Background: The aim of this study was to describe the presence of pain sensitization (PS) and its association with baseline factors after cast removal in patients older than 60 years with distal radius fracture (DRF) treated conservatively. Methods: This cross-sectional study included 220 patients older than 60 years with extra-articular DRF who completed the Pain Sensitivity Questionnaire (PSQ). Patients with PSQ score > 7 points were considered positive for PS. In addition, sociodemographic, anthropometrics, clinical, radiological, lifestyle behaviors, pain-related psychological factors, and functional outcomes were analyzed as baseline predictors, all measured were performed 2 weeks after cast removal. Results: A total of 159 patients (72.3%) showed PS. The results showed an association between higher values of PSQ-total with the affected dominant hand (β = 1.1; P = 0.04), high energy of injury (β = 3.5; P <.001), extra-articular comminuted metaphyseal DRFs (β = 1.8; P <.001), lower values of Rapid Assessment of Physical Activity questionnaire (β = 3.1; P <.001), higher values of Pittsburgh Sleep Quality Index (β = 2.5; P <.001), higher values of Tampa Scale of Kinesiophobia (β = 1.9; P <.001), higher values of Pain Catastrophizing Scale (β = 1.8; P <.001), higher values of Disabilities of the Arm, Shoulder and Hand questionnaire (β = 1.6; P <.001), lower values of grip strength (β = 1.4; P <.001) and higher values of Visual analog scale (β = 4.2; P <.001). Conclusions: A high percentage of patients older than 60 years with extra-articular DRFs present PS at 2 weeks after cast removal. Our results may help physicians and physiotherapists identify risk and/or prognostic baseline factors for the occurrence of PS after DRF, and the need for a therapeutic approach that incorporates the clinical management of this condition in these patients.