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Correspondence to Author: Osman Suliman ¹ , Sara Altom ² , Maan Almehmadi ³ , Abdullah Alamri ³ , Zainab Abdullah ³ , Rana Abdelmagid ⁴ , Riham Abdelmagid ⁴ , Ahmed Abdelmagid ⁵ . 

1.Department of Surgery, Faculty of Medicine, University of Medical sciences and Technology (UMST) Khartoum, Sudan.
2.Department of Basic Sciences, Al-Rayan National College of Medicine, Al- Rayan National Colleges, Al-Madinah, Saudi Arabia.
3.Al-Rayan National College of Medicine, Al-Rayan National Colleges, Al-Madinah, Saudi Arabia.
4.Faculty of Medicine, Capital University, Cairo, Egypt.
5.Emergency Department, St. George’s Hospital Foundation Trust. London, United Kingdom

DOI: 10.52338/tjop.2026.5754

Abstract:

Background: Fragility fractures in postmenopausal women represent a major global health concern due to age-related osteoporosis and estrogen deficiency. These fractures are frequently associated with significant complications such as delayed union, nonunion, infection, fixation failure, refracture, and functional decline, leading to increased morbidity, mortality, and healthcare burden.
Objective: To systematically evaluate and synthesize current evidence on the management of complications following fragility fractures in postmenopausal women and to identify effective therapeutic, surgical, and rehabilitative strategies for improving clinical outcomes.
Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. A comprehensive search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was performed for studies published between January 2022 and March 2026. Studies involving postmenopausal women with fragility fractures and reporting management of related complications were included. Data were extracted and analyzed using qualitative synthesis and, where appropriate, quantitative methods.
Results: A total of 30 studies met the inclusion criteria. The most common complications identified were nonunion, delayed union, infection, fixation failure, refracture, and functional impairment. Pharmacological therapies, particularly anabolic and antiresorptive agents, demonstrated benefits in improving bone healing and reducing fracture risk. Early surgical intervention was associated with better outcomes, while rehabilitation programs improved functional recovery and reduced frailty. Fracture liaison services significantly reduced secondary fractures and improved treatment adherence
Conclusion: Management of fragility fracture complications in postmenopausal women requires a multidisciplinary approach combining pharmacological treatment, surgical optimization, rehabilitation, and preventive healthcare strategies. Despite advances, gaps remain in standardized care and high-quality evidence, highlighting the need for further research and integrated clinical pathways.

Keywords: Fragility fractures; Postmenopausal women; Osteoporosis; Fracture complications; Nonunion.

Citation:

Dr. Osman Suliman, Management of Complications Following Fragility Fractures in Postmenopausal Women: Current Evidence and Future Directions: Meta-Analyses. The Journal of Orthopaedics 2026.