Pathological fractures occur due to underlying diseases, such as osteoporosis or tumors, and can cause pain and limited mobility. Regular screening is recommended for those at risk, and diagnostic measures include blood tests, MRI, and CT scans. Treatment varies and may include chemotherapy, radiation, surgery, or bisphosphonates.
A pathological fracture is a break in a bone that occurs due to an underlying disease rather than direct physical trauma or impact. In fact, most pathological fractures occur spontaneously during normal activity or after a minor injury that would not normally break a bone in most people. The most common cause is a significant loss of bone density due to the development of osteoporosis. However, there are many other conditions that can lead to a pathological fracture, including metabolic disorders, genetic bone deformities, infections, benign tumors and cysts, and tumors that have metastasized to the bone.
Prevention is important for a variety of reasons, not the least of which is avoiding pain and limited mobility. However, for those who may be most at risk, taking a proactive approach to reducing the likelihood of a pathological fracture also translates into fewer surgeries and longer hospital stays. Regular screening is recommended for patients with any of the aforementioned risk factors, particularly if there is reason to suspect skeletal injury.
Often, the only symptom that occurs is localized pain that doesn’t respond to anti-inflammatory or pain-relieving medications. Additionally, it should be noted that pain from skeletal injuries might initially be attributed to other conditions and overlooked. For example, metastases affecting the spinal cord or pelvic region are often misattributed to sciatica.
Diagnostic measures used to detect pathological fractures typically begin with blood tests. Elevated levels of c-reactive protein and red blood cell sedimentation, for example, indicate the presence of a chronic inflammatory condition. Urinalysis may also be performed to evaluate n-telopeptic levels, which serves as an indicator of the rate of collagen deterioration in the bone.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans usually follow, which reveal the rate of marrow replacement and details of bone structure, respectively. When cancer is suspected from these tests, a whole-body radionuclide scan may be done to find specific locations where a pathological fracture is most likely to be found or to occur at a later time.
Treatment varies with each individual. In some cases, chemotherapy or radiation may be needed to shrink the tumors. Patients who experience a pathological fracture due to bone metastases associated with breast cancer are often treated with bisphosphonates. Surgery may also be indicated. For example, some patients may benefit from prophylactic fixation of the fracture site with bone cement and rods, while others may receive an artificial prosthesis to replace the defective bone.
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