J Korean Med Assoc Search

CLOSE


J Korean Med Assoc > Volume 49(1); 2006 > Article
Yang: Surgical Treatment of Fragility Fracture During Menopause

Abstract

Estrogen deficiency causes a severe dysfunction in the bone homeostasis and bone resorption. Because of the wide surface area of cancellous bone, the primary bone loss occurs at the bony trabeculae of cancellous bone. Resorption pits on the surface of the trabeculae also play an important role in the development of fragility fracture as a stress riser. Since the vertebral body and distal radius have a high proportion of cancellous bone, fragility fractures during menopause are usually vertebral fracture and Colles' fracture. Surgical correction of these fractures is sometimes indicated in this age group. When surgical intervention is indicated, an anatomical restoration of the fracture is essential because of the high social activity and long life expectancy in these patients. A collapse of the vertebral body causes bending of the spinal column and shifting of the weight bearing line. It also causes abnormal stress on the adjacent vertebral body and subsequent vertebral fracture. The rationale of the surgical treatment is to control the acute pain from the fracture and to restore the mechanical axis of the spinal column. Stretching of the hand is a protective mechanism of the fall, which decreases the impacting force on the hip joint, while it frequently causes Colles' fracture on the wrist. During the past few decades, it has been thought as a benign injury, which does not cause any dysfunction. Now orthopaedic surgeons are requested to restore the function of the upper extremity as well as the anatomy of the joint.

References

1. van der Linden JC, Homminga J, Verhaar JA, Weinans H. Mechanical consequences of bone loss in cancellous bone. J Bone Miner Res 2001;16:457–465.

3. Ahn YH. Internal fixation in osteoporotic bone 2002;New York: Thieme. 9–21.

4. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA 2001;285:785–795.

6. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Study of Osteoporotic Fracture Research Group. Vertebral fractures and mortality in older women: A prospective study. Arch Intern Med 1999;159:1215–1220.

7. Parfitt AM. Implications of architecture for the pathogenesis and prevention of vertebral fracture. Bone 1992;13:Suppl 2. S41–S47.

8. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 2001;12:429–437.

9. Mehbod A, Aunoble S, Le Huec JC. Vertebroplasty for osteoporotic spine fracture: prevention and treatment. Eur Spine J 2003;12:S155–S162.

10. Kaneda K, Asano S, Hashimoto T. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine 1992;17:S295–S303.

11. Hammerberg KW, DeWald RL. Senile burst fracture: a complication of osteoporosis. Orthop Trans 1989;13:97.

12. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fracture in low-demand patients older than 60 years. J Hand Surg Am 2000;25:19–28.

13. Ring D, Prommersberger KJ, Gonzalez del Pino J, Capomassi M, slulitel M, Jupiter JB. Corrective osteotomy for intra-articular malunion of the distal part of the radius. J Bone Joint Surg 2005;87-A:1503–1509.

14. Paul MS, Andrew JW. Fractures of the distal aspect of the radius: Changes in treatment over the past two decades. Instr Course Lect 2003;52:185–195.

15. Katz MA, Beredjiklian PK, Bozentka DJ, Steinberg DR. Computed tomography scanning of intra-articular distal radius fractures : Does it influence treatment? J Hand Surg Am 2004;26:415–421.

16. Jakob M, Rikli D, Regazzoni P. Fractures of the distal radius treated by internal fixation and early function. J Bone Joint Surg Br 2000;82:340–344.

17. Gupta R, Bozentka DJ, Osterman AL. Wrist arthroscopy: Principles and clinical applications. J Am Acad Orthop Surg 2001;9:200–209.

20. Odvina CV, Zerwekh JE, Rao DS, Maalouf N, Gottschalk FA, Pak CY. Severely suppressed bone turnover: a potential complication of alendronate therapy. J Clin endocrinol Metab 2005;90:1294–1301.

21. Cao Y, Mori S, Mashiba T, Westmore MS, Ma L, Norimatsu H, et al. Raloxifene, estrogen, and alendronate affect the processes of fracture repair differently in ovariectomized rats. J Bone Miner Res 2002;17:2237–2246.

22. Mashiba T, Turner CH, Hirano T, Forwood MR, Johnston CC, Burr DB. Effects of suppressed bone turnover by bisphosphonates on microdamage accumulation and biomechanical properties in clinically relevant skeletal sites in beagles. Bone 2001;28:524–531.

23. Bouxsein ML, Kaufman J, Tosi L, Cummings S, Lane J, Johnell O. Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture. J Am Acad Orthop Surg 2004;12:385–395. (Korean edition).

Figure 1
Incidence of the fragility fracture after menopause
jkma-49-41-g001-l.jpg
Figure 2
Pathomechanism of subsequent vertebral fracture after fragility fracture of the spine
jkma-49-41-g002-l.jpg
Figure 3
Colles' fracture: Deformity, reduction and immobilization
jkma-49-41-g003-l.jpg
Figure 4
Surgical treatment of redisplaced Colles'fracture
jkma-49-41-g004-l.jpg
Figure 5
Bone loss after immobilization
jkma-49-41-g005-l.jpg


ABOUT
BROWSE ARTICLES
EDITORIAL POLICY
FOR CONTRIBUTORS
Editorial Office
37 Ichon-ro 46-gil, Yongsan-gu, Seoul 04427, Korea
Tel: +82-2-6350-6651    Fax: +82-2-792-5208    E-mail: office@jkma.org                

Copyright © 2026 by Korean Medical Association.

Developed in M2PI

Close layer
prev next