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Current Reviews in Musculoskeletal Medicine

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01.03.2013 | Hand and Wrist (DA Osei, Section editor)

Evaluation and treatment of osetoporotic distal radius fracture in the elderly patient

verfasst von: Eric M. Padegimas, Daniel A. Osei

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 1/2013

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Abstract

Distal radius fractures are an increasingly prevalent upper extremity injury, especially among elderly patients. While treatment guidelines for the acute bony injury have been well documented, treatment of the underlying metabolic bone disease has been less commonly discussed in the orthopedic literature. Distal radius fractures in the elderly patient should be considered a sentinel event for injuries associated with greater morbidity and mortality, such as hip fracture. Management of fracture-related factors, such as osteoporosis and increased fall risk following a distal radius fracture, may prevent the mortality and morbidity of future injuries. This review highlights both the fracture-specific and medical goals of treatment in the elderly patient with a distal radius fracture.

Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am. 2001;26:908–15.PubMedCrossRef

•• Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin. 2012;28(2):113–25. Epub 2012 Apr 14. This study showed that epidemiological data over the past 40 years have shown an overall increase in prevalence of DRFs, especially in the elderly and pediatric populations.PubMedCrossRef

Melton III L, Amadio P, Crowson C, et al. Long-term trends in the incidence of distal forearm fractures. Osteoporos Int. 1998;8:341–8.PubMedCrossRef

•• de Putter CE, van Beeck EF, Looman CW, et al. Trends in wrist fractures in children and adolescents, 1997-2009. J Hand Surg Am. 2011;36:1810–5.e2. This study showed an increase in the incidence of sports-related DRFs in the pediatric population.PubMedCrossRef

Hagino H, Yamamoto K, Ohshiro H, et al. Changing incidence of hip, distal radius, and proximal humerus fractures in Tottori Prefecture, Japan. Bone. 1999;24:265–70.PubMedCrossRef

Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury. 2004;35:462–6.PubMedCrossRef

Brenner H, Arndt V. Epidemiology in aging research. Exp Gerontol. 2004;39:679–86.PubMedCrossRef

Baron JA, Karagas M, Barrett J, et al. Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996;7:612–8.PubMedCrossRef

Schoenborn CA. Health habits of U.S. adults 1985: the “Almeda 7” revisited. Public Health Rep. 1985;101:571–80.

10.

Rowe JW, Kahn RL. Successful aging. New York: Pantheon Books; 1998.

11.

Ring D, Jupiter JB. Treatment of osteoporotic distal radius fractures. Osteoporos Int. 2005;16 Suppl 2:S80–4. Epub 2004 Dec 22.PubMedCrossRef

12.

•• Flinkkila T, Sirnio K, Hippi M, et al. Epidemiology and seasonal variation of distal radius fractures in Oulu, Finland. Osteoporos Int. 2011;22:2307–12. This study showed that the incidence of DRFs in elderly women in Finland is significantly higher during the winter months. Concurrent weather analysis from the Finnish Meteorological Institute suggests that slipperiness of the pavement could explain the increased winter risk.PubMedCrossRef

13.

Cummings SR, Black DM, Rubin SM. Lifetime risks of hip, Colles’, or vertebral fracture and coronary heart disease among white postmenopausal women. Arch Intern Med. 1989;149:2445–8.PubMedCrossRef

14.

Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg. 1998;80B:243–8.CrossRef

15.

Kanterewicz E, Yanez A, Perez-Pons A, et al. Association between Colles’ fracture and low bone mass: age-based differences in postmenopausal women. Osteoporos Int. 2002;13:824–8.PubMedCrossRef

16.

Lofman O, Hallberg I, Berglund K, et al. Women with low-energy fracture should be investigated for osteoporosis. Acta Orthop. 2007;78:813–21.PubMedCrossRef

17.

•• Oyen J, Rohde GE, Hochberg M, et al. Low-energy distal radius fractures in middle-aged and elderly women-seasonal variations, prevalence of osteoporosis, and associates with fractures. Osteoporos Int. 2010;21:1247–55. This study showed that patients who have suffered a DRF who are older than 50 years should be evaluated by bone densitometry because of the increased prevalence of osteoporosis in this population.PubMedCrossRef

18.

•• Oyen J, Brudvik C, Gjesdal CG, et al. Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am. 2011;93:348–56. This study showed that patients who have suffered a DRF who are older than 50 years should be evaluated by bone densitometry because of the increased prevalence of osteoporosis in this population.PubMedCrossRef

19.

•• Oyen J, Rohde G, Hochberg M, et al. Low bone mineral density is a significant risk factor for low-energy distal radius fractures in middle-aged and elderly men: a case-control study. BMC Musculoskelet Disord. 2011;12:67. This study suggests that since low bone mineral density is a risk factor for low-energy DRF in men older than 50 years, improvement of bone mineral density by both pharmacological and nonpharmacological means may decrease incidence.PubMedCrossRef

20.

