What is a pathological fracture?

A pathologic fracture is a fracture in a bone that occurs as a result of underlying disease rather than direct physical impact or trauma. In fact, most pathologic fractures occur spontaneously during normal activity, or after a minor injury that would not normally result in a broken bone in most people. The most common cause is significant loss of bone density due to the development of osteoporosis. However, there are many other conditions that can lead to a pathologic fracture, including metabolic disorders, genetic bone deformities, infection, benign tumors and cysts, and cancers that have metastasized to the bone.

Prevention is important for a variety of reasons, including avoiding pain and decreasing mobility. However, for those who may be at higher risk, taking a proactive approach to reducing the likelihood of a pathologic fracture also translates into fewer surgeries and longer hospital stays. Periodic screening is recommended for patients with one of the risk factors listed above, particularly if there is reason to suspect skeletal injury.

Often the only symptom that occurs is localized pain that does not respond to anti-inflammatory medications or pain blockers. Furthermore, it should be kept in mind that pain from skeletal injuries might initially be attributed to other conditions and missed. For example, metastases involving the spinal cord or pelvic region are often mistakenly attributed to sciatica.

Diagnostic measures used to detect pathological fractures usually begin with blood tests. Elevated levels of c-reactive protein and erythrocyte sedimentation rate, for example, indicate the presence of a chronic inflammatory condition. Urinalysis may also be performed to assess levels of n-telopeptices, which serves as an indicator of the rate of collagen deterioration in bone.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans usually follow, revealing the rate of marrow replacement and details of bone structure, respectively. When tumor formation is suspected from these tests, a whole body radionuclide scan may be performed to pinpoint specific locations where a pathologic fracture is most likely to be found or to occur at some later time.

Treatment varies with each individual. In some cases, chemotherapy or radiation may be necessary to shrink the tumors. Patients experiencing pathologic fracture due to bone metastases associated with breast cancer are often treated with bisphosphonates. Surgery may also be indicated. For example, some patients may benefit from prophylactic fixation of the fracture site with bone cement and rods, while others may receive an artificial prosthesis to replace defective bone.

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