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Wrist Fracture an Osteo Warning Sign

Not enough doctors are making the link between the breaks and the bone-thinning disease

SATURDAY, March 30, 2002 (HealthDayNews) -- Sometimes a wrist fracture is just a wrist fracture. But when it happens to a postmenopausal woman, there's a good chance that fracture is the first outward symptom of the bone-thinning disease osteoporosis.

And without proper treatment, it probably won't be the last symptom -- many untreated cases result in much more serious hip fractures down the line.

But despite the probable link and the possibility of future fractures, few doctors appear to even check for the disease when women come in with wrist fractures.

According to a study by University of Pennsylvania researchers who looked at the cases of 1,162 postmenopausal women who sustained wrist fractures, only 24 percent of the women were given any diagnostic tests or medication for the disease in the six months following the fracture.

And even though women's risk for osteoporosis increases with age, the study found that the older patients were less likely to have received treatment for the disease.

Only 9.1 percent of participants aged 85 to 89 years old were treated for osteoporosis; 4.2 percent of those 90 to 94 years old were treated; and 4.7 percent of those 95 or older were treated.

The results were published in The Journal of Bone and Joint Surgery.

Osteoporosis, which literally means "porous bone," affects 28 million Americans and contributes to an estimated 1.5 million bone fractures every year, according to the American Academy of Orthopedic Surgeons.

The disease occurs as people -- especially women -- age, and though the specific causes aren't known, contributing factors include genetics, nutrition and some medications.

When a postmenopausal woman sustains a wrist fracture, it should be followed by a bone density test, says the study's co-author, Frederick Kaplan, a professor of orthopedic molecular medicine at the University of Pennsylvania School of Medicine.

"Every women with a broken wrist is at risk of further fractures and we feel should be tested with a bone density measurement," he says.

The bone density test is a painless scan in which patients lie on an X-ray-like table and are scanned by a machine that measures spine and hip bone density.

Kaplan says the test takes about five to 10 minutes and involves a very small amount of radiation.

If bone loss is discovered, medications and dietary modifications are typically prescribed to prevent further loss.

The most important of those dietary modifications -- supplements of vitamin D and calcium, says Dr. Paul Jellinger, immediate past president of the American Association of Clinical Endocrinologists.

"Calcium supplementation is always recommended with bone loss, as well as a minimum of at least 400 units of vitamin D per day," says Jellinger.

Exercise is also an important component in keeping bones strong, he adds. "You want to be doing weight-bearing exercises, including walking or some kind of aerobic or weight-bearing activity. You really want to avoid a sedentary lifestyle."

Jellinger speculates that one of the reasons there appear to be so few doctors who suspect osteoporosis when postmenopausal women sustain wrist fractures is because research doesn't stress the link between the two, even though it's well known.

"There's been so much emphasis on the link between spine and hip fractures and osteoporosis, but the fact that fractures are more likely to occur anywhere in the body when there's [bone loss] has perhaps not received the emphasis it should," he says.

Then there's the value of supplements.

A prominent French study, involving thousands of women in their 80s, was conducted in the early 1990s and published in the New England Journal of Medicine. It found that women who took regular vitamin D and calcium supplements had substantially lower rates of fractures after 18 months than those not on the supplements.

In addition, the women who had taken supplements had bones found to be less porous and structurally sounder, Kaplan says.

Kaplan says measures like exercise and dietary supplements could play a big role in preventing the 350,000 hip fractures that occur each year in the United States. That number, with the aging population, could reach 650,000 by the year 2050.

What To Do

Visit the American Academy of Orthopaedic Surgeons for extensive information on osteoporosis.

And if your doctor doesn't ask you about osteoporosis, try asking your doctor. Here are some tips on talking to your doctor, from the National Osteoporosis Foundation.

SOURCES: Frederick Kaplan, M.D., Isaac and Rose Nassau professor of orthopedic molecular medicine, and chief, Division of Metabolic Bone Diseases and Molecular Orthopaedics, University of Pennsylvania School of Medicine, Philadelphia; Paul S. Jellinger, M.D., immediate past president of the American Association of Clinical Endocrinologists, Jacksonville, Fla.; The Journal of Bone and Joint Surgery
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