Distal radial fractures in older men. A missed opportunity?
BACKGROUND
Fractures of the distal aspect of the radius are common, yet little is known about this type of fracture among older men. The purpose of this study was to compare fracture characteristics, treatment, and osteoporosis evaluation among men and women who had sustained a distal radial fracture. We hypothesized that the men would have similar patterns of injury and lower rates of evaluation for osteoporosis.


METHODS
We retrospectively reviewed the medical records of ninety-five men and 344 women over the age of fifty years who were treated for a distal radial fracture at a single institution over a five-year period. We assessed whether the patients had received a dual x-ray absorptiometry (DXA) scan and osteoporosis treatment within six months following the injury. Multivariate analysis identified independent predictors of bone mineral density (BMD) testing and osteoporosis treatment.


RESULTS
Men had less severe fractures than women (a Type-C fracture rate of 20% for men compared with 40% for women; p = 0.014). While 184 (53%) of the women had a DXA scan after injury, only seventeen (18%) of the men were evaluated (p < 0.001). Among the patients who underwent DXA scan, nine men (9% of men overall) and sixty-five women (19% of women overall) had a diagnosis of osteoporosis (p = 0.01). Male sex was an independent predictor of failure to undergo BMD testing as well as receive subsequent treatment with calcium and vitamin D or bisphosphonates (p < 0.001).


CONCLUSIONS
Significantly fewer men received evaluation for osteoporosis following a distal radial fracture, with rates of evaluation unacceptably low according to published guidelines.
Harvard Combined Orthopaedic Residency, 55 Fruit Street, White Building 535, Boston, MA 02114.
Carl M
CM
Harper
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115.
Shannon K
SK
Fitzpatrick
Department of Anesthesia, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115.
David
D
Zurakowski
Harvard Medical School, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215. E-mail address for T.D. Rozental: trozenta@bidmc.harvard.edu.
Tamara D
TD
Rozental
D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000175:diagnosis* / Q000188:drug therapy; D011885:Radius Fractures / Q000150:complications*; D012189:Retrospective Studies