The Influence of Ibuprofen on the Healing of Nonsurgically Treated Colles' Fractures.

Nonsteroidal anti-inflammatory drugs can delay bone healing. This knowledge is mainly derived from retrospective and animal studies. The authors therefore conducted a human study to investigate whether ibuprofen affects radiological, functional, densitometrical, and biochemical outcomes following a Colles' fracture, as well as the analgesic effect of ibuprofen. This was a single-center, triple-blinded, randomized, placebo-controlled clinical trial with a total of 96 patients. All of the patients received basic treatment with 1000 mg of acetaminophen 4 times daily. The placebo group received a placebo for 7 days. The 3-day ibuprofen group received 600 mg of ibuprofen 3 times daily for the first 3 days and a placebo for the following 4 days. The 7-day ibuprofen group received ibuprofen 3 times daily for 7 days. The primary outcome was the fragment migration for a period of 5 weeks. The secondary outcomes were changes in the wrist's range of motion; Disabilities of the Arm, Shoulder and Hand score; bone mineral density of the injured wrist; changes in serum CrossLaps (Roche Diagnostics) and osteocalcin; and analgesic effects. Analyses were performed according to an intention-to-treat approach. No significant differences in radiological migration or functional, densitometrical, and biochemical effects were established among the treatment groups (.06≤P≤.9). During the first 3 days, the pain score was lower (P=.02) in the ibuprofen groups than in the placebo group. The findings of this study offer an indication for ibuprofen as a bone-safe analgesic treatment after Colles' fracture and may be translated into other fields of cancellous bone fracture treatment. [Orthopedics. 2021;44(2):105-110.].

A study of male patients with forearm fracture in Northern Ireland.

Osteoporosis, although considered less common, still occurs in men. We present a cross-sectional study of a group of Northern Ireland men with low-trauma forearm fractures to determine the presence of osteoporosis and screen for secondary causes of low bone mineral density. Male patients aged 30-75 years, presenting with distal forearm fracture in 2000-2001 in Northern Ireland, were identified through a Colles fracture database. A total of 37 subjects consented to have bone mineral density measurements undertaken at the femoral neck, spine and forearm using a Lunar expert bone densitometer. Twenty-seven percent of the men had osteoporosis at the spine, femoral neck or forearm, as defined by a bone mineral density score of less than -2.5. We also found that 49% of patients had vitamin D insufficiency or deficiency, 27% had low serum testosterone, 14% had abnormal liver function test results, and 14% had raised parathyroid hormone. Only one patient received advice or treatment regarding osteoporosis at the time of fracture. Increased awareness of male osteoporosis and the need for screening for potential secondary causes in this group of patients is required, both at primary and secondary care level.

The risk of Colles' fracture is associated with the collagen I alpha1 Sp1 polymorphism and ultrasound transmission velocity in the calcaneus only in heavier postmenopausal women.

To compare the ability of the bone mineral density (BMD) at the distal forearm, collagen I alpha 1 (COLIA1) polymorphism, and ultrasound stiffness to identify individuals with increased risk of wrist fracture, we studied 183 postmenopausal Czech women with a wrist fracture and 178 postmenopausal controls, ages 45-70 years. The genotypes "Ss" and "ss" were significantly overrepresented among fracture cases. The BMD measurements at the femoral neck, total femur, and distal forearm as well as ultrasound stiffness of the heel, broadband ultrasound attenuation (BUA), and speed of sound (SOS) were significantly lower in the fracture cohort. BMD of the distal forearm was the main determinant of susceptibility to the wrist fracture. Weight, the COLIA1 genotype, and ultrasound SOS further strengthened the predictive value of BMD. However, we found interaction between weight and both the COLIA1 Sp1 polymorphism and ultrasound parameters. Presence of the "s" allele as well as low SOS acted as significant predictors of wrist fracture only in heavier women, (> or =62 kg) but not in women with a body weight of less than 62 kg. In heavier women, both the COLIA1 Sp1 polymorphism and ultrasound parameters acted as independent markers that contributed to BMD to enhance fracture prediction. However, the COLIA1 enabled a higher specificity (specificity 72.4%, sensitivity 44.2%), whereas SOS enabled a higher sensitivity (sensitivity 73.9%, specificity, 45.7%). We conclude that BMD at total forearm, the COLIA1 polymorphism, and ultrasound SOS are independent predictors of wrist fracture in postmenopausal women. The effect of the COLIA1 Sp1 polymorphism and SOS on wrist fracture risk is more pronounced in patients with a higher body weight.

