title: Short-term and long-term orthopaedic issues in patients with fragility fractures.
abstract: BACKGROUND
  Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short- and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures.
  
  
  OBJECTIVE
  This review summarizes the modifications in perioperative management and fracture fixation in patients with common fragility fractures who have impaired bone quality. It also summarizes the postoperative diagnosis and treatment of secondary causes of impaired bone quality in these patients.
  
  
  METHODS
  We performed a PubMed search, and literature published after 2000 was prioritized, with the exception of benchmark clinical trial studies published before 2000.
  
  
  RESULTS
  Patients with altered bone quality require rapid perioperative management of multiple medical comorbidities. Implant selection in patients with poor quality bone should permit early weightbearing, and constructs should maximize surface area contact with the remaining bone. Long-term diagnosis and treatment of other disease states contributing to poor bone quality (vitamin D deficiency/insufficiency, hypothyroidism, hyperthyroidism, hyperparathyroidism, Cushing's disease, and hypogonadism) must occur to minimize the chances of future fractures.
  
  
  CONCLUSIONS
  Recognition of patients with impaired bone quality and proper treatment of their special needs in both the short and long term are essential for their best opportunity for maximal functional recovery and prevention of future fractures.
authors.affiliation: Department of Orthopaedics, University of Rochester, 601 Elmwood Ave, Box 665, Rochester, NY 14534, USA. susan_bukata@urmc.rochester.edu
authors.forename: Susan V
authors.initials: SV
authors.lastname: Bukata
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kates
authors.forename: Regis J
authors.initials: RJ
authors.lastname: O'Keefe
mesh_terms: D001842:Bone and Bones / Q000503:physiopathology; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology; D004694:Endocardial Cushion Defects / Q000175:diagnosis / Q000453:epidemiology; D005264:Femoral Fractures / Q000453:epidemiology / Q000601:surgery; D006620:Hip Fractures / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology / Q000601:surgery; D006980:Hyperthyroidism / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D019990:Perioperative Care; D014808:Vitamin D Deficiency / Q000453:epidemiology; D016474:Weight-Bearing