Abstract
Introduction
Patients often do not receive osteoporosis screening after a low-energy distal radius fracture (DRF). The effect of osteoporosis on the healing of DRFs remains a debate, and it is unclear if surgical treatment of this injury affects the referral and participation rates in a fracture liaison service (FLS) program. The purpose of this study is to report on a large cohort of low-energy DRFs and identify demographic, clinical, and treatment factors that affect referral and participation rates in an FLS program.
Methods
A retrospective review identified patients over 50 years old who sustained a low-energy DRF between 2013 and 2018. Patients with high-energy or unknown injury mechanisms were excluded. The primary outcome was the effect of DRF surgical treatment on referral and participation rates in an FLS program. Secondary outcomes included patient demographic and clinical characteristic effects on referral and participation rates in an FLS program.
Results
In total, 950 patients met inclusion criteria. Two hundred thirty patients (24.2%) were referred and 149 (15.7%) participated in the FLS program. Patients who underwent surgery were more likely to be referred to the FLS (OR 1.893, CI 1.403–2.555, p < 0.001) and participate in the FLS program (OR 2.47, CI 1.723–3.542, p < 0.001) compared to patients who received non-operative treatment of their DRF.
Conclusions
Patients who undergo surgical treatment of a low-energy DRF are more likely to be referred and participate in a FLS program. Further study is needed to identify why surgical treatment may affect referral and participation rates.
Similar content being viewed by others
References
(2017) Osteoporosis: assessing the risk of fragility fracture. Osteoporosis: assessing the risk of fragility fracture
Kessous R, Weintraub AY, Mattan Y et al (2014) Improving compliance to osteoporosis workup and treatment in postmenopausal patients after a distal radius fracture. Taiwan J Obstet Gynecol 53:206–209. https://doi.org/10.1016/J.TJOG.2014.04.015
Sarfani S, Scrabeck T, Kearns AE et al (2014) Clinical efficacy of a fragility care program in distal radius fracture patients. J Hand Surg 39:664–669. https://doi.org/10.1016/J.JHSA.2014.01.009
Øyen J, Rohde GE, Hochberg M et al (2010) Low-energy distal radius fractures in middle-aged and elderly women-seasonal variations, prevalence of osteoporosis, and associates with fractures. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 21:1247–1255. https://doi.org/10.1007/S00198-009-1065-0
Øyen J, Brudvik C, Gjesdal CG et al (2011) Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am 93:348–356. https://doi.org/10.2106/JBJS.J.00303
(2005) Leadership in orthopaedics: taking a stand to own the bone. American Orthopaedic Association position paper. J Bone Joint Surg Am 87:1389–1391. https://doi.org/10.2106/JBJS.E.00449
Baba T, Hagino H, Nonomiya H et al (2015) Inadequate management for secondary fracture prevention in patients with distal radius fracture by trauma surgeons. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 26:1959–1963. https://doi.org/10.1007/S00198-015-3103-4
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
Harper CM, Fitzpatrick SK, Zurakowski D, Rozental TD (2014) Distal radial fractures in older men. A missed opportunity? J Bone Joint Surg Am 96:1820–1827. https://doi.org/10.2106/JBJS.M.01497
Tulipan J, Jones CM, Ilyas AM The effect of osteoporosis on healing of distal radius fragility fractures. https://doi.org/10.1016/j.ocl.2015.06.012
Ganda K, Puech M, Chen JS et al (2013) Models of care for the secondary prevention of osteoporotic fractures: a systematic review and meta-analysis. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 24:393–406. https://doi.org/10.1007/S00198-012-2090-Y
