A pathological fracture is a break in a bone that occurs as the result of an underlying disease as opposed to direct physical trauma or impact. In fact, most pathological fractures occur spontaneously during normal activity, or after a mild injury that wouldn’t ordinarily lead to a broken bone in most people. A significant loss in bone density due to the development of osteoporosis is most frequently to blame. However, there are many other conditions that can lead to a pathological fracture, including metabolic disorders, genetic bone deformities, infection, benign tumors and cysts, and cancers that have metastasized to the bone.
Prevention is important for a variety of reasons, not the least of which is the avoidance of pain and decreased mobility. However, for those who may be at increased risk, taking a proactive approach to reduce the likelihood of a pathological fracture occurring also translates to fewer surgical interventions and lengthy hospital stays. Regular screening for patients who present one of the previously mentioned risk factors is recommended, particularly if there is reason to suspect skeletal lesions.
Often, the only symptom to occur is localized pain that does not respond to anti-inflammatory drugs or pain blockers. In addition, it should be noted that pain from skeletal lesions might initially be attributed to other conditions and overlooked. For instance, metastases impacting the spinal cord or pelvis region are often mistakenly attributed to sciatica.
Diagnostic measures used to detect pathological fractures typically begin with blood tests. Elevated levels of c-reactive protein and erythrocyte sedimentation, for example, indicate the presence of a chronic inflammatory condition. Urine analysis may also be performed to assess levels of n-telopeptices, which serves as a gauge to the rate of collagen deterioration in bone.
Magnetic resonance imaging (MRI) and computed tomography (CT) scans usually follow, which reveal the rate of marrow replacement and the details of bone structure, respectively. When tumor formation is suspected from these tests, a radionuclide scan of the entire body may be performed to pinpoint specific locations where a pathological fracture is most likely to be found or to occur at some later point.
Treatment varies with each individual. In some cases, chemotherapy or radiation may be necessary to reduce 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 instance, 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 defective bone.
