期刊正文

Fragility fractures are nearly epidemic worldwide, and the occurrence of a fragility fracture is among the strongest risk factors predicting subsequent fractures. Increasing emphasis has been placed on secondary prevention of fragility fractures, which involves initiating evaluation for osteoporosis and, when indicated, treatment following a fragility fracture in order to reduce the risk of future fracture. Despite the increasing national and international attention to secondary prevention efforts, the increasing availability of medications that reduce fracture risk, and the advent of fracture liaison programs, the majority of patients who have sustained a fragility fracture do not receive evaluation or treatment. A recent report of over 129,000 U.S. patients with a fragility fracture treated from 2001 to 2009 indicated that, in fact, the rate of treatment decreased over the decade. Among common sites of fragility fracture, the distal aspect of the radius was associated with the lowest rates of evaluation and treatment, with only 21% and 11% of women with this type of fracture receiving a dual x-ray absorptiometry (DXA) scan and medical treatment, respectively.

Evaluation and treatment rates for men continue to be much lower than those for women. In the study cited above, among the nearly 42,000 men who sustained a fragility fracture, only 10% underwent DXA testing, and 9.6% were started on medical treatment. For the 8277 men in this cohort who sustained a distal radial fracture, the rates were lower still, with 4.3% undergoing DXA testing and 2% being started on treatment. While substantial challenges remain in achieving acceptable rates of evaluation and treatment of all patients who sustain fragility fractures, these challenges are far greater for men—and particularly in men who sustain distal radial fractures.

In the present study, the authors report the results of a consecutive clinical series that highlight some key differences between women and men who sustained a fragility fracture of the distal aspect of the radius. Although men had less severe fracture patterns than women, they had similar mechanisms of injury and similar comorbidity indices. Additionally, men sustained the fracture at a younger age than women and were less likely to have had a fragility fracture prior to the index distal radial fracture. The men in the study were significantly less likely than the women to undergo a DXA scan or to be started on osteoporosis treatment, even at an institution in which evaluation and treatment following fragility fractures has been strongly emphasized.