebral augmentation may provide short-term improvements in pain and function in appropriately selected patients, although its long-term benefits and optimal indications remain under investigation. Surgical decompression and stabilization are reserved for patients with neurological compromise, instability, or progressive deformity. From a public health perspective, deficiencies in osteoporosis screening, delayed diagnosis, and disparities in treatment access continue to affect diverse socioeconomic and racial groups. Emerging innovations, including fracture liaison services, risk stratification tools such as FRAX, and artificial intelligence–based predictive models, may enhance early detection and personalized care. VCFs represent sentinel manifestations of systemic skeletal fragility that warrant evaluation of underlying osteoporosis and implementation of secondary fracture prevention. Pharmacologic therapies, including antiresorptive and anabolic agents, play a key role in reducing recurrent fracture risk, although treatment selection should be individualized. Multidisciplinary, patient-centered strategies focused on early diagnosis, prevention, equitable care delivery, and standardized management are essential to address the growing global burden of VCFs. A structured, patient-centered approach to diagnosis, treatment selection, and post-fracture care may enhance outcomes and reduce the long-term burden associated with VCFs.
G. Findlay, Mark Ehioghae, Lancelot Benn et al.· Asian Spine Journal· 0 citations
Hip fractures are among the most devastating fragility fractures, associated with excess mortality, disability, loss of independence, and substantial healthcare costs. Although age-standardized incidence has declined in several high-income countries, absolute case numbers continue to rise because of population aging. This review summarizes contemporary PubMed-indexed evidence on the epidemiology, risk stratification, and prevention of proximal femoral fractures, with emphasis on hip-fracture outcomes rather than vertebral or composite endpoints alone. We discuss secular trends, FRAX-based case findings and screening, non-pharmacologic strategies, pharmacologic therapy, and health-system interventions relevant to both primary and secondary prevention. Among non-pharmacologic measures, long-term balance-challenging and resistance-based exercise has the most consistent evidence for reducing falls and likely contributes to fracture prevention, whereas multifactorial interventions, home hazard modification, calcium/vitamin D supplementation, and hip protectors are best targeted to selected high-risk populations and care settings. Among medications, bisphosphonates, denosumab, and romosozumab-based sequential strategies show the strongest evidence for reducing hip-fracture risk, while teriparatide and abaloparatide have important roles in very-high-risk patients despite less direct hip-fracture evidence. Menopausal hormone therapy reduces hip fractures in younger postmenopausal women but is limited by extra-skeletal risk, and selective estrogen receptor modulators are primarily vertebral-fracture agents. A major message of this review is that effective prevention depends not only on drug efficacy but also on implementation. Fracture liaison services, orthogeriatric co-management, prompt treatment after fragility fracture, and sustained adherence support are essential to close persistent care gaps. Preventing hip fractures therefore requires an integrated, risk-stratified approach that combines skeletal protection, falls prevention, and reliable health-system delivery.
Toshiyuki Kawai, Yaichiro Okuzu, Yusuke Takaoka et al.· Journal of Clinical Medicine· 0 citations
Thoracolumbar trauma in elderly patients has become increasingly important as population aging has reshaped the epidemiology of spinal injury. In the aging spine, low-energy trauma can produce clinically significant or unstable fractures because osteoporosis, degenerative stiffness, and rigid spine disorders alter mechanical behavior. Conventional classification systems and guideline-based algorithms remain useful for describing fracture morphology, neurological status, and structural instability. However, their applicability in elderly patients is limited because treatment decisions must account for frailty-related vulnerability and the functional consequences of immobilization. This review summarizes the distinctive features of thoracolumbar trauma in the aging spine and proposes an integrated framework that combines structural injury severity with frailty-based assessment of treatment tolerance. Frailty reduces physiologic reserve and limits the ability to tolerate treatment and recover after injury, while poor bone quality and spinal rigidity increase the risk of structural failure even with guideline-concordant care. Treatment should aim to restore stability, preserve neurological function, control pain, and enable early mobilization while minimizing physiologic burden. Depending on structural demand, treatment may range from non-operative care or vertebral augmentation in appropriate patients to definitive fixation, with selection guided by bone quality, frailty, and expected functional benefit. Thoracolumbar trauma in the aging spine should be managed as a distinct clinical entity for which an integrated frailty-based framework may better support practical, patient-centered decision-making.
Seung-Hoon Lee, Matthew W. Scarsbrook, Joonho Byun et al.· Journal of Korean Neurosurgi...· 0 citations
➢ Fragility fracture care remains suboptimal worldwide despite strong evidence supporting timely surgery, orthogeriatric care, early mobilization, unrestricted weight-bearing, and secondary fracture prevention.➢ International quality standards and registry-based audits have translated this evidence into measurable indicators that improve care in many high-income health-care systems.➢ Implementation in low- and middle-income countries (LMICs) is limited primarily by health-system constraints, including workforce shortages, delayed presentation, limited infrastructure, and fragmented care pathways, rather than by lack of evidence.➢ Emerging initiatives demonstrate that evidence-based quality standards can be successfully adapted to local contexts while preserving their core clinical principles.➢ Orthopaedic surgeons have a central role in leading multidisciplinary care, promoting secondary fracture prevention, and driving quality improvement across the entire fragility fracture pathway.➢ Future progress depends on strengthening health systems, embedding auditing and certification programs, and implementing context-sensitive quality standards that bridge the gap between evidence and routine.
Irewin Tabu, E. Armstrong, Matthew L. Costa et al.· Journal of Bone and Joint Su...· 0 citations
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