Surgical Treatment of Fragility Fracture During Menopause

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.