Publication | Closed Access
Risk Factors for Fractures of the Distal Forearm and Proximal Humerus
459
Citations
0
References
1992
Year
Proximal HumerusOsteoporosisOrthopaedic SurgeryBone DiseaseSkeletal TraumaBody CompositionOrthopaedicsGeriatric Fracture CareElbow DisordersHealth SciencesBone HealthRehabilitationHand SurgeryBone DensityRisk FactorsShoulder SurgeryPhysical TherapyHand TraumaDistal ForearmDistal Forearm FractureMedicine
The Study of Osteoporotic Fractures, a prospective cohort of 9,704 women aged 65 and older from Maryland, Minnesota, Oregon, and Pennsylvania, began in 1986 and followed participants for an average of 2.2 years. During follow‑up, 171 distal forearm and 79 proximal humerus fractures occurred, most due to falls; low bone mineral density was the strongest predictor (rate ratios 4.1 and 7.5, respectively), with additional distal forearm risk factors including poor vision, prior falls, and frequent walking, and proximal humerus risk factors such as recent health decline, insulin‑dependent diabetes, infrequent walking, and neuromuscular weakness.
The Study of Osteoporotic Fractures is a prospective cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryland, Minnesota, Oregon, and Pennsylvania. A total of 171 women suffered fractures of the distal forearm, and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up. Most fractures at both sites occurred as a result of a fall. Low bone mineral density was a strong predictor of these fractures; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile, the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus. Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity, number of falls in the year before baseline, and frequent walking. Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status, insulin-dependent diabetes mellitus, infrequent walking, and several indicators of neuromuscular weakness such as inability to stand with feet in a tandem position for more than a few seconds. These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function, while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function.