Fractures in osteoporosis
with special reference to their social & economic impact
Stephan M. Perren, Prof. Dr. med. D.Sc. (h.c.) 
Osteoporosis as a disease:
Osteoporosis is a frequent
and widely underestimated disease. In most cases the diagnosis is
made, when the patient suffers a fracture with inadequate trauma.
To improve this situation the following has priority:
- To increase awareness and understanding of osteoporosis
- To motivate taking action to prevent, diagnose and treat osteoporosis.
- To promote research in the field of osteoporosis
Fracture and treatment there of in osteoporosis
The osteoporotic bone does not only fracture more readily but its treatment
is very demanding and often determines the prognosis quoad vitam: The
choice is either life threatening prolonged bed rest or early return to
normal life. Elderly people with fracture of porotic bone run a high risk
of permanent disability due to today’s shortcoming in fracture treatment
that should allow them to quit early and safely the bed to avoid mainly
cardiovascular and respiratory complications.
Fractures in elderly osteoporotic patients do not only affect quality
of life, they are life threatening.
The prognosis of fractures in porotic bone
General agreement is that in spite of up to date treatment of hip fractures
in osteoporotic bone
- 20% of the patients with hip fractures in porotic bone died within
- 1/3 of the patients remain bed or chair ridden
- 1/3 suffer functional limitations and require assistance
Only 1/3 of osteoporosis patients suffering from hip fractures return
to full function
The goal of fracture treatment
is immediate return of mobility to avoid extended bed rest with
its complications. This should be achieved by surgical stabilization,
to alleviate pain and allow early safe weight bearing.
Stabilization of the fracture in porotic bone is difficult to
achieve because the anchorage of implants in weak bone is deficient. While
surgical stabilization even in healthy bone rarely allows for immediate
full weight bearing the situation in fractures of osteoporotic bone is
extremely difficult: Not only is the bone weak but because control of
weight bearing is missing in elderly people, the stabilization must withstand
peak load of uncontrolled weight bearing. The difficulties mentioned apply
mainly to hip fractures and spine fractures, two very frequent incidences
in osteoporosis beside wrist fractures. The direct costs of fractures
in Osteoporotic bone in the USA are estimated to be 18 Billion $ a year
and increasing, total economic impact is far greater..
Reduction of peak stress in uncontrolled loading can be achieved
by a more appropriate basic construction and application of implants while
improving anchorage at the interface of bone requires a large contact
area and an especially tolerant design of the implant surface in contact
with bone. This concerns the acute phase of fracture treatment that is
before therapeutic improvement of bone quality can be achieved. In a second
phase the thrust of medical activity will serve to improve bone strength
to ensure long term success of the fracture treatment. Beside proper activity
and nutrition the pharmaceutical armamentarium has recently seen a promising
improvement avoiding fractures. Furthermore, physical exercise to improve
coordination not only to prevent falling but to strengthen protecting
muscles and coordinating their activity will help to minimize fracture
 Stephan Perren trained as a trauma surgeon. With a wide spectrum
of biological and technical interests, he took up clinically oriented
biomechanical research. He built within 30 years as director of research
and development of the International AO Foundation an interdisciplinary
team of surgeons, biologists, physicists and engineers in the Davos AO
centre devoted to the improvement of fracture treatment in trauma care.
With his collaborators he contributed essentially to a new understanding
of fracture healing that resulted in basically improved fracture treatment
with global impact.
The data presented here is based on reports of national osteoporosis