Fracture Risk Higher in Postmenopausal Women With Prior Wrist Fracture

Wrist fractures in postmenopausal women can lead to additional hip, vertebral, upper extremity, and lower extremity fractures, according to data published in the Journal of Bone and Mineral Research.

Although postmenopausal women frequently sustain wrist fractures, there is conflicting opinion among clinicians regarding whether nontraumatic wrist fractures should be considered fragility fractures. Establishing the frequency, timing, and types of fractures that occur after a wrist fracture is sustained could help in the development of methods to prevent subsequent nonwrist fracturing.

“This finding, combined with the observation that the associations persisted despite adjustment for all known major fracture risk factors,” the authors wrote, “suggests that aberrations in bone structure and/or strength are at least partly responsible for placing women with wrist fracture at increased risk of subsequent fracture.”

In an analysis of the Women’s Health Initiative Observational Study and Clinical Trials, conducted between 1993 and 2010, researchers examined the data of women aged 50 to 79 years from 40 centers across the United States for an average of 11.8 years. The researchers analyzed bone mineral density and rates of incident fractures of the wrist, clinical spine, humerus, upper extremity, lower extremity, and hip.

Among the women who experienced a wrist fracture, 15.5% experienced an additional nonwrist fracture.

The hazard ratio (HR) for overall nonwrist fractures was 1.40 among women who had already sustained a wrist fracture, which was higher compared with women who had never had a prior wrist fracture. Nonwrist injuries included fracturing in the spine, humerus, upper extremities, lower extremities, and hip (HR=1.48, 1.78, 1.88, 1.36, and 1.50, respectively). The results remained consistent after adjustments for physical activity and lifestyle.

The data suggest that aberrations in bone structure and strength may be responsible for the increased fracture risk for women with prior wrist fractures. Treatment based on bone mineral density measurements in the spine or hip may also underestimate fracture risk if the individual has had a prior wrist fracture.

“Clinicians should identify postmenopausal women with wrist fractures as being at significantly elevated risk for multiple types of future fracture, including hip fracture,” the authors concluded. “Also, clinicians should be aware the younger the woman is when she experiences the first fracture, the higher the relative risk of subsequent fracture.”

Reference

Crandall CJ, Hovey KM, Cauley JA, et al. Wrist fracture and risk of subsequent fracture: findings from the Women’s Health Initiative Study. J Bone Mineral Res. 2015;30(11):2086-2095. doi: 10.1002/jbmr.2559.