Pathological Fractures

Overview

A pathological fracture is a bone break that happens in a part of the bone that has been weakened by an underlying disease. Because the bone is already abnormal, it can break from a minor fall, an everyday movement, or sometimes no obvious injury at all. This sets it apart from an ordinary fracture, which results from a significant force on a healthy bone.

Pathological fractures are important not only because of the break itself but because they can be the first sign of a hidden problem, such as thinning bones (osteoporosis), a bone tumor, an infection, or cancer that has spread to bone. Treatment therefore has two goals: to stabilize and heal the fracture and to diagnose and treat the underlying condition that caused the bone to weaken.

Symptoms

Symptoms are similar to other fractures but may follow little or no trauma:

• Pain at the site, which may have been aching for some time before the break
• Sudden, sharp pain when the bone gives way
• Swelling, bruising, or tenderness over the area
• Difficulty moving or bearing weight on the affected part
• Sometimes a visible deformity

Bone pain that is present before any break, especially pain at night or pain that is not clearly related to an injury, can be a warning sign of a weakened bone and should be evaluated. A fracture from a minor incident also warrants a search for an underlying cause.

Causes

Anything that weakens bone can lead to a pathological fracture. Common causes include:

• Osteoporosis: Thinning, fragile bones, the most common reason for fractures from minor falls, especially in older adults.
• Cancer that has spread to bone (bone metastases): Tumors from the breast, prostate, lung, and other organs can weaken bone.
• Primary bone tumors: Both benign and malignant tumors, such as multiple myeloma.
• Bone infection (osteomyelitis): Infection that erodes bone.
• Metabolic bone diseases: Such as Paget disease of bone, vitamin D deficiency, or overactive parathyroid glands.
• Bone cysts and other localized weak spots.

Risk Factors

• Older age and osteoporosis
• A known cancer, especially breast, prostate, or lung cancer
• Multiple myeloma or other bone tumors
• Long-term corticosteroid use
• Paget disease of bone or other metabolic bone conditions
• Previous radiation to a bone
• Vitamin D or calcium deficiency

Diagnosis

Diagnosis confirms the fracture and searches for the cause:

• X-rays: Show the break and often the weakened or abnormal bone around it.
• CT or MRI: Provide detailed views of the bone and any tumor or infection.
• Bone scan or PET scan: Can reveal cancer spread or other affected areas.
• Blood tests: To check for cancer markers, infection, and bone-related conditions.
• Bone biopsy: A sample may be taken when a tumor or infection is suspected.
• Bone density testing: To assess for osteoporosis.

Treatment

Treatment addresses both the broken bone and the disease that weakened it.

• Stabilizing the fracture: Casts, braces, or surgery with rods, plates, or screws hold the bone while it heals or provide support.
• Treating the underlying cause: For example, medication for osteoporosis, treatment for cancer (which may include radiation, chemotherapy, or hormone therapy), or antibiotics for infection.
• Pain control: Medication and other measures to relieve pain.
• Preventive procedures: Sometimes a weak bone at high risk of breaking is reinforced surgically before it fractures.
• Rehabilitation: Physical therapy to restore strength and function.

Prevention

• Maintain bone health with adequate calcium, vitamin D, and weight-bearing exercise
• Get screened and treated for osteoporosis if you are at risk
• Follow treatment plans for cancer or other conditions that affect bone
• Report new or unexplained bone pain promptly
• Reduce fall risks at home, especially for older adults
• Use medications such as long-term steroids only as needed and with bone protection when advised

When to See a Doctor

See a doctor promptly if you have:

• A bone that breaks from a minor fall or with little or no injury
• Persistent, unexplained bone pain, especially at night
• Bone pain together with a known cancer or risk factors for weak bones
• Swelling, tenderness, or difficulty using a limb without a clear injury

Seek emergency care for a suspected serious fracture, severe pain, an obvious deformity, or inability to move or bear weight. Finding the cause early can prevent further fractures.

Related Topics

Frequently Asked Questions

References

1. American Academy of Orthopaedic Surgeons (AAOS). Pathologic fractures.
2. MedlinePlus, U.S. National Library of Medicine. Osteoporosis.
3. National Cancer Institute (NCI). Metastatic cancer and bone.
4. National Institutes of Health Osteoporosis and Related Bone Diseases Resource Center.