Distal radius fracture in men from working age to the oldest. Bone mass and patient-related outcome.

Forskningsoutput: AvhandlingDoktorsavhandling (sammanläggning)

Abstract

The distal radius fracture is the most common fracture of them all and it affects both men and women of all ages. However, no study had investigated men specifically. The overall aim of this thesis was to comprehensively study adult men with distal radius fracture addressing the bone mass of adult men from working age to the old and in addition, exploring determinants for self-reported outcome and sick leave. Recruitment was as follows: men who fractured during 1999-2000 were evaluated retrospectively in 2003 and men who fractured during 2003-2007 were followed prospectively for one-year post-fracture. A total of 233 patients, response rate 40%, were enrolled and compared with 643 controls. Fractures from all degrees of trauma were included. In paper I, we asked if bone mineral density (BMD) differed between men with distal radius fracture and a control group representative of the background population. Already from the age of 40, men with a distal radius fracture had lower BMD, the difference becoming more pronounced with increasing age. BMD did not differ with trauma level. Osteoporosis was more prevalent at all ages (20-39y: 8.5% vs 1.5%; 40-64y: 16.8% vs 5.1%; >65y: 23.3% vs 8.3%). Sex hormones are crucial to skeletal health in adolescence and older age. In paper II, we investigated the sex hormone profile in younger men with distal radius fracture in order to elucidate, if this contributes to explaining the low bone density and osteoporosis previously observed. The main finding was that younger men, aged 20 to 50, have an altered hormone profile with reduced levels of both free estradiol and testosterone and elevated luteinizing hormone when compared to age-matched controls. A distal radius fracture and probably other appendicular fractures in younger men might therefor be early signs of silent hypogonadism for clinicians to be aware of. Self-reported outcome after distal radius fracture differ between young and elderly. In paper III, we asked how self-reported outcome relate to fracture appearance, BMD and fracture risk in young and elderly men. We found that men over the age of 65 are more likely to have displaced fractures at both initial presentation and at follow up and higher degree of disability independent of radiographic appearance at follow up. BMD per se was not related to displacement or disability; however, most older men initially presenting with a displaced fracture also had unacceptable reduction at follow-up and higher future fracture risk, indicative of poorer bone quality. Sick leave following a fracture is a common negative consequence. But what factors are of importance after distal radius fracture and what is the impact of patient- and fracture related factors, respectively, on length of sick leave? In paper IV we found that higher self-perceived disability and pain as early as one week after fracture are the strongest predictors of length of sick leave, regardless of treatment type. In conclusion, our results show that in men, as in women, a distal radius fracture is a red flag for impaired bone strength. Men should be evaluated for osteoporosis as routine and sex hormones should also be considered. The treatment of older men with radius fracture needs further improvement, since many have disability 1 year after fracture. High degree of pain early after fracture is the greatest risk factor of longer sick leave.

Detaljer

Författare
Enheter & grupper
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Ortopedi

Nyckelord

Originalspråkengelska
KvalifikationDoktor
Tilldelande institution
Handledare/Biträdande handledare
Tilldelningsdatum2020 jun 12
UtgivningsortLund
Förlag
  • Lund University, Faculty of Medicine
Tryckta ISBN978-91-7619-945-9
StatusPublished - 2020
PublikationskategoriForskning

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Relaterad forskningsoutput

Lisa Egund, Fiona McGuigan, Önnby, K., Aleksander Giwercman & Akesson, K., 2016 sep, I : Calcified Tissue International. 99, 3, s. 250-258 9 s.

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

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