Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women's Health Initiative Study

Abstract

Wrist fractures are common in postmenopausal women and are associated with functional decline. Fracture patterns after wrist fracture are unclear. The goal of this study was to determine the frequency and types of fractures that occur after a wrist fracture among postmenopausal women. We carried out a post hoc analysis of data from the Women's Health Initiative Observational Study and Clinical Trials (1993-2010) carried out at 40 US clinical centers. Participants were postmenopausal women aged 50 to 79 years at baseline. Mean follow-up duration was 11.8 years. Main measures included incident wrist, clinical spine, humerus, upper extremity, lower extremity, hip, and total non-wrist fractures and bone mineral density (BMD) in a subset. Among women who experienced wrist fracture, 15.5% subsequently experienced non-wrist fracture. The hazard for non-wrist fractures was higher among women who had experienced previous wrist fracture than among women who had not experienced wrist fracture: non-wrist fracture overall (hazard ratio [HR] = 1.40, 95% confidence interval [CI] 1.33-1.48), spine (HR = 1.48, 95% CI 1.32-1.66), humerus (HR = 1.78, 95% CI 1.57-2.02), upper extremity (non-wrist) (HR = 1.88, 95% CI 1.70-2.07), lower extremity (non-hip) (HR = 1.36, 95% CI 1.26-1.48), and hip (HR = 1.50, 95% CI 1.32-1.71) fracture. Associations persisted after adjustment for BMD, physical activity, and other risk factors. Risk of non-wrist fracture was higher in women who were younger when they experienced wrist fracture (interaction p value 0.02). Associations between incident wrist fracture and subsequent non-wrist fracture did not vary by baseline BMD category (normal, low bone density, osteoporosis). A wrist fracture is associated with increased risk of subsequent hip, vertebral, upper extremity, and lower extremity fractures. There may be substantial missed opportunity for intervention in the large number of women who present with wrist fractures.

Keywords: FRACTURE; OSTEOPOROSIS.

Figure 1

STROBE flow diagram of the analytic sample STROBE flow diagram: Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women’s Health Initiative Study

Figure 2

Figure 2a. Cumulative incidence of non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2b. Cumulative incidence of humerus fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2c. Cumulative incidence of hip fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2d. Cumulative incidence of spine fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate)

Figure 2

Figure 2a. Cumulative incidence of non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2b. Cumulative incidence of humerus fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2c. Cumulative incidence of hip fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2d. Cumulative incidence of spine fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate)

Figure 2

Figure 2a. Cumulative incidence of non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2b. Cumulative incidence of humerus fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2c. Cumulative incidence of hip fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2d. Cumulative incidence of spine fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate)

Figure 2

Figure 2a. Cumulative incidence of non-wrist fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2b. Cumulative incidence of humerus fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2c. Cumulative incidence of hip fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate) Figure 2d. Cumulative incidence of spine fracture in the presence and absence of initial wrist fracture during the WHI follow-up period (non-parametric estimate)