Distal Radius Fracture Risk Reduction With a Comprehensive Osteoporosis Management Program

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• 作者：Neil G. Harness ; MD ; ^{neil.g.harness@kp.org} ; Tadashi Funahashi ; MD ; Richard Dell ; MD ; Annette L. Adams ; PhD ; MPH ; Raoul Burchette ; PhD ; Xuan Chen ; PhD ; Denise Greene ; BS
• 关键词：Osteoporosis ; fracture ; distal radius ; treatment
• 刊名：The Journal of Hand Surgery
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：37
• 期：8
• 页码：1543-1549
• 全文大小：258 K

文摘

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Purpose

To study risk factors associated with osteoporotic distal radius fractures and evaluate the effectiveness of the screening and treatment components of a comprehensive osteoporosis program.

Methods

We retrospectively identified a cohort of patients aged 60 years or older from a large health maintenance organization. For the period 2002 to 2008, information on age, race, sex, diabetes status, osteoporosis diagnosis, osteoporosis screening activity, medications dispensed, and fracture events, including distal radius, proximal humerus, and hip fractures were recorded. We compared demographic and clinical characteristics for patients with and without distal radius fractures. We estimated multivariable estimates of the associations between pharmacologic treatment, and osteoporosis screening and distal radius fracture risk using Cox proportional hazards methods, and adjusted them for age, sex, race, diabetes status, and prior history of hip or proximal humerus fractures.

Results

Overall, 1.7 % of the cohort (n = 8,658) of the study population (N = 524,612) sustained a new distal radius fracture during 2002 to 2008. In the multivariable model, we found that patients who received pharmacological intervention were 48 % less likely to sustain a distal radius fracture. Similarly, patients who were screened for osteoporosis were 83 % less likely to sustain a distal radius fracture. Patients with osteoporosis were 8.9 times more likely to have a distal radius fracture than patients without osteoporosis. White subjects had a 1.6 times higher risk of distal radius fracture than non-whites, and women had a 3.8 times higher risk than men.

Conclusions

White race, female sex, and a diagnosis of osteoporosis are high risks for distal radius fracture. Screening for and pharmacologic management of osteoporosis using a multidisciplinary team approach in a comprehensive osteoporosis management program resulted in a statistically significant decrease in the risk of distal radius fracture.

Type of study/level of evidence

Therapeutic III.