Osteoporosis is a health condition that results in weak bones, making them fragile and prone to fractures. Transverse fractures are a type of bone breakage, where the break runs perpendicular to the bone's length and throughout the whole bone width. It is important to take care if you have osteoporosis, as you are more prone to getting transverse fractures.

Understanding osteoporosis

As we age, the body naturally breaks down old bone cells much faster than it rebuilds new ones, resulting in loss of bone density and structural integrity. However, some people lose bone density faster than usual, leading to osteoporosis. Osteoporosis, a chronic disease, is defined as having a low bone mineral density, making patients susceptible to low-impact, fragility fractures.¹

The stage preceding osteoporosis is called osteopenia, which occurs when your bone density is lower than it should be, but not low enough to be classified as osteoporosis.

Osteoporosis most commonly occurs in the elderly, as bone loss increases with age, as well as in people assigned female at birth (AFAB) undergoing menopause, as at this time oestrogen levels drop, and oestrogen helps to rebuild bones. However, the disease can also occur in children and people assigned male at birth (AMAB).

Many factors can increase your risk of developing osteoporosis, including:^2,3

• Heavy drinking and smoking
• Poor diet – lack of Vitamin D and calcium
• Family history of osteoporosis
• Gastrointestinal disorders – e.g. inflammatory bowel disease, coeliac disease 
• Medications – long-term use of high-dose steroids, proton-pump inhibitors and antiepileptic medications
• Hormone-related conditions – reduced sex hormones, overactive thyroid gland, diabetes
• Not exercising regularly 
• Low body mass index and being underweight

The common sites affected are the bones in the hips, wrists and spine. When these bones are weak, they are the most susceptible to breakage.

What is a transverse fracture?

A bone fracture that breaks in a straight line at a right angle to its long axis is called a transverse fracture.

 A transverse fracture can be caused in several ways:

• A strong impact, such as blunt trauma or falling onto a hard surface
• Continuous pressure on a bone, as seen in individuals who work in physically demanding jobs, can lead to fractures that may develop into transverse fractures over time
• Osteoporosis can also play a part in transverse fractures since the bones affected are already weak or brittle, hence, being more prone to fractures
• Other diseases, such as cancer, bone infections, and metabolic disorders, can also cause fractures in this manner due to weaker bones

There are other types of fractures, such as spiral fractures, resulting from a twisting force, creating a corkscrew-like break, which are common in injuries from sports. These kinds of fractures can be more challenging to treat due to the complications of a rotated bone. In contrast, an oblique fracture occurs at an angle, caused by indirect force. The fractures can be unstable if not properly aligned. 

Another type of differentiating fracture would be a comminuted fracture, typically more severe than the rest. It’s when the bone shatters into multiple pieces due to high-impact trauma. These types of injuries require surgery with metal plates and rods for stabilisation.

Why does osteoporosis increase the likelihood of fractures?

Osteoporosis increases the risk of fractures due to a combination of weak bone structure and impaired healing mechanisms.⁶ For those with the disease, the spongy inner layer of the bone (the trabecular bone) and the dense outer layer (the cortical bone) are both weakened, leading to loss of structural integrity, meaning the bone cannot absorb impact as effectively. 

So even a minor trauma, like sudden movement or a fall, can cause serious fractures. Osteoporotic bones have a reduced ability to withstand perpendicular forces and hence are more susceptible to all types of fractures, including transverse fractures, where the bone breaks in a straight horizontal line.

Why are the elderly affected the most?

There are a few factors that make elderly populations more prone to transverse fractures:

Ageing

The elderly have a higher risk of osteoporosis, as the natural ageing process causes bone loss and reduced bone density. As we age, our bones become weaker, lose minerals and become more prone to fractures. 

Hormonal changes

Hormonal changes, such as the decline in oestrogen after menopause, further accelerate bone loss. In males, the natural decline in testosterone levels also contributes to a decrease in bone strength (however, this is at a slower rate than in females).

Reduced muscle strength and balance 

Sarcopenia is the loss of muscle mass that comes with ageing. This affects balance and coordination, thereby reducing muscle strength and stability. It increases the likelihood of falls, which are a major cause of fractures.

