Mortality Following Distal Radius Fractures in Older Adults

Background: Distal radius fractures (DRFs) are the most common fragility fractures in adults aged ≥ 50 years and are closely linked to osteoporosis and age-related frailty. Although traditionally regarded as low-risk injuries, emerging evidence suggests they may reflect systemic vulnerability and be associated with long-term mortality risk. The objective of this study was to estimate pooled 1-year and 5-year mortality rates following DRFs and to describe demographic and clinical factors associated with increased mortality.

Methods: A systematic review and pooled analysis were performed in accordance with PRISMA guidelines. PubMed, Scopus, the Cochrane Library, CINAHL and Web of Science were searched from inception to June 2025 for observational studies reporting 1-year or 5-year mortality after DRFs in adults aged ≥ 50 years, published in English. Random-effects modelling was used to generate pooled estimates. Heterogeneity was quantified using the I² statistic and publication bias was examined using funnel plots and Egger’s regression test.

Results: Nine studies (n = 418,221) contributed to the pooled 1-year mortality estimate of 3% (95% CI: 2%–4%; I² = 99%). Eight studies (n = 393,844) contributed to the pooled 5-year estimate of 10% (95% CI: 4%–23%; I² = 100%). Mortality was higher in men despite lower fracture incidence. Older age, osteoporosis and greater comorbidity burden were associated with increased mortality risk. Egger’s tests were non-significant for the 1-year (p = 0.4741) and 5-year (p = 0.5013) analyses, although the small number of studies limits the ability to exclude publication bias.

Conclusions: DRFs in older adults were associated with an increased mortality risk, particularly amongst men, older patients and those with multiple comorbidities. These findings support treating DRFs as entry points into fragility-fracture care pathways. Findings are derived from pooled observational data and should be interpreted accordingly.

Level of Evidence: Level III (Therapeutic)