Ong Jessica, Snee Isabel, Marcano Isabel, Tintle Scott, Cheikh Malek, Giladi Aviram M
The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
J Hand Surg Glob Online. 2025 Mar 12;7(3):100709. doi: 10.1016/j.jhsg.2025.02.002. eCollection 2025 May.
Fragility fractures, which are often linked to osteoporosis, are fractures resulting from minimal trauma or low-impact falls. Although osteoporosis treatment can reduce risk of fragility fractures, many patients do not meet diagnostic criteria for osteoporosis before their first fracture. Additionally, fragility fractures are often overlooked as signs of underlying bone health issues, leading to untreated patients despite the availability of effective therapies. Appropriate bone health care can considerably reduce the risk of fragility fractures and prevent subsequent fractures in individuals with a fracture history. Alarmingly, only 8% of Medicare beneficiaries who sustained osteoporotic fractures received a bone mineral density test. Hand surgeons are uniquely positioned to identify patients at risk of underlying bone health problems during routine practice. This includes managing fragility fractures that warrant referral for a comprehensive bone health evaluation, particularly low-energy distal radius fractures that often occur years before more severe fragility fractures (eg, hip or spine). Additionally, routine radiographs and computed tomography scans also provide valuable screening opportunities even in patients without fragility fractures. Enhancing access to tools for detecting bone health problems can help address gaps in fracture management and prevention. As fractures remain a growing global health concern, we advocate for increased involvement of hand surgeons in early bone health detection.
脆性骨折通常与骨质疏松症相关，是由轻微创伤或低能量跌倒导致的骨折。尽管骨质疏松症治疗可以降低脆性骨折的风险，但许多患者在首次骨折前未达到骨质疏松症的诊断标准。此外，脆性骨折常被忽视，未被视为潜在骨骼健康问题的迹象，导致尽管有有效的治疗方法，仍有患者得不到治疗。适当的骨骼保健可以显著降低脆性骨折的风险，并预防有骨折史的个体再次骨折。令人担忧的是，在患有骨质疏松性骨折的医疗保险受益人中，只有8%接受了骨密度测试。手外科医生在日常诊疗过程中处于独特的位置，能够识别有潜在骨骼健康问题风险的患者。这包括处理需要转诊进行全面骨骼健康评估的脆性骨折，特别是低能量桡骨远端骨折，这类骨折往往比更严重的脆性骨折（如髋部或脊柱骨折）早数年发生。此外，即使对于没有脆性骨折的患者，常规X线片和计算机断层扫描也提供了有价值的筛查机会。增加获取检测骨骼健康问题工具的途径有助于解决骨折管理和预防方面的差距。由于骨折仍然是一个日益严重的全球健康问题，我们主张手外科医生更多地参与早期骨骼健康检测。
