TTSH initiative aims to address osteoporosis in older patients with wrist fractures

SINGAPORE - In 2020, Mr Chong Kee Kong was on an escalator with his grandson when the boy bent down to pick up his pacifier and lost his footing.

While trying to stop his grandson from falling, Mr Chong, now 79, tumbled down the escalator himself, earning an abrasion and a fractured left wrist.

After undergoing surgery to repair the fracture, Mr Chong found out that he had osteoporosis – a bone disease characterised by an increased fracture risk due to the deterioration of bone tissue.

To help people like him, Tan Tock Seng Hospital (TTSH) has started a service aimed at proactively diagnosing osteoporosis in patients aged 50 and above who have had wrist fractures, and managing their conditions.

TTSH hand and reconstructive microsurgery department senior consultant Mala Satku said the hospital sees about 600 people aged 50 and above with distal radius fractures, or broken wrists, each year.

In 2022, the hospital reviewed more than 2,500 patients aged 50 and above who had suffered low-impact wrist fractures between 2013 and 2016.

It found that of the 1,034 patients who had undergone subsequent screening, 56 per cent were found to have osteoporosis, while 37.4 per cent were found to have osteopenia, a less severe condition which can eventually lead to osteoporosis.

The findings of the study were published in The Journal Of Hand Surgery (Asian-Pacific Volume) in 2022.

As Singapore’s population ages – with a quarter of the country’s population expected to be aged 65 and above by 2030 – wrist fractures are increasingly becoming a concern, Dr Mala said, noting the average age of patients with such fractures to be about 68.

While osteoporosis is sometimes thought of as a women’s disease, it also affects men, she said, noting that one in five men has osteoporosis, compared with one in three women.

She said that while older patients with hip and spine fractures are often screened for osteoporosis, this is not the case for those with wrist fractures.

However, wrist fractures can be an indicator of a greater risk of hip and spine fractures, she added.

“Studies have shown that anyone with a wrist fracture has a 5.6 times higher risk of a hip fracture compared with someone who doesn’t have a wrist fracture,” she said.

Addressing osteoporosis in patients with wrist fracture can help reduce this risk, said Dr Mala.

She said studies have shown that active osteoporosis care after a patient suffers a wrist fracture can lead to an 86 per cent reduction in hip fractures, as well as a 65 per cent reduction in all other subsequent fractures.

The new initiative, said Dr Mala who is leading it, involves first treating the wrist fracture, either through surgery or the use of a cast.

A bone mineral density scan, typically done using a low-radiation X-ray to measure the presence of minerals such as calcium in bone, is conducted to diagnose osteoporosis.

During follow-up visits, patients undergo rehabilitation and monitoring of the fracture.

“At the same time, there is also evaluation and treatment of osteoporosis by our panel nurses,” she said, noting that this is often done during the same appointment to save patients’ time.

Even after their fractures heal, patients whose bone densities remain low are referred to polyclinics or their general practitioners for ongoing management.

Osteoporosis treatment is typically a long-term affair, conducted across three to five years, with regular reviews and scans done at the TTSH Hand Surgery Clinic.

Treatment can include shots of the drug denosumab, to strengthen bone, in addition to exercise and adjusting a patient’s diet to include more calcium.

The programme has seen a 60 per cent increase in the number of wrist fracture patients screened for osteoporosis at TTSH after a pilot, which ran between 2021 and 2023, Dr Mala said.

Meanwhile, the number of patients seen for osteoporosis care after wrist fractures tripled between 2022 and 2025 under the programme, which won merit awards at the NHG Quality Day Awards in 2022 and 2023.

TTSH aims to expand the service to other institutions under the NHG Health cluster.

“We would like as many patients as possible to benefit from this programme and discussions are in place,” said Dr Mala, noting, however, that a timeline for such an expansion had not yet been set.

Mr Chong has since recovered from the fracture, and said the interventions have helped him become stronger, in addition to addressing his osteoporosis. “I can now carry up to 5kg,” he said.