•• Melton 3rd LJ, Christen D, Riggs BL, et al. Assessing forearm fracture risk in postmenopausal women. Osteoporos Int. 2010;21:1161–9. This study shows that in postmenopausal women, femoral neck bone mineral densitometry is an adequate test for routine clinical risk assessment of DRF.PubMedCrossRef

21.

Clayton RA, Gaston MS, Ralston SH, et al. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91:613–9.PubMedCrossRef

22.

Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–81.PubMedCrossRef

23.

Bahlous A, Farjallah N, Bouzid K, et al. Hypovitaminosis D in Tunisian osteoporotic postmenopausal women and the relationship with bone fractures. Tunis Med. 2009;87:188–90.PubMed

24.

Bakhtiyarova S, Lesnyak O, Kyznesova N, et al. Vitamin D status among patients with hip fracture and elderly control subjects in Yekaterinburg, Russia. Osteoporos Int. 2006;17:441–6.PubMedCrossRef

25.

Wright S, Beringer T, Taggart H, Keegan D, Kelly J, Whithead E, et al. A study of male patients with forearm fracture in Northern Ireland. Clin Rheumatol. 2007;26:191–5.PubMedCrossRef

26.

•• Jang WY, Chung MS, Baek GH, Song CH, Cho HE, Gong HS. Vitamin D levels in post-menopausal Korean women with a distal radius fracture. Injury. 2012;43(2):237–41. Epub 2011 Nov 14. This study shows that postmenopausal women with DRFs had significantly lower vitamin D levels than the control group.PubMedCrossRef

27.

•• Oyen J, Apalset EM, Gjesdal CG, Brudvik C, Lie SA, Hove LM. Vitamin D inadequacy is associated with low-energy distal radius fractures: a case–control study. Bone. 2011;48:1140–5. This study shows an association between vitamin D inadequacy and low-energy DRFs. The differences in vitamin D levels are independent of bone mineral densitometry, body mass index, or smoking history.PubMedCrossRef

28.

Owen RA, Melton 3rd LJ, Ilstrup DM, Johnson KA, Riggs BL. Colles’ fracture and subsequent hip fracture risk. Clin Orthop Relat Res. 1982:37–43.

29.

Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo UB, Bergstrom R. 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. 1993;52:269–72.PubMedCrossRef

30.

Lauritzen JB, Schwarz P, McNair P, Lund B, Transbøl I. Radial and humeral fractures as predictors of subsequent hip, radial or humeral fractures in women, and their seasonal variation. Osteoporos Int. 1993;3(3):133–7.PubMedCrossRef

31.

Haentjens P, Autier P, Collins J, Velkeniers B, Vanderschueren D, Boonen S. Colles fracture, spine fracture, and subsequent risk of hip fracture in men and women. A meta-analysis. J Bone Joint Surg Am. 2003;85-A(10):1936–43.PubMed

32.

Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am. 2000;25(1):19–28.PubMedCrossRef

33.

U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med. 2011;154(5):356–64. Epub 2011 Jan 17.

34.

Nelson HD, Haney EM, Dana T, Bougatsos C, Chou R. Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153(2):99–111.PubMed

35.

Jackson RD, LaCroix AZ, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354(7):669–83.PubMedCrossRef

36.

•• Kuehn BM. USPSTF: Taking vitamin D and calcium doesn't prevent fractures in older women. JAMA. 2012;308(3):225–6. This study showed no statistically significant decrease in fracture incidence with low-dose vitamin D and calcium supplementation in otherwise healthy women between the ages of 50 and 79 years.PubMedCrossRef

37.

Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr. 2001;73:288–94.PubMed

38.

Aloia JF, Patel M, Dimaano R, et al. Vitamin D intake to attain a desired serum 25-hydroxyvitamin D concentration. Am J Clin Nutr. 2008;87:1952–8.PubMed

39.

•• Clemson L, Fiatarone Singh MA, Bundy A, Cumming RG, Manollaras K, O'Loughlin P, Black D. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012;345:e4547. This study shows that a functional-based exercise program integrated into activities of daily living is more effective at reducing falls in the elderly than are traditional exercise regimens.PubMedCrossRef

40.

Synn AJ, Makhni EC, Makhni MC, Rozental TD, Day CS. Distal radius fractures in older patients: is anatomic reduction necessary? Clin Orthop Relat Res. 2009;467(6):1612–20. Epub 2008 Dec 12.PubMedCrossRef

41.

Abbaszadegan H, Jonsson U. External fixation or plaster cast for severely displaced Colles’ fractures? Prospective 1-year study of 46 patients. Acta Orthop Scand. 1990;61:528–30.PubMedCrossRef

42.

Fitoussi F, Ip WY, Chow SP. Treatment of displaced intraarticular fractures of the distal end of the radius with plates. J Bone Joint Surg Am. 1997;79:1303–12.PubMed

43.

Howard PW, Stewart HD, Hind RE, Burke FD. External fixation or plaster for severely displaced comminuted Colles’ fractures? A prospective study of anatomical and functional results. J Bone Joint Surg Br. 1989;71:68–73.PubMed

44.

Jenkins NH, Jones DG, Mintowt-Czyz WJ. External fixation and recovery of function following fractures of the distal radius in young adults. Injury. 1988;19:235–8.PubMedCrossRef

45.

