Orthopedists should suspect osteoporosis in patients with low-trauma wrist fractures

CHICAGO — Orthopedic surgeons treating low-trauma fragility wrist fractures should be aware of the possibility of underlying osteoporosis and educate and refer the patient for testing, according to a study presented here.

Canadian investigators retrospectively reviewed 590 wrist fractures, of which 532 (90%) in 451 women and 81 men were characteristic of fragility fractures.

“The data were collected in an urban teaching hospital and in a community hospital,” Jennifer Ingram, MD, FRCPC, said.

Ingram made her comments during a presentation at the 63rd Annual Meeting of the American Society for Surgery of the Hand, here.

The mean age for patients in the study was 66.7 years. Of the patients with fragility fractures, 16% of the men and 37% of the women had previously been diagnosed with osteoporosis or osteopenia, she said.

Also, 15 men and 225 women in that group had bone mineral density testing, and 81% of the men and 93% of the women were reported to be on calcium, vitamin D and in some cases bisphosphonate supplements, Ingram said.

“The results that we obtained on wrist fractures returned a signal on prior fragility fractures, which I think was a little stronger than we expected,” she said. “In that, 132 had reported prior fragility fractures.”

The data also indicated a need for some form of education, she said. “Of those previously diagnosed with osteoporosis, only 63% thought their bones were thin. The rest did not.”

Also, only 8% of those who did not have an osteoporosis diagnosis previously were able to link their bone health and their fracture, she said.

“Surgeons are often the first and only physicians who may see some of these patients. Therefore, you have the unique opportunity to be a primary advocate to review bone health,” Ingram said.

“The key message that we are hoping you will bring to your patients is that their fracture may be related to osteoporosis, and that having a fragility fracture puts you in a much higher risk of having a hip fracture or another fragility fracture. Fortunately, the preventative treatment is simple effective and safe,” she added.

In reviewing the paper, Arnold-Peter C. Weiss, MD, questioned the investigators’ determinations of which patients had fragility fractures. However, “Sometimes as hand surgeons, we look at the broken part and don’t think about the patient. It behooves all of us to change our mindset,” Weiss said.

For more information:
Ingram J. Osteoporosis management in patients with a fragility fracture of the wrist. Paper 34. Presented at the 63rd Annual Meeting of the American Society for Surgery of the Hand. Sept. 18-20, 2008. Chicago.