Antwi E, Groenwold RHH, Browne JL et al (2017) Development and validation of a prediction model for gestational hypertension in a Ghanaian cohort. BMJ Open 7:12670. https://doi.org/10.1136/BMJOPEN-2016-012670
Ahmed LA, Center JR, Bjørnerem Å et al (2013) Progressively increasing fracture risk with advancing age after initial incident fragility fracture: the Tromsø study. J Bone Mineral Res: Off J Am Soc Bone Mineral Res 28:2214–2221. https://doi.org/10.1002/JBMR.1952
Haentjens P, Autier P, Collins J et al (2003) Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis. J Bone Joint Surg Am 85:1936–1943. https://doi.org/10.2106/00004623-200310000-00011
Johnson NA, Stirling ERB, Divall P et al (2017) Risk of hip fracture following a wrist fracture-a meta-analysis. Injury 48:399–405. https://doi.org/10.1016/J.INJURY.2016.11.002
Mallmin H, Ljunghall S, Persson I et al (1993) Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int 52:269–272. https://doi.org/10.1007/BF00296650
Lauritzen JB, Schwarz P, McNair P et al (1993) Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 3:133–137. https://doi.org/10.1007/BF01623274
Chen CW, le Huang T, Su LT et al (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. https://doi.org/10.1097/TA.0B013E31824BB325
Dang DY, Zetumer S, Zhang AL (2019) Recurrent fragility fractures: a cross-sectional analysis. J Am Acad Orthop Surg 27:E85–E91. https://doi.org/10.5435/JAAOS-D-17-00103
Bolland MJ, Grey AB, Gamble GD, Reid IR (2010) Effect of osteoporosis treatment on mortality: a meta-analysis. J Clin Endocrinol Metab 95:1174–1181. https://doi.org/10.1210/JC.2009-0852
Hochberg M (2000) Preventing fractures in postmenopausal women with osteoporosis. A review of recent controlled trials of antiresorptive agents. Drugs Aging 17:317–330. https://doi.org/10.2165/00002512-200017040-00007
Matzkin EG, DeMaio M, Charles JF, Franklin CC (2019) Diagnosis and treatment of osteoporosis: what orthopaedic surgeons need to know. J Am Acad Orthop Surg 27:E902–E912. https://doi.org/10.5435/JAAOS-D-18-00600
Christensen DL, Nappo KE, Ficke B, Tintle SM (2018) Frequency of bone health presentations at national hand meetings. J Hand Surg 43:187.e1-187.e5. https://doi.org/10.1016/J.JHSA.2017.09.005
Rianon N, Anand D, Rasu R (2013) Changing trends in osteoporosis care from specialty to primary care physicians. Curr Med Res Opin 29:881–888. https://doi.org/10.1185/03007995.2013.809335
Beaton DE, Dyer S, Jiang D et al (2014) Factors influencing the pharmacological management of osteoporosis after fragility fracture: results from the Ontario Osteoporosis Strategy’s fracture clinic screening program. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 25:289–296. https://doi.org/10.1007/S00198-013-2430-6
Roh YH, Koh Y do, Noh JH, et al (2017) Effect of health literacy on adherence to osteoporosis treatment among patients with distal radius fracture. Arch Osteoporos 12:.https://doi.org/10.1007/S11657-017-0337-0
Spadaro JA, Werner FW, Brenner RA et al (1994) Cortical and trabecular bone contribute strength to the osteopenic distal radius. J Orthop Res 12:211–218. https://doi.org/10.1002/JOR.1100120210
Thormann U, el Khawassna T, Ray S et al (2014) Differences of bone healing in metaphyseal defect fractures between osteoporotic and physiological bone in rats. Injury 45:487–493. https://doi.org/10.1016/J.INJURY.2013.10.033
Namkung-Matthai H, Appleyard R, Jansen J et al (2001) Osteoporosis influences the early period of fracture healing in a rat osteoporotic model. Bone 28:80–86. https://doi.org/10.1016/S8756-3282(00)00414-2
Giannoudis P, Tzioupis C, Almalki T, Buckley R (2007) Fracture healing in osteoporotic fractures: is it really different? A basic science perspective. Injury 38:S90–S99. https://doi.org/10.1016/J.INJURY.2007.02.014
