Osteoporosis Intervention Following Distal Forearm Fractures

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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.