Distal Radius Fractures as a Call to Action: Reducing Subsequent Fragility Fracture Risk Through Early Osteoporosis Therapy

Purpose: Distal radius fractures (DRF) often serve as the initial indication of bone mineral disease. This study aims to determine the extent to which the risk of subsequent fragility fractures can be reduced by initiating anti-osteoporotic therapy after initial presentation of a DRF. Methods: This study utilized TriNetX, an online database with de-identified patient data from 79 US healthcare organizations. Females above the age of 50 were categorized based on receiving initial anti-osteoporotic treatment within a year of the DRF. Group characteristics, antiosteoporosis medications, and bone density evaluations were analyzed. After propensity matching, the risk of subsequent DRF, hip and vertebral fractures, as well as incidence of additional DEXA scans from 2004 to 2024 was explored. Results: The Medication (M) group (n = 6709) had a mean age of 69, the No Medication (NM) group (n = 181,065) had a mean age of 65 at the index incidence. Baseline differences included higher rates of bone density disorders, inflammatory polyarthropathies, spondylopathies, metabolic disorders, obesity, malnutrition, and neoplasm in the M group. Notably, 43% of the M group had a prior DEXA scan compared to 8.7% of the NM group. The most prescribed anti-osteoporotic medication in the M group was Alendronate (49%). After propensity matching (n = 6627), the M group had 32% more DEXA scans and were 25% less likely to have a subsequent DRF fracture compared to the NM group. There was no difference between groups in combined intertrochanteric and femoral neck fractures. Vertebral compression fractures demonstrated a small but statistically significant increase in the M group, with an absolute risk difference of 0.8% (number needed to treat = 125) and an effect size (Cohen’s h = 0.079), suggesting limited clinical relevance. Conclusions: Timely assessment and medical intervention can prevent future DRF. However, post-DRF bone density evaluations remain infrequent. This study highlights the hand surgeon’s role in identifying osteoporosis. Level of Evidence: Level III Cohort Study.