Osteoporosis--a modifying factor of surgical treatment.

Increasing knowledge of fragile bone has been gained by non-invasive mineral assessments. Its future importance seems to be twofold. First by, it seems likely that patients with low bone mineral will be treated to try to increase this bone mineral or at least to keep it steady. Secondly, in the presence of osteoporosis special strategies must be taken into consideration. In many locations osteoporotic fractures may need special solutions. It seems that osteosynthesis with plates and screws which have their definite indications in younger patients may be replaced by alternatives, such as cerclage wiring and intramedullary implants. Polymethylmethacrylate has been a good adjunct to strengthen screw fixation and to fill defects after compression of fragile cancellous bone.