The Effect of Osteoporosis on Healing of Distal Radius Fragility Fractures

Although the decision for operative versus nonoperative treatment of distal radius fractures remains subjective and is performed on a case-by-case basis, evaluation and treatment of patients with concomitant osteoporosis requires understanding of the behavior of this injury as a distinct subset of distal radius fractures. Age, infirmity, and osteoporosis affect every aspect of the fracture. Understanding what makes these fractures unique assists surgeons in more effective and efficient treatment. The authors present the current understanding of osteoporotic fragility fractures of the distal radius, focusing on epidemiology, biomechanics of bone healing, and its implication on strategies for management.

Key points

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Distal radius fractures are among the most common fractures seen and are increasing in incidence because of increased prevalence of osteoporosis and increasing age of our population.
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The osteoporotic distal radius is deficient in both cortical and trabecular bone, but early changes in cortical bone most predispose to fragility fractures.
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The fracture callus formed around an osteoporotic fracture is less stiff than a normal fracture callus, but it is unclear how this affects long-term function or biomechanics.
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Nonoperative management of osteoporotic distal radius fractures in low-demand patients remains well indicated and can lead to long-term clinical outcomes similar to operative management.
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There are multiple acceptable methods for operative management of osteoporotic distal radius fractures; but volar locking plates are most commonly used, safely and readily applied, allowing for early motion, and have an acceptable complication profile.