Osteoporosis is a systemic, metabolic disease of the skeletal system characterized by decreased bone mass, destruction of bone microstructure, increased bone fragility, decreased bone strength, and increased risk of fracture, and can be divided into primary osteoporosis and secondary osteoporosis. The osteoporotic fracture (fragility fracture) referred to in this guideline refers to primary osteoporosis resulting in decreased bone density and bone mass, reduced bone strength, and fractures that can occur with minor violence during daily activities, which is the most serious consequence of osteoporosis. Common fracture sites are the spine, hip, distal radius and proximal humerus. Characteristics and treatment difficulties of osteoporotic fractures: 1. After bed braking, patients with osteoporotic fractures will experience rapid bone loss, which will aggravate osteoporosis. 2. The fracture site has low bone mass and poor bone quality, and most of them are comminuted fractures, which are difficult to reset and not easy to achieve satisfactory results. 3.The stability of the internal fixation treatment is poor, the internal fixation and implants are easy to loosen and dislodge, and the bone implants are easy to be absorbed. 4.The fracture healing process is slow, the recovery time is long, and the fracture is prone to delayed healing or even non-healing. 5. The risk of re-fracture at the same site and other sites is significantly increased. 6. Most often seen in the elderly population, often combined with other organs or systemic diseases, poor general condition, prone to complications during treatment, increasing the complexity and risk of treatment. 7. The disability and mortality rates are high, which seriously threaten the physical and mental health, quality of life and life expectancy of the elderly. Therefore, the treatment of osteoporotic fractures is different from general traumatic fractures, and it is necessary to pay attention to both the treatment of the fracture itself and the active treatment of osteoporosis. Osteoporotic fractures are mostly seen in the elderly, female population, mostly with minor trauma (referring to injuries caused by falls on flat ground or at the height of the body’s center of gravity) or without a history of significant trauma, and can occur even during daily activities. Clinical manifestations: 1. General manifestations of fracture: pain, pressure pain, swelling and functional impairment may occur. However, patients with osteoporotic fractures may also have no pain or only mild pain, or may show an increase in their existing pain. The functional impairment may also be very mild, and even the affected limb may still be mobile. 2. Specific manifestations of fracture: deformity, bone rubbing sensation (sound), and paradoxical activity may occur. However, there are patients who lack the above typical manifestations after osteoporotic fracture in clinical practice. 3. manifestations of osteoporosis: shortening of height, scoliosis or hunchback deformity may appear. X-ray examination can determine the site, type, direction of displacement and degree of fracture, which is of great value for diagnosis and treatment. x-ray films have special manifestations of fracture, but also manifestations of osteoporosis, such as reduced bone density, thinning of bone trabeculae, thinning of bone cortex and enlargement of bone marrow cavity. The scope of radiography should include the L and lower adjacent joints of the injury site, hip fracture should include bilateral hip joints, and spine fracture should be combined with physical examination to determine the projection site and scope to avoid missing diagnosis. CT and MR examinations should be applied reasonably. CT can accurately show the degree of fracture comminution and compression in the vertebral canal; CT three-dimensional imaging technology can clearly show intra- or periarticular fractures; MRI is important for detecting occult fractures and identifying fresh or old fractures. Patients with a proposed diagnosis of osteoporotic fracture are eligible for bone density testing. There are many methods of bone density examination (such as DXA, pDXA, QCT, pQCT, etc.), among which dual-energy X-ray absorptiometry (DXA) is currently the internationally accepted method of bone density examination. With reference to the diagnostic criteria recommended by WHO, a DXA measurement of bone mineral density less than 1 standard deviation below the peak bone mineral density of healthy adults of the same sex and race is considered normal (T value ≥ -1.0 SD). A decrease of l to 2.5 standard deviations is considered low bone mass or reduced bone mass f -2.5 SD < T value < -1.0 SD). A decrease equal to or greater than 2.5 standard deviations was considered osteoporosis (T value ≤ -2.5 SD). The degree of reduction meets the diagnostic criteria for osteoporosis and is accompanied by one or more fractures as severe osteoporosis. The commonly used clinical measurement sites are L1 to L4 and the hip. Laboratory tests are as follows: 1. Routine blood and urine tests, liver and kidney function, blood glucose, calcium, phosphorus, alkaline phosphatase, sex hormones, 25(OH)VitD and parathyroid hormone can be selected as needed. 