Pathologic Fracture

What are pathologic fractures?

Pathologic fractures are a type of broken bone (bone fracture). They happen when something weakens your bones and makes them much more likely to break than usual. Bone tumors or health conditions like osteoporosis are common causes. Healthcare providers sometimes call them pathological fractures.

A pathologic fracture might break one of your bones after a minor injury that wouldn’t normally cause serious damage. Instead of being able to absorb impacts from falls, sports injuries or other forces, your bones will break much more easily than usual.

Pathologic fractures can happen in any bone. But they’re most common in strong bones that usually don’t break easily, including your:

• Vertebrae (the bones that make up your spine).
• Pelvis.
• Humerus (upper arm bone).
• Femur (thigh bone).
• Tibia (shin bone).
• Fibula (calf bone).

Normally, tripping on a bunched-up rug or losing your balance on a single step won’t damage your body enough to break larger bones like the ones in your arms and legs. But if you have a health condition that weakens your bones, you might experience a pathologic fracture from everyday slips, falls or bumps.

You might need surgery to repair your broken bone, or to prevent a pathologic fracture. Your healthcare provider will suggest other treatments for the health condition that’s affecting your bones. How long it takes to recover will depend on which bone is broken and what causes it.

What are pathologic fracture symptoms?

Pathologic fractures share symptoms with other types of bone fractures, including:

• Pain.
• Swelling.
• Tenderness.
• Inability to move a part of your body like you usually can.
• Bruising or discoloration.
• A deformity or bump that’s not usually on your body.

What causes pathologic fractures?

Health conditions that make your bones unnaturally weak (usually without you noticing) cause pathologic fractures. Osteoporosis and tumors are the most common causes.

Osteoporosis

Osteoporosis weakens bones, making them more susceptible to sudden fractures. Many people don’t know they have osteoporosis until after it causes a broken bone. There usually aren’t obvious symptoms.

People assigned female at birth (AFAB) and adults older than 65 have an increased osteoporosis risk.

Bone tumors or lesions

A tumor is any solid mass of abnormal cells inside your body. Some are cancerous (malignant), and others aren’t (benign). Bone lesions aren’t solid tumors. They’re areas of abnormal cells that make a bone weaker than it should be.

Pathologic fractures can happen when a tumor or lesion forms inside (or spreads to) one of your bones and weakens its natural shape and strength.

Malignant tumors can develop in a bone on their own if you have bone cancer (sarcoma). It’s much more common for cancer to spread from an organ near your bone into the bone itself (bone metastasis).

Benign bone tumors are noncancerous growths in your bones. There are several different types. They can all cause pathologic fractures in your affected bones.

How are pathologic fractures diagnosed?

A healthcare provider will diagnose a pathologic fracture with a physical exam and imaging tests.

Your provider will use at least one of the following imaging tests to take pictures of your injured bone and the area around it:

• X-rays.
• MRI (magnetic resonance imaging).
• CT scan (computed tomography scan).

You may need other tests depending on what causes the fracture, including:

• Blood tests for cancer.
• Biopsy.
• Bone density test (DXA scan).

What is the treatment for a pathologic fracture?

How your provider treats a pathologic fracture depends on which bone is broken and what causes it. Like all fractures, pathologic fractures can be treated with:

• Immobilization: You’ll need to wear a cast or splint. How long you’ll need to wear one depends on which type of fracture you have. Most people need a cast for several weeks. You’ll need follow-up X-rays to make sure your bones heal correctly.
• Surgery: Some pathologic fractures need surgical repair. Your surgeon will realign (set) your bone to its correct position and then secure it in place so it can heal and grow back together. They usually perform what’s called an internal fixation, which means your surgeon inserts metal plates, screws or pins into your bone to hold it in place while it heals. You might live with these pieces inserted in your bone forever. Some people need follow-up surgery to remove them.
• Radiation therapy: Your provider may use radiation to treat an impending pathologic fracture if they find a tumor or lesion before it breaks your bone. The radiation will kill the growth in your bone and allow healthy bone cells to regrow in its place. You may need radiation after surgery if bone cancer causes a pathologic fracture.
• Treating the underlying health condition: You’ll need other treatments for the condition or tumor that caused the pathologic fracture. If you have cancer, you’ll work with an oncologist. Your provider will tell you what to expect and which treatments you’ll need.

Pathologic fracture complications

Pathologic bone fractures share complications with other types of broken bones, including:

• Acute compartment syndrome (ACS): A buildup of pressure in your muscles may stop blood from getting to tissue, which can cause permanent muscle and nerve damage.
• Malunion: This happens when parts of a broken bone don’t line up correctly while healing.
• Nonunion: Your bone may not grow back together fully or at all.

Can I prevent pathologic fractures?

You can prevent a pathologic fracture if your provider finds a tumor, lesion or signs of osteoporosis before they can break your bone. Tumors and conditions that weaken your bones can cause pain even before they break. This is called an impending pathological fracture. Visit a healthcare provider if you’re feeling any new bone pain.

You might need surgery to remove a tumor or lesion before it breaks your bone (a prophylactic fixation). Your provider will suggest medications and other treatments to strengthen your bones and reduce your fracture risk if you have osteoporosis or another condition that affects your bone density.

Visit your provider once a year (or as often as they suggest), and let them know as soon as you notice new symptoms like pain or tenderness around a bone. If you’re worried about your risk, ask them about genetic testing for cancer or a bone density test that can catch osteoporosis early.

How long does a pathologic fracture to heal?

How long it takes a pathologic fracture to heal depends on a few factors:

• Which bone was broken.
• What caused the fracture.
• Which treatments you need.
• Any other injuries you experienced.

Most broken bones need a few months to heal. Talk to your provider or surgeon about a timeline that fits your specific situation. Your recovery time will also depend on which health condition caused the fracture. It can take extra time to treat osteoporosis, benign bone tumors or cancer, even after your broken bone heals.

When should I go to the emergency room?

Go to the emergency room right away if you think you have a broken bone, including any of the following symptoms:

• Intense pain.
• You can’t move a part of your body.
• A body part is noticeably different-looking or out of its usual place.
• You can see bone through your skin.
• Swelling.
• New bruising that appears at the same time as any of these other symptoms.

Which questions should I ask my doctor?

Questions you may want to ask your provider include:

• Which bone is broken?
• Is this a pathologic or another type of fracture?
• Will I need other treatments?
• Which condition caused the fracture?
• Do I have cancer?