Significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines, according to a study published November 5 in Journal of Bone & Joint Surgery.
Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications,” said study investigator Tamara Rozental, MD, Associate Professor of Orthopaedic Surgery, Harvard Medical School in Boston, Massachusetts.
Tamara Rozental, MD
In this study, researchers reviewed the medical records of 95 men and 344 women older than 50, who were treated for a wrist fracture at a single institution between 2007 and 2012. Data collected included age, mechanism of injury, fracture severity, associated comorbidities, and type of treatment. Fractures were classified according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification system. Comorbidities were estimated with use of the Charlson comorbidity index (CCI), providing a weighted score to predict short and long-term outcomes, taking into account the number and severity of predefined comorbid conditions. The WHO online Fracture Risk Assessment Tool (FRAX) was used to estimate the 10-year risk of major osteoporotic fractures in men.
Patient injuries were assessed to determine whether or not they were screened for osteoporosis before their injury and/or if they received a dual-energy x-ray absorptiometry scan and osteoporosis treatment within six months following their wrist fracture.
Fewer men than women underwent bone mass density testing prior to their fracture. Following the wrist fracture, the number of men undergoing osteoporosis assessment continued to be lower, 184 (53%) of women versus 17 (18%) of men.
Study findings also indicate:
• Twenty-one percent of men compared with 55% of women initiated treatment with calcium and vitamin D supplements within six months of injury, and 3% of men versus 22% of women started taking bisphosphonates.
• Using the World Health Organization (WHO) online Fracture Risk Assessment Tool (FRAX), 50% of men who obtained a bone density test were deemed at risk for a second major osteoporotic fracture in the next decade.
• Male sex, less severe fracture patterns and high-energy mechanism of injury were independent predictors of failure to initiate treatment with calcium and vitamin D.
• Overall, the men had less severe fractures than women with 20% of the men and 40% of the women in the study having a “Type-C” fracture.
“The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo bone density testing and evaluation with the FRAX algorithm to better identify those at high risk for future fracture and those who would benefit from further treatment,” said Dr. Rozental.