Differences in Function and Fracture Risk in Postmenopausal Women With and Without a Recent Distal Radius Fracture

in Journal of Aging and Physical Activity
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A distal radius fracture (DRF) is commonly the first fracture to occur in early postmenopausal women. The reasons for sustaining a DRF may be related to fall risk, bone fragility, or both. The objective of this study was to compare functional and fracture risk status in postmenopausal women with and without a recent DRF and explore the relationships between function, grip strength, and fracture risk status. Seventy-seven women a ges 50–78 with (n = 32) and without (n = 45) a history of DRF in the past 2 years participated. Balance, timed up and go (TUG), gait velocity, balance confidence, sit to stand, grip strength, and fracture risk were assessed. There was a significant group difference after controlling for physical activity level (Pillai’s Trace, p < .05) where women with DRF had poorer outcomes on sit to stand, gait velocity, TUG, and fracture risk status. Grip strength was associated with functional tests, particularly in women with DRF. Women with a recent DRF demonstrated lower functional status and higher fracture risk compared to women without. Grip strength was associated with measures of function and fracture risk, and may complement screening tools for this population.

Crockett, Bath, and Arnold are with School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada. Kontulainen, Farthing, Chilibeck, and Baxter-Jones are with the College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

Address author correspondence to Katie Crockett at katie.crockett@usask.ca.
  • Abellan van Kan, G., Rolland, Y., Andrieu, S., Bauer, J., Beauchet, O., Bonnefoy, M., . . . Vellas, B. (2009). Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. The Journal of Nutrition, Health and Aging, 13(10), 881889. PubMed doi:10.1007/s12603-009-0246-z

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Albrand, G., Munoz, E., Sornay-Rendu, E., Duboeuf, F., & Delmas, P.D. (2003). Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: The OFELY study. Bone, 32, 7885. PubMed doi:10.1016/S8756-3282(02)00919-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Barrett-Conner, E., Weiss, T.W., McHorney, C.A., Miller, P.D., & Siris, E.S. (2009). Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporosis International, 20, 715722. PubMed doi:10.1007/s00198-008-0748-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Berg, K., Wood, D.S., Williams, J.I., & Gayton, D. (1989). Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada, 41(6), 304311. doi:10.3138/ptc.41.6.304

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bohannon, R.W. (1997). Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Aging, 26(1), 1519. PubMed doi:10.1093/ageing/26.1.15

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bohannon, R.W., Andrews, A.W., & Thomas, M.W. (1996). Walking speed: reference values and correlates for older adults. Journal of Orthopaedic and Sports Physical Therapy, 24, 8690. PubMed doi:10.2519/jospt.1996.24.2.86

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bohannon, R.W., Larkin, P.A., Cook, A.C., Gear, J., & Singer, J. (1984). Decrease in timed balance test scores with aging. Physical Therapy, 64, 10671070. PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Borson, S., & Scanlan, J.M. (2003). The mini-cog as a screen for dementia: validation in a population-based sample. Journal of the American Geriatrics Society, 51(10), 14511454. PubMed doi:10.1046/j.1532-5415.2003.51465.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Burke-Doe, A., Hudson, A., Werth, H., & Riordan, D.G. (2008). Knowledge of osteoporosis risk factors and prevalence of risk factors for osteoporosis, falls, and fracture in functionally independent older adults. Journal of Geriatric Physical Therapy, 31(1), 1117. PubMed doi:10.1519/00139143-200831010-00003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cho, Y.J., Gong, H.S., Song, C.H., Lee, Y.H., & Baek, G.H. (2014). Evaluation of physical performance level as a fall risk factor in women with a distal radial fracture. Journal of Bone & Joint Surgery, American, 96(5), 361365. PubMed doi:10.2106/JBJS.L.01359

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2nd ed.). Hillsdale, NJ: Lawrence Eribaum Associates.

  • Crockett, K., Ardell, K., Hermanson, M., Penner, A., Lanovaz, J., Farthing, J., . . . Arnold, C. (2013). The relationship of knee-extensor strength and rate of torque development to sit-to-stand performance in older adults. Physiotherapy Canada, 65(3), 229235. PubMed doi:10.3138/ptc.2012-04

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Crockett, K., Arnold, C.M., Farthing, J.P., Chilibeck, P.D., Johnston, J.D., Bath, B., . . . Kontulainen, S.A. (2015). Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture. Osteoporosis International, 26, 24612469. PubMed doi:10.1007/s00198-015-3160-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Downs, S., Marquez, J., & Chiarelli, P. (2013). The berg balance scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: A systematic review. Journal of Physiotherapy, 59, 9399. PubMed doi:10.1016/S1836-9553(13)70161-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eastell, R., Reid, D.M., Compston, J., Cooper, C., Fogelman, I., Francis, R.M., . . . Stevenson, J.C. (2001). Secondary prevention of osteoporosis: When should a non-vertebral fracture be a trigger for action? QJM, 94(11), 575597. PubMed doi:10.1093/qjmed/94.11.575

