Colles' Fracture of the Wrist as an Indicator of Underlying Osteoporosis in Postmenopausal Women: A Prospective Study of Bone Mineral Density and Bone Turnover Rate

Abstract

Colles' fracture has been shown to be associated with an increased risk of hip fracture. The incidence of low bone mineral density (BMD) and high bone turnover in such patients is uncertain. The aim of this study was to prospectively assess BMD and bone turnover in a cohort of consecutive postmenopausal Colles' fracture patients. BMD (spine, hip and contralateral radius) was measured by dual-energy X-ray absorptiometry (DXA) within 2 weeks of fracture. Bone turnover was assessed within 4 days by measurement of serum osteocalcin, total alkaline phosphatase (TALP), bone-specific alkaline phosphatase (BSAP) and urine hydroxyproline. We recruited 106 (71%) of 149 consecutive patients. Fifty-one per cent of subjects had a history of previous fracture, and 25% a past history of wrist, hip or vertebral body fracture. The incidence of osteoporosis was 21%, 42% and 22% at the spine, hip and radius respectively. Fifty per cent of subjects had osteoporosis of at least one of these sites. When compared with the values expected for their age the patients were found to have higher BMD than expected at the spine, and slightly lower BMD at the hip and distal radius. Patients aged 65 years or less had lower hip BMD than expected from the age-matched normal range (p < 0.01). Osteocalcin and TALP levels did not differ from the normal ranges, but BSAP and hydroxyproline levels were significantly elevated (p < 0.001), with 37% and 25% of patients having levels above the respective normal ranges. We conclude that osteoporosis is common in patients with Colles' fracture; however, in older patients BMD is not lower than would be expected in the normal population. In patients aged 65 years or less BMD is lower than expected at the hip. Bone turnover rate is high in many such patients. Intervention to prevent future fracture would be appropriate in women aged 65 years or less with Colles' fracture.

Comparison of Central and Peripheral Bone Mineral Density Measurements in Postmenopausal Women

“…It has been observed that women aged b66 years with wrist fracture have considerably low BMD in the hip. 26 The results of the current study are supported by Eftekhar-Sadat et al, 27 who evaluated the role of wrist BMD in diagnosing osteoporosis in postmenopausal women. BMD measurements revealed osteopenia and osteoporosis in the wrist in 40.4% and 59.6% of participants, in the hip in 38.4% and 24.2% of participants, and in the lumbar spine in 36.4% and 49.5% of participants.…”

Low calcaneal bone mineral density and the risk of distal forearm fracture in women and men: A population-based case-control study

“…In two previous studies, a significantly higher prevalence of osteoporosis in women with distal forearm fracture compared with age-matched women without fracture was found only among those aged 65 years or younger [6,7]. Results of such comparisons could be influenced in different studies by factors such as the size of the fracture cohort, participation rate, age ranges included, sites measured, or type of control cohorts (normative population or agematched women with no fracture).…”

“…In an English cohort of 106 women, mean age 66 (37-89) years, the prevalence of osteoporosis was 21% (spine), 42% (hip), and 50% (either site) [6], and in a Spanish cohort of 58 women, mean age 66 (45-80) years, the prevalence was 47% (spine) and 19% (hip) [7]. In a Dutch cohort of 94 women, mean age 69 (55-79) years, osteoporosis prevalence (spine or hip) was 51% [8], and in an Irish cohort of 100 women, mean age 68 (60-86) years, it was 68% [9].…”

“…The prevalence of osteoporosis in individuals with a distal forearm fracture has been predominantly studied in women based on lumbar spine and hip BMD measurements using dual energy X-ray absorptiometry (DXA) total body scanner, but these studies, mostly with small sample sizes, have yielded disparate results [6][7][8][9]. No studies have specifically focused on BMD in men with distal forearm fracture.…”

Genetic determination in onset age of wrist fracture

“…Wrist fracture (WF) is one of the most common forms of osteoporotic fractures and can help predict subsequent vertebral and hip fractures (Owen et al 1982;Earnshaw et al 1998;Cuddihy et al 1999). The lifetime incidence of WF is generally about 16% in white women.…”