Distal forearm fracture history in an older community-dwelling population:the Nottingham Community Osteoporosis (NOCOS) study

Objectives: to assess the prevalence of a history of Colles' fracture (occu rring after the age of 40 years) and to ascertain the extent of investigati on and treatment of osteoporosis in this population. Methods: we studied subjects aged greater than or equal to 60 years from th e age-sex register of three general practices. We recorded a history of fra ctures and details of any previous investigation for osteoporosis and treat ment with bone-protective drugs. Bone mineral density was performed at the heel using dual-energy x-ray absorptiometry (Lunar PIXI machine). We classi fied subjects into normal, osteopaenic or osteoporotic according to the mac hine manufacturer's recommended World Health Organisation 'equivalent T-sco re thresholds' (0.6 for osteopaenia and 1.6 for osteoporosis). Results: of the 605 subjects invited, we recruited 259 women and 194 men (r esponse rate=74.8%). Twenty-eight (10.8%) of the women and five (2.6%o) of the men had a history of Colles' fracture. Of women with a prevalent Colles ' fracture, 39% were osteoporotic and 36% were osteopaenic. These rates wer e significantly greater than in women without a Colles' fracture (19.9% ost eoporotic, 29.4% osteopaenic; P=0.018). Assuming the same PIXI thresholds f or men, two (40%) of the five men with a history of Colles' fractures were osteoporotic and the rest were osteopaenic, compared with 20.6 and 31.2% of men without a history of Colles' fractures. None of the subjects in the Co lles' fracture group had previously been investigated with bone densitometr y. Women with and without a history of Colles' fracture did not differ sign ificantly in ever having (32.1% vs 27.2%; P=0.4) or currently having (14.3% vs 10.4%; P=0.4) hormone replacement treatment. None of the men and only o ne woman with a previous Colles' fracture had ever taken a non-hormone repl acement treatment for osteoporosis. Conclusions: older community-dwelling subjects with previous Colles' fractu re have a high prevalence of osteoporosis and are under-investigated and un der-treated. Methods for identifying subjects with a previous Colles' fract ure need to be developed in primary and secondary care.