Value of Measuring Bone Microarchitecture in Fracture Discrimination in Older Women with Recent Hip Fracture: A Case-control Study with HR-pQCT

Tracy Y Zhu, Vivian W Y Hung, Wing-Hoi Cheung, Jack C Y Cheng, Ling Qin, Kwok-Sui Leung, Tracy Y Zhu, Vivian W Y Hung, Wing-Hoi Cheung, Jack C Y Cheng, Ling Qin, Kwok-Sui Leung

Abstract

We aimed to determine whether loss of volumetric bone mineral density (vBMD) and deterioration of microarchitecture imaged by high-resolution peripheral quantitative computed tomography at the distal radius/tibia provided additional information in fracture discrimination in postmenopausal women with recent hip fracture. This case-control study involved 24 postmenopausal Chinese women with unilateral femoral neck fracture (average [SD] age: 79.6[5.6]) and 24 age-matched women without any history of fracture. Each SD decrease in T-score at femoral neck (FN) was associated with a higher fracture risk (odds ratio: 6.905, p = 0.001). At the distal radius, fracture women had significantly lower total vBMD (-17.5%), fewer (-20.3%) and more unevenly spaced (81.4%) trabeculae, and thinner cortices (-14.0%) (all p < 0.05). At the distal tibia, vBMD was on average -4.7% (cortical) to -25.4% (total) lower, trabecular microarchitecture was on average -19.8% (number) to 102% (inhomogeneity) inferior, cortices were thinner (-21.1%) and more porous (18.2%) (all p < 0.05). Adding parameters of vBMD and microarchitecture in multivariate models did not offer additional discriminative capacity of fracture status compared with using T-score at FN. In old postmenopausal women with already excessive loss of bone mass, measuring bone microarchitecture may provide limited added value to improve identification of risk of femoral neck fracture.

Figures

Figure 1. Representative 3D images of the…
Figure 1. Representative 3D images of the distal radius and tibia of a femoral neck fracture women and a control.
Disruption of the trabecular network is particularly noticeable in the fracture women.