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Edwards, B.J., Langman, C.B., Martinez, K., Johnson, M., Mille, M.L., & Rogers, M.W. (2006). Women with wrist fractures are at increased risk for future fractures because of both skeletal and non-skeletal risk factors. Age and Ageing, 35(4), 438441. PubMed doi:10.1093/ageing/afl018

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Faul, F., Erdfelder, E., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 11491160. PubMed doi:10.3758/BRM.41.4.1149

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Frank, A., Lorbergs, A.L., Chilibeck, P.D., Farthing, J.P., & Kontulainen, S.A. (2010). Muscle cross sectional area and grip torque contraction types are similarly related to pQCT derived bone strength indices in the radii of older healthy adults. Journal of Musculoskeletal and Neuronal Interactions, 10(2), 136141. PubMed

    • Search Google Scholar
    • Export Citation
  • Geusens, P. (2009). Strategies for treatment to prevent fragility fractures in postmenopausal women. Best Practice and Research Clinical Rheumatology, 23, 727740. PubMed doi:10.1016/j.berh.2009.09.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Geusens, P., Milisen, K., Dejaeger, E., & Boonen, S. (2003). Falls and fractures in postmenopausal women: A review. Journal of British Menopause Society, 9(3), 101106. PubMed doi:10.1258/136218003100322314

    • Search Google Scholar
    • Export Citation
  • Graafmans, W.C., Ooms, M.E., Bezemer, P.D., Bouter, L.M., & Lips, P. (1996). Different risk profiles for hip fractures and distal forearm fractures: A prospective study. Osteoporosis International, 6(6), 427431. PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Günther, C.M., Bürger, A., Rickert, M., Crispin, A., & Schulz, C.U. (2008). Grip Strength in healthy caucasian adults: Reference values. Journal of Hand Surgery, 33(4), 558565. PubMed

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Handol, H.H.G., Madhok, R., & Howe, T.E. (2006). Rehabilitation for distal radial fractures in adults (Review). Cochrane Database of Systematic Reviews, (3), CD003324. PubMed doi:10.1002/14651858.CD003324.pub2

    • Search Google Scholar
    • Export Citation
  • Hasegawa, Y., Schneider, P., & Reiners, C. (2001). Age, sex, and grip strength determine architectural bone parameters assessed by peripheral quantitative computed tomographer (pQCT) at the human radius. Journal of Biomechanics, 34(4), 497503. PubMed doi:10.1016/S0021-9290(00)00211-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hill, K. (2005). Activities-specific and balance confidence (ABC) scale. Australian Journal of Physiotherapy, 51(3), 197.

  • Hillier, T.A., Cauley, J.A., Rizzo, J.H., Pedula, K.L., Ensrud, K.E., Bauer, D.C., . . . Cummings, S.R. (2011). WHO absolute fracture risk models (FRAX): Do clinical risk factors improve fracture prediction in older women without osteoporosis? Journal of Bone and Mineral Research, 26(8), 17741782. PubMed doi:10.1002/jbmr.372

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hofheinz, M., & Schusterschitz, C. (2010). Dual task interference is estimating the risk of falls and measuring change: A comparative, psychometric study of four measurements. Clinical Rehabilitation, 24(9), 831842. PubMed doi:10.1177/0269215510367993

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Isles, R.C., Low Choy, N.L., Steer, M., & Nitz, J.C. (2004). Normal values of balance tests in women aged 20-80. Journal of the American Geriatrics Society, 52(8), 13671372. PubMed doi:10.1111/j.1532-5415.2004.52370.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jarvinen, T.L.N., Slevanen, H., Khan, K.M., Heinonen, A., & Kannus, P. (2008). Shifting the focus in fracture prevention from osteoporosis to falls. British Medical Journal, 336(7636), 124126. PubMed doi:10.1136/bmj.39428.470752.AD

