Osteoporosis and Wrist Fractures
I'm sure you've heard of osteroprosis but do you know what it means? Osteoporosis is decreased bone mineral density, or thinning of the bone, making it susceptible to fracture, aka, breaking. Osteoporosis does not cause pain by itself, but a fractured bone results in significant pain and loss of function requiring a period of immobilization and possibly surgery. Osteoporosis can occur as a natural part of aging but risk factors include: being female, low body weight, menopause, lack of activity, smoking, alcohol, certain medications, and different hormone conditions.
The most common osteoporosis-related fractures include vertebral fractures, hip fractures, and wrist fractures. The consequence of an osteoporosis-related fracture includes pain, loss of function, time lost from work, deformity and risk of future fractures. It is estimated that one of every two Caucasian women will experience an osteoporosis-related fracture. Moreover, only 33% of patients incurring a hip fracture re-gain their pre-fracture level of function and about 20% will die within a year following the fracture. Osteoporosis-related wrist (distal radius) fractures represent about 250,000 fractures treated annually in the U.S1. The prevalence of osteoporosis in patients with wrist fractures is 34% for women and 17% and men. Wrist fractures are often the first sign of osteoporosis and incurring a wrist fracture results in a two to fourfold increase in the risk of a subsequent fracture compared with individuals with no prior fracture.
Diagnosis of osteoporosis can provisionally be made by X-ray but is best determined and quantified by a DEXA (Dual Energy X-ray Absorptiometry) scan. There are well established guidelines published by the National Osteoporosis Foundation for the recommended evaluation of osteoporosis, and include:
- All women aged 65 and older
- All post-menopausal women, less than 65, with risk factors for osteoprosis
- All post-menopausal women who have incurred a fracture
- Women with any of a list of 50 medical conditions to be determined by a physician.
The goal of treatment of osteoporosis is prevention. Treatment options include:
- Lifestyle modifications – regular exercise, smoking cessation, discontinuing alcohol use, and maintaining a balanced diet.
- Dietary supplementation – current guidelines for patients older than 50 having experienced an osteoporosis-related fracture is 1000-1500mg of calcium and 800-1000iu of Vitamin D daily.
- Medications that prevent bone loss – include hormone replacement therapy for post-menopausal women or anti-resorptive medications such as alendronate (Fosamax), risedronate (Actonel), raloxifene (Evista), ibandronate (Boniva), calcitonin (Calcimar), and zoledronate (Reclast).
- Medication that increase bone production – include teriparatide (Forteo) and denosumab (Prolia).
A wrist fracture is often the first sign that one may have osteoporosis. If you incur a fracture of the wrist it is important to be evaluated for osteoporosis. If present, osteoporosis treatment should be initiated to avoid future fractures.