No association between osteoporosis and AO classification of distal radius fractures: an observational study of 289 patients

Abstract

Background It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures. Methods In this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex). Results Patients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture. Conclusions Distal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

Does Osteoporosis or Vitamin D Affect the Severity of Minimal Trauma Distal Radius Fractures? A Prospective Cohort Study

“…Furthermore, despite being underpowered, the number in this study is within the participant range used in similar studies and thus comparable to current literature [10,[25][26][27].…”

“…Hollevoet and Verdonk [26] conducted a similar study which found no significant differences in BMD, clinical or radiological results between intraarticular and extraarticular fractures (n=40). Hjelle [27] DRF and found that those with osteoporosis did not sustain more complex fractures than those with osteopenia or normal BMD, as per the AO classification. Dhainaut [10] demonstrated no significant association between classical BMD and severity of fracture, whilst also finding no relationship between decreased hand cortical BMD and the nature of DRF.…”

Asociación entre osteoporosis y la clasificación AO de fracturas de radio distal

“…Estudios previos como los de Lill y colaboradores o los de Clayton RAE y su equipo observaron correlación entre una menor DMO y una menor fuerza de carga para generar un patrón complejo de fractura; 22,23 sin embargo, estudios como los Dhainaut A y colegas o Hjelle AM y colaboradores afirman que no existe correlación entre la baja DMO y un aumento de la complejidad de trazo de la fractura; lo que muestras que otros factores, como el uso de glucocorticoides, tienen una mayor relevancia en la prevalencia de las fracturas con trazo articular. 25,26 Tabla 3: Factores asociados a la complejidad de la fractura.…”

“…El único factor que se relacionó a una mayor fractura con trazo articular fue el uso de glucocorticoides. 26 Ante esta disyuntiva sobre la relación de la DMO, nos pareció necesario discernir si existe una relación entre ésta y la complejidad de trazo en las fracturas de radio distal, por lo que usamos la clasificación AO para fracturas. Además, deseábamos determinar si el uso de esta clasificación puede predecir la existencia de un padecimiento de osteoporosis sin necesidad de la densitometría, para así realizar una adecuada planificación y tratamiento durante los tiempos pre, intra y postoperatorios.…”

Variations in Strain Distribution at Distal Radius under Different Loading Conditions

“…Some clinical studies have investigated the effect of these factors on fracture patterns. Investigation of the relationship between BMD and distal radius fracture shows that, although BMD may be related to the presence of fracture, it cannot be used as a predictor of the fracture pattern [ 13 , 14 , 15 ]. Moreover, an investigation on the effect of bone shape on scaphoid fractures also revealed that there is a relationship between the bone shape and the presence of fractures [ 16 ].…”