Egol KA, Walsh M, Romo-Cardoso S et al (2010) Distal radial fractures in the elderly: operative compared with nonoperative treatment. J Bone Joint Surg Am 92:1851–1857. https://doi.org/10.2106/JBJS.I.00968
Arora R, Lutz M, Deml C et al (2011) A prospective randomized trial comparing nonoperative treatment with volar locking plate fixation for displaced and unstable distal radial fractures in patients sixty-five years of age and older. J Bone Joint Surg Am 93:2146–2153. https://doi.org/10.2106/JBJS.J.01597
Jennings LA, Auerbach AD, Maselli J et al (2010) Missed opportunities for osteoporosis treatment in patients hospitalized for hip fracture. J Am Geriatr Soc 58:650–657. https://doi.org/10.1111/J.1532-5415.2010.02769.X
Daffner SD, Karnes JM, Watkins CM (2016) Surgeon specialty influences referral rate for osteoporosis management following vertebral compression fractures.https://doi.org/10.1055/s-0035-1569057
LaVallee LA, Scott MA, Hulkower SD (2016) Challenges in the screening and management of osteoporosis. North Carolina Med J 77:416–419. https://doi.org/10.18043/NCM.77.6.416
Jantzen C, Cieslak LK, Barzanji AF et al (2016) Colles’ fractures and osteoporosis - a new role for the emergency department. Injury 47:930–933. https://doi.org/10.1016/J.INJURY.2015.11.029
Beaton DE, Mamdani M, Zheng H, et al (2017) Improvements in osteoporosis testing and care are found following the wide scale implementation of the Ontario Fracture Clinic Screening Program: an interrupted time series analysis. Medicine 96:https://doi.org/10.1097/MD.0000000000009012
Rothmann MJ, Möller S, Holmberg T et al (2017) Non-participation in systematic screening for osteoporosis-the ROSE trial. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 28:3389–3399. https://doi.org/10.1007/S00198-017-4205-Y
Roh YH, Lee ES, Ahn J et al (2019) Factors affecting willingness to get assessed and treated for osteoporosis. Osteoporos Int: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 30:1395–1401. https://doi.org/10.1007/S00198-019-04952-5
Palcu P, Munce S, Jaglal SB et al (2020) Understanding patient experiences and challenges to osteoporosis care delivered virtually by telemedicine: a mixed methods study. Osteoporos Int 31:351. https://doi.org/10.1007/S00198-019-05182-5
Harness NG, Funahashi T, Dell R et al (2012) Distal radius fracture risk reduction with a comprehensive osteoporosis management program. J Hand Surg 37:1543–1549. https://doi.org/10.1016/J.JHSA.2012.04.033
Wang N, Chen Y, Ji J, et al (2020) The relationship between serum vitamin D and fracture risk in the elderly: a meta-analysis. J OrthopSurg Res 15:https://doi.org/10.1186/S13018-020-01603-Y
Kelm N, Wasfie T, Volk M, et al (2021) Role of fracture liaison service program in reducing refracture rate in the elderly osteoporotic trauma patients presenting with vertebral compression fracture: a six-year study. Am Surg.https://doi.org/10.1177/00031348211047512
Jackson A, Wasfie T, Brock C et al (2020) Fragility vertebral compression fractures in postmenopausal women: the role of a fracture liaison service program. Am Surg 86:1636–1639. https://doi.org/10.1177/0003134820933254
Nakayama A, Major & G, Holliday E, et al Evidence of effectiveness of a fracture liaison service to reduce the re-fracture rate. https://doi.org/10.1007/s00198-015-3443-0
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Vaughn, N., Akelman, M., Marenghi, N. et al. Patients undergoing surgical treatment for low-energy distal radius fractures are more likely to receive a referral and participate in a fracture liaison service program. Arch Osteoporos 17, 96 (2022). https://doi.org/10.1007/s11657-022-01122-9
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-022-01122-9