J Korean Orthop Assoc.  2011 Dec;46(6):464-471.

The Incidence of Osteoporosis and the Necessity of Bone Mineral Density Measurement in Distal Radius Fractures by Minor Trauma

• Heo YM
• Kim SB
• Yi JW
• Lee JB
• Lee JY
• Lim JW
• Ryu SK

Abstract

PURPOSE
In this study, we examined the incidence of osteoporosis and the related factors in distal radius fractures (DRFs) caused by minor trauma, as well as the necessity of a bone mineral density (BMD) measurement.
MATERIALS AND METHODS
One hundred and sixty patients, who had their BMD measured after DRFs caused by minor trauma, were enrolled in this study. The BMD was measured at the lumbar spine and proximal femur by dual energy X-ray absorptiometry. The BMD values were categorized as normal, osteopenia and osteoporosis by the WHO T-score criteria and each incidence was investigated. The BMD values were compared with the change of age and among age-based groups. The relationship between the BMD and factors such as age, gender, body mass index, or AO classifi cation were assessed. The agreement in BMD values between the lumbar spine and proximal femur was evaluated.
RESULTS
The incidence of osteoporosis in DFRs by minor trauma was 74%. The minimum BMD in the DRFs had a negative correlation with age. Signifi cant differences in the BMD values were observed between the groups divided by the 10-year-old intervals (p<0.001) but the differences in the groups aged over 60 were signifi cantly lower than those under the age of 60 (p<0.001). There was a close relationship between the BMD values and the patients' age (p<0.001), but not between the BMD values and the AO classifi cation (p=0.670). The simple agreement between the lumbar spine and proximal femur was 0.619, but the Kappa index was 0.305.
CONCLUSION
Because the incidence of osteoporosis in the DRFs by minor trauma is relatively high, it is necessary to measure the BMD. The BMD should be measured at more than two body parts to ensure that osteoporosis accompanied by DRFs is not missed.

Keyword

distal radius; fracture; osteoporosis; bone mineral density

MeSH Terms

Absorptiometry, Photon
Aged
Body Mass Index
Bone Density
Bone Diseases, Metabolic
Child
Dietary Sucrose
Femur
Human Body
Humans
Incidence
Osteoporosis
Radius
Radius Fractures
Spine
Dietary Sucrose

Figure

• 

  Figure 1 Changes of the bone mineral density (BMD) according to the change in age. The examination was measured at both lumbar spine (L1-L4) and proximal femur (neck, wards, and trochanter). Graphs show results measured at (A) both spine and femur, (B) spine and (C) proximal femur.

Reference

1. Wigderowitz CA, Cunningham T, Rowley DI, Mole PA, Paterson CR. Peripheral bone mineral density in patients with distal radial fractures. J Bone Joint Surg Br. 2003. 85:423–425.

2. Hung LK, Wu HT, Leung PC, Qin L. Low BMD is a risk factor for low-energy Colles' fractures in women before and after menopause. Clin Orthop Relat Res. 2005. (435):219–225.

3. Mallmin H, Ljunghall S, Persson I, Bergström R. Risk factors for fractures of the distal forearm: a population-based case-control study. Osteoporos Int. 1994. 4:298–304.

4. Earnshaw SA, Cawte SA, Worley A, Hosking DJ. Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int. 1998. 8:53–60.

5. Cuddihy MT, Gabriel SE, Crowson CS, O'Fallon WM, Melton LJ 3rd. Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int. 1999. 9:469–475.

6. Löfman O, Hallberg I, Berglund K, et al. Women with low-energy fracture should be investigated for osteoporosis. Acta Orthop. 2007. 78:813–821.

7. Mallmin H, Ljunghall S. Distal radius fracture is an early sign of general osteoporosis: bone mass measurements in a population-based study. Osteoporos Int. 1994. 4:357–361.

8. Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH. Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am. 2009. 91:2376–2380.

