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An Analysis From the Manitoba Bone Density Program

Anthony B. Hodsman, MBBS, FRCPC; William D. Leslie, MD, FRCPC, MSc; James F. Tsang, BSc; Greg D. Gamble, MSc

Arch Intern Med. 2008;168(20):2261-2267.

Background  Wrist fractures are the most prevalent type of fracture occurring in postmenopausal women. We sought to contrast the probability of recurrent osteoporotic fractures after a primary wrist fracture with other important primary fracture sites.

Methods  A historical cohort study comprising 21 432 women 45 years or older referred for bone mineral density (BMD) testing. Longitudinal health service records were assessed for the presence of fracture codes before and after BMD testing (359 737 person-years of observation).

Results  A total of 2652 women (12.4%) experienced a primary fracture (wrist, vertebra, humerus, hip) prior to BMD testing, of which wrist fractures were the largest single group (1225 [46.2%]). The adjusted hazard ratio (HR) for recurrent osteoporotic fracture following a primary wrist fracture (HR, 1.58; 95% confidence interval [CI], 1.29-1.93) was lower than for other primary fractures (HR, 2.66; 95% CI, 2.30-3.08). Primary wrist fractures were not significantly associated with subsequent hip fractures (adjusted HR, 1.29; 95% CI, 0.88-1.89), whereas other primary fracture sites were individually and collectively significant predictors of future hip fractures (HR, 1.72; 95% CI, 1.31-2.26). The 10-year probability of any recurrent fracture after a primary wrist fracture was 14.2% (95% CI, 11.9%-16.5%), which was significantly less than for other primary fractures (spine, 25.7%; hip, 24.9%; humerus, 23.7%; P < .001 for all comparisons vs wrist) but greater than in those without prior fractures (10.8%; P < .001). The relationship between BMD and fracture risk was much stronger after a primary wrist fracture (HR, 2.20 per standard deviation; 95% CI, 1.70-2.80) than after other primary osteoporotic fractures (HR, 1.21; 95% CI, 1.05-1.40), reflecting the dominance of the other fracture information over BMD.

Conclusions  Wrist fractures are the most common of the clinical osteoporotic fractures in patients referred for BMD testing. However, the risk of recurrent fractures in the 10 years following a wrist fracture is substantially lower than that following other osteoporotic fractures, although it remains significantly higher than for those who have yet to experience a fracture.

Author Affiliations: Osteoporosis Program, Department of Medicine, University of Western Ontario, London, Ontario, Canada (Dr Hodsman); Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Leslie and Mr Tsang); and Department of Medicine, University of Auckland, New Zealand (Mr Gamble).

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