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Trauma fractures result from the direct, physical impact of an event such as tumbling off a ladder, being injured in a car accident, or falling while playing pickleball. Trauma fractures, unlike osteoporosis-related fractures, are not necessarily associated with an underlying weakness in the bones. They occur because the bones cannot withstand the amount of force exerted on them by the trauma event. It is important for patients and doctors to determine whether or not the health of the bone was also at play adding to the extent of the fracture. The fact that trauma was involved does not necessarily meant the the bone is healthy.
Bottom-line: if you have any fracture of significance, you should get a bone density test.
Of course, there are gray areas. Osteoporosis may predispose some individuals to fracture a bone with less trauma than would be expected. That’s why it is important to tease out the details of any activities or life events that result in a fracture, as this information can influence medical decisions and life activities.
Stress fractures are generally classified in the trauma category because the repetitive pounding of an activity like running causes physical stress that can produce hairline breaks over time. But a stress fracture can also be a red flag for low bone density or poor bone quality. It’s one thing if a stress fracture occurs in a person who trains for and runs a marathon, but there could be other problems if it happens after a long walk.
Stress fractures are not always visible on x-rays; an MRI or CT scan may be required to confirm them. You may want to seek this type of assessment if it seems the area in question has not healed after three to four weeks. If you or someone in your life experiences repeated stress fractures (or a fracture that seems to be of questionable origin), consider getting an accurate bone density test to investigate the problem further.
Note: “Insufficiency fracture” is a term you may see in medical reports, and these are only seen in severe bone cases. Sometimes referred to as a ‘subtype’ of stress fracture, insufficiency fractures can happen without any trauma. These fractures occur due to loss of trabecular (porous) bone, and they are “caused by normal or physiologic stress upon weakened bone.” In other words, the bone is so weak it can collapse due to the mere stress of body weight. Insufficiency fractures are seen only in extreme cases of osteoporosis or some other bone pathology.
Osteoporosis-Related Fractures:
Different terms are used to identify fractures caused by or related to osteoporosis. This can be confusing when you’re talking to your doctor or doing online research!
The following is a list of a few names for osteoporosis-related fractures. Please note that all these terms basically mean the same thing:
The World Health Organization describes all osteoporosis-related fractures as “fracture[s] caused by injury that would be insufficient to fracture a normal bone.” So, even though the above labels differ, they each describe bone breaks that fall under an ‘osteoporosis-related fracture’.
In other words, these fractures occur with minimal or no trauma from a standing height or lower.
This means if you have osteoporosis, you can fracture a bone if you trip and fall onto the floor or the street. That’s a fall from a standing height, and when there is no underlying pathology, most people can fall that far without breaking a bone. (Although certainly there are instances when falling from a standing height can have significant impact, which is why it is important to ask a lot of questions about a fracture).
For instance, if someone falls hard from a standing height and breaks their wrist, it does not necessarily mean their bones are significantly weak. However, if the bones shatter in pieces or if surgery is necessary it certainly is possible that poor bone health was part of the reason the bone fracture, get a bone density test.
When my patients are unclear about whether a recent fracture could be due to osteoporosis, I sometimes ask them, “If this had happened when you were twenty-five years old, do you think you would have fractured?” Answering “no” to that question is one indication that their fractures may not be due to a specific trauma event and that further investigation is needed.
Your bones must carry you through a lifetime.
There is so much to know regarding your bones. Diagnosis is paramount, and if you have sustained a significant fracture, you can help yourself by learning all you can from reputable sources. There is no osteoporosis specialty and most doctors of any persuasion are not specialists. If you have not sustained a fracture and you are diagnosed with osteoporosis with a bone density test, consider yourself lucky to catch it when you did and learn all you can to see if your fracture risk is of concern.
Most medical doctors tend to “treat” the bone density test, and recommend a bone medication without doing proper lab work. On the other hand, alternative doctors may recommend a simple supplement program, but they too are not experts in reading bone density reports and ordering proper lab work. In both instances your bones were not fully evaluated.
Bottom-line: stay informed so you know the questions to ask your doctor.