Does regional loss of bone density explain low trauma distal forearm fractures in men (the Mr F study)?

Osteoporos Int. 2017 Oct;28(10):2877-2886. doi: 10.1007/s00198-017-4122-0. Epub 2017 Jul 6.


The pathogenesis of low trauma wrist fractures in men is not fully understood. This study found that these men have lower bone mineral density at the forearm itself, as well as the hip and spine, and has shown that forearm bone mineral density is the best predictor of wrist fracture.

Introduction: Men with distal forearm fractures have reduced bone density at the lumbar spine and hip sites, an increased risk of osteoporosis and a higher incidence of further fractures. The aim of this case-control study was to investigate whether or not there is a regional loss of bone mineral density (BMD) at the forearm between men with and without distal forearm fractures.

Methods: Sixty-one men with low trauma distal forearm fracture and 59 age-matched bone healthy control subjects were recruited. All subjects underwent a DXA scan of forearm, hip and spine, biochemical investigations, health questionnaires, SF-36v2 and Fracture Risk Assessment Tool (FRAX). The non-fractured arm was investigated in subjects with fracture and both forearms in control subjects.

Results: BMD was significantly lower at the ultradistal forearm in men with fracture compared to control subjects, in both the dominant (mean (SD) 0.386 g/cm2 (0.049) versus 0.436 g/cm2 (0.054), p < 0.001) and non-dominant arm (mean (SD) 0.387 g/cm2 (0.060) versus 0.432 g/cm2 (0.061), p = 0.001). Fracture subjects also had a significantly lower BMD at hip and spine sites compared with control subjects. Logistic regression analysis showed that the best predictor of forearm fracture was ultradistal forearm BMD (OR = 0.871 (0.805-0.943), p = 0.001), with the likelihood of fracture decreasing by 12.9% for every 0.01 g/cm2 increase in ultradistal forearm BMD.

Conclusions: Men with low trauma distal forearm fracture have significantly lower regional BMD at the ultradistal forearm, which contributes to an increased forearm fracture risk. They also have generalised reduction in BMD, so that low trauma forearm fractures in men should be considered as indicator fractures for osteoporosis.

Keywords: Bone density; DXA; Forearm fracture; Male; Osteoporosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon / methods
  • Aged
  • Bone Density / physiology*
  • Case-Control Studies
  • England / epidemiology
  • Hip Joint / physiopathology
  • Humans
  • Lumbar Vertebrae / physiopathology
  • Male
  • Middle Aged
  • Osteoporosis / complications
  • Osteoporosis / epidemiology
  • Osteoporosis / physiopathology
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / physiopathology*
  • Radius / physiopathology
  • Radius Fractures / epidemiology
  • Radius Fractures / etiology*
  • Radius Fractures / physiopathology
  • Risk Assessment / methods
  • Ulna Fractures / epidemiology
  • Ulna Fractures / etiology*
  • Ulna Fractures / physiopathology
  • Wrist Injuries / epidemiology
  • Wrist Injuries / etiology
  • Wrist Injuries / physiopathology