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Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures

Shah GM1, Gong HS2, Chae YJ2, Kim YS2, Kim J3, Baek GH3.

Clin Orthop Surg. 2020 Mar;12(1):9-21. doi: 10.4055/cios.2020.12.1.9. Epub 2020 Feb 13.

Abstract

Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.

CONCLUSIONS

DRFs occur on average 15 years earlier than hip fractures and are a condition that is at the start of the fragility fracture cascade. Therefore, occurrence of a DRF can be considered for physicians as an important opportunity to diagnose and treat osteoporosis and sarcopenia to prevent a secondary fracture. However, there is still a care gap between fragility fractures and osteoporosis care, especially for DRFs. Systematic approaches to address this care gap, such as FLS, are now implemented and further studies are necessary to confirm the effectiveness of such approaches.

Because DRFs can reflect early changes of bone and muscle weakness, studies on characteristics of patients with DRFs can suggest some insights on how to prevent these aging processes. Previously, measurement of BMD by DXA was considered the standard method but not all patients with DRFs have osteoporosis defined by the current BMD criteria. Recent studies using other assessment technologies such as HR-pQCT highlight the importance of cortical porosity in predicting fractures. In addition, studies on physical performance and muscles in DRF patients suggest identifiable risk factors for falls or fractures, such as decreased grip strength. Further studies are necessary to better identify patients with an increased risk of fractures or falls and intervention strategies to strength the bone and muscle.