Low-energy distal radius fractures in middle-aged and elderly men and women—the burden of osteoporosis and fracture risk
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One third of 218 men and half of 1,576 women with low-energy distal radius fractures met the bone mineral density (BMD) criteria for osteoporosis treatment. A large proportion of patients with increased fracture risk did not have osteoporosis. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry.
Main objectives were to determine the prevalence of patients with a low-energy distal radius fracture in need of osteoporosis treatment according to existing guidelines using T-score ≤ −2.0 or ≤−2.5 standard deviation (SD) and calculate their fracture risk.
A total of 218 men and 1,576 women ≥50 years were included. BMD was assessed by dual energy X-ray absorptiometry (DXA) at femoral neck, total hip, and lumbar spine (L2–L4). The WHO fracture risk assessment tool (FRAX®) was applied to calculate the 10-year fracture risk.
T-scores ≤−2.0 and ≤−2.5 SD at femoral neck was found in 37.7% and 19.6% of men and 51.1% and 31.2% of women, respectively. The risk of hip fracture was 6.2% for men and 9.0% for women. The corresponding figures for patients with T-score ≤−2.0 SD were 11.6% and 14.5% and for T-score ≤−2.5 SD 16.3% and 18.2%, respectively. A large proportion of distal radius fracture patients with a high 10-year FRAX® risk did not have osteoporosis.
Every second to every third fracture patient met the present BMD criteria for osteoporosis treatment. Because a large proportion of distal radius fracture patients did not have osteoporosis, treatment decisions should not be based on fracture risk assessment without bone densitometry. Thus, all distal radius fracture patients ≥50 years should be referred to bone densitometry, and if indicated, offered medical treatment.
KeywordsBone densitometry Bone mineral density Distal radius fractures FRAX® Norway Osteoporosis
- 1.Ismail AA, Pye SR, Cockerill WC, Lunt M, Silman AJ, Reeve J, Banzer D, Benevolenskaya LI, Bhalla A, Bruges Armas J, Cannata JB, Cooper C, Delmas PD, Dequeker J, Dilsen G, Falch JA, Felsch B, Felsenberg D, Finn JD, Gennari C, Hoszowski K, Jajic I, Janott J, Johnell O, Kanis JA, Kragl G, Lopez Vaz A, Lorenc R, Lyritis G, Marchand F, Masaryk P, Matthis C, Miazgowski T, Naves-Diaz M, Pols HA, Poor G, Rapado A, Raspe HH, Reid DM, Reisinger W, Scheidt-Nave C, Stepan J, Todd C, Weber K, Woolf AD, O'Neill TW (2002) Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 13:565–571CrossRefPubMedGoogle Scholar
- 5.Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382CrossRefPubMedGoogle Scholar
- 8.Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541CrossRefPubMedGoogle Scholar
- 9.Black DM, Delmas PD, Eastell R, Reid IR, Boonen S, Cauley JA, Cosman F, Lakatos P, Leung PC, Man Z, Mautalen C, Mesenbrink P, Hu H, Caminis J, Tong K, Rosario-Jansen T, Krasnow J, Hue TF, Sellmeyer D, Eriksen EF, Cummings SR (2007) Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356:1809–1822CrossRefPubMedGoogle Scholar
- 11.Cummings SR, Martin JS, McClung MR, Siris ES, Eastell R, Reid IR, Delmas P, Zoog HB, Austin M, Wang A, Kutilek S, Adami S, Zanchetta J, Libanati C, Siddhanti S, Christiansen C (2009) Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 361:756–765CrossRefPubMedGoogle Scholar
- 15.Statens Legemiddelverk (2004) Behandling av osteoporose for å forebygge brudd. http://www.legemiddelverket.no/upload/74375/Terapi-Osteoporose-Sept2004.pdf
- 16.Scottish Intercollegiate Guidelines Network (2003) Management of osteoporosis, SIGN publication 71, Edinburgh. http://www.guidelines.gov/summary/summary.aspx?doc_id=3876
- 18.Royal College of Physicians (1999) Clinical guidelines for strategies to prevent and treat osteoporosis, London. http://www.rcplondon.ac.uk/pubs/wp/wp_osteo_update.htm
- 19.National Osteoporosis Society (2008) Osteoporosis charity rejects NICE guidance. https://www.nos.org.uk/NetCommunity/SSLPage.aspx?pid=311&srcid=234
- 27.Cooper C, Melton LJ 3rd (1996) Magnitude and impact of osteoporosis and fractures. Academic, San DiegoGoogle Scholar
- 28.Rockwood CA, Green DP, Bucholz RW (2006) Rockwood and Green's fractures in adults. Fractures of the Distal Radius and Ulna. Lippincott William & Wilkins, Philadelphia, p 911Google Scholar
- 29.Lewiecki EM, Gordon CM, Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Silverman S, Bishop NJ, Leonard MB, Bianchi ML, Kalkwarf HJ, Langman CB, Plotkin H, Rauch F, Zemel BS (2008) Special report on the 2007 adult and pediatric Position Development Conferences of the International Society for Clinical Densitometry. Osteoporos Int 19:1369–1378CrossRefPubMedGoogle Scholar
- 31.Haugeberg G, Uhlig T, Falch JA, Halse JI, Kvien TK (2000) Reduced bone mineral density in male rheumatoid arthritis patients: frequencies and associations with demographic and disease variables in ninety-four patients in the Oslo County Rheumatoid Arthritis Register. Arthritis Rheum 43:2776–2784CrossRefPubMedGoogle Scholar
- 35.Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046CrossRefPubMedGoogle Scholar
- 36.Altman D (1999) Comparing groups: categorical data. Practical statistics for medical research. Chapman and Hall/CRC, London, p 230Google Scholar
- 38.Sosa M, Saavedra P, Gomez-Alonso C, Mosquera J, Torrijos A, Munoz-Torres M, Diaz V, de la Madrid C, Diaz Curiel M, Martinez Diaz Guerra G, Perez-Cano R, Alegre J, Del Pino J, Lofman O, Hallberg I, Berglund K, Wahlstrom O, Kartous L, Rosenqvist AM, Larsson L, Toss G, Beringer TR, Finch M, Mc ATH, Whitehead E, Keegan DA, Kelly J, Lee G, McKane R, McNally C, McQuilken M (2005) Postmenopausal women with Colles' fracture have bone mineral density values similar to those of controls when measured with calcaneus quantitative ultrasound. Eur J Intern Med 16:561–566CrossRefPubMedGoogle Scholar
- 39.Nordvall H, Glanberg-Persson G, Lysholm J (2007) Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life. Acta Orthop 78:271–277CrossRefPubMedGoogle Scholar
- 42.Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. Cmaj 167:1–34Google Scholar
- 43.National Osteoporosis Foundation (2003) Physician's guide to prevention and treatment of osteoporosis. http://www.guideline.gov/summary/summary.aspx?doc_id=3862&nbr=003073&string=osteoporosis Google Scholar