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Distal Radius Fracture Risk Reduction with a Comprehensive Osteoporosis Managment Program
SUMMARY POINTS ∙ Reduction of the palmar lunate facet correlates with improved clinical outcomes both at the radiocarpal joint and at the DRUJ, and impacts functional outcome as noted by improved Gartland and Werley scores at one year. ∙ While previous studies have reported the implications of the significance of the lunate facet of the distal radius, no published studies correlate the significance of the palmar lunate facet reduction to clinical and functional outcomes. REFERENCES 1. Knirk J, Jupiter J. Intraarticular fractures of the distal end of the radius in young adults. J Bone Joint Surg 1986 Jun;68A(5):647-59. 2. McQueen M, Caspers J. Colles’ Fracture: Does the anatomical result affect the final function? J Bone Joint Surg 1988 Aug;70B(4):649-51. 3. Anderson DD, Bell AL, Gaffney MB, Imbriglia JE. Contact stress distributions in malreduced intraarticular distal radius fractures. J Orthop Trauma 1996;10(5):331-7. 4. Chung KC, Kotsis SV, Kim HM. Predictors of functional outcomes after surgical treatment of distal radius fractures. J Hand Surg [Am ] 2007 Jan;32(1):76-83. 5. Goldfarb CA, Rudzki JR, Catalano LW, Hughes M, Borrelli J, Jr. Fifteen-year outcome of displaced intra-articular fractures of the distal radius. J Hand Surg [Am] 2006 Apr;31(4):633-9. 6. Catalano LW, III, Cole RJ, Gelberman RH, Evanoff BA, Gilula LA, Borrelli J, Jr. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg Am 1997 Sep;79(9):1290-302. 7. Harness NG, Jupiter JB, Orbay JL, Raskin KB, Fernandez DL. Loss of fixation of the volar lunate facet fragment in fractures of the distal part of the radius. J Bone Joint Surg Am 2004 Sep;86-A(9):1900-8. 8. Fernandez DL. Should anatomic reduction be pursued in distal radial fractures? J Hand Surg [Br ] 2000 Dec;25(6):523-7. 9. Trumble TE, Schmitt S, Vedder NB. Factors affecting functional outcome of displaced intra-articular distal radius fractures. J Hand Surg 1994 Mar;19A(2):325-40. M
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PAPER 32 ∙
Friday, October 8, 2010 9:21-9:28 AM Paper Session 4: Distal Radius Fracure and Tumor
Distal Radius Fracture Risk Reduction with a Comprehensive Osteoporosis Managment Program Level 3 Evidence v Neil G. Harness, MD
Tadeshi Funahashi, MD Annette L. Adams, PhD, MPH Grace Chen, PhD Denise Greene, RNP Richard Dell, MD
26
HYPOTHESIS 1. The risk of suffering a distal radius fracture is directly related to age, race, sex and the diagnosis of osteoporosis. 2. The risk of suffering a distal radius fracture is reduced by being screened and/or treated for osteoporosis in a comprehensive osteoporosis screening and treatment program. METHODS From enrollees in a large health maintenance organization, we identified a cohort of participants who were aged 60 years or older as of January 1, 2002, and who had no history of a prior distal radius fracture. For the period 2002-2008, and using hospital administrative data, radiology records, and pharmacy records, we gathered 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. Demographic and clinical characteristics were compared univariately for patients with and without distal radius fractures. Multivariable estimates of the associations between a) pharmacologic treatment and b) osteoporosis screening and distal radius fracture risk were estimated using Cox proportional hazards methods, and were adjusted for age, sex, race, diabetes status, and prior history of hip or proximal humerus fractures. RESULTS Overall, 1.65% (n = 8,656) of the study population (N=524,612) sustained a new distal radius fracture during 2002-2008. In the multivariable model, we found that patients who received pharmacological intervention were 48% less likely to sustain a distal radius fracture (HR 0.52; 95% CI 0.50-0.55). Similarly, patients who were screened for osteoporosis were 83% less likely to sustain a distal radius fracture (HR 0.17; 95% CI 0.16-0.18). Patients with osteoporosis are 8.9 (95% CI: 8.4-9.5) times more likely to have a distal radius fracture than patients without osteoporosis, even after adjusting for osteoporosis screening and pharmacologic treatment. Subjects of white race had a 1.6 times higher risk of distal radius fracture (95% CI: 1.5-1.7) and females had a 3.8 times higher risk (95% CI: 3.6-4.0). After adjusting for other factors, increasing age conferred only marginal increased risk for fracture (HR 1.01; 95% CI 1.01-1.03). SUMMARY POINTS ∙ Patients diagnosed with osteoporosis are 9 times more likely to sustain a distal radius fracture. ∙ Pharmacologic management of osteoporosis decreases the risk of fracture by 48%. ∙ Osteoporosis screening decreases risk of distal radius fracture by 83%. ∙ Females and patients of white race remain at elevated risk, after adjusting for osteoporosis screening and treatment factors.
