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

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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.

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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.
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f1: 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.

Mentions: Parameters of vBMD and microarchitecture were obtained from images of the distal radius and tibia from HR-pQCT. Micro-finite element (μFE) analyses were performed on images to obtained parameters of estimated bone strength. Table 2 shows differences in vBMD, microarchitecture, and estimated bone strength between the two groups. Figure 1 shows representative images of the distal radius and tibia of one fracture women and one control. At the distal radius, fracture women had significantly lower cortical area fraction (by −15.4%), lower total vBMD (by −17.5%), fewer (lower trabecular number [Tb.N] by −20.3%) and more unevenly spaced (higher inhomogeneity by 81.4%) trabeculae, and thinner cortices (lower cortical thickness [Ct.Th] by −14.0%). Differences in trabecular and cortical vBMD, trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and cortical porosity (Ct.Po) were not significant. Whole bone stiffness and failure load were significantly lower by −12.5% and −12.7%, respectively, in fracture women.


Value of Measuring Bone Microarchitecture in Fracture Discrimination in Older Women with Recent Hip Fracture: A Case-control Study with HR-pQCT
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.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037450&req=5

f1: 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.
Mentions: Parameters of vBMD and microarchitecture were obtained from images of the distal radius and tibia from HR-pQCT. Micro-finite element (μFE) analyses were performed on images to obtained parameters of estimated bone strength. Table 2 shows differences in vBMD, microarchitecture, and estimated bone strength between the two groups. Figure 1 shows representative images of the distal radius and tibia of one fracture women and one control. At the distal radius, fracture women had significantly lower cortical area fraction (by −15.4%), lower total vBMD (by −17.5%), fewer (lower trabecular number [Tb.N] by −20.3%) and more unevenly spaced (higher inhomogeneity by 81.4%) trabeculae, and thinner cortices (lower cortical thickness [Ct.Th] by −14.0%). Differences in trabecular and cortical vBMD, trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), and cortical porosity (Ct.Po) were not significant. Whole bone stiffness and failure load were significantly lower by −12.5% and −12.7%, respectively, in fracture women.

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus