Osteoporosis - The silent cause of femoral neck fractures in the elderly

Recently, you may have noticed that I have written many posts regarding the “lightning-fast” recovery of elderly patients (>60 years old) with femoral neck fractures or intertrochanteric fractures following surgery. Methods such as muscle-sparing hip arthroplasty for femoral neck fractures and minimally invasive PFNA (Proximal Femoral Nail Antirotation) for intertrochanteric fractures bring patients much faith and hope in increasingly modern surgical techniques. However, does having a hip replacement mean everything is settled?

The clear answer is NO. The leading cause of proximal femur fractures in the elderly is osteoporosis. As you age, along with hormonal changes, your trabecular bone structures are no longer as solid as before, becoming brittle and prone to fracture.

In our childhood, we were all familiar with the folk rhyme: “The hunchbacked grandma goes to the market in the rain, shrimps and prawns come to escort her.” So who among us has ever asked ourselves why grandma was hunchbacked? And if we did ask, the answer was often a witty remark like the pressures of life were so heavy that her back became bent. But scientifically speaking, it is simply severe osteoporosis leading to wedge-shaped collapse of the vertebrae. Over time, all vertebrae collapse, resulting in a hunchback. And systemic osteoporosis not only affects the spine but also impacts the femoral neck region. When the trabecular bone becomes brittle and weak, just a minor fall indoors can lead to a femoral neck fracture.

Therefore, after successfully performing a hip replacement or intramedullary nailing for an elderly patient, the doctor has another equally important task, which is treating the patient's osteoporosis. Occasionally, we surgeons joke among ourselves: “if you guys treat osteoporosis too well, where will we find femoral neck fracture patients to operate on?” However, that is merely a joke to praise our colleagues. Obviously, prevention is always better than cure.

Patients who come to us with a femoral bone fracture inherently mean that, to a greater or lesser extent, they already suffer from osteoporosis. And treating osteoporosis is not a matter of days or weeks; it is a multi-year commitment, much like alluvium being deposited onto a riverbank year after year. As people age and their health declines, suffering a femoral neck fracture at a time when the body is weak and unable to undergo surgery means the patient will endure their final years in extreme pain, misery, and unable to care for themselves. Physical pain is one thing, but it is accompanied by mental anguish, not only for the patient themselves but also for other family members. I believe that anyone who has been through this situation would wish they had known about preventive treatment beforehand.

I hope this article will help everyone better understand osteoporosis and its consequences, such as proximal femur injuries and vertebral compression fractures, so that we can better treat and prevent osteoporosis. As for the patients I have operated on, please strictly follow your doctor's instructions so that we do not have to meet again under the circumstance of operating on the other side.