Distal radius fracture (DRF) is one of the most common fall-related osteoporotic (OP) fracture
and is an early predictor of subsequent falls and OP fractures among people with DRF. The
majority of older people with DRF present with low bone mineral density (BMD) and there is
often transition to reduced muscle strength, poor balance, fear of falling and physically inactive
lifestyle after fall-related DRF. This thesis consists of three manuscripts which are aimed to
explore the recovery patterns and the role of modifiable risk factors in predicting subsequent
falls, OP fractures and BMD in patients with DRF.
The first manuscript explores the recovery patterns in modifiable risk factors for falls and OP
fractures over four years in patients with DRF. Our study findings showed that patients with
DRF experienced both short-term (6 months) and long-term (4 years) improvement in fracture specific
pain/disability, physical activity, fear of falling, BMD and general health status;
although the majority of the recovery was achieved at six months after DRF.
The second manuscript is a cross-sectional study identifying modifiable risk factors for BMD in
patients with DRF. The unaffected hand grip strength was identified as the independent predictor
of BMD explaining 17% and 12% of total variability in the BMD-femoral neck and BMD-total
hip, respectively. Among age-stratified women with DRF, balance and unaffected hand grip
strength were identified as independent determinants of BMD explaining 10% and 32% of the
total variability in BMD-femoral neck among 50-64 year and 65-80 year old, respectively.
The third manuscript is a longitudinal study identifying modifiable risk factors for subsequent
falls and OP fractures at four years after DRF. The results suggest that nearly 24% of patients
reported one or more subsequent falls (in the last six months) and 19% of patients experienced at
least one subsequent OP fracture after DRF. Patients with poor balance, low BMD, fracture specific
pain/disability of >81 points on patient-rated wrist evaluation questionnaire and presence
of a prior history of multiple falls (≥2) had three times higher odds of subsequent falls. When
adjusted for BMD, age and gender, only prior falls was identified as a significant independent
predictor of subsequent falls. We were not fully powered to explore association of various
modifiable and non-modifiable risk factors with subsequent fractures. However, we found that
patients with osteopenia or osteoporosis had clinically four times higher odds of subsequent OP
fractures than patients with normal BMD. / Thesis / Doctor of Philosophy (PhD) / Wrist fractures are the most common fall-related fragility fractures and often an early indicator of future falls and fractures. This thesis project described recovery patterns in various risk-factors at 4-years after wrist fracture and explored their association with bone mineral density (BMD) and subsequent falls and fractures. We found that the majority of recovery in fracture-specific pain/disability, fear of falling and health-status takes place within six months, although small changes were also noted between 6 months-4 years. People with low unaffected hand grip-strength might have low BMD. Furthermore, people with poor balance, greater fracture-specific pain/disability, osteopenia or osteoporosis and a prior history of multiple falls (≥2) had nearly 3 times higher odds of secondary falls and those with osteopenia or osteoporosis had 4 times higher odds of a secondary fracture. We believe this information will help therapists/clinicians to identify people at risk of future falls/fractures and offer preventive services.
| Identifer | oai:union.ndltd.org:mcmaster.ca/oai:macsphere.mcmaster.ca:11375/20956 |
| Date | January 2017 |
| Creators | Dewan, Neha |
| Contributors | MacDermid, Joy, Grewal, Ruby, Beattie, Karen, Rehabilitation Science |
| Source Sets | McMaster University |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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