You are assessing a woman who has sustained a distal forearm fracture. When she provides the history of the injury she says anyone would have fractured their wrist in that way. Don’t take her word for this! Ask yourself: “Does this sound like the result of an abnormal force on a normal bone or a normal force on an abnormal bone?” Is this a fragility fracture that has not been recognized yet? Wrist fractures are one of the classic fractures characteristic of osteoporosis and must be a red flag for every Physiotherapist to prompt further questioning regarding the bone health of their patient.
Why is this so important? Fractures beget fractures. The risk of a hip fracture is increased 1.4 fold in women after a distal forearm fracture. In the osteoporosis world, a wrist fracture predicts a hip fracture. As her Physiotherapist, you have an opportunity to help prevent another fracture. Therefore, next time you assess a woman who has suffered a wrist fracture consider the following:
1. Carefully review the mechanism of injury. If it sounds like a fragility fracture that has not yet been diagnosed or followed up then discuss with the patient that she needs to see her Family Doctor for further testing to determine her bone status.
2. Specifically ask her if she has osteoporosis or osteopenia (50% of fractures occur in people who have osteopenia so don’t let them say “I just have osteopenia”).
3. Ask her if she has had a Bone Mineral Density test.
4. Have her complete the FRAX which is a fracture risk assessment tool from the WHO. The person enters their risk factors and then the tool calculates the 10 year risk of a hip fracture and the 10 year risk of a major osteoporotic fracture.
One half of women over the age of 50 will have an osteoporosis related fracture in their remaining lifetime. Your analysis of your patient’s presentation, knowledge of bone health and encouragement to follow-up with proper testing and potentially treatment, may be a key factor in preventing her next fracture.