Bone Health, Fragility Fractures, and the Hand Surgeon

Fragility fractures, which are often linked to osteoporosis, are fractures resulting from minimal trauma or low-impact falls. Although osteoporosis treatment can reduce risk of fragility fractures, many patients do not meet diagnostic criteria for osteoporosis before their first fracture. Additionally, fragility fractures are often overlooked as signs of underlying bone health issues, leading to untreated patients despite the availability of effective therapies. Appropriate bone health care can considerably reduce the risk of fragility fractures and prevent subsequent fractures in individuals with a fracture history. Alarmingly, only 8% of Medicare beneficiaries who sustained osteoporotic fractures received a bone mineral density test. Hand surgeons are uniquely positioned to identify patients at risk of underlying bone health problems during routine practice. This includes managing fragility fractures that warrant referral for a comprehensive bone health evaluation, particularly low-energy distal radius fractures that often occur years before more severe fragility fractures (eg, hip or spine). Additionally, routine radiographs and computed tomography scans also provide valuable screening opportunities even in patients without fragility fractures. Enhancing access to tools for detecting bone health problems can help address gaps in fracture management and prevention. As fractures remain a growing global health concern, we advocate for increased involvement of hand surgeons in early bone health detection.