Osteoporosis Intervention Following Distal Forearm Fractures

Abstract

OSTEOPOROTIC fractures represent a serious and growing threat to our aging population.¹ The cost of caring for individuals with these fractures was $13.8 billion in 1995,² but since the population at risk of osteoporosis is so large,³ the potential cost of preventing these fractures is also great. Consequently, there is ongoing debate about the relative cost-effectiveness of various management strategies.⁴ It seems clear, however, that treatment of high-risk individuals is both cost-effective and socially important.^5-7 Individuals who have already sustained a fracture are in a particularly high-risk group.⁸ Thus, men and women with a distal forearm fracture have a greatly increased likelihood of experiencing additional osteoporotic fractures in the future,^9-12 including hip fractures that are quite costly.¹ Since forearm fractures typically occur earlier in life than do hip fractures, it has been recommended for many years that interventions be targeted to this group.^13-15 Several studies have confirmed that women younger than 65 years who sustain a distal forearm fracture have reduced bone densitometry compared with same-aged women without a fracture.^16,17 Yet, few postmenopausal women are treated for osteoporosis following a distal forearm fracture¹² despite the availability of antiresorptive agents that have been shown to be effective in preventing future fractures among those who have already experienced one.^18-20 The objective of this study was to investigate the type of interventions for osteoporosis offered to a population-based cohort of postmenopausal women who had sustained a minimal trauma distal forearm fracture, placing them at high risk for future fracture, and to identify predictors of the likelihood of receiving such advice from physicians practicing in the community.