Patient-related outcome, fracture displacement and bone mineral density following distal radius fracture in young and older men

Lisa Egund,Fiona E Mcguigan,Kristina E Åkesson,Niels Egund,Jack Besjakov

doi:10.1186/s12891-020-03843-9

Abstract

BackgroundDistal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied.ObjectiveTo describe patient-reported outcome and the association with bone integrity, fracture severity and future fracture risk among young and older men with distal radius fracture.MethodsThis prospective study includes 133 men with acute distal radius fracture, mean age 54 (range 21–88), who were followed for 12 months. They were categorized as younger (< 65) and older (65+). Main outcome was DASH (Disability of the Arm, Shoulder and Hand) at 12 months; DASH > 15 was defined as poor outcome. Fractures were classified and radiographic displacement identified at initial presentation and follow-up. BMD was measured and FRAX 10-year probability of fracture calculated.ResultsDisability was higher in older men (DASHmedian 10 vs 2; p = 0.002); a clinically meaningful difference (ΔDASH = 10, p = 0.017) remained after adjustment for displacement, fracture classification and treatment method. Almost 50% of older men vs 14% in younger had poor outcome, p < 0.001. Bone mineral density did not independently predict outcome. Older men with a displaced fracture at initial presentation had greater disability (DASHmedian, IQR 45, 14;73) and risk of fracture (FRAXmajor osteoporotic 14, 8;21).ConclusionMen over the age of 65 with a distal radius fracture are more likely to have post-fracture disability regardless of radiographic appearance. Fracture displacement, indicating impaired bone strength, is also more common and associated with an increased risk of fracture within 10-years. Secondary fracture prevention should therefore be considered in men presenting with distal radius fracture.

Highlights

Distal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied
The significance of the distal radius fracture lies in the fact that it is a “signal fracture” being predictive of osteoporosis and future fracture risk, among post-menopausal women who have the highest incidence of this fracture [2, 3]
While women have been extensively studied, men are either not included or constitute a minority in most studies [4,5,6]. To address this paucity of studies, and the gaps in knowledge related to osteoporosis in males with distal radius fracture, our studies have focused solely on men

Summary

Introduction

Distal radius fractures can adversely affect wrist function; for men with this fracture, the role played by fracture severity, age and osteoporosis on fracture outcome has not been sufficiently studied. The distal radius fracture is already the most common fracture and incidence is increasing with the demographic shift towards an aging population [1]. While women have been extensively studied, men are either not included or constitute a minority in most studies [4,5,6]. To address this paucity of studies, and the gaps in knowledge related to osteoporosis in males with distal radius fracture, our studies have focused solely on men. Assessment of future fracture risk often is neglected in men [9]

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Results

Discussion

Conclusion