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Osteoporosis Intervention Following Distal Forearm Fractures
A Missed Opportunity?
Maria-Teresa Cuddihy, MD, MPH;
Sherine E. Gabriel, MD, MS;
Cynthia S. Crowson, BS;
Elizabeth J. Atkinson, MS;
Claudia Tabini, BA;
W. Michael O'Fallon, PhD;
L. Joseph Melton III, MD
Arch Intern Med. 2002;162:421-426.
Background Fractures are a manifestation of osteoporosis, but therapeutic interventions
to reduce the risk of recurrent fractures are not widespread.
Objective To identify predictors of osteoporosis treatment in postmenopausal women
following distal forearm fracture.
Methods This population-based retrospective cohort study included all postmenopausal
women, 45 years or older, residing in Olmsted County, Minnesota, who sustained
a distal forearm fracture due to minimal trauma (a fall from standing height
or under) in 1993 to 1997. Complete medical records were reviewed for each
subject and Cox proportional hazards regression was used to evaluate the relationship
of baseline demographic and clinical characteristics to therapeutic interventions
for osteoporosis within 12 months following the fracture.
Results A total of 343 women with a mean age of 70.5 years had a minimal trauma
distal forearm fracture. Within 12 months, 83% had seen a nonorthopedic physician.
Of these, 17% had a pharmacologic osteoporosis intervention and the 12-month
actuarially estimated cumulative incidence of any intervention was 18% (95%
confidence interval [CI], 14%-22%). In a multivariate analysis, treatment
was more likely to be offered to those with a prior diagnosis of osteoporosis
(relative risk [RR], 2.08; 95% CI, 1.21-3.58), previous distal forearm fracture
(RR, 2.38; 95% CI, 1.30-4.34), or history of cigarette smoking (RR, 1.86;
95% CI, 1.11-3.12).
Conclusions Effective osteoporosis interventions are underutilized among postmenopausal
women who experience an osteoporotic fracture. Further work is needed to overcome
barriers to optimal osteoporosis management in these women who are at high
risk for future complications of osteoporosis.
From the Department of Internal Medicine, Division of Area General
Internal Medicine (Dr Cuddihy and Ms Tabini), and Department of Health Sciences
Research (Drs Gabriel, O'Fallon, and Melton and Mss Crowson and Atkinson),
Mayo Clinic and Mayo Foundation, Rochester, Minn.
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