How would you approach an elderly patient with tibial plateau insufficiency fracture and normal DEXA?

Tibial plateau fractures are common among young individuals and often the result of trauma or injury. In the elderly, they can be related to injury but as well as poor bone strength and quality. In the aging population if DXA testing is normal and the fracture is not the result of major injury searching for other secondary causes of OP is necessary. The DXA test is one surrogate for bone strength. However, considerations would be to do a detailed clinical assessment including lab testing for disorders of calcium, PTH, vitamin D, AP, SPEP as well as more detailed survey of other areas with Vertebral Fracture Assessment and radial DXA imaging. In addition, if individuals have high risk of falls, sarcopenia, immobility these are all considerat...

It depends on the quantity of the medial or lateral compartment that the bone is under since it may really be a spontaneous osteonecrosis rather than a tibial plateau fracture. I don’t believe that we understand the etiology of SONK. I have seen quite a few who I treated with an immobilizer and modified weight bearing and all improved to their baseline. I did not alter their bone status.