Fragility Fractures in Focal Neurological Conditions

Survivors of focal neurological injuries experience accelerated bone loss, particularly in the paretic upper extremity, substantially increasing the risk of fragility fractures. Mechanical unloading, neuromuscular impairment, and altered bone remodeling contribute to rapid reductions in bone mineral density and unfavorable changes in bone geometry within the first year after stroke and brachial plexus palsy. Despite growing evidence, bone health assessment is rarely incorporated into routine poststroke care, and referrals often occur only after fracture. This article discusses the role of hand surgeons and proposes practical screening, multidisciplinary care strategies, and interventions to improve early detection, prevention, and management of upper extremity fragility fractures.