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Fragility Fractures in Focal Neurological Conditions.

Aslan Baradaran1, Tamara D Rozental1

  • 1Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

The Journal of Hand Surgery
|April 1, 2026
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Summary
This summary is machine-generated.

Focal neurological injuries cause rapid bone loss in the affected arm, raising fracture risk. Early screening and multidisciplinary care are crucial for preventing fragility fractures in stroke and brachial plexus palsy survivors.

Keywords:
Brachial plexusfragility fractureosteoporosisstroke

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Area of Science:

  • Orthopedics
  • Neurology
  • Bone Metabolism

Background:

  • Focal neurological injuries, such as stroke and brachial plexus palsy, lead to accelerated bone loss in the paretic upper extremity.
  • This bone loss, occurring within the first year, is attributed to mechanical unloading, neuromuscular impairment, and altered bone remodeling.
  • Reduced bone mineral density and unfavorable bone geometry significantly increase the risk of fragility fractures.

Purpose of the Study:

  • To highlight the under-recognized issue of bone loss and fracture risk in upper extremity neurological injuries.
  • To emphasize the importance of bone health assessment in post-stroke care.
  • To propose strategies for early detection, prevention, and management of fragility fractures.

Main Methods:

  • Review of existing evidence on bone loss following focal neurological injuries.
  • Discussion of the contributing factors: mechanical unloading, neuromuscular deficits, and bone remodeling changes.
  • Proposal of screening protocols and multidisciplinary care models.

Main Results:

  • Significant bone mineral density reduction and geometric changes in the paretic upper extremity post-injury.
  • High incidence of fragility fractures in survivors, often diagnosed only after fracture occurs.
  • Lack of routine bone health assessment in standard post-stroke care.

Conclusions:

  • Hand surgeons play a vital role in addressing upper extremity bone health.
  • Implementing practical screening and multidisciplinary care is essential for timely intervention.
  • Proactive management can improve outcomes and reduce fracture incidence in affected individuals.