Geriatric Fractures

December 13, 2022

Fractures are some of the most common bone injuries affecting people of all ages. Before we get down to understanding them, we need to understand an important term, Bone Density or Bone Mineral Density (BMD). It is the amount of bone mineral in the bone tissue. In layman’s term it tells you how dense your bone is. The image below shows the difference in bone density between the spine of a healthy person and that of a person suffering from Osteoporosis. There is a clear relationship between BMD and risk of fractures. The lesser the density the chances of fractures are more.

Now that we understand what Bones Mineral Density is, we can get to understanding fractures. Like with every structural support, which our skeletal system is, there is a breaking point at which different bones of the body can either display a hairline fracture or a complete open fracture. These most often happen when bones are subjected to forces beyond their tolerance levels. This can occur by falls, trauma, or because of a direct blow or kick to the body.

Now taking a deeper dive into our central theme, i.e., Geriatric (Elderly people) Fractures, it occurs under similar circumstances as mentioned above but to people older in age. The primary difference being it takes place at levels of forces below the tolerance level of bones of younger people.

The surgical techniques of treating the same type of fractures do not differ with age. However, general medical condition and/or mental makeup of the patient and their family members are to be considered additionally before offering the best possible care.

The frequently asked questions to an orthopedic surgeon in his/her practice with regards to geriatric fractures:

1. Which are the common sites of geriatric fractures?

While there is no bone in the body that cant suffer from a fracture, statistically the back, wrist, shoulder and the hip bone are the common sites of geriatric fractures for various reasons.

2. What are the reasons for fractures in the elderly people?

While a significant trauma can break a bone in anyone, a trivial trauma can result in a fracture in the elderly due to osteoporosis (Low BMD).

Associated medical conditions of poor eyesight, imbalance from weakened nervous system, vertigo/giddiness occurring from age related BP fluctuations or diabetes make older people vulnerable to situations that will exert additional force to their bones resulting in fractures.

3. What are the precautions that one can take to minimize the chances of geriatric fractures from occurring?

Two things need to be considered:

• Strengthening the bones
• Minimizing the chance of injuries

Strengthening the bones can be achieved by a multimodal approach which includes

• Good diet, which includes but not limited to sea food, greens, ragi, milk, egg white. This improves BMD
• Exercising by walk daily on a level surface for 30 mins to an hour as tolerated. Improves BMD and balance.
• Paying equal importance to mental wellbeing, resulting in fewer scenarios leading to fractures.
• Following up on prescribed age related and appropriate medications.

Minimizing the chance of injuries

• As poor vision is one of the primary causes for injuries a well let surrounding is important.
• Keep the surfaces dry, though obvious is again one of the most common reasons for fall among the elderly.
• Supports like railings in the bathrooms, gives additional traction while changing positions.
• Avoid sharp edge furniture in the room. Incase of a fall, sharper or harder the edge more is the force of impact.
• Protective clothing like padded underwear, this helps with the hip related injuries as it gives a certain degree of cushioning when the fall occurs.
• Keeping a watch on their whereabouts. Though a sensitive subject, one that needs more understanding, mental imbalance among the elderly causes them to face scenarios that can lead to injuries and falls.

4. What are the mediations that are available to strengthen the bones?

Calcium with vit D: The daily requirement of calcium in an adult is 1.2 -1.5 g. In most cases with a balance diet, the daily requirement can be reached. In cases of postmenopausal women, men with co morbidities like diabetes, those who smoke and do heavy drinking and those individuals on long term epilepsy medications and steroids, calcium supplements are crucial and are prescribed.

Multiple formulations of Calcium are available such as Citrate, Carbonate etc. A more recent formulation called Aquamin, has lesser effects from gastritis and constipation, usually associated with traditional Calcium supplements.

Additionally, medications such as Calcitonin nasal spray: One puff per day in alternate nostrils for a period of 2 months, strengthens the back bone and reduces the pain. Bisphosphonates : A weekly or monthly oral formulation or an annual injection like inj Zolendronic acid. Denusomab: An annual injection for strengthening of bones is a rather expensive but effective option.

Ancillary medications include anabolic steroids like nandrolone, isoflavones etc.

5. Is calcium supplement absolutely necessary and will it cause kidney failure ?

Consumption of Calcium supplements is not mandatory but advisable. Contrary to common misconception, consumption of calcium supplements does not increase the chances of Kidney failure. Patients who have an increased tendency of kidney stones formation can have more occurrences.

6. What needs to be done in the case of an unfortunate incident resulting in a fracture?

The site of the fracture and the general condition and activity demand of the patient would govern the necessary decisions.

Spine Fractures: These are usually managed non surgically through rest, braces, analgesics, and anti-osteoporotic treatment.

If the pain persists after conventional measures beyond the 3-6 week window, a procedure called vertebroplasty is advised , wherein a specialized bone cement is injected to the spine to reduce the pain.