Comorbidities

Arthritis is a disease of the joints that causes pain and swelling, and reduces mobility. When bones are not under the normal stresses of weight-bearing activity, they can quickly lose their density and lead to the development of osteoporosis.⁴

Vision impairment can increase the likelihood of falls and tripping.

Common medications taken by the elderly, like blood pressure drugs, can have side effects that cause dizziness, further contributing to the risk of falling.

Common sites of osteoporotic transverse fractures

Transverse fractures mostly affect the long bones in the body, including:

• Spine
• Femur (thigh bone)
• Hip 
• Distal radius (in the forearm)

Diagnosis and imaging

A combination of imaging techniques can be used to correctly identify a transverse fracture and bone quality to determine the best treatment approach for osteoporotic patients.

The first line of diagnosis would be to have an X-ray, which can help identify the type of fracture, its location and alignment. A transverse fracture would appear as a distinct, horizontal break and is usually easiest to identify.

To assess overall bone health and the severity of osteoporosis, a DEXA scan can be used to measure bone mineral density and the risk of future fractures.

In a complex fracture, that is the involvement of soft tissue (muscles, ligaments and tendons). MRI or CT scans are provided to provide a more detailed analysis. A CT scan allows for a 3D view of the fracture, and an MRI can detect soft tissue damage. A combination of the two helps pre-surgical planning if required.

Prevention strategies

Knowing exactly how healthy our bones are can help us make early intervention decisions about how we can maintain or improve bone health.^5,6

• It is important to have early screening for osteoporosis, especially once you are over the age of fifty. You can request your doctor to have a DEXA scan, which is a low-dose X-ray which determines how dense bones are. If you already have osteoporosis, it is recommended that you have a DEXA scan repeated every 2-5 years, to keep an eye on bone health
• Since falls are the leading cause of osteoporotic fractures, it is good to have fall prevention strategies in place. These include removing tripping hazards and installing handrails for support around living spaces
• Taking supplements such as vitamin D, calcium, magnesium, and zinc contributes to keeping bones healthy. If you plan on taking such supplements, consult your doctor to advise you on the correct dosages
• Practising weight-bearing activities creates mechanical stress on your bones, stimulating bone-building cells
• In some cases, doctors prescribe long-term medications like alendronic acid or risedronate to osteoporosis patients, which can help increase bone density

Treatment and management

It is important to manage transverse fractures in individuals with osteoporosis comprehensively, stabilising the bone and promoting its recovery.⁷ 

Fracture stabilisation 

• If the fracture is nondisplaced, which means the bone hasn’t moved out of its position, but it is broken, it can be treated with casting or using a brace
• Displaced fractures, where the bone is out of alignment, require surgical interventions^. These procedures introduce an internal fixation device such as plates, screws and rods. In some cases, bones are replaced (e.g hip replacements)

Rehabilitation and physiotherapy 

Therapy and rehabilitation allow for the gradual restoration of strength and mobility after a severe fracture. Weight-bearing exercises and supervised movement training are commonly practised to regain function safely.

Long-term medications

Over-the-counter supplements like Vitamin D and calcium or prescribed long-term medications like bisphosphonates, risedronate or denosumab, help slow bone loss and promote bone formation.

Summary

Osteoporosis is a health condition causing weak bones, making them fragile and prone to fractures like transverse fractures, where the break runs perpendicular to the bone's length and throughout the whole bone width. Osteoporosis most commonly occurs in the elderly and post-menopause, with other predisposing factors being poor diet, heavy drinking and smoking, certain medical conditions, as well as the use of certain medications.

Osteoporosis increases the risk of fractures due to weak bone structure and impaired healing mechanisms. Fractures and related injuries can be detected by tests like X-rays, CT and MRI scans, and osteoporosis can be assessed by DEXA scans. 

Treatment of fractures includes stabilisation of the fracture along with physiotherapy and rehabilitation for gradual restoration of bone strength and mobility. Calcium and vitamin D supplements, along with certain medications like bisphosphonates, risedronate or denosumab, can help in bone healing, slowing bone loss, and promoting bone formation.