2. According to the needs of disease monitoring, drug selection, efficacy observation and differential diagnosis, bone metabolism and bone turnover indexes (including bone formation and bone resorption indexes) can be tested if necessary, in order to perform bone turnover typing, assess the rate of bone loss, disease progression and risk of re-fracture, and select intervention measures. Bone formation indicators include serum alkaline phosphatase, osteocalcin, bone-derived alkaline phosphatase, and type I precollagen C- and N-terminal peptides. Bone resorption indicators included fasting urinary calcium/creatinine ratio, plasma antitartaric acid phosphatase and type I collagen C-terminal peptide, urinary pyridinoline and deoxypyridinoline, urinary type I collagen C-terminal peptide and N-terminal peptide. Low BMD and high bone turnover rate suggest a significantly increased risk of fracture. 3. Combined biochemical index testing and assessment is superior to single BMD or bone biochemical index testing. Note the differentiation from bone tumors such as bone metastases, multiple myeloma, and other metabolic bone diseases such as hyperparathyroidism that result in secondary osteoporotic fractures. The diagnosis of osteoporotic fracture should be made by a comprehensive analysis of the patient's age, gender, history of menopause, history of fragility fracture and clinical manifestations, as well as the results of imaging and/or bone density tests. Displacement, fixation, functional exercise and anti-osteoporosis treatment are the basic principles of treatment for osteoporotic fractures, and the ideal treatment is an organic combination of the above four. The fracture should be repositioned without aggravating the local blood flow obstacle as much as possible, and the functional exercise should be carried out as early as possible under the premise that the fracture is firm and fixed, so that the fracture healing and functional recovery can reach a more ideal result. At the same time, anti-osteoporosis drugs should be reasonably selected and used to avoid aggravation of osteoporosis or the occurrence of re-fracture. Treatment of osteoporotic fractures should emphasize individualization and can be non-surgical or surgical. The specific method should be determined according to the fracture site, fracture type, degree of osteoporosis and the patient's general condition, weighing the advantages and disadvantages of non-operative and operative treatment and making a reasonable choice. Osteoporotic fractures are mostly seen in the elderly, and the principle of simple, safe and effective methods of revision and fixation should be used to restore the quality of life before the injury as soon as possible. The method with less trauma and less impact on joint function should be chosen as much as possible, and the anatomical repositioning of the fracture should not be forced, but should focus on tissue repair and functional recovery. For those who need surgical treatment, the following measures can be taken as appropriate, taking into account the characteristics of osteoporotic fractures, such as poor bone quality and slow healing, which are different from general traumatic fractures: 1. Use special internal fixation devices, such as locking compression plates, coarse thread screws, internal fixation devices with special coating materials, etc. 2. Use internal fixation devices with less stress masking to reduce further loss of bone volume. 3.Adopt special internal fixation techniques, such as screw fixation through the bilateral bone cortex to increase the holding force. 4, the use of internal fixation reinforcement techniques, such as the use of bone cement, expanders and biomaterial reinforcement around the screws. 5.For severe bone defect, autologous or allogeneic bone graft and bovine material (bone cement, calcium sulfate, etc.) filling can be considered. 6. Depending on the firmness of the fracture, the fracture site and the patient's general condition, external fixation should be used as appropriate. External fixation should be relied on, maintained for a sufficient period of time, and minimize the homeostasis of the fracture adjacent joints. The rehabilitation of patients with osteoporotic fractures should follow the general postoperative rehabilitation rules of fractures, but also take into account the poor bone quality, poor internal fixation and slow fracture healing of patients. It is emphasized that early passive and fulminant exercise of muscles and joints, early movement of unfixed joints, and minimizing the time of bed rest should be carried out. In addition to the prevention and treatment of local complications caused by fracture, patients with osteoporotic fracture should also pay attention to the improvement of systemic conditions and actively prevent and treat complications such as deep vein thrombosis of the lower limbs, crushing pneumonia, urinary tract infection and decubitus ulcers to reduce the disability and mortality rates.