Incidence of Anti-osteoporosis Diagnosis and Treatment After Distal Radius Fractures

Abstract

Introduction: There is still lack of adequate diagnosis and treatment of osteoporosis in elderly patients. Hand surgeons can prevent secondary osteoporotic fractures when treating distal radius fractures if they evaluate patients at risk and treat them adequately. The aim of this study was to determine osteoporosis diagnosis and treatment in patients with distal radius fractures treated surgically. Methods: A retrospective study including patients treated surgically for posttraumatic distal radius fractures between 2012 and 2014 was performed. All patients were treated in a level I trauma center, by hand surgeons. Inclusion criteria were women and males older than 50 and 60 years, respectively, with isolated low-energy distal radius fractures, treated surgically and having a follow-up longer than 6 months. Exclusion criteria were polytrauma, high-energy fractures, nonunions, and fractures treated nonsurgically. Several variables were evaluated: age, sex, smoking, fracture type, associated pathologies, previous fractures, preoperative and postoperative anti-osteoporotic treatments (if any), specialty of the physicians that indicated anti-osteoporotic treatment, and bone mineral density (BMD) studies performed. The osteoporosis incidence rate of our institution was calculated as reference for comparison purposes. Logistic multiple regression models were fitted and odds ratios for covariates were estimated. Results: The study included 41 patients (32 female and 9 male), with ages averaging 65 (SD = 8.5) and 63 (SD = 7.3) years, respectively, being 22% smokers, 14% diabetic, 30% had high blood pressure (HBP), and 5% hypothyroidism (HT). Twenty-eight percent had had previous fractures secondary to osteoporosis, and 56% (23 patients) had a BMD performed previous to the fracture (37% evidenced osteoporosis). Seventeen percent were under anti-osteoporotic treatment previous to the fracture (all women). After surgical treatment of their distal radius fracture, 17% had anti-osteoporotic treatment indicated (only 10% of them had had the prescription indicated previous to the fracture). BMD pathologic results were not associated to smoking ( P = .32) and HBP or HT ( P = .58 and P = .82, respectively), but there was an association to diabetes, showing an increased chance (odds ratio = 2.10, P = .049) for diabetic patients to have pathologic BMD. Finally, annual osteoporosis incidence rate, calculated using all patients who attended our institution during 2014, was 0.88%. Conclusion: Distal radius fractures in elderly patients can be considered as indicators of high risk of osteoporosis. A high percentage of patients with these fractures had already had osteoporotic fractures before (28% in our series). Our study shows that there is poor prevention of secondary osteoporotic fractures in patients with distal radius fractures (after surgical treatment only 17% of patients had anti-osteoporotic treatment indicated). Osteoporosis may induce the occurrence of fragility fractures, and hand surgeons have an important role in their diagnosis and treatment. All patients included in this study, who were not adequately evaluated after their distal radius fracture for osteoporosis, had a BMD performed. The results of our study evidenced the need of a program for secondary osteoporotic fracture prevention; this program has now been developed and is active at our institution.