Drug Treatment for Osteoporosis of the Upper Extremity

Osteoporosis (decreased bone mineral density) is a very common disorder affecting the skeleton. In a patient with osteoporosis, the bones begin losing their minerals and support beams, leaving the skeleton brittle and prone to fractures.

In the U.S., 10 million individuals are estimated to already have the disease and almost 34 million more have low bone mass, placing them at increased risk for osteoporosis. Of the 10 million Americans affected by osteoporosis, eight million are women and two million are men. Most of them over age 65.

Half of all bone fractures are related to osteoporosis. More than 300,000 hip fractures occur in the United States every year. A person with a hip fracture has a 20 percent chance of dying within six months as a result of the fracture. Osteoporotic-related fragility fractures can also affect just the arm.

In fact, each year in the United States, one-quarter of a million adults (250,000) experience bone fractures of the arm from this condition. A fragility fracture is a bone break that occurs without significant trauma. The person could just be lifting a cup of coffee, turning a key in the door lock, or picking up a small book when the bone fractures. The underlying osteoporosis is the reason for these fractures.

One-third (34 per cent) of fragility bone fractures of the arm affect the wrist for women. In men, this figure is closer to 17 per cent. But even one osteoporosis-related fracture increases the risk two to four times for another fracture later. This is serious because many people who have a fracture related to osteoporosis spend considerable time in the hospital and in rehabilitation.

Hand surgeons treating upper extremity fractures associated with osteoporosis will need to address this condition. Assessing for risk factors (e.g., older age, female, postmenopausal, decreased testosterone, Asian or European ancestry) and asking about a past history of any previous low-energy fractures is important. It may be necessary to order a DEXA scan to evaluate the severity and extent of the bone thinning.

Treatment with dietary supplementation (e.g., calcium, vitamin D), hormones, bisphosphonates (e.g., Boniva, Fosamax, Reclast), and biologic therapy (e.g., monoclonal antibodies) are often advised. And some patients may want to pursue alternative therapies such as additional drug therapy with calcitonin, strontium, hormone replacement therapy, and/or estrogen receptor modulators.

Referral from the orthopedic or hand surgeon to a specialist with advanced knowledge of osteoporosis may be a good idea. This could be the primary care physician, a rheumatologist, or an endocrinologist. They will be familiar with the appropriate medications to prescribe and any contraindications (reasons NOT to prescribe certain drugs). Having one physician supervise all aspects of care and management of this condition is important to prevent future fractures from occurring.