Background Patients suffering a distal radial fracture have a high prevalence of osteoporosis [1]. Ankle fractures have traditionally not been considered to be an osteoporotic fracture, however more recent studies suggest otherwise [2, 3]. Patients with celiac disease (CD) have low bone mineral bone density (BMD), and overall findings indicate an increased risk of fracture [4, 5].

Objectives To investigate and compare the prevalence of osteoporosis in patients with acute distal radius or ankle fracture and describe risk factors for osteoporosis in the two groups.

Methods 400 consecutive patients over the age of 40 with acute distal radius or ankle fracture were included in this study after referral from the orthopedic department at Forde General Hospital in Sogn og Fjordane county, Norway. BMD of the hips and spine was measured and history of previous fracture, comorbidities, medication, physical activity, smoking habits, body mass index (BMI) and nutritional factors were registered. Serum analysis to detect secondary osteoporosis including IgA tissue transglutaminase was performed.

Results The prevalence of osteoporosis was 44.7% in the patients with distal radius fracture (n=293) compared to 23.4% in the ankle fracture group (n=107). Significant risk factors for having osteoporosis when having suffered a distal radius fracture were older age, female gender, lower BMI, and celiac disease (defined as either known celiac disease AND/OR positive IgA tissue transglutaminase). Elevated PTH or low vitamin D was not significant. The patients with radius fracture and osteoporosis had a higher prevalence of celiac disease (7.6%) than the ones with radius fracture and osteopenia or normal BMD (0.6%). In the ankle fracture patients with osteoporosis there were no celiac disease cases, versus 3.7% in the ankle fracture patients with osteopenia/normal BMD. In the ankle fracture group, low BMI was a significant risk factor for being osteoporotic, but no other significant risk factors were found.

Conclusions The prevalence of osteoporosis was higher among persons suffering a distal radius fracture than among those with acute ankle fracture. Several well-known risk factors for osteoporosis were associated with being osteoporotic among subjects suffering a distal radius fracture, but only BMI was associated with osteoporosis in the ankle fracture group.

1. Oyen, J., et al., Osteoporosis as a risk factor for distal radial fractures: a case-control study. J Bone Joint Surg Am, 2011. 93(4): p. 348–56.

2. Giannini, S., et al., Ankle fractures in elderly patients. Aging Clin Exp Res, 2013. 25 Suppl 1: p. S77–9.

3. Lee, K.M., et al., Ankle fractures have features of an osteoporotic fracture. Osteoporos Int, 2013. 24(11): p. 2819–25.

4. Olmos, M., et al., Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease. Dig Liver Dis, 2008. 40(1): p. 46–53.

5. Hjelle, A.M., et al., Celiac disease and risk of fracture in adults–a review. Osteoporos Int, 2014. 25(6): p. 1667–76.

Disclosure of Interest None declared