Other non-vertebral fractures

Non-vertebral non-hip (NVNH) fractures account for 90% of all fractures in patients up to 80 years of age and for 59% thereafter. There is a significant relationship between reductions in peripheral bone mineral density and the risk of fractures at various NVNH sites except for the face. Fractures of the clavicle, upper arm, forearm, spine, ribs, hip, pelvis, upper leg and lower leg elevate the risk of future fractures. Among NVNH fractures in women aged 80 years or over, forearm fractures have the highest incidence, and proximal humerus fractures have the second highest incidence. There is a large variation in incidence across geographical regions, with incidence higher in Northern Europe and lower in Asia and Africa. NVNH fractures are associated with higher mortality and significantly higher health-care costs than controls with osteoporosis. Reductions in health-related quality of life (HRQOL) for women with major NVNH fractures are of a similar magnitude as reductions for women with incident hip fractures; however, forearm fractures do not significantly affect HRQOL. Therapeutic options for NVNH fractures differ by fracture location. The recent development of implants for internal fixation made it a more popular choice for treating distal radius and proximal humerus fractures; however, treatment decisions should take into account patient age, activity levels, co-morbidities and injury characteristics. The recent increase in the number of patients with osteoporotic pelvic fractures is drastic, although they can generally be treated non-surgically with pain management and mobilisation.