Significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines, according to a study published November 5 in the Journal of Bone and Joint Surgery.
“Given that the prevalence of fragility fractures among men is expected to increase threefold by the year 2050, adequately evaluating and treating men for osteoporosis is of paramount importance,” said lead author Tamara Rozental, MD, an investigator in the Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center and an Associate Professor of Orthopedic Surgery at Harvard Medical School.
Tamara Rozental, MD
Dr. Rozental, who specializes in hand, wrist, and elbow injuries, examined five years of data from 2007 to 2012, from patients who suffered a distal radial fracture.
“We know that a distal radial fracture can often be an early indication of bone loss. We typically see this type of fracture 10 to 15 years before we might see a hip fracture,” said Dr. Rozental. “When we treat fractures of the wrist, it gives us the opportunity to do a bone mass density evaluation and, if necessary, get patients into treatment with the goal of preventing more serious injury, like a hip fracture down the line.”
Even though existing clinical practice guidelines recommend bone mass density evaluation after hip fracture for both men and women, studies continue to show that screening rates are unacceptably low, particularly among men. Dr. Rozental examined the data to see if the same trend would play out when examining clinical follow up to wrist fractures.
Fifty-three percent of women received dual x-ray absorptiometry, compared with only 18% of men. In addition, 21% of men versus 55% of women initiated treatment with calcium and vitamin D supplements within six months of injury, and 3% of men versus 22% of women began taking bisphosphonates.
Studies have shown that men have twice the mortality rate of women both during initial hospitalization and in the year following a hip fracture. Survival rates following a wrist fracture also are lower among men.
“Treating men for bone fractures, but not the underlying cause, places them at a greater risk for future bone breaks and related complications,” said Dr. Rozental. “The results of this study lead us to suggest that men over the age of 50 with fractures of the distal radius should undergo further clinical assessment and bone density testing to better identify those at high risk for future fracture as well as those who would benefit from further treatment.”