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The Osteoporosis Needs of Patients With Wrist Fracture

Objectives: To provide information for practitioners regarding the osteoporosis (OP)-related needs of patients who present with low-trauma wrist fractures and are at high risk of subsequent hip fracture. Design: Prospective protocol, retrospective analysis. Setting: Large urban teaching hospital, regional trauma center. Patients: All outpatients (women ≥40 years; men ≥50 years) who sustained fragility fractures of the wrist between December 1, 2002 and June 30, 2005. Intervention: Patients were evaluated by a coordinator and recruited to an OP program for education, diagnosis, and treatment. Patient demographic data were collected. A baseline questionnaire included fracture and OP risk history, sociodemographics, Osteoporosis Health Beliefs Scale, and Osteoporosis Self-Efficacy Scale. Main Outcome Measures: Fracture history, OP risk factors, attitudes, and beliefs. Results: Of 339 patients with wrist fractures, 286 had fragility fractures (mean age 64.8 years; 82% female) and met the age criteria. Seventeen percent of men and 36% of women with fragility wrist fractures had been previously diagnosed with OP or osteopenia; nearly all of them had been prescribed supplements, and two thirds had received aminobisphosphonate treatment for OP. Half of the patients had one or more risk factors for OP. Most patients were aware of OP, but few felt their fracture could result from OP. Bone densitometry completed on 55 patients in the first year indicated OP or osteopenia in 43 of 55 patients. Patients' health beliefs underestimated the seriousness of OP. Every patient with a fragility fracture of the wrist should understand that: (1) their fracture may be related to OP; (2) by having a fragility fracture, they are at higher risk for hip fracture; and (3) preventive treatment is effective and safe. Information should be partly gender specific. Patients who believe that weak bones didn't cause their fracture require additional attention to motivate them to undergo special treatment. Conclusions: Intervention by the orthopaedic team to address potential underlying OP in patients with low-trauma wrist fractures should include directed patient education, testing, treatment with supplements and pharmacotherapy where indicated, and referral as needed.