An osteoporotic postmenopausal woman is most likely to experience which type of pathologic fracture?

• A. Vertebral fracture
• B. Pelvic fracture
• C. Femur fracture
• D. Tibial fracture

Answer: (A)

Osteoporosis in postmenopausal women most severely weakens trabecular bone, which is abundant in the spine. This makes vertebral bodies particularly prone to compression fractures from minimal trauma. A vertebral compression fracture is the classic osteoporotic fracture in this group, often presenting with back pain, height loss, and sometimes kyphosis, and can even be asymptomatic on initial imaging.

While hip fractures and other sites can occur, vertebral fractures are the most common osteoporotic fractures overall. The lumbar and thoracic vertebrae bear substantial compressive loads and rely on a robust trabecular lattice that becomes fragile with estrogen deficiency and aging, explaining why the vertebrae are the typical target.