Relationship between distal radius fracture severity and 25-hydroxyvitamin-D level among perimenopausal and postmenopausal women

Abstract

Aims: Low-energy distal radius fractures (DRFs) are the most common upper arm fractures correlated with bone fragility. Vitamin D deficiency is an important risk factor associated with DRFs. However, the relationship between DRF severity and vitamin D deficiency is not elucidated. Therefore, this study aimed to identify the correlation between DRF severity and serum 25-hydroxyvitamin-D level, which is an indicator of vitamin D deficiency.

Methods: This multicentre retrospective observational study enrolled 122 female patients aged over 45 years with DRFs with extension deformity. DRF severity was assessed by three independent examiners using 3D CT. Moreover, it was categorized based on the AO classification, and the degree of articular and volar cortex comminution was evaluated. Articular comminution was defined as an articular fragment involving three or more fragments, and volar cortex comminution as a fracture in the volar cortex of the distal fragment. Serum 25-hydroxyvitamin-D level, bone metabolic markers, and bone mineral density (BMD) at the lumbar spine, hip, and wrist were evaluated six months after injury. According to DRF severity, serum 25-hydroxyvitamin-D level, parameters correlated with bone metabolism, and BMD was compared.

Results: The articular comminuted group (n = 28) had a significantly lower median serum 25-hydroxyvitamin-D level than the non-comminuted group (n = 94; 13.4 ng/ml (interquartile range (IQR) 9.8 to 17.3) vs 16.2 ng/ml (IQR 12.5 to 20.4); p = 0.005). The AO classification and volar cortex comminution were not correlated with the serum 25-hydroxyvitamin-D level. Bone metabolic markers and BMD did not significantly differ in terms of DRF severities.

Conclusion: Articular comminuted DRF, referred to as AO C3 fracture, is significantly associated with low serum 25-hydroxyvitamin-D levels. Therefore, vitamin D₃ supplementation for vitamin D deficiency might prevent articular comminuted DRFs. Nevertheless, further studies must be conducted to validate the results of the current study. Cite this article: Bone Jt Open 2022;3(3):261-267.

Keywords: 25-hydroxyvitamin-D; 3D CT scan; Bone fragility; Distal radius fracture; Fracture severity; Osteoporosis; Serum; Vitamin D; Vitamin D deficiency; arm fractures; bone metabolism; bone mineral density (BMD); deformity; distal radius fractures.

Fig. 1

Articular comminution was defined as a fragment involving three or more fragments. a) Articular comminution and b) non-comminution. Volar cortex comminution was defined as a fracture in the volar cortex of the distal fragment. c) Volar cortex comminution and d) non-comminution.

Fig. 2

Serum 25-hydroxyvitamin-D level (25(OH)D) was compared according to fracture classifications. The box plot indicated interquartile range and median as well as mean value (cross mark). *p < 0.05.

Fig. 3

The serum 25-hydroxyvitamin-D levels (25(OH)D) according to each season are shown in box plots. Spring, March to May; summer, June to August; autumn, September to November; and winter, December to February.