Distal Radius Fractures in Patients Aged 50 Years or Older: Obstacles to Bone Health Analysis and Follow-Up in a Community Setting

Rachel Silverstein; Sonya Khurana; Rachel Talley-Bruns; Alexander Lundy; Michael Brownstein; Haik Kavookjian

doi:10.1016/j.jhsg.2021.01.001

Distal Radius Fractures in Patients Aged 50 Years or Older: Obstacles to Bone Health Analysis and Follow-Up in a Community Setting

J Hand Surg Glob Online. 2021 Feb 10;3(2):88-93. doi: 10.1016/j.jhsg.2021.01.001. eCollection 2021 Mar.

Authors

Rachel Silverstein¹, Sonya Khurana¹, Rachel Talley-Bruns¹, Alexander Lundy¹, Michael Brownstein¹, Haik Kavookjian¹

Affiliation

¹ Department of Orthopedic Surgery, Stamford Hospital, Stamford, CT.

Abstract

Purpose: To determine barriers to implementing an osteoporosis protocol in a community institution following distal radius (DR) fragility fracture to help prevent subsequent fragility fractures.

Methods: This cross-sectional study included elderly patients with DR fractures that occurred between 2016 and 2018. Exclusion criteria were age under 50 years, high-energy mechanism, and inability to follow-up locally. Patients were directed to follow-up with the hospital's osteoporosis center (OC) or an endocrinologist. Patients were contacted to identify if care was established with the OC and screened for potential barriers in evaluation for bone health. Primary outcomes included the completion of a follow-up visit with an osteoporosis care provider and identification of barriers for patients who did not complete this visit. Secondary outcomes included whether or not patients obtained bone health labs, dual-energy x-ray absorptiometry (DEXA) scans, and/or underwent medical treatment for osteoporosis.

Results: One hundred seventy-five patients met final inclusion criteria and were contacted after discharge. Fifty patients agreed to follow-up with the OC, voicemails were left for 66 patients, only 70 (60.3%) patients actually followed up for bone health analysis. Patients were lost to follow-up due to lack of accessibility (32 patients; death, incorrect phone number, no voicemail, or impaired cognition), and lack of interest (27 patients). Ninety-six (54.9%) patients received appropriate treatment based on bone health labs and/or DEXA scan. Ninety (51.4%) patients had chemical treatment for osteoporosis. Fifty-five patients underwent DEXA scans with equal distribution of patients with normal, osteopenic, and osteoporotic bone. Forty-three (78%) patients who had DEXA scans underwent treatment.

Conclusions: Establishing a protocol for follow-up for bone health assessment following a DR fracture is challenging. Only half of the patients underwent evaluation and management of their bone health. It is imperative to understand the barriers for at-risk patients to provide them with care that will improve their quality of life.

Type of study/level of evidence: Diagnostic III.

Keywords: Bone health; Distal radius fracture; Fragility fracture; Osteoporosis; Osteoporosis center.