After low-energy wrist fracture follow up is needed
Clin Orthop Relat Res. 2007 Sep 21;[Epub ahead of print]. Missed Opportunities in Patients with Osteoporosis and Distal Radius Fractures, Freedman BA and others. PMID: 17006362. This study, done at Walter Reed Army Medical Center, involved 111 patients with low-energy distal radius (wrist) fractures in patients 50 years of age or older. The study was retrospectively done from July to December 2002. Note that a low-energy fracture is, if not diagnostic for osteoporosis by itself, highly suggestive and indicates that further evaluation and diagnosis are needed to rule out osteoporosis. The results showed that only 25% of patients were referred to endocrinology, 20% had dual-energy X-ray absorptiometry done, 30% of patients had an approved osteoporosis medication prescribed and 47% were prescribed an approved osteoporosis medication and/or vitamin D and calcium. Men were not as likely to have any kind of post-fracture diagnostic or treatment intervention. Editor's comments: It is simply totally unacceptable in this era to have a low-energy fracture occur and not initiate treatment or referral to a specialist to diagnose and (if needed) treat the patient's osteoporosis. I have often commented that, unfortunately, it is necessary for patients to be educated about their own medical needs. In this case it is apparent that orthopaedic surgeons get tunnel vision and see only the fracture and forget that it is part of an entire human body—one with osteoporosis when the fracture occurs due to low-energy trauma. At a world-renowned medical center, this is even harder to understand or forgive. The bottom line is that patients—particularly older ones--must demand referral to an osteoporosis specialist for diagnosis and treatment after they suffer any kind of low-energy fracture, whether it is the wrist, hip, spine, or elsewhere.