Hip fractures: There are two principle fractures that can occur

• Fracture neck of femur
• Inter trochanter fractures

Fracture neck of femur: As this fracture doesn’t selfheal naturally, surgery is a must without which a person would be bed bound. The surgeries advised are a total hip replacement ( currently advocated) or hemiarthroplasty ( patients whose medical condition doesn't allow a total hip replacement to be done )


Inter trochanteric fractures: Surgery is an advisable option as it would help in the earlier healing of the fracture resulting in faster pain relief and early mobility /


Wrist fractures: These fractures heal with or without surgery. However, the decision is taken depending on the following factors

• Displacement of the fracture
• Activity demand of the patient
• Other co morbidities.

If the fracture is displaced, surgery is a better option to avoid mal alignment of the wrist joint and restriction of stiffness resulting in decreased functionality of the hand.


7. What are the problems faced if hip fractures aren't operated on?

This might result in the patient being bed bound, which in turn results in multiple issues including bed sores, chest infections, urinary infections, bowel disturbances, aspiration of food and liquids into the lungs, vein blockages of the lower limbs which might even
result in Death.

8. Will the surgery be hundred percent successful?

This is another common question faced by the health care providers. There is no 100% assurance about any surgery that's performed even in the most skilled hands, however the recent medical and surgical advances have significantly mitigated risks of the procedure. There is definitely an age-related risk in operating on an elderly person when compared to a youngster but if things pan out as planned which is usually the result these days we can alleviate the suffering of our loved ones.


By Dr Vivian Roshan D' Almeida
Dr. Vivian Roshan D' Almeida , MBBS, MS(Ortho), MRCS(Eng), MRCS(Ire), MRCPS(Glasgow), Fellow in Knee Surgery, Arthroscopy & Sports Medicine(USA, South Korea) is an associate professor and unit chief, department of Orthopaedic Surgery, at Father Muller Medical College& Hospital and Consultant Orthopaedic, Knee & Arthroscopy Surgeon, Ortho 1 Speciality Clinic.Email:
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Comment on this article

  • Keshava Prasad, Mangalore

    Sun, Jan 15 2023

    Very Informative Doctor. Thanks for sharing. The information can be understood by common people too

  • Sujai Lobo, Mangalore

    Thu, Dec 22 2022

    Very good information Doctor you have explained it so beautifully every common can make use of it ... Specially precautions what you have mentioned are very useful in todays houses and workplaces where aesthetics and beauty is adopted more than practicality. Thank you for such and good article.

  • Lenny D Costa, Mangalore

    Thu, Dec 15 2022

    Thank you doctor. Very well explained and very informative.kerp up your good work sir. God bless you always .

  • Dipendra Pratap Rana, Mangalore

    Thu, Dec 15 2022

    Thank you Doctor for sharing such a important topic about elderly people

  • Sr Helen mendonca, K..r Pete. Ashirvad. Karnataka

    Thu, Dec 15 2022

    Very well written article. well informative. We look forward valuable articles in future too. Congratulations Dr. Vivian.

  • Sr Helen mendonca, K..r Pete. Ashirvad

    Thu, Dec 15 2022

    Very well written article. well informative. We look forward valuable articles in future too. Congratulations Dr. Vivian.

  • Harish, Udupi

    Thu, Dec 15 2022

    Thank you Doctor for Sharing this Knowledge. Very good Information for Normal people. You are a very kind and caring Doctor. I am very grateful for the excellent care .

  • Merlyn N Roche, Phajeer, mangalore.

    Wed, Dec 14 2022

    Thank you very much for sharing this knowledge which is, highly appreciable. May Almighty bless you.

  • mohan prabhu, mangalore/canada

    Wed, Dec 14 2022

    Thank you, Dr. D'Almeida, for a clear, informative and most helpful article on geriatric fractures whicI deeply appreciate. I am afraid I am unable to make a copy of your article for following the various steps you mention, and wonder if you would send me a copy. It will be of great help to a nonagenerian like me. I will give my current email address to you, shortly (by email request to the address you have given).

  • P. Fernandes, Mangalore

    Wed, Dec 14 2022

    Thank you very much Doctor. Very useful and enlightening information. Kind of you to share. God Bless

  • Bhavish Kumar, Mangalore

    Wed, Dec 14 2022

    Thank you for sharing this information doctor. Very helpful for geriatric and old age patients.

  • Ivan Saldanha, Mangalore

    Wed, Dec 14 2022

    Thank You dear Dr....Indeed a very valuable article full of clear expert information. It is sure that older people are prone to falls and fractures and cause for expensive troublesome hospitalizations and poor quality of life. The information here needs to be noted by each and every one and know the various details to avoid hazards and illness.

  • Aster Miranda, Mangalore

    Wed, Dec 14 2022

    It's a really informative insight into Age related bone problems and the management options to rectify it. It's important to also focus on rehabilitation and thereby improve quality of life. Thank you sir

  • Sr Leena, Karwar

    Wed, Dec 14 2022

    Thank you very much Dr Vivian for the informative article.

  • Ashok Shah, Mangalore

    Tue, Dec 13 2022

    Thankyou Doctor for sharing such important information about aged health.....

  • Melita Fernandes, Mangalore

    Tue, Dec 13 2022

    Thank you very much Dr Vivian for this informative and educative writeup. You have dispelled many doubts and myths and also given an honest opinion on surgery. This instills a lot of confidence in the elderly. God bless you in your professional and personal life for all the good work you do.

  • Martin, Bangalore

    Tue, Dec 13 2022

    Well written and informative article

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