Synopsis
Recognise a fragility fracture as both an acute mechanical injury and a sentinel event, then combine safe orthopaedic treatment with prompt investigation and secondary fracture prevention.
- A fragility fracture follows force no greater than a fall from standing height and is a treatment trigger, not a reason to postpone prevention until DXA.
- First-line orthopaedic assessment addresses the current fracture: mechanism, pre-injury function, pain, skin, distal neurovascular status, imaging in two planes and safe loading instructions.
- Use FRAX for ten-year probability and add femoral-neck DXA when the result will alter treatment; a recent hip or vertebral fracture already establishes high risk.
Key red flags
A painful deformed limb, inability to bear weight after trivial trauma or focal bony tenderness in an older adult may be a fracture even when bruising is slight.
Investigation priorities
Define location, displacement, articular involvement, bone texture and any destructive feature before loading or reduction decisions.
Management branches
A low-energy injury produces focal pain, deformity or loss of weight-bearing ability.
- Use ABCDE when indicated, provide analgesia and document skin, compartments and distal neurovascular findings.
- Immobilise the painful region and restrict loading until radiographs and orthopaedic review establish stability.
Key medicines
Alendronic acid first-line oral antiresorptiveUse 70 mg orally once weekly, swallowed after an overnight fast with plain water while upright; wait at least 30 minutes before food, drink, other medicine or lying down.
Zoledronic acid after fragility fractureGive 5 mg by intravenous infusion no faster than 15 minutes, usually once yearly, only after confirming hydration, creatinine clearance, corrected calcium and adequate vitamin-D and calcium provision.