Skip to main content
SpringerLink
Log in

Osteoporosis care after distal radius fracture reduces subsequent hip or spine fractures: a 4-year longitudinal study

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

We evaluated whether active osteoporosis care in patients experiencing their first distal radius fracture (DRF) reduces subsequent hip or spine fractures by comparing two cohorts. The incidence of subsequent fractures was significantly lower in the active care cohort than the other cohort in 4-year follow-up.

Purpose

Studies show that osteoporosis care in patients with osteoporotic fracture reduces subsequent fractures, but the impact of such active care in patients with distal radius fracture (DRF) has not been well studied. We evaluated how much osteoporosis care in patients experiencing their first DRF can reduce subsequent hip or spine fractures at 4-year follow-up.

Methods

Active osteoporosis care by orthopedic surgeons for patients with DRF started from September 2009 at our institution, thus we had a unique opportunity to compare the two cohorts: pre-involvement (PreI) group (DRF before September 2009) and post-involvement (PostI) group (DRF from September 2009). We compared the two cohorts for subsequent hip or spine fracture incidence in the 4 years following DRF.

Results

Overall, 1057 patients with a DRF (85% women; mean age, 70 years) were studied, of whom 205 patients were in PreI group and 852 in PostI group. Subsequent fractures occurred in 27 patients (2.6%), with a mean interval of 29 months after DRF. The incidence was significantly lower in the PostI group than in the PreI group (1.9% vs. 5.4%, p = 0.004), especially in hip fractures (0.4% vs. 2.9%, p = 0.002). The relative risk reduction was 65% for all subsequent fractures and 86% for hip fractures.

Conclusion

This study demonstrates that active osteoporosis care in patients with DRF significantly reduces subsequent fracture incidence even for the 4-year follow-up period. These findings add an evidence for the current proactive osteoporosis care programs such as fracture liaison services.

Level of evidence

Therapeutic level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Black DM, Cooper C (2000) Epidemiology of fractures and assessment of fracture risk. Clin Lab Med 20:439–453

    Article  CAS  Google Scholar 

  2. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res 22:465–475. https://doi.org/10.1359/jbmr.061113

    Article  PubMed  Google Scholar 

  3. Chen CW, Huang TL, Su LT, Kuo YC, Wu SC, Li CY, Chen KB, Sung FC (2013) Incidence of subsequent hip fractures is significantly increased within the first month after distal radius fracture in patients older than 60 years. J Trauma Acute Care Surg 74:317–321

    Article  Google Scholar 

  4. Crandall CJ, Hovey KM, Cauley JA, Andrews CA, Curtis JR, Wactawski-Wende J, Wright NC, Li W, LeBoff MS (2015) Wrist fracture and risk of subsequent fracture: findings from the women's health initiative study. J Bone Miner Res 30:2086–2095. https://doi.org/10.1002/jbmr.2559

    Article  PubMed  PubMed Central  Google Scholar 

  5. Barrett-Connor E, Sajjan SG, Siris ES, Miller PD, Chen YT, Markson LE (2008) Wrist fracture as a predictor of future fractures in younger versus older postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 19:607–613. https://doi.org/10.1007/s00198-007-0508-8

    Article  CAS  PubMed  Google Scholar 

  6. Lauritzen JB, Schwarz P, McNair P, Lund B, Transbol I (1993) Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation. Osteoporos Int 3:133–137

    Article  CAS  Google Scholar 

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

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Khosla S, Cauley JA, Compston J, Kiel DP, Rosen C, Saag KG, Shane E (2017) Addressing the crisis in the treatment of osteoporosis: a path forward. J Bone Miner Res 32:424–430. https://doi.org/10.1002/jbmr.3074

    Article  PubMed  Google Scholar 

  9. Gong HS, Oh WS, Chung MS, Oh JH, Lee YH, Baek GH (2009) Patients with wrist fractures are less likely to be evaluated and managed for osteoporosis. J Bone Joint Surg Am 91:2376–2380. https://doi.org/10.2106/JBJS.H.01871

    Article  PubMed  Google Scholar 

  10. Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH (2003) Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 163:2052–2057. https://doi.org/10.1001/archinte.163.17.2052

    Article  PubMed  Google Scholar 

  11. Pflimlin A, Gournay A, Delabriere I, Chantelot C, Puisieux F, Cortet B, Paccou J (2019) Secondary prevention of osteoporotic fractures: evaluation of the Lille University Hospital’s fracture liaison service between January 2016 and January 2018. Osteoporos Int 30:1779–1788. https://doi.org/10.1007/s00198-019-05036-0

    Article  CAS  PubMed  Google Scholar 

  12. Nakayama A, Major G, Holliday E, Attia J, Bogduk N (2016) Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. Osteoporos Int 27:873–879. https://doi.org/10.1007/s00198-015-3443-0

