Table 1.

Clinical options in osteoporotic fractures

Clinical options	Characteristic	Index	Methods	Fracture site and pattern	Disadvantage in osteoporotic bone	Ref.
Cortical bone screws	Narrow outer diameters and decreased thread pitch compared to cancellous bone screw	BMD Thickness and porosity of cortical bone	DXA QCT	Femoral heads Femoral neck fractures	50% reduction of the holding strength per 1 mm decrease of cortical thickness	175, 194, 195
Cancellous bone screw	Reach the plateau torque level prior to contact of all the screw threads	BMD, TBS SMI BV/TV	DXA HR-pQCT μMRI	Femoral metaphysis Distal radius Femoral heads	Reduction of thread-bone interface that produces torque	183, 184, 196, 197
Bicortical lag screw	Potential improvement of thread purchase	BMD, TBS SMI BV/TV	DXA HR-pQCT	Medial malleolus fractures		185, 198, 199
Traditional plates	Compress the fracture fragments between bone implant interface to create fixation strength	BMD Bone stiffness and strength	DXA	Regular fractures	Decrease of the axial and torsional stiffness	190, 200, 201
Locking plate	Fixed-angle construct between screw and plate	BMD, TBS Proximal cortical thickness Failure load	DXA QCT	Proximal humerus fractures	Reduction of callus formation without micromotion across the fracture site; Loss of fixation and screw cut-out	5, 187, 188, 198, 202
Intramedullary nail	Preserving the soft tissues around fracture site	BMD Cortical thickness	DXA QCT	Proximal humerus fractures	A larger-diameter nail is required to achieve a diaphyseal fit and stability	191, 203
Bone augmentation	Increase surface area; PMMA carries osteogenic and antibiotic drugs; Tricalcium phosphate and Allograft fibulas act more as a scaffold	BMD SMI BV/TV BMSi	DXA QCT	Femoral neck fractures Spine fractures Comminuted proximal humerus fractures	Damage surrounding soft tissues or initiate thermal bone necrosis; Difficult to remove	38, 162– 164, 196, 204, 205
External fixation	Lower fixation failure rates	BMD, TBS	DXA HR-pQCT	Comminution of tibial plateau fractures		190
Primary arthroplasty	Early mobilization and weight bearing	BMD, TBS Subchondral bone quality	DXA HR-pQCT DensiProbe	Acute acetabular fractures; Displaced intra-articular fractures of the tibial plateau		193

BMD bone mineral density, DXA dual-energy X-ray absorptiometry, QCT quantitative computed tomography, HR-pQCT high-resolution peripheral QCT, μMRI micromagnetic resonance imaging, TBS trabecular bone score, BMSi bone material strength index, PMMA polymethylmethacrylate, SMI structure model index, BV/TV bone volume fraction