Pre-existing osteoporosis and serum vitamin D levels in patients with distal radius fractures: are we missing something?

Arch Orthop Trauma Surg. 2024 Mar;144(3):1281-1287. doi: 10.1007/s00402-024-05199-4. Epub 2024 Feb 2.


Introduction: Given the significant therapeutic gap for osteoporosis, this study aims to investigate the most common osteoporosis-related fracture. The analysis will also consider patients' serum vitamin D levels and the indications for basic osteoporosis diagnostic tests and osteoporosis therapy prior to fracture.

Materials and methods: This prospective clinical trial included patients with distal radius fractures who underwent surgery at our hospital between 1 April 2021 and 7 April 2022. Blood samples were taken from all participants and existing risk factors for osteoporosis were recorded. In addition, the indication for a guideline-based osteoporosis diagnosis was assessed and the risk of another future fracture with FRAX® was calculated. This information was used to decide whether there was an indication for specific osteoporosis therapy.

Results: A diagnosis gap of 53% and a treatment gap of 84% were identified among the 102 patients investigated. The patients' ages ranged from 46 to 91 years, with an average vitamin D level of 57 nmol/l, which was below the recommended level of 75 nmol/l. It was noted on a monthly basis that the vitamin D level (without substitution) never exceeded the recommended value of 75 nmol/l in any month. Three-quarters of patients had indications for a baseline osteoporosis diagnosis, yet less than 50% received one. According to FRAX® data, 57% of patients had indications for specific osteoporosis treatment before experiencing the fracture.

Conclusion: Even without a previous distal radius fracture, many patients are in need of osteoporosis diagnosis or treatment. Our research suggests that patients with distal radius fractures should have their vitamin D levels checked via a blood test and be evaluated for osteoporosis. As endogenous vitamin D levels are often inadequate, year-round vitamin D supplementation should be considered for the prevention of osteomalacia and as a basis for the treatment of osteoporosis.

German clinical trial register id: DRKS00028085.

Keywords: Diagnosis gap; Distal radius; Elderly; Osteoporosis; Treatment gap; Vitamin D.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bone Density
  • Humans
  • Middle Aged
  • Osteoporosis* / diagnosis
  • Osteoporotic Fractures* / drug therapy
  • Prospective Studies
  • Radius Fractures* / complications
  • Radius Fractures* / therapy
  • Risk Factors
  • Vitamin D / therapeutic use
  • Wrist Fractures*


  • Vitamin D

Associated data

  • DRKS/DRKS00028085