Revista de Medicina Desportiva (English) January 2019 | Page 21

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Dr. Henrique Sousa 1,4 , Dra.
Joana Matos 2 , Dra. Andreia
Ferreira 3,4
1
Resident on orthopaedics;
2
Resident on Physical and
Rehabilitation Medicine at
the Centro Hospitalar entre
Douro e Vouga
3
Specialist on orthopaedics.
4
Centro Hospitalar Vila Nova
de Gaia-Espinho.
Weak bones, broken bones
Osteoporosis is systemic skeletal dis-
ease characterized by the decrease of
the mineral bone mass and degener-
ation of the bone microarchitecture
and the consequent increase of the
risk for fracture. It predominantly
afflicts the older people and the
postmenopausal women. Its main
complication, the pathological frac-
tures, causes high morbi-mortality
and high economic and social costs,
which make osteoporosis one of the
main problems of public health of
population in aging.
The risk for a osteoporotic fracture
– hip, back and wrist – throughout
life is about 30-40% on the develo-
ped countries. 1 Between 70 and 80%
of the total fractures will occur in
women, which will decrease in the
next years due to the increase of the
prevalence in men. 2 It is estimated
that in 2050 the cost of the osteopo-
rotic fractures in Europe will be 77
billions of euros. 3
Vertebral fractures
The vertebral fractures are most
frequent fractures. Its prevalence in
the population is 10 to 24%, surplus
on both sexes. 4,5 They usually occur
after a minor trauma, like falling
from own’s height, to flex and rota-
tion of the back or to lift weights.
They can occur, however, in the
absence of trauma. Two thirds of
the vertebral fractures are asymp-
tomatic, being only detected on the
image exams. After a vertebral frac-
ture, there is an increase of the risk 4
to 5 times to occur another vertebral
fracture and 2 to 4 times the risk to
occur other osteoporotic fracture,
besides the significant mortality, the
risks that exponentially increase
with the accumulation of fractures. 6
The complications of vertebral frac-
tures include dorsalgia / back pain,
neurologic deficits, limitation of the
mobility / march, kyphosis with limi-
tation of the ventilatory dynamics
and increased the risk for pneu-
monia. 7,8 The treatment of these
fractures is usually conservative
with orthosis, analgesia and postural
changes. The surgical treatment is
indicated when there is neurological
injury for mechanical stabilization
or control of the refractory pain with
the conservative measures. 9
the decrease of the mineral bone
mass, but also with the increase of
the risk of fall and, as such, they
characteristically afflict the older
people. 10 They are associated to the
increase on mortality of 15 to 25%
during the year after the fracture,
being higher on men. However, its
main impact reflects on the inher-
ent elevated morbidity, on half of the
cases with loss or autonomy, tempo-
rary or permanent institutionaliza-
tion, incapacity to walk and deterio-
ration of the quality of life. 11,12
The treatment is almost always
surgical, and it includes the fixation
of the fracture or partial or total
replacement of hip joint. A high
number of patients has a second
fracture which causes an even more
mortality. 13
Fractures of the distal radio
The fractures of the distal radio are
one of the most precocious manifes-
tations of osteoporosis, with a peak
of incidence during the 6 th decade of
life, and posterior stabilization. For
that reason, they are quite often the
first manifestation of osteoporosis
and, as such, it is a good moment
for the precocious diagnosis and for
treatment and prevention of falls.
However, only 18% of the patients
benefit of treatment on the first year
after the fracture, in part because
they are not recognized as a frailty
fracture on that age group. 14
Although they don’t have the
same impact on mortality and on
morbidity as the pelvic fractures
have, they are associated with a
significant decrease of the quality of
life and autonomy, and labor incapa-
city as well. 15 The treatment can be
conservative, after closed reduction
and immobilization with cast, or, on
the most severe cases, it can be sur-
gical with percutaneous fixation or
open reduction and osteosynthesis.
Other fractures
Proximal femur fractures
Proximal femur fractures are of the
most dreaded and disastrous con-
sequences of the osteoporosis. The
incidence increases not only with
Other fractures on patients with
osteoporosis include fractures of the
proximal humerus, collar bone, pel-
vic rim, femur and tibia. All together
they are responsible for a substan-
tial proportion of the economic and
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