Many organizations and work groups have issued recommendations regarding which patients should undergo bone densitometry. In 2004, the US Surgeon General recommended bone mineral density (BMD) evaluation for all women over age 65 years and for women and men with fragility fractures.1 The Centers for Medicare & Medicaid Services recommended BMD assessment for estrogen-deficient patients, for patients with vertebral abnormalities or hyperparathyroidism, and for patients receiving either steroid therapy or osteoporosis medications approved by the US Food and Drug Administration.2 The US Preventive Services Task Force and the National Osteoporosis Foundation each recommended screening for all women age 65 years or older and for postmenopausal women (age, 60-64 years) at high risk.3,4 The International Society for Clinical Densitometry (ISCD) recommended screening for all women age 65 years or older, all men age 70 years or older, and high-risk women under age 65 years.5
These current recommendations for BMD evaluation focus on women over age 65 years. More recent studies of postmenopausal women with distal radius fractures (DRFs) have found that both younger women (age, 45-65 years) and older women (age, ≥65 years) can have lower BMD and increased risk for hip and spine fracture.6,7 The authors of those studies recommended that all postmenopausal women with DRFs be evaluated for low BMD and that fracture prevention treatment be initiated. Earnshaw and colleagues8 and Oyen and colleagues9 found that men and women (age, ≥50 years) with DRFs had low BMD and elevated 10-year fracture rates. They concluded that BMD should be evaluated and treated in all DRF patients age 50 years or older. Other studies have shown low BMD in the contralateral distal radius of patients of all ages who presented with Colles fractures.10,11 These 2 studies did not measure spine or hip BMD.
The literature on BMD of younger women with DRFs is limited, relying solely on data collected for the contralateral distal radius.10,11 The ISCD recommended measuring both hip and spine BMD in premenopausal women. They also stated that z scores, not t scores, should be used for premenopausal women.5 The causes of low BMD in women over age 55 years are primarily nutritional deficiency and normal aging.1 In younger females, low BMD results from secondary causes, such as diet, medications, medical conditions, and endocrine disorders. When the secondary cause of low BMD can be identified and treated, osteoporosis can be stopped and even reversed in younger patients.12-14 Low BMD is more amenable to treatment in younger patients than in postmenopausal women. Younger patients with low BMD carry a higher lifetime fracture risk because they have more years of life with low BMD; therefore, early identification and treatment have a more significant impact on fracture prevention in these patients.
In the present study, we determined the prevalence of osteoporosis and osteopenia in younger women (age, 35-50 years) with DRFs and compared BMD measurements from younger women (age, 35-50 years) and older women (age, >50 years) with DRFs. The main goal was to determine which patients should be referred for bone densitometry and subsequent treatment.
Patients and Methods
This study received institutional review board approval. During a 5-year period (January 2005–August 2010), we prospectively collected dual-energy x-ray absorptiometry (DXA) scans for 128 women (age, >35 years) who presented with DRFs to our level I trauma center. Age ranged from 35 to 86 years. Data on mechanism of injury, treatment, and body mass index (BMI) were collected. The 128 patients were divided into a younger group (47 women; age range, 35-50 years; mean age, 44 years) and an older group (81 women; age, ≥51 years; mean age, 61 years). Mean BMI was 29.3 in the younger group and 28.8 in the older group (P = .88) (Table).
BMD was measured with a General Electric Lunar Prodigy Advance scanner that was tested annually for accuracy and precision. BMD of hips and lumbar spines was measured with a 76-Kv x-ray source. All DXA scans were analyzed by the same physician. BMD was omitted in cases of patients with a history of lumbar spine or hip fracture.
Two-sample Student t test was used to compare the 2 groups’ data. When multiple groups were being compared, analysis of variance was used. Spearman rank-order test was used to calculate a correlation coefficient for evaluation of the relationships between age and BMD.
Mean lumbar spine (L1–L4) BMD was 1.12 in the younger group and 1.063 in the older group (P = .02); t scores were –0.63 and –1.132, respectively (P = .02); and mean z scores were –0.69 and –0.61, respectively (P = .81). Mean femoral neck BMD was 0.91 in the younger group and 0.80 in the older group (P < .05); t scores were –0.87 and –1.65, respectively (P < .01), and mean femoral neck z scores were –0.69 and –0.67, respectively (P = .92).