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kelsey, J.L., Prill, M.M., Keegan, T.H.M., Tanner, H.E., Bernstein, A.L., Quesenberry, C.P., & Sidney, S. (2005). Reducing the risk for distal forearm fracture: Preserve bone mass, slow down, and don’t fall! Osteoporosis International, 16, 681690. PubMed doi:10.1007/s00198-004-1745-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lajoie, Y., & Gallagher, S.P. (2004). Predicting falls within the elderly community: Comparison of postural sway, reaction time, the Berg balance scale and ABC scale for comparing fallers and non-fallers. Archives of Gerontology and Geriatrics, 38, 1126. PubMed doi:10.1016/S0167-4943(03)00082-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Laroche, D.P., Millett, E.D., & Kralian, R.J. (2011). Low strength is related to diminished ground reaction forces and walking performance in older women. Gait & Posture, 33(4), 668672. PubMed doi:10.1016/j.gaitpost.2011.02.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lewiecki, M.E. (2010). Fracture risk assessment in clinical practice: T-scores, FRAX, and beyond. Clinical Reviews in Bone and Mineral Metabolism, 8, 101112. doi:10.1007/s12018-009-9054-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Low Choy, N., Brauer, S., & Nitz, J. (2008). Linking stability to demographics, strength, and sensory system function in women over 40 to support pre-emptive preventive intervention. Climacteric, 11(2), 144154. PubMed doi:10.1080/13697130801931821

    • Crossref
    • Search Google Scholar
    • Export Citation
  • MacDermid, J., Roth, J.H., & Richard, R.S. (2003). Pain and disability reported in the year following a distal radius fracture: A cohort study. BMC Musculoskeletal Disorders. 2003, 4, 24. PubMed doi:10.1186/1471-2474-4-24

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: Normative data for adults. Archives of Physical Medicine and Rehabilitation, 66, 6972. PubMed

    • Search Google Scholar
    • Export Citation
  • Mehta, S.P., MacDermid, J.C., Richardson, J., MacIntyre, N. J., & Grewal, R. (2015). Reliability and validity of selected measures associated with increased fall risk in females over the age of 45 years with distal radius fracture – A pilot study. Journal of Hand Therapy, 28, 210. PubMed doi:10.1016/j.jht.2014.09.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Moayyer, A., Besson, H., Luben, R., Wareham, N., & Khaw, K. (2010). The association between physical activity in different domains of life and risk of osteoporotic fractures. Bone, 47(3), 693700. PubMed doi:10.1016/j.bone.2010.06.023

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mulhall, K.J., Ahmed, A., Khan, Y., & Masterson, E. (2002). Simultaneous hip and upper limb fracture in the elderly: Incidence, features and management considerations. Injury, 33(1), 2931. PubMed doi:10.1016/S0020-1383(01)00097-3

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Myers, A.M., Fletcher, P.C., Myers, A.H., & Sherk, W. (1998). Discriminative and evaluative properties of the activities-specific balance confidence (ABC) scale. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 53(4), 287294. PubMed doi:10.1093/gerona/53A.4.M287

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Myers, T.A., & Briffa, N.K. (2003). Secondary and tertiary prevention in the management of low-trauma fracture. Australian Journal of Physiotherapy, 49, 2529. PubMed doi:10.1016/S0004-9514(14)60185-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nguyen, T.V., Center, J.R., Sambrook, P.N., & Eisman, J.A. (2001). Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: The Dubbo osteoporosis epidemiology study. American Journal of Epidemiology, 153(6), 587595. PubMed doi:10.1093/aje/153.6.587

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Nordvall, H., Glanberg-Persson, G., & Lysholm, J. (2007). Are distal radius fractures due to fragility or to falls? A consecutive case-control study of bone mineral density, tendency to fall, risk factors for osteoporosis, and health-related quality of life. Acta Orthopaedica, 78(2), 271277. PubMed doi:10.1080/17453670710013799

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Osteoporosis Canada. (2013, October). Make the first break the last with fracture liason services. Retrieved from http://www.osteoporosis.ca/wp-content/uploads/FLS-TOOLKIT.pdf

    • Export Citation
  • Oyen, J., Apalset, E.M., Gjesdal, C.G., Brudvik, C., Lie, S.A., & Hove, L.M. (2011). Vitamin D inadequacy is associated with low-energy distal radius fractures: A case-control study. Bone, 48(5), 11401145. PubMed doi:10.1016/j.bone.2011.01.021

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Palvanen, M., Kannus, P., Parkkari, J., Pitkajarvi, T., Pasanen, M., Vuori, I., & Järvinen, M. (2000). The injury mechanisms of osteoporotic upper extremity fractures among older adults: A controlled study of 287 consecutive patients and their 108 controls. Osteoporosis International, 11(10), 822831. PubMed doi:10.1007/s001980070040

