Distal Radius Fractures and Osteoporosis

Abstract

Risk factors for falls and distal radius or other fragility fractures should be evaluated in a structured way in patients with high risk for osteoporosis. This is especially true for patients with a previous distal radius or other fragility fractures since one indicates more to come. Modifiable risk factors should be addressed, and prophylactic treatment should be considered as there are a number of pharmacological and non-pharmacological regimens that reduce the risk of fragility fractures. It can no longer be acceptable clinical practice to neglect investigation or treatment of patients with osteoporosis who present with a distal radius or other fragility fractures. A bone mass scan should therefore be considered in these patients as pharmacological treatment in those with osteoporosis or with low bone mass and additional risk factors has been found to reduce fracture risk. In individuals with osteoporosis who require pharmacological treatment, bisphosphonate is usually the drug of choice, always in combination with calcium and vitamin D. Other possible treatments include selected estrogen receptor modulators (SERMs), strontium ranelate, subcutaneous parathyroid hormone (PTH), and denosumab. Physical activity should, independently of age, be recommended to all patients with a distal radius or other fragility fractures, together with a well-balanced diet. Individual risk factors should be addressed and avoided. As several interventions have been shown to reduce the fall risk in elderly, also fall-preventive interventions should be initiated in elderly with a distal radius or other fragility fractures.