Osteoporosis-related fractures, commonly referred to as fragility fractures, occur as a consequence of reduced bone strength and structural deterioration of bone tissue, resulting in fractures from low-energy trauma that would not normally cause injury in healthy bone. These fractures represent a major orthopaedic and public health concern due to their association with significant morbidity, loss of independence, and increased mortality, particularly in older adults.

Fragility fractures most commonly affect the hip, spine, wrist, and proximal humerus. Hip fractures are associated with the highest rates of disability and mortality, while vertebral compression fractures may occur silently yet lead to chronic pain, spinal deformity, and reduced pulmonary function. Wrist fractures often serve as an early indicator of underlying osteoporosis and increased future fracture risk.

Patients typically present following a low-impact fall or minimal trauma, often surprised by the severity of injury relative to the mechanism. Pain, deformity, functional loss, or inability to bear weight are common presenting features. Vertebral fractures may present more insidiously with back pain, height loss, or kyphotic deformity rather than acute trauma.

Orthopaedic evaluation begins with assessment of fracture pattern, stability, and functional impact, alongside recognition that the underlying pathology is compromised bone quality rather than isolated trauma. Imaging confirms fracture characteristics, while clinical assessment evaluates mobility, balance, and risk of further falls. Recognition of osteoporosis as the root cause is essential for comprehensive management.

Management principles focus on fracture stabilization, pain control, early mobilization, and prevention of secondary complications. Surgical decision-making must account for poor bone quality, which influences fixation strategy and implant selection. Stable fixation is critical to allow early mobilization and reduce complications such as pneumonia, pressure injuries, and venous thromboembolism.

Non-operative management may be appropriate for selected stable fractures, particularly vertebral compression fractures, provided pain and function are adequately controlled. However, prolonged immobilization must be avoided due to its deleterious systemic effects.

Equally important is secondary fracture prevention. Orthopaedic care does not end with fracture healing; identification of osteoporosis, coordination with medical management, and fall-risk mitigation are essential to prevent recurrent fractures. A prior fragility fracture is the strongest predictor of future fracture.

Osteoporosis-related fractures require an integrated orthopaedic approach addressing both mechanical stabilization and systemic bone health to restore mobility and preserve long-term independence.