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Papaioannou, A., Morin, S., Cheung, A.M., Atkinson, S., Brown, J.P., Feldman, S., . . . Scientific Advisory Council of Osteoporosis Canada (2010). 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. Canadian Medical Association Journal, 182, 18641873. PubMed doi:10.1503/cmaj.100771

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pijnapples, M., Reeves, N.D., Maganaris, C.N., & van Dieën, J.H. (2008). Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly. Journal of Electromyography and Kinesiology, 18(2), 188196. doi:10.1016/j.jelekin.2007.06.004

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Pijnapples, M., van der Burg, P.J., Reeves, N.D., & van Dreën, J.H. (2008). Identification of elderly fallers by muscle strength. European Journal of Applied Physiology, 102(5), 585592. doi:10.1007/s00421-007-0613-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Podsiadlo, D., & Richardson, S. (1991). The timed “up & go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142148. PubMed doi:10.1111/j.1532-5415.1991.tb01616.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Quach, L., Galica, A.M., Jones, R.N., Procter-Gray, E., Manor, B., Hannan, M.T., & Lipsitz, L.A. (2011). The nonlinear relationship between gait speed and falls: The maintenance of balance, independent living, intellect, and Zest in the elderly of Boston study. Journal of the American Geriatrics Society, 59(6), 10691073. PubMed doi:10.1111/j.1532-5415.2011.03408.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rantanen, T., Volpato, S., Ferrucci, L., Heikkinen, E., Fried, L.P., & Guralnik, J.M. (2003) Handgrip strength and cause-specific and total mortality in older disabled women: Exploring the mechanism. Journal of the American Geriatrics Society, 51(5), 636641. PubMed doi:10.1034/j.1600-0579.2003.00207.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rikli, R.E., & Jones, C.J. (1999). Functional fitness normative scores for community residing older adults ages 60-94. Journal of Aging and Physical Activity, 7, 160179. doi:10.1123/japa.7.2.162

    • Search Google Scholar
    • Export Citation
  • Rikli, R.E., & Jones, C.J. (2001). Senior fitness test manual. Champaign, IL: Human Kinetics.

  • Rinne, M.B., Pasanen, M.E., Miilunpalo, S.I., & Oja, P. (2001) Test-retest reproducibility and inter-rater reliability of a motor skill test battery for adults. International Journal of Sports Medicine, 22, 192200. PubMed doi:10.1055/s-2001-16384

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shumway-Cook, A., Baldwin, M., Polissar, N.L., & Gruber, W. (1997). Predicting the probability for falls in community-dwelling older adults. Physical Therapy, 77(8), 812819. PubMed doi:10.1093/ptj/77.8.812

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical Therapy, 80(9), 896903. PubMed

    • Search Google Scholar
    • Export Citation
  • Steffen, T.M., Hacker, T.A., & Mollinger, L. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical Therapy, 82(2), 128137. PubMed doi:10.1093/ptj/82.2.128

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stevens, P., Syddall, H., Patel, H., Martin, H., Cooper, C., & Aihie Sayer, A. (2012). Is grip strength a good marker of physical performance among community-dwelling older people? The Journal of Nutrition, Health & Aging, 16(9), 769774. PubMed doi:10.1007/s12603-012-0388-2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tabachnick, B.G., & Fidell, L.S. (2007). Using multivariate statistics. 5th ed. Boston, MA: Pearson Education Inc.

  • van Helden, S., van Geel, A.C., Geusens, P.P., Kessels, A., Nieuwenhuijzen Kruseman, A.C., & Brink, P.R. (2008). Bone and fall-related fracture risks in women and men with a recent clinical fracture. Journal of Bone and Joint Surgery – American Volume, 90(2), 241248. PubMed doi:10.2106/JBJS.G.00150

    • Crossref
    • Search Google Scholar
    • Export Citation
  • VanSwearingen, H.M., & Brach, J.S. (2001). Making geriatric assessment work: Selecting useful measures. Physical Therapy, 81, 12331252. PubMed

    • Search Google Scholar
    • Export Citation
  • Washburn, R.A., McAuley, E., Katula, J., Mihalko, S.L., & Boileau, R.A. (1999) The physical activity scale for the elderly (PASE): Evidence for validity. Journal of Clinical Epidemiology, 52, 643651. PubMed doi:10.1016/S0895-4356(99)00049-9

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Weiner, D.K., Duncan, P.W., Chandler, J., & Studenski, S.A. (1992). Functional reach: A marker of physical frailty. Journal of the American Geriatrics Society, 40(3), 203207. PubMed doi:10.1111/j.1532-5415.1992.tb02068.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • World Health Organization. (2008). FRAX WHO fracture risk assessment tool. Geneva, Switzerland: World Health Organization.

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