    Article  CAS  PubMed  Google Scholar 

  13. Sietsema DL, Araujo AB, Wang L, Boytsov NN, Pandya SA, Haynes VS, Faries DE, Taylor KA, Baser O, Jones CB (2018) The effectiveness of a private orthopaedic practice-based osteoporosis management service to reduce the risk of subsequent fractures. J Bone Joint Surg Am 100:1819–1828. https://doi.org/10.2106/JBJS.17.01388

    Article  PubMed  Google Scholar 

  14. American Orthopaedic Association Own the Bone About own the bone. https://www.ownthebone.org/OTB/About/OTB/About/About.aspx?hkey=ab7a03e5-56fb-44f3-bb82-50b6cb533908 Accessed Sep 26 2019

  15. Tosi LL, Gliklich R, Kannan K, Koval KJ (2008) The American Orthopaedic Association’s “own the bone” initiative to prevent secondary fractures. J Bone Joint Surg Am 90:163–173. https://doi.org/10.2106/JBJS.G.00682

    Article  PubMed  Google Scholar 

  16. Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA (2000) Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am 82:1063–1070. https://doi.org/10.2106/00004623-200008000-00001

    Article  CAS  PubMed  Google Scholar 

  17. Newman ED, Ayoub WT, Starkey RH, Diehl JM, Wood GC (2003) Osteoporosis disease management in a rural health care population: hip fracture reduction and reduced costs in postmenopausal women after 5 years. Osteoporos Int 14:146–151. https://doi.org/10.1007/s00198-002-1336-5

    Article  CAS  PubMed  Google Scholar 

  18. Axelsson KF, Jacobsson R, Lund D, Lorentzon M (2016) Effectiveness of a minimal resource fracture liaison service. Osteoporos Int 27:3165–3175. https://doi.org/10.1007/s00198-016-3643-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Khan SA, de Geus C, Holroyd B, Russell AS (2001) Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med 161:1309–1312. https://doi.org/10.1001/archinte.161.10.1309

    Article  CAS  PubMed  Google Scholar 

  20. Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O'Fallon WM, Melton LJ 3rd (2002) Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med 162:421–426. https://doi.org/10.1001/archinte.162.4.421

    Article  PubMed  Google Scholar 

  21. Shah GM, Gong HS, Chae YJ, Kim YS, Kim J, Baek GH (2020) Evaluation and management of osteoporosis and sarcopenia in patients with distal radius fractures. Clin Orthop Surg 12:9–21. https://doi.org/10.4055/cios.2020.12.1.9

    Article  PubMed  PubMed Central  Google Scholar 

  22. Dell RM, Greene D, Anderson D, Williams K (2009) Osteoporosis disease management: what every orthopaedic surgeon should know. J Bone Joint Surg Am 91(Suppl 6):79–86. https://doi.org/10.2106/JBJS.I.00521

    Article  PubMed  Google Scholar 

  23. Shin YH, Gong HS, Gang DH, Shin HS, Kim J, Baek GH (2016) Evaluation of trabecular bone score in patients with a distal radius fracture. Osteoporos Int 27:3559–3565. https://doi.org/10.1007/s00198-016-3686-4

    Article  CAS  PubMed  Google Scholar 

  24. Webber T, Patel SP, Pensak M, Fajolu O, Rozental TD, Wolf JM (2015) Correlation between distal radial cortical thickness and bone mineral density. J Hand Surg [Am] 40:493–499. https://doi.org/10.1016/j.jhsa.2014.12.015

    Article  Google Scholar 

  25. Michael Lewiecki E (2017) Osteoporosis: treat-to-target. Curr Osteoporos Rep 15:103–109. https://doi.org/10.1007/s11914-017-0350-7

    Article  PubMed  Google Scholar 

  26. Adler RA, El-Hajj Fuleihan G, Bauer DC et al (2016) Managing osteoporosis in patients on long-term bisphosphonate treatment: report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res 31:16–35. https://doi.org/10.1002/jbmr.2708

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Bouxsein ML, Eastell R, Lui LY, Wu LA, de Papp AE, Grauer A, Marin F, Cauley JA, Bauer DC, Black DM, FNIH Bone Quality Project (2019) Change in bone density and reduction in fracture risk: a meta-regression of published trials. J Bone Miner Res 34:632–642. https://doi.org/10.1002/jbmr.3641

    Article  Google Scholar 

Download references

Funding

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Science and ICT) (Grant No. 2020R1A2C1005778).

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 olympic-ro, 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Y.H. Shin

  2. Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea

    W.K. Hong & J. Kim

  3. Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gumi-ro 173, 82 Beon-gil, Bundang-gu, Seoungnam-si, Gyeonggi-do, 13620, South Korea

    W.K. Hong & H.S. Gong

Authors
  1. Y.H. Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W.K. Hong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H.S. Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.S. Gong.

Ethics declarations

Conflict of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, Y., Hong, W., Kim, J. et al. Osteoporosis care after distal radius fracture reduces subsequent hip or spine fractures: a 4-year longitudinal study. Osteoporos Int 31, 1471–1476 (2020). https://doi.org/10.1007/s00198-020-05410-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05410-3

Keywords

Search

Navigation