SAN DIEGO, Sept. 30-Women who have had a wrist fracture on the threshold of menopause or later are more likely to have a future osteoporotic fracture, a researcher reported here Thursday.
Analysis of data from the National Osteoporosis Risk Assessment (NORA) indicates that women with a history of wrist fractures have a doubling of risk for future breaks, said Ya-Ting Chen, Ph.D. Furthermore, these findings identify an at-risk anatomic site that can easily fall under the radar, according to Dr. Chen and colleagues who analyzed data from nearly 160,000 women.
Dr. Chen, who is director of outcomes research and management at Merck Pharmaceutical in West Point, Pennsylvania, reported results of the analysis at the annual meeting of the North American Menopause Society.
Dr. Chen said that in clinical practice, doctors tend to focus on spine and hip fractures.
“This practice is consistent with the National Osteoporosis Foundation recommendations, which state that you should consider treatment in women with fractures in these locations,” Dr. Chen said.
“The implication of our study is that you should also pay attention to women who fracture wrists, because they have high risks down the road,” said Dr. Chen.
The NORA trial included 158,940 postmenopausal women. The team analyzed prior wrist fractures by their association with future fractures at the hip, spine, rib, wrist, and forearm. The investigators also analyzed the women’s fracture risk by age, and divided the women into two groups, those 50 to 64 years old and those at least 65 years old. The data included three years of follow-up.
At baseline, no women had a diagnosis of osteoporosis and did not use any bone-specific medication. They had responded to a follow-up survey and had reported their wrist-fracture status since they were 45 years old at the time of enrollment. The investigators excluded women who reported fractures at other anatomic sites.
The investigators then calculated the participants’ absolute risk, based on a per 1,000 person-year basis, by summing up new fractures divided by person-years of follow-up. They calculated the relative risk of future fractures for the 8,665 women with prior wrist fractures and compared their rate to that of 150,275 women without wrist fractures.
Within this group, 4,316 women reported 4,728 new fractures. Those who were 50 to 64 years old had a rate of 24.2 new fractures per 1,000 person-years, compared with a rate of 7.7 for those without a prior wrist fracture. In women 65 or older, the rates were 36.4 for those with wrist fractures and 13.9 for women with no wrist fracture.
Among the women 50 to 64 years old, the adjusted relative risk showed that those with a history of wrist fracture were 2.4 times more likely to have a subsequent fracture. Those older than 65 with such fractures were 2.1 times more likely to have a later fracture.
On the basis of these findings, the investigators concluded that women with a history of wrist fractures should be evaluated for preventive treatment.
“We know from just about everything regarding osteoporosis research that one of the best predictors of a fracture is a previous fracture. What this study shows us is that we should include wrist fractures,” said Wulf H. Utian, M.D., Ph.D., the executive director of the North American Menopause Society and a consultant gynecologist at The Cleveland Clinic. Dr. Utian was not involved in the study.
“We used to say that a vertebral fracture was the key risk factor, but these findings show us that the wrist is also an important predictor,” he added. “Anyone with a previous fracture should have a bone evaluation and may well need to be on anti-osteoporosis therapy.”
Primary source: North American Menopause Society. 16th annual meeting. September 28-30, 2005. Abstract #S-1.