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Distal Radial Fractures in Older Men: A Missed Opportunity?

Harper, Carl M. MD; Fitzpatrick, Shannon K. MD; Zurakowski, David PhD; Rozental, Tamara D. MD

Journal of Bone & Joint Surgery - American Volume: 5 November 2014 - Volume 96 - Issue 21 - p 1820–1827
doi: 10.2106/JBJS.M.01497
Scientific Articles
Disclosures

Background: Fractures of the distal aspect of the radius are common, yet little is known about this type of fracture among older men. The purpose of this study was to compare fracture characteristics, treatment, and osteoporosis evaluation among men and women who had sustained a distal radial fracture. We hypothesized that the men would have similar patterns of injury and lower rates of evaluation for osteoporosis.

Methods: We retrospectively reviewed the medical records of ninety-five men and 344 women over the age of fifty years who were treated for a distal radial fracture at a single institution over a five-year period. We assessed whether the patients had received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within six months following the injury. Multivariate analysis identified independent predictors of bone mineral density (BMD) testing and osteoporosis treatment.

Results: Men had less severe fractures than women (a Type-C fracture rate of 20% for men compared with 40% for women; p = 0.014). While 184 (53%) of the women had a DXA scan after injury, only seventeen (18%) of the men were evaluated (p < 0.001). Among the patients who underwent DXA scan, nine men (9% of men overall) and sixty-five women (19% of women overall) had a diagnosis of osteoporosis (p = 0.01). Male sex was an independent predictor of failure to undergo BMD testing as well as receive subsequent treatment with calcium and vitamin D or bisphosphonates (p < 0.001).

Conclusions: Significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines.

Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Harvard Combined Orthopaedic Residency, 55 Fruit Street, White Building 535, Boston, MA 02114

2Harvard Medical School, 25 Shattuck Street, Boston, MA 02115

3Department of Anesthesia, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115

4Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address for T.D. Rozental: trozenta@bidmc.harvard.edu.

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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