Original Research

Prevalence of Low Bone Mineral Density in Younger Versus Older Women With Distal Radius Fractures

Am J Orthop. 2015 December;44(12):E493-E496

References

1. US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: US Dept of Health and Human Services, Public Health Service, Office of the Surgeon General; 2004. http://www.ncbi.nlm.nih.gov/books/NBK45513/pdf/Bookshelf_NBK45513.pdf. Accessed November 3, 2015.

2. Bone mass measurement (bone density). Medicare website. https://www.medicare.gov/coverage/bone-density.html. Accessed November 3, 2015.

3. Final update summary: osteoporosis: screening. US Preventive Services Task Force website. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/osteoporosis-screening. Updated July 2015. Accessed November 3, 2015.

4. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010. http://nof.org/files/nof/public/content/file/344/upload/159.pdf. Accessed November 3, 2015.

5. Khan AA, Bachrach L, Brown JP, et al. Canadian Panel of International Society of Clinical Densitometry. Standards and guidelines for performing central dual-energy x-ray absorptiometry in premenopausal women, men, and children. J Clin Densitom. 2004;7(1):51-64.

6. Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen YT, Markson LE. Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int. 2008;19(5):607-613.

7. Lauritzen JB, Schwarz P, Lund B, McNair P, Transbøl I. Changing incidence and residual lifetime risk of common osteoporosis-related fractures. Osteoporos Int. 1993;3(3):127-132.

8. Earnshaw SA, Cawte SA, Worley A, Hosking DJ. Colles’ fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int. 1998;8(1):53-60.

9. Oyen J, Brudvik C, Gjesdal CG, Tell GS, Lie SA, Hove LM. Osteoporosis as a risk factor for distal radius fractures: a case–control study. J Bone Joint Surg Am. 2011;93(4):348-356.

10. Wigderowitz CA, Cunningham T, Rowley DI, Mole PA, Paterson CR. Peripheral bone mineral density in patients with distal radial fractures. J Bone Joint Surg Br. 2003;85(3):423-425.

11. Wigderowitz CA, Rowley DI, Mole PA, Paterson CR, Abel EW. Bone mineral density of the radius in patients with Colles’ fracture. J Bone Joint Surg Br. 2000;82(1):87-89.

12. Khan A, Syed Z. Bone mineral density assessment in premenopausal women. Womens Health. 2006;2(4):639-645.

13. Fitzpatrick LA. Secondary causes of osteoporosis. Mayo Clin Proc. 2002;77(5):453-468.

14. Hudec SM, Camacho PM. Secondary causes of osteoporosis. Endocr Pract. 2013;19(1):120-128.

15. Scane AC, Sutcliffe AM, Francis RM. Osteoporosis in men. Baillieres Clin Rheumatol. 1993;7(3):589-601.

16. Binkley N, Bilezikian JP, Kendler DL, Leib ES, Lewiecki EM, Petak SM. Summary of the International Society for Clinical Densitometry 2005 Position Development Conference. J Bone Miner Res. 2007;22(5):643-645.

17. Kelepouris N, Harper KD, Gannon F, Kaplan FS, Haddad JG. Severe osteoporosis in men. Ann Intern Med. 1995;123(6):452-460.

Secondary causes of osteoporosis have been documented in 30% of premenopausal women and 55% of men with vertebral fractures.^13-15 Primary osteoporosis results from the normal aging process; secondary osteoporosis results from reversible causes, including medications, gastrointestinal disorders, renal disease, endocrine disorders, and sedentary lifestyle.^15,16 When a secondary cause of osteoporosis is identified, treatment can be initiated to increase BMD. As younger patients can reverse bone loss and even increase BMD, it is important to identify reversible causes of osteopenia and osteoporosis in this age group. It is well documented that both younger and older patients with DRFs are at increased risk for subsequent fractures.⁶ Preventing further bone loss at a younger age may drastically decrease lifetime fracture risk.^12,17

Most previous studies of BMD in women were limited to patients with DRFs caused by a low-energy mechanism or by a fall from standing. Current recommendations for BMD testing focus on postmenopausal women who have sustained a fragility or low-energy DRF. When an osteoporotic or osteopenic patient’s distal radius is subjected to a high-energy force, a fracture is likely. Therefore, we expanded our study to include high-energy mechanisms of injury. Our analysis of BMD in patients with DRFs sustained in MVCs indicated that 12% of this group were osteoporotic, and 44% were osteopenic. Forty-three percent of our younger patients with a DRF fractured in a MVC were osteopenic, and 6% were osteoporotic. Among 4 mechanisms of injury for DRFs, there was no statistically significant difference in z scores (P = .22) (Figure 2). This provides evidence that a significant portion of patients with DRFs from both high- and low-energy mechanisms are osteoporotic or osteopenic. Patients with DRFs sustained in MVCs or in falls from heights of more than 6 feet should be referred for BMD evaluation.

Conclusion

A significant proportion of younger patients with DRFs are osteopenic or osteoporotic (43% and 6%, respectively), and their z scores are comparable to those of older patients with DRFs. There was no statistically significant difference in BMD z scores between younger and older patients and no difference in mechanisms of injury. This is evidence that younger patients with DRFs caused by a high- or low-energy mechanism of injury should undergo both DXA scan and BMD evaluation. If osteoporosis or osteopenia can be diagnosed at an earlier age, and if these patients can be properly treated, subsequent fractures could be prevented. The present study provides evidence supporting a simplification of the current recommendations for BMD evaluation: All women with DRFs should undergo bone densitometry.