To the Editor:
I read the paper by Clayton et al. (1) with much interest. I would point out that, although the authors were unable to cite previous
clinical studies investigating an association between osteoporosis and fracture
severity or an association between bone mineral density and radiographic
outcomes after injury, a number of relevant publications on these subjects do exist.
Xie and Bärenholdt found that bone mineral density of the cortex of
the distal radius was lower in displaced than in undisplaced distal radius
fractures (2).
We reported that bone mineral density correlated with an increase in
ulnar variance of the fractured wrist (3). Increase in ulnar variance
gives an indication of fracture severity and is higher with radial
shortening and/or change in palmar tilt.
In a recent Japanese study, an association has been shown between bone mineral
density and deformity of the distal radius in low-energy Colles' fractures in women above 50 years of age, before treatment (4).
However, only the study of Clayton et al. demonstrated an association between fracture severity and bone mineral density measured with dual-energy X-ray absorptiometry at the hip (1). Xie and Bärenholdt
measured bone mineral density with peripheral quantitative tomography at
the distal radius. They could not find a difference between displaced and undisplaced distal radius fractures when bone mineral density was measured
at the lumbar spine or the femoral neck with Dual-energy X-ray absorptiometry (2).
We found that bone mineral density correlated with an increase in ulnar
variance when it was measured at the contralateral distal forearm, but not
at the hip or lumbar spine (3). Sakai et al. measured bone mineral density of the lumbar spine with dual-energy X- ray absorptiometry (4).
The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of her immediate family, is affiliated or associated.
References
1. Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal
radius fractures. J Bone and Joint Surg Am. 2009;91:613-9.
2. Xie X, Bärenholdt O.
Bone density and geometric properties of the distal radius in displaced
and undisplaced Colles’ fractures: quantitative CT in 70 women. Acta Orthop Scand. 2001;72:62-6.
3. Hollevoet N, Verdonk R.
Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg. 2003;69:510-4.
4. Sakai A, Oshige T, Zenke Y, Suzuki M, Yamanaka Y, Nakamura T. Association of bone mineral density with deformity of the distal radius in
low-energy Colles’ fractures in Japanese women above 50 years of age. J Hand Surg [Am]. 2008;33:820-6.
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