Change in bone mass after Colles' fracture: a case report on unique data collection and long-term implications.
The cast immobilization of a fractured limb results in a loss of bone mass; however, the long-term implications of that effect with regard to bone mineral status, particularly in other skeletal sites, are less known. The purpose of this study was to describe changes in bone mass in different skeletal sites triggered by Colles' fracture. The case is unique regarding the existence of baseline measurements taken just a few days before the fracture on all measurable skeletal sites, including the fractured radius. Therefore, it was also possible to determine whether the injury caused long-term bone loss in the affected and unaffected skeletal sites. The patient was a healthy, premenopausal Caucasian woman, in her late forties, who fractured her nondominant wrist as a result of low-impact fall on ice. The arm and the metacarpals were immobilized to the elbow for 5 wk. Bone mass measurements were performed with DPX-MD densitometer (Lunar Corp. Madison, WI) at baseline and 5, 10, 13, 21, and 52 wk postinjury. At the 5-wk measurement (on plaster removal) there was a notable increase in bone mineral density (BMD) and bone mineral content (BMC) in all sites of ulna and radius of the injured forearm (from 10 to 73%), followed by the apparent decline to or below the baseline at 10, 13, 21 and 52 wk of follow-up. Other skeletal sites were measured at 10 wk when a substantial decrease in BMD and BMC in some of the hip regions and lumbar spine was noticed; most notably in L3-L4, Ward's triangle, and femoral neck (from 2 to 8%) and remained such after 1 yr. Although this patient had a normal bone mineral status and no osteopenia detected before fracture, the trauma of radial fracture caused long-standing bone loss in fracture-prone areas-hip and spine. Because about 70% of bone strength is explained by its mineral density, the patient might be at increased risk for fracture later in life. The changes in bone mass after injury should be monitored and interpreted carefully, and more elaborate treatment of patients presenting with wrist fractures are needed to prevent any potential risk for later osteoporotic fractures in spine and hip and possible refracture of the injured extremity.
Ilich
J Z
JZ
University of Connecticut, School of Allied Health, 358 Mansfield Rd. U-101, Storrs, CT 06269, USA. Ernst@uconnvm.uconn.edu
Zito
M
M
Brownbill
R A
RA
Joyce
M E
ME
D015502:Absorptiometry, Photon; D015519:Bone Density; D003100:Colles' Fracture / Q000503:physiopathology*; D005260:Female; D006615:Hip / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D011446:Prospective Studies; D014457:Ulna / Q000503:physiopathology