Wrist Fractures: Treatment and a Warning for Osteoporosis

Wrist fractures, also known as distal radius fractures, account for 18% of all fractures in people age 65 and older. The wrist is a complex joint connecting the forearm's two bones—the radius and the ulna—to the hand. Bone fractures are a common complication of osteoporosis, particularly in the wrists, hips, and spine.

This article discusses the connection between osteoporosis and wrist fractures, including symptoms, treatments, wrist-strengthening exercises, and ways to prevent wrist fractures. 

Wrist Fracture as a Warning for Osteoporosis

A broken wrist is often the first warning sign of osteoporosis for many people. As bones become more fragile, wrist fractures can occur from minor events, such as falling from a standing height.

Globally, osteoporosis causes 8.9 million fractures each year. The risk of osteoporosis-related fractures increases with age, particularly for postmenopausal women. About 85% of wrist fractures linked to osteoporosis occur in women age 50 and older.

How Osteoporosis Affects the Bones

Cells called osteoblasts, and osteoclasts regenerate bone tissue. Osteoblasts build new bone (formation), while osteoclasts break down and remove old bone (resorption). Bone formation and resorption rate usually are balanced, which helps keep bones healthy and strong. 

As people age, bone resorption begins to outpace bone formation. By age 40, the rate of bone loss gradually increases. By the age of 70, both men and women have higher odds of experiencing low bone mass. Losing bone density can lead to osteoporosis and an increased risk of fractures. 

The loss rate increases more rapidly in women after menopause due to decreased estrogen levels. Bone mass loss can continue throughout life, but the most rapid loss occurs during the first 10 years after menopause.

Other Early Symptoms

Osteoporosis is often called a “silent disease” because bone loss occurs gradually and often without symptoms. If osteoporosis symptoms do develop, they can include the following:

• Posture changes, such as a hunched-over posture (kyphosis)
• Height loss
• Severe back pain (from spinal fracture)
• Fractured bone(s)

Wrist Fractures

A wrist fracture is a break that occurs on one or more of the bones that make up the wrist (the radius and the ulna). The majority of wrist fractures are one of these two types of distal radius fractures:

• Colles fracture: Occurs when the wrist is bent back (e.g., when an outstretched hand cushions the blow of a fall), and the broken end of the radius pushes toward the back of the hand.
• Smith fracture: Occurs when the wrist is bent forward or when the back of the wrist experiences trauma and the broken end of the radius is pushed down toward the palm. 

Symptoms

The symptoms of a wrist fracture can vary, depending on the fracture type and the severity of the injury. Common symptoms include:

• Pain
• Swelling 
• Bruising
• Stiffness
• Deformity (the wrist may hang or bend oddly) 
• Loss of function
• Numbness or tingling

Not all fractures cause severe pain; some can be subtle and hard to detect, especially if they only cause minor discomfort and swelling. After a fall, it’s always a good idea to visit your healthcare provider for a proper diagnosis and treatment.

Diagnosis

Your healthcare provider will diagnose a broken wrist through a physical examination and imaging tests. Standard diagnostic methods include the following:

• Physical examination: Your healthcare provider will examine your wrist and hand for signs of swelling, tenderness, deformity, and loss of function. They may also ask you to move your wrist and hand to check for pain and evaluate your range of motion. 
• X-ray: X-rays use electromagnetic waves to create detailed images and the positioning of the bones in the wrist.
• CT (computed tomography) scan: CT scans can provide more detailed images of the bones in the wrist than X-rays. They can help identify small fractures and other injuries that may not be visible on an X-ray.

Based on the examination and imaging tests, your healthcare provider will determine the type and severity of the fracture and recommend the appropriate treatment.

Treatment

The treatment plan for a fractured wrist depends on the type and severity of the fracture. The primary goal is to realign the broken bone(s) and prevent movement to promote healing.

Standard treatment options for a wrist fracture include:

• Reduction: A healthcare provider realigns the affected bones (moves them into their proper place). 
• Immobilization: A splint or cast is used to immobilize the broken bone and keep it in place while it heals.
• Medication: A healthcare provider prescribes pain medication to help control pain and inflammation.
• Surgery: Surgery is sometimes necessary to repair the broken bone. Pins, plates, or screws may hold the bone in place while it heals.
• Rehabilitation: Once the bone has healed, you may need to follow a rehabilitation program (e.g., physical therapy) to regain strength, range of motion, and wrist function. 

If you have osteoporosis, your healthcare provider may order follow-up X-rays to monitor the healing process and ensure your bones are correctly aligned. 

