Forearm Fractures as Predictors of Subsequent Osteoporotic Fractures

Cuddihy, Maria-Teresa; Gabriel, Sherine E.; Crowson, Cynthia S.; O’Fallon, W. Michael; Melton, L. Joseph

doi:10.1007/s001980050172

Cited by 332 publications

(158 citation statements)

References 43 publications

(40 reference statements)

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“…It is estimated that a vertebral fracture increases by 4-to 5-fold the risk of a further vertebral fracture [7][8][9]. A doubling of the risk of a hip fracture is also expected after a vertebral fracture [10][11][12], or after a fracture of the proximal humerus or distal forearm [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

Chevalley¹,

Hoffmeyer

Bonjour³

et al. 2002

Osteoporos Int

157

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Patients with an osteoporotic fracture have at least a 2-fold risk for additional fracture and should benefit from targeted diagnostic and treatment procedures for osteoporosis. To address this issue, we set up an osteoporosis clinical pathway (OCP) for the medical management of patients with low-trauma fracture. Following acute management of the fracture by the orthopedic team, patients are enrolled in the pathway, which is based on an interaction between the OCP multidisciplinary team, orthopedic surgeons and/or primary care physicians. After collection of patient data, suggestions for additional diagnostic examinations with their interpretation, and treatment proposals are made. Patients and their families are also invited to attend a multidisciplinary interactive educational program on physical therapy, lifestyle habits and nutrition. During a 36-month period, 385 patients (311 women, 74 men; mean age +/- SD: 73.0 +/- 13.5 years; hip fracture 45%, ankle/tibia 24%, proximal humerus 8.6%, spine 5.5%, pelvis 3.9%, distal forearm 3.6%, other sites 17.4%) were enrolled in the OCP. An osteoporosis awareness questionnaire administered within 10 days of fracture showed that 73% of patients believed that their fracture was not related to the disease. Dual-energy X-ray absorptiometry, performed in 63% of patients, showed that 86% had low bone mass or osteoporosis. Specific antiosteoporotic therapy was proposed for 33% of patients in addition to calcium and vitamin D supplements, the latter suggested for 93%. A survey performed in 216 patients 6 months later, indicated that 63% of the suggested treatments had been prescribed and that 67% of this group were continuing treatment. Such a clinical pathway for the medical management of low-trauma fracture can help to identify patients with osteoporosis in a high-risk population, provide support to the orthopedic surgeon and/or the primary care physician for diagnostic and treatment procedures, and should significantly contribute to increase awareness of the disease in patients and their families.

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Section: Introductionmentioning

confidence: 99%

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

Chevalley¹,

Hoffmeyer

Bonjour³

et al. 2002

Osteoporos Int

157

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“…In women, low-trauma distal forearm fracture is widely regarded as a typical early manifestation of postmenopausal osteoporosis [7,8]. Indeed, 50% of women who suffer a distal forearm fracture of Colles' type will have osteoporosis [9].…”

Section: Introductionmentioning

confidence: 99%

Is Distal Forearm Fracture in Men due to Osteoporosis?

2002

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Although widely regarded as a disease of women, osteoporosis does cause considerable morbidity and mortality in men. The lifetime risk of an osteoporortic fracture for a man is 1 in 12 and 30% of all hip fractures occur in men. In women, low-trauma distal forearm fracture is widely regarded as a typical early manifestation of postmenopausal osteoporosis. Traditionally, this has not been thought to be the case for men. We present a case-control study of 147 men with distal forearm fracture compared with 198 age-matched controls. The controls were selected from a pre-existing database of dual-energy X-ray absorptiometry scans of healthy volunteers. Both groups were sent questionnaires regarding basic demographics, fracture history and risk factors for osteoporosis, and the fracture group was asked to attend for bone densitometry. There were 103 responses from the fracture group (70%), of whom 67 (47%) underwent densitometry. There were 165 (83%) responses from the control group. Secondary causes of osteoporosis could be identified in 51% of the fracture group and 37% of the control group. The fracture group had significantly lower bone mineral density at all sites measured compared with the controls (0.75 g/cm(2) vs 0.85 g/cm(2) at the femoral neck, p<0.0001; 0.95 g/cm(2) vs 1.03 g/cm(2) at the total femur, p = 0.001; and 0.99 g/cm(2) vs 1.06 g/cm(2) at the lumbar spine, p = 0.001). These differences remained after adjusting for age and body mass index ( p<0.0005 at all sites). Overall, 41.8% of the fracture group were osteoporotic in at least one site ( T-score <-2.5 SD below the mean for young men) compared with only 10.3% of controls. This study is the first to demonstrate that men with distal forearm fractures have lower bone mineral density than their peers and a higher risk of osteoporosis.

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“…The study conducted in Rochester, Minnesota, has also been used to ascertain the ability of distal forearm fractures to predict future fractures [27]. Among residents who experienced their first distal forearm fracture at the age of 35 years or older, excluding fractures that occurred on the same day as an index forearm fracture, hip fracture risk was increased 1.4-fold in women (95% CI, 1.1–1.8) and 2.7-fold in men (95% CI, 0.98–5.8).…”

Section: Epidemiology Of Fracturesmentioning

confidence: 99%

“…In a population-based, retrospective cohort study in Rochester, Minnesota, USA, residents younger than 70 years of age who were radiologically diagnosed with one or more vertebral deformities were followed up for the development of subsequent limb fractures [27]. The standardized morbidity ratios of observed to expected fractures were 1.7 (95% confidence interval [CI], 1.3–2.2) for the hip, 1.4 (95% CI, 1.0–1.8) for the forearm and 1.5 (95% CI, 1.3–1.8) for any limb fracture.…”

Section: Epidemiology Of Fracturesmentioning

confidence: 99%

Epidemiology of Osteoporotic Fractures

Dennison

Cooper²

2000

Horm Res Paediatr

124

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Osteoporosis constitutes a major public health problem through its association with age-related fractures. These fractures typically occur at the hip, spine and distal forearm. It has been estimated that the lifetime risk of a hip fracture in white women is 17.5%, with a comparable risk in men of 6%. Hip fractures lead to an overall reduction in survival of about 15% (relative or observed/expected survival at 5 years of 0.83), and the majority of excess deaths occur within the first 6 months following the fracture. Such fractures are also associated with considerable morbidity. Although all vertebral deformities do not come to clinical attention, the lifetime risk of clinically diagnosed vertebral fractures is about 15% in white women. Vertebral fractures tend to be associated with back pain and kyphosis, and also with an impairment of survival, though this is likely to be due to clustering of comorbidity. About one-quarter of clinically diagnosed vertebral deformities result in hospitalization.

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Forearm Fractures as Predictors of Subsequent Osteoporotic Fractures

Cited by 332 publications

References 43 publications

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

An Osteoporosis Clinical Pathway for the Medical Management of Patients with Low-Trauma Fracture

Is Distal Forearm Fracture in Men due to Osteoporosis?

Epidemiology of Osteoporotic Fractures

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