distal radius fractures of the upper extremities are relatively common accounting for approximately 17% of all fractures in patients visiting the emergency room ( 1 ) . in recent years , osteoporotic fractures have become a major health issue ; and many studies have been done on relationship between distal radius fractures and osteoporosis .
however , there have been still controversies whether this relationship is statistically significant or not ( 2,3,4 ) .
also , the prevalence of low bone mineral density ( bmd ) and osteoporosis in patients with low - energy distal radial fractures compared with that of normal korean population without such fractures is not well known . in previous study , lee et al .
( 5 ) assessed age- and site - related bmd and the prevalence of osteoporosis in korean women with a distal radius fracture , and compared these with reference data derived from a study done in a large population - based cohort in korea ( 6 ) . for the study , they recruited only small number of 54 consecutive korean women , 50 to 79 years of age , with a distal radius fracture . however , in this study we recruited large number of 206 consecutive korean women patients . this study has shown that bmd is lower in patients with a distal radius fracture in women younger than 60 years of age or over 70 years of age than in normal controls .
in addition , low - energy distal radius fractures are predictive of future 15 years prior to osteoporotic hip and spine fractures ( 7,8,9 ) . considering these findings , it is important to analyze the relationship between bmd and distal radius fractures in postmenopausal women for the prevention of secondary fractures ( 10 ) .
the aim of this study was to compare the bmd and prevalence of osteoporosis of postmenopausal korean women with low - energy distal radius fractures with those of aged - matched normal korean women .
we retrospectively reviewed 206 patients who visited our hospital between march 2006 and march 2010 because of distal radius fractures .
inclusion criteria of this study were low - energy distal radius fractures caused by out - stretched injury of the wrist and postmenopausal women older than 50 years of age .
patients previously diagnosed systemic diseases affecting bone metabolism ( e.g. , metabolic bone disease , renal osteodystrophy ) or those who had been taken steroid for extended period were excluded from this study .
we also excluded patients with previous distal radius fractures , those with high - energy injuries caused by a vehicle accident or fall , those with pathologic fractures , and those who had previously diagnosed osteoporosis .
the bmd was measured at the spine and proximal femur using a lunar prodigy advance dual energy x - ray absorptiometry ( ge healthcare , madison , wi , usa ) . at the spine
, bmd values were obtained from the first to the fourth lumbar vertebral body . at the proximal femur
, bmd values were obtained from the femoral neck , ward s triangle , and the intertrochanteric area separately . for each area ,
the t - score and z - score , which represent differences in bmd from the maximum bone density of young and same aged people , respectively , were calculated . according to the diagnostic criteria of the world health organization ( who )
, osteoporosis was defined as any t - score lower than -2.5 , osteopenia as any t - scores between -2.5 and -1.0 , and normal bone density as any t - scores equal to or greater than -1.0 ( 11 ) .
patients were divided into three groups by age ; group 1 ( 50 - 59 years ) , group 2 ( 60 - 69 years ) , and group 3 ( 70 - 79 years ) .
the bmd values and prevalence of osteoporosis in each age group were compared with those of age - matched control .
the bmd values and prevalence of osteoporosis of the control were based on the reference data from healthy community dwelling korean population ( 6 ) .
these reference data were obtained from a study that used a large cohort of community dwelling korean women , 20 to 79 years of age .
this study included the entire female age group , including women with osteoporosis , and had 599 women 50 to 59 years of age , 894 women 60 to 69 years of age , and 313 women 70 to 79 years of age , and it provided age- and site - specific bmd reference values .
the equipment used in this study was dpx bravo ( ge healthcare , madison , wi , usa ) , which is small and measures only hip and spine bmd .
results are reported as means with standard deviations or frequencies with 95% confidence intervals ( ci ) .
continuous variables between patients and controls were compared with use of independent - sample t tests .
chicago , il , usa ) , and p - values < 0.05 were considered statistically significant .
this study protocol was reviewed and approved by the institutional review board of asan medical center ( irb no .
informed consent was waived for this study since it is an observational study with minimal risk .
results are reported as means with standard deviations or frequencies with 95% confidence intervals ( ci ) .
continuous variables between patients and controls were compared with use of independent - sample t tests .
chicago , il , usa ) , and p - values < 0.05 were considered statistically significant .
this study protocol was reviewed and approved by the institutional review board of asan medical center ( irb no .
informed consent was waived for this study since it is an observational study with minimal risk .
the mean height , weight , and body mass index ( bmi ) of the total 206 patients were 155.7  5.2 cm , 55.7  5.6 kg , and 23.1  2.8 kg / m , respectively .
the differences of the mean height , weight , and bmi in each group were not statistically significant compared to control group ( table 1 ) . in group 1 , except for the spine , all bmd values of the patients were significantly lower than those of age - matched control . while the bmd values in groups 2 and 3 were lower than those of age - matched controls , those differences were not statistically significant ( table 2 ) .
