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Surveillance of Distal Radius Fractures: Impact on Subsequent Osteoporosis Screening, Treatment, and Fracture Risk
Eileen N Phan, MD
1, Abdullah Ghali, MD
1, Umar Ghilzai, Dr
1, Jad Lawand, MS
2, Macy Bell, BS
1; Adil Shahzad Ahmed, M.D.
3(1)Baylor College of Medicine, Houston, TX, (2)UTMB, Galvestone, TX, (3)Emory University School of Medicine, Atlanta, GA
Introduction: Despite their frequency and value as predictors of underlying bone density loss, DRFs are often under-screened and undertreated for osteoporosis. This study assesses the impact of early pharmacological intervention and osteoporosis screening following DRF on reducing future fracture risk.
Materials & Methods: Using data from the TriNetX US Collaborative Network, a retrospective cohort study was conducted to analyze electronic health records of 43,939 patients over 50 years old who sustained a DRF. Patients were initially grouped based on osteoporosis diagnosis status before the index DRF and whether they received anti-osteoporotic therapy (AOT) in the year post-DRF. Propensity score matching controlled for age, gender, and comorbidities. The primary outcome of the study was the 5-year fracture risk, stratified based on prior osteoporosis diagnosis, post-fracture AOT exposure, and osteoporosis screening status following the index DRF.
Results: Of the 43,939 patients who sustained a DRF, 17.4% had a prior diagnosis of osteoporosis, but only 30.2% had received AOT. Among AOT-naive patients, 91.3% remained untreated post-DRF. For patients with a prior diagnosis of osteoporosis, the 5-year fracture risk was high regardless of treatment status, ranging from 27.59% to 30.95%. Interestingly, propensity-matched analysis showed increased fragility fracture rates among those initiated on AOT post-DRF (13.36%) compared to both untreated patients (6.26%) and those who received AOT prior to DRF (9.76%). In patients without prior osteoporosis, the overall five-year fracture risk was 19.37%. Surprisingly, propensity-matched analysis showed increased fragility fracture rates among those initiated on AOT post-DRF (13.36%) compared to both untreated patients (6.26%) and those who received AOT prior to DRF (9.76%).
Conclusions: Despite DRF being a known fragility fracture, our study shows that very few patients receive post-fracture screening. Our results show an increase in fracture rates in those that start AOT after an index DRF compared to both untreated patients and those who received prior AOT. However, these results are not likely due to the AOT therapy itself but rather due to inconsistent management of osteoporosis following a DRF where earlier AOT treatment is being reserved only for those that are ‘high risk' of future fractures. These findings call for a need for a more comprehensive approach in treating patients with distal radius fractures including improving osteoporosis screening, timely initiation of treatment, adherence to therapy, and prevention of future fractures.
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