Wrist Fracture a Red Flag for Osteoporosis
Feb. 15, 2000 (Los Angeles) -- Women who fracture a wrist should be screened for osteoporosis, especially if they are less than 66 years of age, according to a study in the Journal of Bone and Joint Surgery. The authors state that women who fracture a wrist within 10 years of entering menopause have an eightfold increase in the risk of hip fractures over the general population, but this increase subsides by the age of 70.
According to the National Institutes of Health, approximately 10 million Americans have osteoporosis, and another 18 million have diminished bone mineral density that places them at risk of osteoporosis. One of every two women and one of every eight men over the age of 50 will have an osteoporosis-related fracture in their lifetime. In all, osteoporosis causes more than 1.5 million fractures annually, including 250,000 fractures of the wrist. The estimated cost for hospital and nursing home care of people with osteoporosis-related injuries is $14 billion.
To conduct their study, lead author Carlos A. Wigderowitz, PhD, clinical lecturer in orthopaedics at the University of Dundee, Scotland, and his co-authors measured bone density in 31 women between the ages of 40 and 82 who had sustained a type of wrist fracture known as a Colles' fracture. They were compared to a group of 289 healthy women 20-83 years old with no wrist fractures. Bone mineral density (BMD) was consistently lower in the women with fractures than in the comparison subjects. However, these differences were most pronounced in women aged 41-66. The differences grew smaller in the older patients.
Wigderowitz tells WebMD he was surprised to see that "the younger the women are after menopause, the greater the deficit is in BMD." His group has just completed another study that confirms those findings. They conclude that women younger than 66 who sustain a wrist fracture should be "fully assessed for osteoporosis."
"That is absolutely correct -- we've been advocating that the presence of prior fracture is a sign for a bone density scan, for men as well as women," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation (NOF). She tells WebMD, "All fractures that occur in adults that are not caused by major trauma are due, at least in part, to osteoporosis." The fracture may occur in any bone, but the three "classic sites" are the hip, spine, and wrist. No one knows for certain why the wrist is such a common fracture site, but Cosman suggests that when she falls, a younger woman may be more likely to extend her hands to break the fall, while an older woman may simply crumple to the ground and break her pelvis or hip.
Women with low BMD often are placed on hormone-replacement therapy (HRT), but Wigderowitz believes each woman should make that decision for herself. "HRT decreases the risk of fractures and helps replace bone mass," says Robert P. Heaney, MD, professor of medicine at Creighton University in Omaha, Neb., and a member of the NOF board of directors. However, he tells WebMD, it has annoying side effects in some women, like breakthrough bleeding, and is thought to increase the risk of breast cancer. Newer agents, such as Fosamax (alendronate) and Evista (raloxifene), help preserve bone mass without increasing cancer risk.
Osteoporosis management should be thought of as a "three-legged stool" consisting of drug treatment, good nutrition, and a healthy lifestyle that includes regular exercise, Heaney says. "You need all three for optimum bone health."