Considerations in the Treatment of Osteoporotic Distal Radius Fractures in Elderly Patients

Abstract

Purpose of Review With the incidence of distal radius fractures increasing in the elderly population, we sought to summarize the current orthopedic and medical management of these fractures in the elderly osteoporotic population. Recent Findings The number of osteoporotic patients undergoing surgical fixation for distal radius fractures has increased in recent years. This is likely due to the improved outcomes seen with volar locking plates, as well as an increase in the number of fellowship-trained hand surgeons. Despite this potential improvement in acute fracture management, a majority of these patients are underdiagnosed and undertreated for their underlying osteoporosis or endocrinopathies. The implementation of fracture liaison services and the ability of the treating orthopedist to recognize this gap in patient care result in a higher number of patients initiating appropriate treatment. Summary It is vital that when discussing acute fracture management, a thorough discussion is had with patients regarding functional outcome and the benefits of both surgical and non-operative management. As these fractures become more prevalent and a greater percentage undergo surgical intervention, the economic burden of distal radius fractures will continue to rise. It is imperative that the treating surgeon view these fractures as sentinel events that are predictive of future hip and vertebral fractures. While relatively new, the use of fracture liaison services to help aide in proper screening and treatment of osteoporotic patients is of great value. Non-pharmacologic therapy such as physical therapy, smoking and alcohol cessation programs, and dietary modifications are crucial in treating patients with osteoporosis. While bisphosphonates remain the first-line treatment in patients with osteoporosis, novel therapies show promise for future use.

Implementation of a Postfracture Care Program in a Private Hospital in Colombia

“…Remarkably after hip fractures, distal radius fractures (DRFs) were more frequent than vertebral ones, correlating with a reported increase in these fractures in people older than 65 [ 13 ]. Otherwise, vertebral fractures remain a diagnosis and treatment concern.…”

Comparison between Surgical and Conservative Treatment for Distal Radius Fractures in Patients over 65 Years

“…Prevention of this fracture is possible by treating osteoporosis with diet [ 20 ] and drugs [ 21 ], including vitamin D, calcium, bisphosphonate medications, and recombinant human parathyroid hormone (PTH). Osteoporotic bone presents challenges for both conservative and surgical management of DRF, and goals of care should be discussed with the patient prior to deciding on treatment method [ 22 ]. In fact, in patients with decreased bone density, a trabecular bone deterioration was found, especially in early postmenopausal years, and subsequent lower bone strength [ 23 ].…”

Preventing hip fractures with multidisciplinary teams: a Canadian perspective

“…Osteoporosis is often seen as a low priority by primary care providers: rather than seeing osteoporosis as a treatable condition, many physicians still see it as an unpreventable part of aging. 17 This directly contradicts evidence supporting the use of pharmacotherapy in the treatment of osteoporosis. 1 , 6 The fact that many vertebral fractures are often overlooked is very clinically relevant, as this would be an essential time to initiate treatment of osteoporosis.…”

“… 7 A similar relation exists with distal radius fractures. 17 The majority of these gaps can be addressed through the use of multidisciplinary teams.…”