Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women's Health Initiative Study

Abstract

Wrist fractures are common in postmenopausal women and are associated with functional decline. Fracture patterns after wrist fracture are unclear. The goal of this study was to determine the frequency and types of fractures that occur after a wrist fracture among postmenopausal women. We carried out a post-hoc analysis of data from the Women’s Health Initiative Observational Study and Clinical Trials (1993–2010) carried out at 40 U.S. clinical centers. Participants were postmenopausal women aged 50–79 at baseline. Mean follow-up duration was 11.8 years. Main measures included incident wrist, clinical spine, humerus, upper extremity, lower extremity, hip, and total non-wrist fractures and bone mineral density (BMD) in a subset. Among women who experienced wrist fracture, 15.5% subsequently experienced non-wrist fracture. The hazard for non-wrist fractures was higher among women who had experienced previous wrist fracture than among women who had not experienced wrist fracture: non-wrist fracture overall (hazard ratio [HR] 1.40, 95% confidence interval [CI] 1.33–1.48), spine (HR 1.48, 95% CI 1.32–1.66), humerus (HR 1.78, 95% CI 1.57–2.02), upper extremity (non-wrist) (HR 1.88, 95% CI 1.70–2.07), lower extremity (non-hip) (HR 1.36, 95% CI 1.26–1.48), and hip (HR 1.50, 95% CI 1.32–1.71) fracture. Associations persisted after adjustment for BMD, physical activity, and other risk factors. Risk of non-wrist fracture was higher in women who were younger when they experienced wrist fracture (interaction p-value 0.02). Associations between incident wrist fracture and subsequent non-wrist fracture did not vary by baseline BMD category (normal, low bone density, osteoporosis). A wrist fracture is associated with increased risk of subsequent hip, vertebral, upper extremity, and lower extremity fractures. There may be substantial missed opportunity for intervention in the large number of women who present with wrist fractures.

Incident Fragility Fractures Have a Long-Term Negative Impact on Health-Related Quality of Life of Older People: The Canadian Multicentre Osteoporosis Study

“…Thus, we did not see the deficit in HUI scores measured at 10 years. However, we need to be cautious since initial forearm fracture increases the risk of subsequent hip fracture among postmenopausal women …”

“…However, we need to be cautious since initial forearm fracture increases the risk of subsequent hip fracture among postmenopausal women. (25) Our study examined the impact of time after fracture on HRQL. As expected, the more recent fractures (occurring in year 6 to10) were associated with greater deficits in HRQL at year 10.…”

Epidemiology, classification, treatment and mortality of distal radius fractures in adults: an observational study of 23,394 fractures from the national Swedish fracture register

“…The association between DRFs and a reduced bone mineral density in post-menopausal women is well established [6,7]. Furthermore, a DRF in this patient group has been shown to increase the risk of subsequent osteoporotic fractures in the vertebrae, proximal humerus and proximal femur [12,13]. The rising number of osteoporotic fractures in the western world due to greater life expectancy in combination with an increasingly active and demanding elderly population as well as more advanced and expensive treatment options pose a growing burden to the health care system [14][15][16].…”

What is the rationale for early intervention after osteoporotic fractures to avoid recurrent fractures?

“…There may be substantial missed opportunities for intervention in the large number of females who present with wrist fractures. [3] The risk of a subsequent fracture immediately after an osteoporotic fracture is highest immediately after the event. [4] This is the rationale for early intervention after osteoporotic fractures to avoid recurrent fractures, and the treatment options available for patients at high risk of subsequent fractures may contribute to clinical decisionmaking and improved outcomes for patients with osteoporosis.…”