Clinical issues - non-surgical management of fractures in patients with osteoporosis

When it is considered

Non-surgical (conservative) fracture management is considered in older patients when surgical risk outweighs benefit, when the fracture pattern is inherently stable, or when the patient's goals of care do not favour an invasive intervention
Surgical fixation is generally preferred for most hip fractures given superior pain control and earlier mobilisation compared with conservative management, but conservative management remains appropriate for selected fracture types and patients

Conservative management avoids anaesthetic/surgical risk but carries its own risks - prolonged immobility (pressure injury, venous thromboembolism, deconditioning, pneumonia) that can exceed surgical risk in some patients, making the decision genuinely balanced rather than automatically "safer"

Decision-making weighs: fracture stability/displacement, surgical/anaesthetic risk (frailty, comorbidity), pre-fracture mobility and goals, and patient/family preference where capacity allows
Multidisciplinary input (orthogeriatrics, anaesthetics, the patient/family) improves decision quality for frail patients with a marginal surgical risk-benefit balance

When conservative management is chosen, active measures to mitigate the risks of immobility are essential: pressure injury prevention, VTE prophylaxis, early mobilisation where the fracture allows, and proactive management of pain, nutrition, and bowel/bladder function
Analgesia adequate to allow safe mobilisation/participation in care is central regardless of the management pathway chosen

Hip fracture, vertebral compression fracture, osteoporosis, orthogeriatric co-management models

Conservative management is not simply "doing less" - it requires an equally active, structured care plan to prevent the complications of immobility that would otherwise offset any risk avoided by not operating

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