v Speaker has nothing of financial value to disclose
Consulting fees with Zimmer
PAPER 32 ∙
Friday, October 8, 2010 9:21-9:28 AM Paper Session 4: Distal Radius Fracure and Tumor
Distal Radius Fracture Risk Reduction with a Comprehensive Osteoporosis Managment Program Level 3 Evidence v Neil G. Harness, MD
Tadeshi Funahashi, MD Annette L. Adams, PhD, MPH Grace Chen, PhD Denise Greene, RNP Richard Dell, MD
26
HYPOTHESIS 1. The risk of suffering a distal radius fracture is directly related to age, race, sex and the diagnosis of osteoporosis. 2. The risk of suffering a distal radius fracture is reduced by being screened and/or treated for osteoporosis in a comprehensive osteoporosis screening and treatment program. METHODS From enrollees in a large health maintenance organization, we identified a cohort of participants who were aged 60 years or older as of January 1, 2002, and who had no history of a prior distal radius fracture. For the period 2002-2008, and using hospital administrative data, radiology records, and pharmacy records, we gathered 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. Demographic and clinical characteristics were compared univariately for patients with and without distal radius fractures. Multivariable estimates of the associations between a) pharmacologic treatment and b) osteoporosis screening and distal radius fracture risk were estimated using Cox proportional hazards methods, and were adjusted for age, sex, race, diabetes status, and prior history of hip or proximal humerus fractures. RESULTS Overall, 1.65% (n = 8,656) of the study population (N=524,612) sustained a new distal radius fracture during 2002-2008. In the multivariable model, we found that patients who received pharmacological intervention were 48% less likely to sustain a distal radius fracture (HR 0.52; 95% CI 0.50-0.55). Similarly, patients who were screened for osteoporosis were 83% less likely to sustain a distal radius fracture (HR 0.17; 95% CI 0.16-0.18). Patients with osteoporosis are 8.9 (95% CI: 8.4-9.5) times more likely to have a distal radius fracture than patients without osteoporosis, even after adjusting for osteoporosis screening and pharmacologic treatment. Subjects of white race had a 1.6 times higher risk of distal radius fracture (95% CI: 1.5-1.7) and females had a 3.8 times higher risk (95% CI: 3.6-4.0). After adjusting for other factors, increasing age conferred only marginal increased risk for fracture (HR 1.01; 95% CI 1.01-1.03). SUMMARY POINTS ∙ Patients diagnosed with osteoporosis are 9 times more likely to sustain a distal radius fracture. ∙ Pharmacologic management of osteoporosis decreases the risk of fracture by 48%. ∙ Osteoporosis screening decreases risk of distal radius fracture by 83%. ∙ Females and patients of white race remain at elevated risk, after adjusting for osteoporosis screening and treatment factors.
v Speaker has nothing of financial value to disclose