Significance of high- and low-distal energy forearm fractures

To determine in men and women aged 50 years or older the proportion of distal forearm fractures related to high- or low-energy events and subsequent fracturing.

We reviewed records of patients presenting to emergency departments and urgent care facilities with distal forearm fractures occurring during a 7-year entry period and studied for an additional 3.5 years.

High-energy events proportionally were 3.25 times more likely in men, whereas low-energy distal forearm fractures proportionally were 7.98 times more likely in women. Although 25% received bone densitometry evaluations, only 3.59% were performed within the first year after a distal forearm fracture. Osteoporosis and osteopenia did not differ between high- and low-energy distal forearm fractures. In logistic regression, subsequent fractures were associated with prior fracture and age 80 years or older. The occurrence of individuals subsequently fracturing was similar in men and women. Compared with controls, the odds ratio of individuals subsequently fracturing was 1.74 (95% confidence interval 1.32-2.30) in women and 1.9 (95% confidence interval 1.07-3.43) in men. Approximately 60% of total subsequent fractures occurred within 3 years. Osteoporosis was significantly more in patients with distal forearm fractures than controls (P < 0.001), but control patients had significantly more osteopenia (P < 0.001). No differences were noted in therapeutic intervention between those with prior distal forearm fractures and controls.

Regardless of trauma occurrence, both men and women age 50 years and older with recent distal forearm fractures should be evaluated early for treatment by bone densitometry and clinical risk factors because the majority of recurrent fractures occur within 3 years.