Fracture of the distal forearm as a forecaster of subsequent hip fracture: A population-based cohort study with 24 years of follow-up

Mallmin, Hans; Ljunghall, Sverker; Persson, Ingemar; Naessén, Tord; Krusemo, Ulla Brith; Bergström, Reinhold

doi:10.1007/bf00296650

Cited by 246 publications

(158 citation statements)

References 23 publications

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“…In addition to their own associated morbidity and costs, distal radial fractures can be considered sentinel events as they are associated with an estimated 2 to 4 times increased risk of subsequent hip fractures among older adults [23][24][25][26] . If these patients could be identified prior to wrist fracture or more severe injury, interventions to improve postural control could be implemented.…”

Section: Discussionmentioning

confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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Background: The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. Methods: This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. Results: There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. Conclusions: Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Postural Stability in Older Adults with a Distal Radial Fracture

Louer

Boone

Guthrie

et al. 2016

The Journal of Bone and Joint Surgery

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“…In adults, forearm fractures are associated with bone health deficits, including lower bone mineral density (BMD), and are predictors of future osteoporosis-related fractures. [7][8][9][10] Similarly, studies of predominantly healthy white children with forearm fractures demonstrate an association with lower BMD relative to peers without forearm fractures. [11][12][13][14][15][16] Other factors associated with forearm fracture risk in white children include low dietary calcium intake, 17 low dietary milk intake, 17 and high BMI.…”

mentioning

confidence: 97%

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Ryan¹,

Teach²,

Singer

et al. 2012

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Forearm fractures are unique injuries which are associated with lower bone mineral density in adults and white children. The relationships among bone mineral density, 25-hydroxyvitamin D status, and risk for forearm fracture have not been investigated in African American children. WHAT THIS STUDY ADDS:Our data support an association between both lower bone mineral density and vitamin D deficiency and increased odds of forearm fracture in African American children. Promotion of bone health is indicated in this population.abstract OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level #20 ng/mL) compared with fracture-free control patients. METHODS:This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS:The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 6 0.96 vs 0.98 6 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS:These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits. Pediatrics 2012;130:e553-e560

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“…Great differences in turnover between different bones and regions within bones place constraints on the capacity of biochemical indices to capture the behavior of the overall skeleton from a single bone site. However, a prior forearm fracture has been shown to be associated with an approximately twofold increase in the likelihood of a subsequent hip, radial or humeral fracture [15][16][17][18][19][20]. Thus, measurements of cortical bone density and content at the radius and tibia could potentially be applicable in the prediction of hip fracture risk.…”

Section: Discussionmentioning

confidence: 99%

Cortical and trabecular bone at the radius and tibia in postmenopausal breast cancer patients: A Peripheral Quantitative Computed Tomography (pQCT) study

Szabo

Webber

Adachi

et al. 2011

Bone

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Bone morbidity associated with antineoplastic treatment is a significant health concern for postmenopausal breast cancer patients. Trials have demonstrated that adjuvant therapy with an Aromatase Inhibitor is associated with an increase in musculoskeletal disorders and bone fractures. The objective of this study was to utilize Peripheral Quantitative Computed Tomography (pQCT) to assess in vivo trabecular and cortical volumetric bone at peripheral skeletal sites in healthy postmenopausal women and breast cancer patients prescribed Anastrozole. Fifty-eight women were recruited for this study: 27 breast cancer patients and 31 healthy control participants. pQCT measurements were taken at distal and diaphyseal sites of the radius and tibia using a Stratec XCT-2000 pQCT scanner. Bone measurement values for total density and total content at the 4% radius; total and cortical content as well as cortical density at the 20% radius; total density at the 4% tibia; and cortical density at the 38% tibia were found to be significantly lower in breast cancer patients. Moreover, the duration of time on Anastrozole showed a significant negative correlation with the following measurements: total content at the 4% radius (r=−0.36, p<0.01); total content (r=−0.33, p<0.05), cortical content (r=−0.34, p<0.05) and cortical density (r=−0.44, p<0.01) at the 20% radius; as well as cortical density (r=−0.39, p<0.01) and cortical content (r= −0.27, p<0.05) at the 38% tibia. Overall, the breast cancer patients demonstrated significantly lower values for volumetric bone density and content at the radius and tibia compared with healthy postmenopausal women. Furthermore, this novel study found adverse effects from Anastrozole treatment primarily in cortical bone.

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Fracture of the distal forearm as a forecaster of subsequent hip fracture: A population-based cohort study with 24 years of follow-up

Abstract: Patients with a fracture of the distal forearm run an increased risk of sustaining a subsequent hip fracture. They therefore appear to constitute a group in which appropriate prophylactic measures against osteoporosis and fractures should be considered.

Cited by 246 publications

References 23 publications

Postural Stability in Older Adults with a Distal Radial Fracture

Postural Stability in Older Adults with a Distal Radial Fracture

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Cortical and trabecular bone at the radius and tibia in postmenopausal breast cancer patients: A Peripheral Quantitative Computed Tomography (pQCT) study

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