The risk of fracture in the elderly: Determinant factors

The remarkable advances in bone mass measurement techniques permit us to make an accurate determination of bone mineral density, which at the present time, represents the most important index in the clinical assessment of fracture risk. However, there are cases in which fractures are caused by moderate trauma in spite of satisfactory skeletal mineralization. These cases emphasize the fact that the mechanical incompetence of bone cannot be explained merely by decreased skeletal mineralization, and that other factors contribute toward increasing the incidence of fractures in the course of the aging process. This paper takes into consideration all of the factors that may be involved in the occurrence of a fracture in an elderly patient, based on the most recently acquired scientific information in this field. These factors are schematically divided as factors extrinisic and intrinsic to bone. They include muscular synergy, reflex reactions, sensory status, soft tissue properties, bone tissue properties, structural characteristics, and loading modalities in relation to structural orientation. Awareness of these factors may enable better management of preventive and therapeutic measures against fractures in the elderly by extending the traditional pharmacological treatment to include diversified strategies that might lead to important results from both the epidemiological point of view and that of the cost-to- benefit ratio profile.