Osteoporosis intervention following distal forearm fractures: a missed opportunity?
BACKGROUND
Fractures are a manifestation of osteoporosis, but therapeutic interventions to reduce the risk of recurrent fractures are not widespread.


OBJECTIVE
To identify predictors of osteoporosis treatment in postmenopausal women following distal forearm fracture.


METHODS
This population-based retrospective cohort study included all postmenopausal women, 45 years or older, residing in Olmsted County, Minnesota, who sustained a distal forearm fracture due to minimal trauma (a fall from standing height or under) in 1993 to 1997. Complete medical records were reviewed for each subject and Cox proportional hazards regression was used to evaluate the relationship of baseline demographic and clinical characteristics to therapeutic interventions for osteoporosis within 12 months following the fracture.


RESULTS
A total of 343 women with a mean age of 70.5 years had a minimal trauma distal forearm fracture. Within 12 months, 83% had seen a nonorthopedic physician. Of these, 17% had a pharmacologic osteoporosis intervention and the 12-month actuarially estimated cumulative incidence of any intervention was 18% (95% confidence interval [CI], 14%-22%). In a multivariate analysis, treatment was more likely to be offered to those with a prior diagnosis of osteoporosis (relative risk [RR], 2.08; 95% CI, 1.21-3.58), previous distal forearm fracture (RR, 2.38; 95% CI, 1.30-4.34), or history of cigarette smoking (RR, 1.86; 95% CI, 1.11-3.12).


CONCLUSIONS
Effective osteoporosis interventions are underutilized among postmenopausal women who experience an osteoporotic fracture. Further work is needed to overcome barriers to optimal osteoporosis management in these women who are at high risk for future complications of osteoporosis.
Cuddihy
Maria-Teresa
MT
Division of Area General Internal Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, 200 First St SW, Rochester, MN 55905, USA.
Gabriel
Sherine E
SE
Crowson
Cynthia S
CS
Atkinson
Elizabeth J
EJ
Tabini
Claudia
C
O'Fallon
W Michael
WM
Melton
L Joseph
LJ
D015331:Cohort Studies; D005260:Female; D005543:Forearm Injuries / Q000209:etiology* / Q000517:prevention & control; D050723:Fractures, Bone / Q000209:etiology* / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D008910:Minnesota; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies