Predicting Broken Wrist Risks in Older Women

Chair stand and grip strength test might help predict women at risk for broken wrists from falls

(RxWiki News) Some older women who fall are at an increased risk for a broken wrist. A few simple tests may be able to help indicate which women are more prone to this.

Researchers evaluated physical performance of postmenopausal women who had broken their wrist from a fall and compared the results to women who had not broken their wrists.

Results of two physical tests — the chair stand and grip strength tests — were significantly lower in women who had broken a wrist. This decreased physical performance may have had a role in the fracture risk.

"Ask your doctor before you start an exercise program."

Young Jae Cho, MD, led a research group from the Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.

The researchers recruited 40 postmenopausal women into the patient group who were over the age of 50 and had broken their wrist from a fall. A control group of 40 postmenopausal women who had not broken their wrist were also included in the study.

The study team tested the women’s ability to perform certain physical tasks, called the Short Physical Performance Battery. The test included walking speed, standing balance and chair stand score. The chair stand score was based on standing five times from a seated position with arms folded at the chest.

Each section was scored from 0 to 4, with a total score possible of 12, with higher scores indicating better physical performance. Study participants were also given a grip strength test as another measure of physical ability.

Overall results of the Short Physical Performance Battery were similar between the women in the patient group (10.8 points) and the women in the control group (11.2 points).

The results of chair stand and grip strength tests were different between the two groups.

The patient group scored an average of 3.3 on the chair stand and 14.4 kg on the grip strength test. The control group scored an average of 3.6 on the chair stand and 16.7 kg on the grip strength test.

Higher chair stand scores were associated with a 68 percent decreased risk of wrist fractures and higher grip strength was associated with a 12 percent decrease risk of wrist fractures.

The researchers considered other factors that might have accounted for an increased risk for falling, such as low blood pressure, use of certain medications, heart problems, dizziness and osteoarthritis. These factors were similar between both groups.

“Differences in chair stand test scores and grip strength may imply early subtle decrease in physical performance level in patients with distal radial fracture (broken wrist),” the authors concluded.

"These simple inexpensive tests may allow doctors and other health care providers to identify those at higher risk for wrist fractures," said Alan L. Jones, MD, Medical Director of Orthopedic Trauma Services at Baylor University Medical Center at Dallas.

"Wrist fractures in women over 50 are most commonly associated with osteoporosis. Osteoporosis results in increased susceptibility to fractures with minor traumatic events or 'Fragility Fractures'. Common types of fragility fractures are fractures of the spine, hip, pelvis and wrist, often with significant associated disability," Dr. Jones told dailyRx News.

"Although osteoporosis affects many postmenopausal women, it affects some men as well. A family history of osteoporosis, a history of falls, having other conditions that are associated with osteoporosis such as diabetes or rheumatoid arthritis, alcohol or tobacco use, or a prior fragility fracture are all factors that place patients of both sexes at higher risk of a subsequent fragility fracture," Dr. Jones explained.

According to the authors of this study, “Further studies are warranted on whether preventive measures such as muscle strengthening exercise would be helpful for preventing further fall events and fractures in patients with a distal radial fracture."

"For patients, if you are over 50, or have had a recent fall or if you have a condition that weakens the bone, your doctor should be talking with you about your bone health. Your doctor could test your physical function as suggested in this study, or he or she may ask you to have a bone density exam to compare your bone strength to the norm. Fall prevention, osteoporosis treatment and other interventions are very effective in reducing fragility fracture risk," said Dr. Jones, who was not involved in this study.

The research study was published in March issue of The Journal of Bone and Joint Surgery.

Funding for the study was provided by a grant from Ildong Pharmaceutical to one of the authors.

The authors reported no potential conflicts of interest.

Review Date: 
March 8, 2014