Colles' Fracture Definition
A Colles' fracture is a fracture of the distal radius (wrist) that represents a major osteoporotic fracture site and serves as an important clinical marker of underlying skeletal fragility, particularly in older adults with osteoporosis. 1
Anatomic and Clinical Characteristics
Colles' fracture specifically involves the distal section of the radius, the larger of the two forearm bones at the wrist level 2, 3
This fracture is classified as a "major osteoporotic fracture" along with hip, spine (vertebral), and humerus fractures 1, 4
The fracture typically results from a fall from standing height or lower (fragility fracture), which would not cause a fracture in most healthy individuals 1
Epidemiology and Significance in Osteoporosis
Colles' fractures are extremely common in elderly patients and tend to result in displacement due to underlying osteoporotic bone 2
The epidemiological association between osteoporosis and distal radius fractures is strongest for women up to 65 years of age, with the association weakening for older women and other skeletal locations 5
These fractures occur earlier in life than other osteoporotic fractures (such as hip or vertebral fractures), making them an important warning signal for future, more deleterious fractures 3
Clinical Implications for Fracture Risk
A Colles' fracture in an older adult confirms skeletal fragility regardless of bone mineral density T-score, as 60% of osteoporotic fractures occur in patients with T-scores higher than -2.5 4
The occurrence of a Colles' fracture indicates an approximately 2-fold increased relative risk of sustaining another fracture, particularly in the first 1-2 years following the injury (imminent fracture risk period) 4, 6
In the first 10-15 years after postmenopause, a Colles' fracture indicates increased relative risk of future fractures, though this relative risk approaches baseline after a few years 5
Management Implications
Any Colles' fracture in an older adult warrants full osteoporosis evaluation and treatment, including assessment for additional undiagnosed fractures and immediate consideration of pharmacological intervention 4
The presence of a Colles' fracture should trigger systematic investigation of both skeletal causes (osteoporosis) and extraskeletal factors (fall risk, balance, vision) that contributed to the fracture 5
Current guidelines recommend osteoporosis treatment in all fragility fractures over age 75 without requiring bone density testing, and after bone density assessment in younger patients 7
Common Pitfalls
Fracture displacement in elderly patients does not necessarily result in functional impairment, so treatment decisions must consider individual functional status 2
Bone loss continues during the course of treatment and directly affects prognosis, with significant bone mass decrease occurring 6 weeks after fracture and not fully returning to normal even at one year 8
Most patients with Colles' fractures are not identified as having osteoporosis and do not receive treatment to prevent future fractures, representing a critical gap in secondary fracture prevention 9, 7
Extraskeletal factors (fall risk, balance, muscle strength) are of equal or greater importance than bone density alone in the development of Colles' fractures 5