The effect of alendronate on bone mass after distal forearm fracture.

Fracture and immobilization of an extremity lead to bone loss at the fracture and at adjacent sites. We conducted a 1-year, single-center, prospective, randomized, double-blind study to determine whether bone loss would occur in the distal radius after a Colles' fracture and whether this loss could be prevented using an antiresorptive drug (alendronate). Thirty-seven women with a recent fracture of the distal forearm and low bone mineral density (BMD) of the lumbar spine were randomized to receive either 10 mg alendronate daily or placebo. BMD of both forearms was measured at baseline and after 3, 6, and 12 months. The results of four women who developed reflex sympathetic dystrophy were not included in the analysis. In the placebo group, there was a significant reduction at 3 months and 6 months in BMD of total radius (p < 0.01), one-third distal radius (p < 0.01), middistal radius (p < 0.05), and ultradistal radius (p < 0.01) on the fractured side. The loss in BMD at one-third distal radius remained significant at month 12 (p < or = 0.001). In the alendronate group BMD of total distal radius, one-third distal radius, and middistal radius at the fractured side remained unchanged. BMD of ultradistal radius increased significantly at months 3, 6, and 12, compared with baseline (p < 0.05). The difference between the two treatment groups was significant at 3 months and 6 months and borderline significant (p = 0.054) after 1 year in total distal radius. In ultradistal radius the differences were significant at all time points. We conclude that BMD of the distal radius of a recently fractured forearm decreases significantly in the 6 months after fracture and the resulting deficit remains evident at least 1 year after fracture. This bone loss can be prevented by alendronate.

Bone mineral density of the radius in patients with Colles' fracture.

To ascertain whether patients with Colles' fracture should be investigated for osteoporosis and the risk of future fractures, we measured the bone mineral density of the distal radius of the other arm in 31 women patients and compared the results with those of a control group of 289 normal women. We divided the patients into two groups, those younger than 66 years and those older. In 25 patients we found values for bone mineral density which were lower than one standard deviation below the mean value for their age. Younger patients had a deficit greater than that expected for their ages. We believe that women with Colles' fracture should be evaluated routinely for osteoporosis, particularly if they are under 66 years of age.

Ultrasound attenuation of the calcaneus in normal subjects and in patients with wrist fracture.

We determined broadband ultrasound attenuation (BUA) of the calcaneus, and bone mineral density (BMD) of the spine, proximal femur and radius in 137 healthy subjects (79 women and 58 men) and in 56 women with Colles' fracture. The repeated measurements on 9 healthy subjects indicated a short-term reproducibility (coefficient of variation) of 4 percent for BUA. There was a small (7 percent) but significant difference in BUA between normal men and women. The age-dependence in normal subjects was weak. When all the study subjects were pooled, modest correlations between BUA of the calcaneus and BMD at all measured skeletal sites were found (rs values 0.3-0.4). However, it was not possible to make an accurate prediction of the axial BMD, using BUA. BUA values were 13 percent lower in the wrist fracture patients than in the age-matched normals. In general, BUA could discriminate the fracture patients from normals as effectively as BMD. As suggested by the physical theory of ultrasound attenuation, our results support the idea that BUA reflects not only the bone density but also other factors related to the structural properties of bone.

Biochemical markers of bone metabolism in patients with fracture of the distal forearm.

Biomarkers for bone turnover have established a place in the investigation and follow-up examinations of patients with osteoporosis, but has received little attention for the possibility that the fracture itself might interfere with the interpretation of the results. In this investigation of patients with fracture of the distal forearm, biomarkers for bone formation (serum osteocalcin and alkaline phosphatases) and for resorption (urinary calcium and hydroxyproline) were determined together with serum calcium and parathyroid hormone (PTH) in longitudinal and cross-sectional studies. During 16 weeks of follow-up examinations, starting on the day of the fracture, 13 patients with Colles' fracture displayed a consistent pattern with a moderate increase in serum alkaline phosphatase and osteocalcin, whereas the indices of bone resorption appeared unaffected. There was also a significant increase in the serum calcium concentration and a reciprocal decrease in serum PTH. A cross-sectional comparison between 99 patients and controls showed elevated osteocalcin levels in the patients and an inverse relationship between these levels and bone mineral density. The findings demonstrate that fracture healing should be considered in the interpretation of biomarkers in osteoporotic patients, and that among patients with a fracture of the distal forearm, those with biochemical evidence of increased bone turnover have the lowest bone mass.

Colles' fracture and bone density of the ultradistal radius.

To determine whether Colles' fracture, generally considered a manifestation of postmenopausal osteoporosis, is associated with a decrease in bone density at the site of fracture, we measured bone mineral density of the ultradistal radius (UDR-BMD) by single-photon absorptiometry with computer-assisted image processing. In 119 normal women (ages 22-92 years), UDR-BMD decreased by 17% between ages 30 and 75 years. From UDR-BMD measurements in these normal women and in 40 women (ages 53-80 years) with Colles' fracture alone, a population-based analysis was made to estimate fracture risk at different values of UDR-BMD. Colles' fracture was uncommon at UDR-BMD greater than 0.40 g/cm2 (the "fracture threshold"). As bone density decreased below this level, fractures became more frequent (a "gradient of risk").

Regional bone mineral density changes after Colles' and forehand fractures.

Patients who sustain a second Colles' fracture only in one of five instances refracture the previously injured wrist. In those who have sustained fractures of the metacarpals or phalanges of the hand (forehand) subsequent fractures of the forehand are twice as likely to be ipsilateral. We investigated whether persisting regional bone mineral changes could be the mechanism underlying these observations. Bilateral bone mineral density measurements were performed on twenty patients who had sustained a Colles' fracture and twenty-nine who had sustained forehand fractures more than one year previously. Among Colles' fracture patients there was an increase in bone mineral density in the distal radius of the fractured side when compared to the uninjured side of thirty-nine percent. The protection of these patients from subsequent ipsilateral Colles' fracture seems to be due to increased bone strength induced by the healing process. Among patients with forehand fractures no significant bone mineral changes could be demonstrated.

Trabecular osteopenia in Colles' fracture.

Bone density was measured in 23 postmenopausal women with Colles' fracture. Trabecular spine density was measured by quantitative computed tomography. The bone mineral density in the distal radius and in the diaphysis of the radius and ulna was measured by the gamma ray attenuation method. Compared with age-matched controls, the patients were found to have reduced trabecular bone mass in the spine and distal radius, but no osteopenia in the diaphysis of the radius and ulna. The mean age-corrected decrease was 0.7 SD in the spine and 0.5 SD in the distal end of the radius. The results suggest that patients with Colles' fracture have trabecular but not cortical osteopenia.

Bone mineral content in women with Colles' fracture: effect of calcium supplementation.

The effect of dietary calcium supplementation on bone mineral content was studied in 40 postmenopausal women with Colles' fracture. The participants were divided into two groups which were given either placebo or 1 g of calcium per day. The bone mineral content of the femur was determined before and after 1 year of medication. Women with Colles' fracture were found to have the same mineral content in the femur as age-matched controls without fractures. Calcium supplementation had no significant effect on the bone mineral content.

Long-term observations on the loss of bone mineral following colles' fracture.

Seventy-four women were studied at various points in time between 1 month and 12 years after a fracture of the distal end of the radius--Colles' fracture. In 50 cases the maximum loss of bone after fracture was considered to have taken place in that more than 4 months had elapsed since the accident. The bone mineral content was measured in both forearms with gamma absorptiometry. It was demonstrated that the degree of post-traumatic osteoporosis, calculated as the difference between the values obtained for the injured and the uninjured arms, decreased with time. The difference between the arms was greater in peri- and early postmenopausal and in very old women suggesting that these groups had lost more bone and/or been less able to restore lost mineral with time.