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Low-energy distal radius fractures in middle-aged and elderly men and women—the burden of osteoporosis and fracture risk

A study of 1794 consecutive patients

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Abstract

Summary

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.

Introduction

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

The authors are grateful to the medical staff at Bergen Accident and Emergency Department, the centers for orthopedic trauma at Haukeland University Hospital in Bergen, Sørlandet Hospital in Kristiansand, and Telemark Hospital in Skien and the technicians at the Osteoporosis centers in Bergen, Kristiansand, and Skien. We would also like to thank Stein Atle Lie for statistical advice, and Professor John A. Kanis and Helena Johansson at the WHO Collaborating Centre for Metabolic Bone Diseases for helping us estimate the FRAX® data. This work has been supported by research grants from The Research Council of Norway and the University of Bergen to associate professor Christina Brudvik, research grants from The Western Norway Regional Health Authority to professor Leiv Hove, and research grants from The Competence Development Fund of Southern Norway and Sørlandet Hospital HF to professor Glenn Haugeberg.

Conflicts of interest

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Authors and Affiliations

  1. Department of Surgical Sciences, Faculty of Medicine and Dentistry, University of Bergen, 5021, Bergen, Norway

    J. Øyen, C. Brudvik & L. M. Hove

  2. Department of Rheumatology, Haukeland University Hospital, Bergen, Norway

    C. G. Gjesdal & E. M. Apalset

  3. Section of Rheumatology, Institute of Medicine, University of Bergen, Bergen, Norway

    C. G. Gjesdal

  4. Bergen Accident and Emergency Department, University of Bergen, Bergen, Norway

    C. Brudvik

  5. Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway

    L. M. Hove

  6. Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway

    E. M. Apalset

  7. Department of Rheumatology, Betanien Hospital, Skien, Norway

    H. C. Gulseth

  8. Department of Rheumatology, Sørlandet Hospital, Kristiansand, Norway

    G. Haugeberg

  9. Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway

    G. Haugeberg

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  1. J. Øyen
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  7. G. Haugeberg
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Correspondence to J. Øyen.

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Øyen, J., Gjesdal, C.G., Brudvik, C. et al. Low-energy distal radius fractures in middle-aged and elderly men and women—the burden of osteoporosis and fracture risk. Osteoporos Int 21, 1257–1267 (2010). https://doi.org/10.1007/s00198-009-1068-x

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  • DOI: https://doi.org/10.1007/s00198-009-1068-x

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