l1-l4 , from the first lumbar vertebrae to the fourth vertebrae ; sd , standard deviation .
one hundred and six ( 51.5% ) of the 206 patients were newly diagnosed with osteoporosis .
osteoporosis was diagnosed most frequently at the ward s triangle ( 101 of 206 patients ; 49.0% ) , followed by the spine ( 93 of 206 patients ; 45.1% ) , the femoral neck ( 14 of 206 patients ; 6.8% ) , and the trochanteric area ( 9 of 206 patients ; 4.4% ) . compared with age - matched controls ,
all groups had significantly higher prevalence rates of osteoporosis at the ward s triangle ; however , the prevalence of osteoporosis at the spine , femoral neck and trochanteric area were not significantly different from those of age - matched controls ( table 3 ) .
we analyzed the bmd and prevalence of osteoporosis in postmenopausal korean women with low - energy distal radius fractures .
the patients were divided into three groups by age , and results were compared with age - matched normal korean women without fractures .
this study showed that prevalence of osteoporosis at all measurement sites in the patients was not significantly lower than those of age - matched controls except at the ward s triangle .
the ward s triangle , however , is not considered by international society for clinical densitometry to be a suitable site for bone density measurement , because the rate of osteoporotic prevalence at this site can be overestimated ( 12,13 ) . in this
regard , our results seems to be against the previous studies , which showed the prevalence of osteoporosis in patients with distal radius fractures to be higher than that of the control ( 3,14,15,16 ) . in this study , however , 106 new cases of 206 patients ( 51.5% ) of distal radius fractures were diagnosed as osteoporosis . the rates of newly diagnosed osteoporosis were 21 of the 71 patients ( 29.6% ) aged 50 - 59 years , 51 of the 93 patients ( 54.8% ) aged 60 - 69 years , and 39 of the 42 patients ( 92.8% ) aged 70 - 79 years . although the prevalence of osteoporosis of patients in our study was comparable with those of age - matched controls at all measured sites , except the ward s triangle ,
our results indicate that osteoporosis should be evaluated and managed by screening bmd in patients with distal radius fractures .
our study results showed that the bmd values were lower in all measured area in all patients groups ; however , it was interesting that only the bmd in the femur area in group 1 was significantly lower than age - matched control
. there has been still inconsistency in correlation between low bmd and age . in one study ,
patients younger than 65 years of age with distal radius fractures had significantly low bmd values , whereas low bmd values associate with older patients in another study ( 2,17 ) .
our results are partly consistent with those of a previous study , which showed younger postmenopausal women with distal radius fractures to have low bmd values .
the rate of bone loss in lumbar vertebrae decreases after menopause and stabilizes in women at 60 - 69 years of age , whereas in the femur it continues or accelerates with age ( 18,19 ) .
therefore , postmenopausal women at 50 - 59 years of age with low - energy distal radius fractures should be evaluated for osteoporosis to prevent other osteoporotic fractures such as those of the hip and spine .
the bmd of women peaks in their 30s and declines thereafter with age , greatly decreasing during the perimenopausal period ( 20 ) . while healthy korean women have peak bmd values , bone loss is more rapid after 50 years of age compared to caucasian and lebanese women ( 6 ) .
early detection of osteoporosis in younger postmenopausal women with distal radius fractures may help to prevent future osteoporotic fractures .
low bmd values associate with the severity of osteoporotic distal radius fractures ( 21 ) .
in contrast with distal radius fractures , hip and spine fractures were associated with an increased mortality ( 22 ) .
our results indicate that an osteoporotic hip fracture can occur after a distal radius fracture in younger postmenopausal women with distal radius fractures .
the major limitation of this study was that normative data were based on the reference data from korean community dwelling population ( 6 ) .
bmd values obtained by different densitometers can not be compared because technical differences in the devices exist .
nevertheless , we were able to compare bmd values with reference data because the densitometer and measurement sites were identical .
 the aim of this study was to evaluate the bone mineral density and the prevalence of osteoporosis in postmenopausal korean women with low - energy distal radius fractures and compared with those of aged - matched normal korean women . 
 two hundred and six patients with distal radius fractures between march 2006 and march 2010 were included in this study . 
 patients were divided into three groups by age ; group 1 ( 50 - 59 years ) , group 2 ( 60 - 69 years ) , and group 3 ( 70 - 79 years ) . 
 controls were age - matched normal korean women . 
 the bone mineral density values at all measured sites , except for the spine , were significantly lower in group 1 than those of control . while the bone mineral density values in group 2 and 3 were lower than those of controls , 
 these differences were not statistically significant . 
 all groups had significantly higher prevalence of osteoporosis at the ward s triangle ; however , at the spine , femoral neck and trochanteric area it was not significantly different from those of age - matched controls . 
 although the prevalence of osteoporosis of the postmenopausal women with low - energy distal radius fractures may not be higher than that of the control , osteoporosis should be evaluated especially in younger postmenopausal patients to prevent other osteoporotic hip and/or spine fractures . 