Of all orthopedic injuries, wrist fractures are among the most common, and one particularly common fracture affects the distal radius. A recent study reported that distal radius fractures comprise 16.4% of all fractures. This statistic can be a bit misleading because all fragility fractures, including distal radius fractures, are increasing in part because our aging patient population is staying physically active. Without additional demographic information it’s hard to know if these distal radius fractures occur in young patients or older patients. If our suspicions that an increasingly active elderly population is contributing to the frequency of distal radius fractures, it’s important to know how poor bone density, otherwise known as osteoporosis, may affect the treatment of distal radius fractures. With that in mind, let’s review what we know about osteoporosis and wrist fractures.
How are osteoporosis and wrist fractures related?
Unfortunately, the incidence of bone density-related distal radius fractures will likely increase with our aging population. Our group, Proliance Hand, Wrist & Elbow Physicians, explores distal radius fractures as a larger group of fragility fractures in this blog post about osteoporosis.
Many patients who experience fragility fractures are undergoing osteoporosis treatment prescribed by their primary care doctor. For other patients, a wrist fracture is the first suggestion that there may be a bone health problem.
An osteoporosis evaluation is recommended for patients older than 50 who sustain a wrist fracture after a low energy trauma, such as a fall from a standing height. The gold standard for diagnosing osteoporosis has long been the DEXA scan. Shreiber et al. describe another osteoporosis diagnosis method using standard wrist radiographs which measures the second metacarpal cortical percentage (2MCP). The 2MCP method is easily implemented and can reliably identifies osteoporotic patients. For me, this new screening tool is an excellent way to identify distal radius fracture patients at risk for osteoporosis.
I know about osteoporosis but how does it affect my wrist fracture?
Choosing the right treatment option is of the upmost importance. National guidelines give surgeons radiographic criteria to support different treatment options. In my practice the decision for treatment is patient-specific based on radiographic features as well as the patient’s history, e.g. (hand dominance, activity level, and age).
Recent research on patients with osteoporosis and distal radius fractures shows this patient population is more prone to larger fracture displacement than patients without osteoporosis. Researchers documented a 1.4mm increase in ulnar variance, meaning the distal radius collapses, after 6 weeks of conservative management of all distal radius fractures with an additional 1.2mm on average in patients with poor bone mineral density via 2MCP as well. While radiographic parameters do not correlate exactly with clinical outcomes, this knowledge is useful for helping surgeons best advise patients who are carefully considering conservative or surgical management, especially as more patients are more active later in life.
So what should I do?
It can be complicated to decide which treatment option, conservative or surgical, is best for you. Your surgeon can help guide decision making for you and your distal radius fracture.
