Should we consider ankle fractures as osteoporotic fractures?

Since ankle fractures are common fractures in the lower limb, it is worth exploring their potential association with osteoporosis. As part of the research, patients with ankle fractures were screened for osteoporosis to assess its potential for identifying patients with osteoporosis (osteoporosis cases). Consequently, screening should be included as part of fracture management. Ankle fractures are part of the orthopaedic surgeon's daily routine. They are the most common lower limb fractures in the elderly. The absence of an age peak, such as that seen in distal radius fractures, makes it difficult to distinguish between fractures that are likely to be related to osteoporosis and those that are not. The DVO (German Osteological Association) guideline, published in 2017, mainly mentions exceptions for osteoporotic fractures, such as ankle fractures. This study examined patients with ankle fractures to assess whether this fracture type can be used for identifying osteoporosis.

Considering the fact that ankle fractures are the most prevalent fractures in the lower extremity, it is worth investigating what proportion of these fractures are related to osteoporosis. As part of the research, patients with ankle fractures underwent screening for osteoporosis to determine its potential utility in identifying patients with osteoporosis.

The present study included all patients aged 45 or older with ankle fractures that occurred within a period of 24 months. Participants were asked about their osteoporosis risk factors. The Fracture Risk Assessment Tool® was used to assess eligibility for treatment. The information from the questionnaire was used to determine whether there was an indication for diagnostic testing for osteoporosis according to the DVO guideline. It was also recorded whether, based on the risk factors assessed, the patient had an indication for osteoporosis therapy.

A total of 131 patients were enrolled. The average age was 65 years. Osteoporosis screening was necessary for 61 percent. Based on age, 85% of patients aged 60 years or older were recommended for osteoporosis screening. Fifty-five percent of the patients aged 61 years and above had an indication for a specific therapy. The treatment gap in patients requiring specific therapy was 97%.

Screening should be provided and conducted as part of fracture management due to the substantial number of patients who require screening. Ankle fractures could help to close the existing treatment gap of 78-80% in Germany.

ClinicalTrials.gov Identifier: DRKS00028085.