Is surgery enough for an elderly fracture? Detailed explanation of orthopedic surgeon

For most people, reaching retirement age in their 60s often means that they can do things that interest them later. However, some elderly people will have various fractures after daily activities. This situation in the elderly may be caused by osteoporosis!

According to research reports, the population over the age of 60 in my country accounted for more than 30% of the total population in 2019, and the prevalence of osteoporosis was 27.8%, of which the prevalence of females was higher than that of males. higher, at a staggering 32.1%. Osteoporosis can lead to a large loss of bone mass, making the bones of the elderly “brittle”, which can easily lead to fractures, and then minor trauma can cause brittle fractures, which often occur in the femoral neck, spine, wrist and shoulder joints and other parts with more movement .

Some people may have this question: isn’t it just a fracture? Is it okay to do surgery to fix the bones and let the bones grow? However, osteoporosis not only makes people’s bones brittle, but with a large amount of bone loss, the repair cycle of bone damage will also lengthen. In layman’s terms, it takes more time to rest after a fracture, and for the elderly, reduced activity during rest is likely to cause other diseases, such as lower extremity venous thrombosis, bedsores, and lung infections. Second, fractures caused by osteoporosis are by no means over once they occur. According to clinical statistics, the probability of recurrence within one year of fragility fracture is 45%. About 57% of recurrent fractures occurred within 2 years of the initial fracture. Retrospective studies have shown that the use of anti-osteoporotic therapy after fragility fractures can prevent an average of more than 60% of recurrent fractures.

Therefore, when a fragility fracture occurs in the elderly, the first thing to do is to seek medical treatment in time and choose appropriate treatment methods, such as casting, upper brace protection, and even minimally invasive procedures. Surgery or open reduction and internal fixation to relieve pain and promote fracture healing and functional recovery. Second, we must choose the appropriate postoperative anti-osteoporosis treatment plan. In addition to daily supplementation of sufficient calcium and vitamin D, the anti-osteoporosis drug treatment plan also needs to choose an anti-osteoporosis drug according to the specific situation. Commonly used anti-osteoporosis drugs mainly include the following: bisphosphonates, denosumab, estrogen receptor modulators, parathyroid hormone, vitamin K2 and so on. Specific drugs should be selected according to the changes in bone metabolism and physical conditions of patients.

After taking a sufficient course of drugs as prescribed by the doctor, regular follow-up of osteoporosis indicators is required to evaluate the treatment effect, so as to adjust the plan in time. Specifically, the bone metabolism markers were followed up every 3-6 months, and the bone mineral density was followed up every 1 year.

As a doctor, I hope that the public will not suffer from osteoporosis, let alone fragility fractures. We should start from daily life, avoid staying up late, stay away from tobacco and alcohol, drink less strong tea, drink coffee in moderation, do regular exercise every day and get more sun exposure. It is recommended to choose moderate-intensity exercise methods, such as jogging, cycling, Resistance training, etc. At the same time, pay attention to eating fish, animal liver, milk and other foods rich in vitamin D in the daily diet.

This article is scientifically checked by Dong Jian, chief physician of the Department of Orthopedics, Zhongshan Hospital Affiliated to Fudan University.