Nonspinal Fragility Fractures

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This article focuses on nonspinal fragility or insufficiency fractures. Fragility fractures occur when normal levels of energy are applied to weakened bone, and they normally represent spontaneous fractures or traumatic fractures from minimal energy trauma that would not normally result in fracture in healthy people. This is the case in osteoporosis, where there is reduction of bone mass as well as loss of normal trabecular architecture leading to changes in structural characteristics that compromise biomechanics.

The prevalence and most common locations, as well as clinical and diagnostic aspects, of nonspinal fragility fractures are presented. Osteoporosis is highly prevalent and can have different causes. The most common ones are primary, such as postmenopausal and senile osteoporosis, and secondary to several causes.

Clinically, patients with insufficiency fractures present with pain, in many cases severe, and usually no history of trauma or eventually a history of minor trauma, such as a fall from standing height. If some cases, when these fractures are not displaced, detection is a challenge. In other cases, due to their location and equivocal features, differential diagnosis with malignancy has to be made. Radiographs, magnetic resonance imaging, multidetector computed tomography, positron emission tomography-computed tomography, and radionuclide scans have diverse roles in the diagnosis of insufficiency fractures.

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