Background The Yentl syndrome1 occurs where a woman has to masquerade as a man in order to receive the same treatment. It was described in the management of ischaemic heart disease where women were shown to be undertreated in comparison to men until they suffered a defining event such as myocardial infarction.
Low energy fractures are a manifestation of established and developing osteoporosis. Women who sustain a wrist fracture within ten years of the menopause are at an eight-fold increased risk of hip fracture compared to the general population.2 Osteoporosis also carries an appreciable risk of hip fracture in men.3
Objectives We hypothesised that men may receive less intervention than women after low energy fractures.
Methods All patients 40 years of age and over who had a distal radius fracture in a 3 month period (from 1.12.1999) at a General Hospital were identified from radiograph reports. The manner of injury and subsequent management were assessed from self-completed patient questionnaires. Low energy fractures were defined as a fall from standing height or less, at walking speed or slower and confirmed where necessary by case note review or telephone. Men and women who sustained low energy fractures were compared for advice, investigation and treatment relating to osteoporosis.
Results Ninety-one of 105 people identified (87%) returned the questionnaire, of whom 72 (79%) were judged to have sustained low energy fractures [12 males (17%) and 60 females (83%), with average age at fracture 63 (range 43?85) and 68 years (range 40?92) respectively]. By questionnaire, 8 women (15%) but none of the men were advised at the time of the fracture of the possibility of osteoporosis. Nine women (16%) and none of the men had been investigated (8 cases by DEXA scan, and one case by bone ultrasound). Sixteen women (28%) were currently taking bone protection therapy (5 hormone replacement therapy, 3 etidronate, 2 calcium and vitamin D supplements and 5 calcium supplements alone). None of the men were taking any medication for osteoporosis, a difference in comparison to women of borderline significance (p = 0.055, Fisher?s Exact Test).
Conclusion Only a small minority of patients with low energy fractures were made aware of the possibility of having osteoporosis and were adequately investigated or treated. Men accounted for 17% of presentations, but the complete absence of advice and appropriate investigation and treatment of osteoporosis among males is striking. There is much scope for improvement in the management of low energy fractures, especially in men. A reverse of the Yentl syndrome may exist in osteoporosis.
Healy B. The Yentl syndrome. N Engl J Med. 1991;325:274–6
Wigderowitz CA, Rowley DI, Mole PA, et al. Bone mineral density of the radius in patients with Colles? fracture. Br J Bone Joint Surg. 2000;82B:87–9
Nyquist F, Gardsell P, Sernbo I, et al. Assessment of sex hormones and bone mineral density in relation to occurrence of fracture in men. Bone 1998;22:147–51
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