Recovery and Complications

Wrist fracture recovery depends on the fracture type, your age, and your overall health. When healing goes as planned, most wrist fractures require three months of healing before you can return to normal activities, though full recovery can take up to a year. Residual achiness in the wrist can last up to two years and may last much longer in people age 50 or older or with an underlying condition like osteoarthritis.

Complications after a wrist fracture are possible and may include the following: 

• Delayed healing: In people with osteoporosis, bone healing may take longer than in someone without osteoporosis.
• Nonunion: In rare cases, the bone may not heal together properly, requiring additional treatments, such as bone stimulation or surgery.
• Malunion: In some cases, the bone may heal in an improper position, which can lead to chronic pain, arthritis, and loss of function in the wrist.
• Refracture: People with osteoporosis have a higher risk of breaking the same bone again.
• Complex regional pain syndrome (CRPS): CRPS is a rare condition that can occur after a bone fracture. It causes severe pain, swelling, and changes in skin color and temperature in the affected body part.
• Nerve injury: Though rare, a nerve injury may occur along with a bone fracture, which can cause numbness, tingling, or weakness in the hand or fingers.
• Tendon irritation and rupture: Tendon irritation or rupture can occur when the wrist is forcibly rotated during a fall or trauma or due to the displacement of the broken bone fragments. This can cause pain and weakness in the wrist and hand. 

Wrist-Strengthening Exercises

Wrist-strengthening exercises target the muscles in the wrist and forearm, which can help improve wrist strength, flexibility, and stability and reduce pain. These exercises can benefit people with osteoporosis who want to strengthen their wrists to heal from a wrist fracture or reduce the risk of future fractures.

It is important to perform these exercises under the guidance of your healthcare provider or a physical therapist to ensure proper form and avoid further injury: 

• Wrist curls are a simple exercise that can help strengthen the muscles in the wrist and forearm.
• Grip-strengthening exercises improve the strength and stability of the muscles in the wrist and hand.
• Lateral wrist exercises can help strengthen muscles involved in the side-to-side movements of the wrist.
• Resistance band exercises provide gradual and controlled resistance, which is beneficial for people recovering from a wrist injury who need to build strength gradually.
  

Other Ways to Prevent Wrist Fractures

About half of the osteoporosis-related repeat fractures are preventable. Making healthy lifestyle choices can help support your bone health to prevent wrist fractures.

Diet

Eating a well-balanced diet rich in fruits, vegetables, and lean protein can promote bone health and reduce the risk of fractures. Foods high in calcium and vitamin D can particularly benefit bone health. Limit your consumption of processed foods, refined grains, and added sodium and sugars. 

Calcium

Calcium is an essential mineral that is necessary for maintaining healthy bones. If you get insufficient calcium, your body will use the calcium from your bones, which may lead to bone loss.

Adequate calcium intake is necessary through diet or calcium supplements to help prevent bone loss and support bone health. Calcium-rich foods include:

• Milk
• Cheese
• Yogurt
• Tofu
• Nuts and seeds
• Legumes

Vitamin D

Vitamin D helps the body to absorb calcium and is essential for maintaining healthy bones. Low vitamin D levels are associated with decreased bone density and a higher risk of osteoporosis and broken bones.

You can ensure you get enough vitamin D through sunlight exposure, diet, or supplements. The best food sources of vitamin D are:

• Fatty fish (such as salmon, tuna, pollack, and trout)
• Mushrooms
• Cheese
• Egg yolks
• Cereals or orange juice fortified with vitamin D

Quit Smoking and Drinking Alcohol

Smoking and excessive alcohol consumption are linked to an increased risk of bone loss and fractures of the spine, hip, and wrists. Drinking large amounts of alcohol can interfere with calcium levels in the body and the production of hormones that protect bones. Quitting smoking and limiting alcohol intake can help maintain bone health and reduce the risk of fractures.

Avoid Falls

Falls are a common cause of wrist fractures, especially in older adults and people with osteoporosis. Exercises, such as yoga or tai chi, can help improve your balance and coordination to help avoid falls. Consider making changes to your home environment to make it safer, such as removing tripping hazards from floors (e.g., wires, shoes), installing grab bars in the bathroom, and cleaning up spills to avoid slipping.

Summary

Wrist fractures are common among people with osteoporosis and are often the first indication of the disease. If you've fallen or experienced trauma to your wrist, your healthcare provider will do a physical exam and order imaging tests to diagnose a fracture. Recovery from a wrist fracture can take months, but a calcium and vitamin D-rich diet and specific exercises can help strengthen your bones and prevent future fractures.