Bone Mineral Density is Not Correlated with One-Year Functional Outcome in Distal Radial Fractures: A Preliminary Study

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2016 Jan 28

PMID 26814905

Citations 3

Authors

Tim A E J Boymans

Svenhjalmar van Helden

Alfons Kessels

Rene Ten Broeke

Peter R G Brink

Affiliations

Soon will be listed here.

Abstract

Introduction: The intrinsic stability of fractures related to soft tissue injury and the comminution of the metaphyseal part of the distal radius influence the chance of secondary displacement in distal radial fractures treated conservatively. A low bone mineral density may also contribute to this secondary displacement and could therefore play a role in functional outcome. This possible relation between functional outcome and bone mineral density is poorly studied.

Patients And Methods: Patients with a unilateral conservatively treated distal radial fracture were assessed one year after their fracture with the DASH score (disabilities of the arm, shoulder and hand) and the Cooney score. Fractures were classified according to the AO classification. Radial inclination, radial shift, radial tilt and ulnar variance were measured on the first and follow-up radiographies. Bone mineral densities of both the hip and lumbar spine were measured by DXA and expressed as T-scores.

Results: Fifty-four patients participated in this study (mean age 68 years). Osteoporosis (T-score ≤ -2.5) was present in 20 patients (37%), osteopenia (T-score of -1 to -2.5) in 30 patients (56%), and normal bone density (T-score > -1) in four patients (7%). The distribution of fracture types according to the AO classification showed 32 A-type fractures, eight B-type fractures and 14 C-type fractures. Both univariate linear and multivariate regression analysis with covariates of age, sex, body mass index and AO classification showed no significant correlation between T-score and functional outcome.

Conclusion: The functional outcome of conservatively treated distal radial fractures in this study does not correlate with bone mineral density. Therefore, BMD measurement cannot be used to predict functional outcome in these patients.

Citing Articles

Optimizing Treatment Strategies for Distal Radius Fractures in Osteoporosis: A Comparative Review.

Gullborg E, Kim J, Ward C, Simcock X Medicina (Kaunas). 2024; 60(11).

PMID: 39597033 PMC: 11596178. DOI: 10.3390/medicina60111848.

Analysis of Postoperative Distal Radius Fracture Outcomes in the Setting of Osteopenia and Osteoporosis for Patients with Comorbid Conditions.

Tuano K, Fisher M, Lee N, Khatter N, Le E, Washington K J Hand Surg Glob Online. 2023; 5(5):601-605.

PMID: 37790836 PMC: 10543796. DOI: 10.1016/j.jhsg.2023.04.005.

Egund L, McGuigan F, Egund N, Besjakov J, Akesson K BMC Musculoskelet Disord. 2020; 21(1):816.

PMID: 33287782 PMC: 7722451. DOI: 10.1186/s12891-020-03843-9.

References

. Standardization of proximal femur bone mineral density (BMD) measurements by DXA. International Committee for Standards in Bone Measurement. Bone. 1997; 21(4):369-70. View

Celiktas M, Kozanoglu E, Aikimbaev K, Soyupak S, Binokay F . Osteopenia and osteoporosis in postmenopausal women. Assessment by radiogrammetric measurement. Acta Radiol. 2002; 43(6):609-14. DOI: 10.1080/j.1600-0455.2002.430613.x. View

ONeill T, Cooper C, Finn J, Lunt M, Purdie D, Reid D . Incidence of distal forearm fracture in British men and women. Osteoporos Int. 2001; 12(7):555-8. DOI: 10.1007/s001980170076. View

Taaffe D, Lewis B, Marcus R . Quantifying the effect of hand preference on upper limb bone mineral and soft tissue composition in young and elderly women by dual-energy X-ray absorptiometry. Clin Physiol. 1994; 14(4):393-404. DOI: 10.1111/j.1475-097x.1994.tb00398.x. View

Thompson P, Taylor J, Dawson A . The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury. 2004; 35(5):462-6. DOI: 10.1016/S0020-1383(03)00117-7. View

Rud B, Greibe R, Hyldstrup L, Sorensen H . Does a distal forearm fracture lead to evaluation for osteoporosis? A retrospective cohort study in 147 Danish women. J Clin Densitom. 2005; 8(1):18-24. DOI: 10.1385/jcd:8:1:018. View

GARTLAND Jr J, WERLEY C . Evaluation of healed Colles' fractures. J Bone Joint Surg Am. 1951; 33-A(4):895-907. View

Chen J, Gong J, Zhang T, Wu Q, Xu H . Correlations between bone mineral density of the hand and other skeletal sites as measured by DXA in Chinese women and men. J Clin Densitom. 2006; 9(4):461-8. DOI: 10.1016/j.jocd.2006.07.006. View

van Helden S, van Geel A, Geusens P, Kessels A, Nieuwenhuijzen Kruseman A, Brink P . Bone and fall-related fracture risks in women and men with a recent clinical fracture. J Bone Joint Surg Am. 2008; 90(2):241-8. DOI: 10.2106/JBJS.G.00150. View

10.

Hollevoet N, Verdonk R . Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg. 2004; 69(6):510-4. View

11.

Kanis J, Gluer C . An update on the diagnosis and assessment of osteoporosis with densitometry. Committee of Scientific Advisors, International Osteoporosis Foundation. Osteoporos Int. 2000; 11(3):192-202. DOI: 10.1007/s001980050281. View

12.

Changulani M, Okonkwo U, Keswani T, Kalairajah Y . Outcome evaluation measures for wrist and hand: which one to choose?. Int Orthop. 2007; 32(1):1-6. PMC: 2219945. DOI: 10.1007/s00264-007-0368-z. View

13.

Dias J, Wray C, Jones J . Osteoporosis and Colles' fractures in the elderly. J Hand Surg Br. 1987; 12(1):57-9. DOI: 10.1016/0266-7681_87_90058-1. View

14.

Kanis J . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994; 4(6):368-81. DOI: 10.1007/BF01622200. View

15.

Ismail A, Pye S, Cockerill W, Lunt M, Silman A, Reeve J . Incidence of limb fracture across Europe: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int. 2002; 13(7):565-71. DOI: 10.1007/s001980200074. View

16.

Hollevoet N, Van Maele G, Van Seymortier P, Verdonk R . Comparison of palmar tilt, radial inclination and ulnar variance in left and right wrists. J Hand Surg Br. 2000; 25(5):431-3. DOI: 10.1054/jhsb.2000.0466. View

17.

Schwenkglenks M, Lippuner K, Hauselmann H, Szucs T . A model of osteoporosis impact in Switzerland 2000-2020. Osteoporos Int. 2004; 16(6):659-71. DOI: 10.1007/s00198-004-1743-x. View

18.

Hollevoet N, Goemaere S, Mortier F, Van Bouchaute P, Kaufman J, Verdonk R . The role of osteoporosis in distal radius fractures. Acta Orthop Belg. 2000; 66(2):163-8. View

19.

Endres H, Dasch B, Lungenhausen M, Maier C, Smektala R, Trampisch H . Patients with femoral or distal forearm fracture in Germany: a prospective observational study on health care situation and outcome. BMC Public Health. 2006; 6:87. PMC: 1526725. DOI: 10.1186/1471-2458-6-87. View

20.

Itoh S, Ohta T, Samejima H, Shinomiya K . Bone mineral density in the distal radius in a healthy Japanese population and in relation to fractures of the distal radius. J Hand Surg Br. 1999; 24(3):334-7. DOI: 10.1054/jhsb.1999.0073. View