Wrist Fractures and Osteoporosis.

Is a distal radius fracture (a wrist fracture) in your future? Is osteoporosis going to interfere with your recovery if you do break your wrist?

You may know that in June of 2024, I took a tumble (okay, it was pretty much a faceplant) into the dirt while trail running. I knew within minutes that I had broken my wrist. The impact on my left wrist was high; it swelled quickly, and once my embarrassment passed, I realized I couldn't move it without pain. I was lucky it was my non-dominant hand, and I was able to drive myself to the emergency room and get it assessed quickly.

I am now 13 weeks post non-displaced, stable distal radius fracture. At just over three months, I have regained almost full motion and strength. I notice my wrist only with my higher-level activities, like push-ups or heavy weight lifting.

Because of my wrist fracture, I am watching the wrist research more closely.

In August, the Journal of Orthopaedic & Sports Physical Therapy published Clinical Practice Guidelines for the treatment of Distal Radius Fractures (DRF). Clinical Practice Guidelines are compiled from the latest research papers and give a summary of the best practices to help clinicians stay up-to-date. They are very helpful and practical.

As I scanned through the wrist treatment guidelines, I was happy to see osteoporosis as a topic they addressed. I was eager to see what the treatment and outcomes were for women with bone loss.

Happily, the guidelines found that the diagnosis of osteoporosis did not have any effect on the outcome of a wrist fracture (Choi et al, 2015). This means your chance of recovering from a wrist fracture is similar to that of someone who does not have a diagnosis of osteoporosis/osteopenia. This is good news.

But what does a broken wrist mean for your future?

​It is often assumed that a broken wrist indicates bone loss. But 80% of women with wrist fractures do not have osteoporosis (Shah et al, 2020).

This is important to note for several reasons.

First, if you do break your wrist, it doesn't automatically mean you have osteoporosis.

Second, if you are under 65 and have not had a DEXA scan, you can now get one to check your bone status. You may not have osteoporosis, but you may be bordering on osteopenia. This is a great time to change your habits and strengthen your bones.

Rehab.

Much of your wrist rehab will depend on your fracture. The bigger the break, the longer the rehab. I had a non-displaced fracture and did not need surgery, screws or pins. I was able to move my wrist easily by week 5, and in the 6th week, I wore my splint only at night.

If you have a more complicated fracture and require surgery, the time frame will be different as the protection phase is likely to be longer.

Regardless of your fracture, early shoulder, elbow, and wrist motion should start in the first three weeks, followed by light daily activities. This will help you recover more quickly and get back to your lifestyle faster. Seeing a hand therapist, either a PT or OT, can help move you along safely.

​Key Takeaways:

If you have a wrist fracture and have not been screened for bone loss with a DEXA scan, request that you get one scheduled. You are at risk. (I recommend asking about including a Trabecular Bone Score (TBS) with your DEXA scan).

Bisphosphonates, denosumab, and romosozumab do not change healing times to any significant degree and may help.

Wrist fractures occur, on average, 15 years earlier than hip fractures. It is a key moment to get assessed for bone loss and get bone-building interventions going before bone loss progresses.

I hope this is helpful.

As always, my references are listed below. You can read more in-depth if that is your thing - I gave you an overview today. Wrist fractures are not fun but can help initiate lifestyle changes and prevent further bone loss.

Retire active with me,

Andrea

References:

Choi W, Lee HJ, Kim D, et al. Does osteoporosis have a negative effect on the functional outcome of an osteoporotic distal radial fracture treated with a volar locking plate?. Bone Joint J. 2015;97-B(2):229-234. doi:10.1302/0301-620X.97B2.34613

Mehta SP, Karagiannopoulos C, Pepin ME, Ballantyne BT, Michlovitz S, MacDermid JC, Grewal R, Martin RL. Distal Radius Fracture Rehabilitation. J Orthop Sports Phys Ther. 2024 Sep;54(9):CPG1-CPG78. doi: 10.2519/jospt.2024.0301. PMID: 39213418.

Shah GM, Gong HS, Chae YJ, Kim YS, Kim J, Baek GH. Evaluation and Management of Osteoporosis and Sarcopenia in Patients with Distal Radius Fractures. Clin Orthop Surg. 2020 Mar;12(1):9-21. doi: 10.4055/cios.2020.12.1.9. Epub 2020 Feb 13. PMID: 32117533; PMCID: PMC7031429.

PS Link to my online programs.