References

    1. Cummings S. R. & Melton L. J. Epidemiology and outcomes of osteoporotic fractures. Lancet 359, 1761–1767 (2002).
    1. Center J. R., Nguyen T. V., Schneider D., Sambrook P. N. & Eisman J. A. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353, 878–882 (1999).
    1. Gullberg B., Johnell O. & Kanis J. A. World-wide projections for hip fracture. Osteoporos. Int. 7, 407–413 (1997).
    1. Schuit S. C. et al.. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34, 195–202 (2004).
    1. Sanders K. M. et al.. Half the burden of fragility fractures in the community occur in women without osteoporosis. When is fracture prevention cost-effective? Bone 38, 694–700 (2006).
    1. Marshall D., Johnell O. & Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312, 1254–1259 (1996).
    1. Boutroy S., Bouxsein M. L., Munoz F. & Delmas P. D. In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J. Clin. Endocrinol. Metab. 90, 6508–6515 (2005).
    1. Sornay-Rendu E., Boutroy S., Munoz F. & Delmas P. D. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J. Bone Miner. Res. 22, 425–433 (2007).
    1. Stein E. M. et al.. Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J. Bone Miner. Res. 25, 2572–2581 (2010).
    1. Melton L. J. 3rd et al.. Assessing forearm fracture risk in postmenopausal women. Osteoporos. Int. 21, 1161–1169 (2010).
    1. Bala Y. et al.. Cortical porosity identifies women with osteopenia at increased risk for forearm fractures. J. Bone Miner. Res. 29, 1356–1362 (2014).
    1. Sornay-Rendu E., Cabrera-Bravo J. L., Boutroy S., Munoz F. & Delmas P. D. Severity of vertebral fractures is associated with alterations of cortical architecture in postmenopausal women. J. Bone Miner. Res. 24, 737–743 (2009).
    1. Szulc P. et al.. Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: the STRAMBO study. J. Bone Miner. Res. 26, 1358–1367 (2011).
    1. Sundh D. et al.. Increased Cortical Porosity in Older Men With Fracture. J. Bone Miner. Res. 30, 1692–1700 (2015).
    1. Boutroy S. et al.. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J. Bone Miner. Res. 23, 392–399 (2008).
    1. Melton L. J. 3rd et al.. Relation of vertebral deformities to bone density, structure, and strength. J. Bone Miner. Res. 25, 1922–1930 (2010).
    1. Cohen A. et al.. Bone microarchitecture and stiffness in premenopausal women with idiopathic osteoporosis. J. Clin. Endocrinol. Metab. 94, 4351–4360 (2009).
    1. Vilayphiou N. et al.. Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in men. J. Bone Miner. Res. 26, 965–973 (2011).
    1. Rozental T. D. et al.. Premenopausal women with a distal radial fracture have deteriorated trabecular bone density and morphology compared with controls without a fracture. J. Bone Joint Surg. Am. 95, 633–642 (2013).
    1. Vico L. et al.. High-resolution pQCT analysis at the distal radius and tibia discriminates patients with recent wrist and femoral neck fractures. J. Bone Miner. Res. 23, 1741–1750 (2008).
    1. Vilayphiou N. et al.. Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in postmenopausal women. Bone 46, 1030–1037 (2010).
    1. Johnell O. et al.. Predictive value of BMD for hip and other fractures. J. Bone Miner. Res. 20, 1185–1194 (2005).
    1. Liu X. S. et al.. Bone density, geometry, microstructure, and stiffness: Relationships between peripheral and central skeletal sites assessed by DXA, HR-pQCT, and cQCT in premenopausal women. J. Bone Miner. Res. 25, 2229–2238 (2010).
    1. Seeman E. Structural basis of growth-related gain and age-related loss of bone strength. Rheumatology (Oxford). 47 Suppl 4, iv2–8 (2008).
    1. Metcalfe D. The pathophysiology of osteoporotic hip fracture. McGill journal of medicine: MJM: an international forum for the advancement of medical sciences by students 11, 51–57 (2008).
    1. Parkkari J. et al.. Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif. Tissue Int. 65, 183–187 (1999).
    1. Hayes W. C. et al.. Impact near the hip dominates fracture risk in elderly nursing home residents who fall. Calcif. Tissue Int. 52, 192–198 (1993).
    1. Ivers R. Q., Norton R., Cumming R. G., Butler M. & Campbell A. J. Visual impairment and risk of hip fracture. Am. J. Epidemiol. 152, 633–639 (2000).
    1. Gruber-Baldini A. L. et al.. Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up. J. Am. Geriatr. Soc. 51, 1227–1236 (2003).
    1. Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. International journal of general medicine 3, 1–17 (2010).
    1. Mile S. & Shevlin M. Applying regression and correlation: a guide for students and researchers. (SAGE Publications Ltd., 2001).
    1. Uebelhart D. et al.. Modifications of bone and connective tissue after orthostatic bedrest. Osteoporos. Int. 11, 59–67 (2000).
    1. Qin L. et al.. Age-related vessel calcification at distal extremities is a risk factor of osteoporosis. Journal of Orthopaedic Translation 2, 43–48 (2014).
    1. Lynn H. S., Lau E. M., Au B. & Leung P. C. Bone mineral density reference norms for Hong Kong Chinese. Osteoporos. Int. 16, 1663–1668 (2005).
    1. Buie H. R., Campbell G. M., Klinck R. J., MacNeil J. A. & Boyd S. K. Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone 41, 505–515 (2007).
    1. Burghardt A. J., Buie H. R., Laib A., Majumdar S. & Boyd S. K. Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone 47, 519–528 (2010).
    1. van Rietbergen B., Weinans H., Huiskes R. & Odgaard A. A new method to determine trabecular bone elastic properties and loading using micromechanical finite-element models. J. Biomech. 28, 69–81 (1995).
    1. Pistoia W. et al.. Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone 30, 842–848 (2002).

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する