For an older adult presenting with new musculoskeletal pain after minor trauma, which two signs indicate fracture risk?

For an older adult presenting with new musculoskeletal pain after minor trauma, which two signs indicate fracture risk?

• A. Severe focal tenderness on palpation and history of osteoporosis or glucocorticoid use.
• B. Mild tenderness with full range of motion.
• C. Pain relieved by rest and elevation.
• D. Normal imaging expectations.

Answer: (A)

In older adults, a small amount of trauma can reveal underlying fragility fractures, so two red flags stand out: focal, severe tenderness where the injury is localized, and a history that raises fracture risk, such as osteoporosis or glucocorticoid (steroid) use. Severe focal tenderness means pressing on the exact spot hurts a lot, suggesting there could be a fracture beneath that area rather than a generic bruise or soft-tissue strain. A history of osteoporosis or steroid use is a major risk factor because osteoporosis weakens bone, and long-term steroids accelerate bone loss, making fractures more likely even with minor bumps.

Other patterns are less concerning for fracture. Mild tenderness with full range of motion doesn’t point to a fracture; pain that improves with rest and elevation often fits soft-tissue injury rather than a broken bone; and imaging results can sometimes appear normal early on or in certain fracture types, so a normal imaging expectation by itself doesn’t help identify fracture risk. The combination of localized severe tenderness and a high-risk bone health history is the strongest signal to investigate for fracture.