Primary prevention

The identification of decreased bone mineral density in people with any risk factors for osteoporosis suggests a greater risk of osteoporotic fracture.[24]​ Primary prevention of wrist fractures requires optimisation of peak bone mass in childhood, which is influenced mainly by genetic factors, adequate nutrition, and exercise. Thereafter, primary prevention depends on minimising loss of bone mass and maintaining skeletal trabeculae microarchitecture and cortical thickness. Important factors to consider are good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption.[25]​ Pharmacological treatments available for prevention/treatment of osteoporosis include antiresorptive drugs (to inhibit bone resorption) and anabolic drugs (to stimulate bone formation).[25]​ Patients with osteoporosis, regardless of prior fracture history, should be assessed for fall risk.[17]​​ There is some evidence that multifaceted interventions in hospital inpatients may reduce the relative risk for number of falls; this may be more likely in a subacute setting.[26][27]​ See Osteoporosis.

The use of wrist guards has been shown to reduce the incidence of wrist fractures in snowboarders and in-line skaters. They act by lowering the strain on the distal radius and ulna by sharing the load on the wrist in low-energy falls.[28][29]​​ Comparative data are not available for wrist fractures in other age groups.

Secondary prevention

Assess patients with osteoporosis, regardless of prior fracture history, for fall risk prior to discharge and advise targeted interventions to reduce their specific risks for falling.[17]​​ Consider prescribing physiotherapy or occupational therapy if impaired gait or weakness is present. Also recommend weight-bearing and balance-promoting exercises, and maintenance of calcium and vitamin D supplementation. 

Refer the patient to a fracture liaison service.[90]​ An assessment of bone mineral density (BMD) should be performed as part of the follow-up in all patients aged over 50 years, and in patients under 50 years if they had a low-energy fracture.[17][91] Either FRAX or QFracture should be used, depending on the patient’s age, to estimate 10-year predicted absolute fracture risk. Measuring BMD to assess fracture risk should not be routinely used without prior assessment using FRAX (without a BMD value) or QFracture.[91]

Patients who have undergone a bone mineral density examination are more likely to receive treatment. Ordering a bone mineral density examination in patients over 50 years of age can improve osteoporosis assessment and treatment rates following fragility fractures of the distal part of the radius.[17][48]

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