Osteoporosis a cause for concern in Singapore’s rapidly ageing population

Osteoporosis is a common condition in adults aged 50 years and above, particularly among those with distal radius fractures, and pressing problem in Singapore considering its rapidly ageing population, according to a recent study.

“Routine assessment of all patients above the age of 50 years with distal radius fractures for osteoporosis can lead to timely intervention, which can prevent further fragility fractures,” the researchers said.

The current retrospective study included 2,572 patients (mean age 67.7 years, 75.3 percent women) who had been treated for a distal radius fracture at the Tan Tock Seng Hospital in Singapore. Medical records were reviewed for relevant information, including patient sex, mechanism of injury, and bone mineral density (BMD) scan results. These parameters were assessed in relation to the prevalence of osteoporosis and osteopaenia.

Most (65.5 percent) patients suffered from low-energy injuries, while 10.4 percent (n=267) had high-energy injuries; the mechanism of injury was undescribed for the remaining 620 patients. BMD scans were available for 1,034 patients, of whom only 6.6 percent (n=68) had normal findings. [J Hand Surg Asian Pac Vol 2022;doi:10.1142/S2424835522500023]

Of note, more than half (56.0 percent; n=579) of the patients had BMD scans that showed signs of osteoporosis, while 37.4 percent (n=387) were deemed to be osteopaenic.

Stratifying according to sex showed a higher prevalence of osteoporosis in men (62.9 percent vs 54.9 percent) and osteopaenia in women (38.8 percent vs 28.6 percent). The differences in prevalence did not reach significance.

Univariate analysis confirmed that the high prevalence of osteoporosis in the study cohort was not significantly impacted by sex (p=0.057). Further subdividing sex groupings into high- (p=0.598) and low-energy (p=0.06) injury groups did not reveal significant differences in osteoporosis prevalence. The same was true when stratification was conducted first according to mechanism of injury followed by sex groupings.

“Clinicians may be prompted to order a BMD scan for patients with distal radius fractures in the presence of evidence of bone fragility, low-energy trauma, or other osteoporotic risk factors,” the researchers said. Such risk factors include oestrogen deficiency, prior fractures, and long-term steroid use.

However, the results also suggested that “if BMD scans were ordered based on the energy of injury, then a significant number of patients with osteoporosis would go undiagnosed, seeing as the prevalence of osteoporosis in both groups are comparable.”

Future research could focus on the risk of developing hip and other types of fractures following a first instance of distal radius fracture and whether osteoporosis therapy could affect such risk.

“Other factors influencing the ordering of BMD scans at the time at which the distal radius fracture was sustained (eg, oestrogen deficiency, long-term steroid use, prior history of hip or vertebral fractures, and patient preference) could also be explored in greater detail to determine how they affect the decision to order BMD scans in patients with distal radius fractures,” the researchers said.