9. Freedman BA, Potter BK, Nesti LJ, Cho T, Kuklo TR. Missed opportunities in patients with osteoporosis and distal radius fractures. Clin Orthop Relat Res. 2007. 454:202–206.

10. Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am. 2008. 90:953–961.

11. Lee JO, Chung MS, Baek GH, Oh JH, Lee YH, Gong HS. Age- and site-related bone mineral densities in Korean women with a distal radius fracture compared with the reference Korean female population. J Hand Surg Am. 2010. 35:1435–1441.

12. Kanterewicz E, Yañez A, Pérez-Pons A, et al. Association between Colles' fracture and low bone mass: age-based differences in postmenopausal women. Osteoporos Int. 2002. 13:824–828.

13. Hegeman JH, Oskam J, van der Palen J, Ten Duis HJ, Vierhout PA. The distal radial fracture in elderly women and the bone mineral density of the lumbar spine and hip. J Hand Surg Br. 2004. 29:473–476.

14. Shin A, Choi JY, Chung HW, et al. Prevalence and risk factors of distal radius and calcaneus bone mineral density in Korean population. Osteoporos Int. 2004. 15:639–644.

15. Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N. The diagnosis of osteoporosis. J Bone Miner Res. 1994. 9:1137–1141.

16. Korea health statistics 2009: Korea national health and nutrition examination survey. 2009. IV-3:528–533.

17. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007. 22:465–475.

18. Tuck SP, Raj N, Summers GD. Is distal forearm fracture in men due to osteoporosis? Osteoporos Int. 2002. 13:630–636.

19. Bahari S, Morris S, Lenehan B, McElwain JP. "Osteoporosis and orthopods" incidences of osteoporosis in distal radius fracture from low energy trauma. Injury. 2007. 38:759–762.

20. Øyen J, Rohde GE, Hochberg M, Johnsen V, Haugeberg G. Low-energy distal radius fractures in middle-aged and elderly women-seasonal variations, prevalence of osteoporosis, and associates with fractures. Osteoporos Int. 2010. 21:1247–1255.

21. Øyen J, Gjesdal CG, Brudvik C, et al. Low-energy distal radius fractures in middle-aged and womenthe burden of osteoporosis and fracture risk. A study of 1794 consecutive patients. Osteoporos Int. 2010. 21:1257–1267.

22. Wigderowitz CA, Rowley DI, Mole PA, Paterson CR, Abel EW. Bone mineral density of the radius in patients with Col les' fracture. J Bone Joint Surg Br. 2000. 82:87–89.

23. Gay JD. Radial fracture as an indicator of osteoporosis: a 10-year follow-up study. Can Med Assoc J. 1974. 111:156–157.

24. Olschewski E, Murray P, Buckley R, Fennell C, Powell JN. Assessment of osteoporosis using standard radiographs of the wrist. J Trauma. 2001. 51:912–916.

25. Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009. 91:613–619.

26. Sakai A, Oshige T, Zenke Y, Suzuki M, Yamanaka Y, Nakamura T. Association of bone mineral density with deformity of the distal radius in low-energy Colles' fractures in Japanese women above 50 years of age. J Hand Surg Am. 2008. 33:820–826.

27. Xie X, Bärenholdt O. Bone density and geometric properties of the distal radius in displaced and undisplaced Colles' fractures: quantitative CT in 70 women. Acta Orthop Scand. 2001. 72:62–66.

28. Kettler M, Kuhn V, Schieker M, Melone CP. Do We need to include osteoporosis in today's classification of distal radius fractures? J Orthop Trauma. 2008. 22:8 Suppl. S79–S82.

29. Owen RA, Melton LJ 3rd, Ilstrup DM, Johnson KA, Riggs BL. Colles' fracture and subsequent hip fracture risk. Clin Orthop Relat Res. 1982. (171):37–43.

30. Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med. 2001. 161:1309–1312.