Hand fragility fractures as a missed opportunity for secondary prevention: A retrospective cohort study and…

Cohort studyInjury· Jun 2026

Hand fragility fractures as a missed opportunity for secondary prevention: A retrospective cohort study and assessment of the Second Metacarpal Cortical Index.

Chiraag Thakrar Karia, Tabitha Champion, Lydia Dawes, Grainne Bourke

Emergency Department FlowCohort studyQ1IF 2.3

Only 8% of high-risk hand fracture patients received bone density scanning

Hand fragility fractures as a missed opportunity for secondary prevention: A retrospective cohort study and assessment of the Second Metacarpal Cortical Index.

Chiraag Thakrar Karia … Grainne Bourke

Injury · Jun 2026 · Q1 in Emergency Medicine

Background

Hand fragility fractures are often excluded from routine osteoporosis screening, yet they may represent a sentinel event for future morbidity.

Purpose

This study aimed to assess the fracture risk profile of older adults presenting with hand fragility fractures, quantify the 'treatment gap' in current practice, and evaluate the utility of the Second Metacarpal Cortical Index (2MCI) as a pragmatic triage tool.

Methods

Aged ≥50 presenting with low-energy hand fractures were included.

n = 134 patients

Results

most high-risk hand fracture patients never got bone density scanning

88%

Intermediate/high/very

8%

Underwent DEXA scan

More results

FRAX scoring classified 88% as intermediate, high or very high risk.

Of those scanned, 64% had osteopenia or osteoporosis.

2MCI demonstrated excellent inter-rater reliability (ICC=0.81) and strong correlation with hip T-scores (r = 0.64).

More results

A 2MCI threshold of <45% yielded 100% specificity for detecting low bone mass, though sensitivity was limited.

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Conclusion · 1 of 2

Patients with hand fragility fractures represent a high-risk cohort that is currently underserved by osteoporosis screening pathways.

Conclusion · 2 of 2

While 2MCI shows promise as an adjunctive triage tool, the primary finding is a significant missed opportunity for secondary prevention. Hand surgeons should routinely consider fracture risk assessment in this population.