No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

Anja M Hjelle,Anja Lober,Grethe S Tell,Ellen M Apalset,Roy M Nilsen,Jan-Erik Gjertsen,Pawel Mielnik

doi:10.1186/s12891-020-03842-w

Abstract

BackgroundIt is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures.MethodsIn this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex).ResultsPatients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture.ConclusionsDistal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

Highlights

It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between bone mineral density (BMD) and radiographically verified complexity of distal radius fractures are scarce
We found that 45.0% (n = 130) of patients with distal radius fracture had osteoporosis and 33% (n = 95) had osteopenia (Table 1)
The patients with osteoporosis differed from the patients with osteopenia/ normal BMD at a group level by having a statistically lower body mass index (BMI) (BMI 26 vs 27, p-value 0.005), being older, a greater percentage were female (88% vs 75%, p-value 0.01), and there was a higher prevalence of current smoking (18% vs 13%, p-value 0.1)

Summary

Introduction

It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures. Distal radius fractures are closely related to low bone mineral density (BMD) [4], and risk factors for fracture include increasing age, female sex, low body mass index (BMI), smoking, postmenopausal status, low intake of dairy products, vitamin D deficiency, and autoimmune comorbidities. Patients sustaining a distal radius fracture have an increased risk of a major osteoporotic fracture (MOF) of the hip and vertebrae later in life [5, 6]. According to guidelines of fracture liaison services, a low energy fracture in an atrisk patient (e.g. > 50 years old) should lead to further examination with dual-energy x-ray absorptiometry (DXA) and treatment with anti-osteoporotic drugs if indicated [7]

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