Kapoor H, Agarwal A, Dhaon BK. Displaced intra-articular fractures of distal radius: a comparative evaluation of results following closed reduction, external fixation and open reductionbwith internal fixation. Injury. 2000;31:75–9.PubMedCrossRef

46.

Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–59.PubMed

47.

Knox J, Ambrose H, McCallister W, Trumble T. Percutaneous pins versus volar plates for unstable distal radius fractures: a biomechanic study using a cadaver model. J Hand Surg Am. 2007;32:813–7.PubMedCrossRef

48.

Leung F, Tu YK, Chew WY, Chow SP. Comparison of external and percutaneous pin fixation with plate fixation for intra-articular distal radius fractures. J Bone Joint Surg Am. 2008;90:16–22.PubMedCrossRef

49.

Merchan EC, Breton AF, Galindo E, Peinado JF, Beltran J. Plaster cast versus Clyburn external fixation for fractures of the distal radius in patients under 45 years of age. Orthop Rev. 1992;21:1203–9.PubMed

50.

Pring DJ, Barber L, Williams DJ. Bipolar fixation of fractures of the distal end of the radius: a comparative study. Injury. 1988;19:145–8.PubMedCrossRef

51.

Stein H, Volpin G, Horesh Z, Hoerer D. Cast or external fixation for fracture of the distal radius: a prospective study of 126 cases. Acta Orthop Scand. 1990;61:453–6.PubMedCrossRef

52.

Beharrie AW, Beredjiklian PK, Bozentka DJ. Functional outcomes after open reduction and internal fixation for treatment of displaced distal radius fractures in patients over 60 years of age. J Orthop Trauma. 2004;18(10):680–6.PubMedCrossRef

53.

Chung KC, Shauver MJ, Birkmeyer JD. Trends in the United States in the treatment of distal radial fractures in the elderly. J Bone Joint Surg Am. 2009;91(8):1868–73.PubMedCrossRef

54.

•• Diaz-Garcia RJ, Oda T, Shauver MJ, Chung KC. A systematic review of outcomes and complications of treating unstable distal radius fractures in the elderly. J Hand Surg Am. 2011;36(5):824–35.e2. This study shows that in DRF patients older than 60 years, there was no statistically significant difference in functional outcome after treatment with cast immobilization or surgical intervention.PubMedCrossRef

55.

Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. 2006;88(9):1944–51.PubMedCrossRef

56.

Arora R, Gabl M, Gschwentner M, Deml C, Krappinger D, Lutz M. A comparative study of clinical and radiologic outcomes of unstable colles type distal radius fractures in patients older than 70 years: nonoperative treatment versus volar locking plating. J Orthop Trauma. 2009;23(4):237–42.PubMedCrossRef

57.

Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am. 2004;29(6):1121–7.PubMedCrossRef

58.

•• Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States medicare population. J Bone Joint Surg Am. 2011;93(23):2154–62. This study shows that the use of internal fixation for DRFs differs widely on the basis of geography and patient demographics.PubMedCrossRef

59.

Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br. 1998;80:243–8.PubMedCrossRef

60.

Thomas E, Wilkie R, Peat G, Hill S, Dziedzic K, Croft P. The North Staffordshire Osteoarthritis Project–NorStOP: prospective, 3-year study of the epidemiology and management of clinical osteoarthritis in a general population of older adults. BMC Musculoskelet Disord. 2004;5:2.PubMedCrossRef

61.

Rozental TD, Makhni EC, Day CS, Bouxsein ML. Improving evaluation and treatment for osteoporosis following distal radial fractures. A prospective randomized intervention. J Bone Joint Surg Am. 2008;90(5):953–61.PubMedCrossRef

62.

•• Bischoff-Ferrari HA, Willett WC, Orav EJ, Lips P, Meunier PJ, Lyons RA, Flicker L, Wark J, Jackson RD, Cauley JA, Meyer HE, Pfeifer M, Sanders KM, Stähelin HB, Theiler R, Dawson-Hughes B. A pooled analysis of vitamin D dose requirements for fracture prevention. N Engl J Med. 2012;367(1):40–9. This study shows that high-dose vitamin D supplementation ( > 800 IU daily) was favorable in prevention of hip fracture and any nonvertebral fracture in people who were 65 years or older.PubMedCrossRef

63.

•• Shauver MJ, Clapham PJ, Chung KC. An economic analysis of outcomes and complications of treating distal radius fractures in the elderly. J Hand Surg Am. 2011;36(12):1912–8.e1-3. This study shows that Medicare patients show little economic preference between different treatment modalities for DRFs.PubMedCrossRef

64.

Ray NF, Chan JK, Thamer M, Melton LJ. Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res. 1997;12:24–35.PubMedCrossRef

Titel: Evaluation and treatment of osetoporotic distal radius fracture in the elderly patient
verfasst von: Eric M. Padegimas
Daniel A. Osei
Publikationsdatum: 01.03.2013
Verlag: Current Science Inc.
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 1/2013
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-012-9153-8

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