Of all orthopedic injuries, wrist fractures are among the most common. One particular type of wrist fracture affects the end, or distal, part of the radius and a recent study reported that distal radius fractures comprise 16.4% of all fractures. Indeed, all fragility fractures, of which distal radius fractures are one type, are increasing in part because our aging patient population is staying physically active further into their golden years. With how common these injuries are it is 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.
Unfortunately, the incidence of bone density-related distal radius fractures will likely increase with our aging population. 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 distal radius 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. recently described 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 identify osteoporotic patients. For me, this new screening tool is an excellent way to identify distal radius fracture patients at risk for osteoporosis.
Choosing the correct patient specific wrist fracture treatment 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 features in a patient’s history, e.g. hand dominance, activity level, and age.
Recent research on patients with osteoporosis and distal radius fractures shows the osteoporotic patient 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.
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. Ask your surgeon about your specific distal radius fracture to see if it meets the radiographic criteria for surgery. Also, I recommend sharing your pre-injury activity level, whether that be playing tennis or gardening, as this can help surgeons understand your expectations of what the wrist should do after treatment. The best results always come from the best surgeon/patient relationships and communication is key.