Age-related changes in proximal humerus bone health in healthy, white males

Roosa, Sara M. Mantila; Hurd, Andrea L.; Xu, Hao; Fuchs, Robyn K.; Warden, Stuart J.

doi:10.1007/s00198-012-1893-1

Cited by 30 publications

(26 citation statements)

References 36 publications

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“…There is general consensus that bones expand with age (14,15). Periosteal expansion appeared to occur with age in the current study, with total area in the throwing and nonthrowing arms predicted using linear regression (29) as increasing by 0.72 mm 2 /y and 0.92 mm 2 /y, respectively. The slower rate of expansion in the throwing arm explains why not all of the benefit in total area/size benefit derived from physical activity during youth persisted throughout life; however, the progressive expansion in the throwing arm with advancing age raises a question regarding its stimulus.…”

Section: Discussionsupporting

confidence: 53%

Physical activity when young provides lifelong benefits to cortical bone size and strength in men

Warden

Roosa

Kersh

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

204

157

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The skeleton shows greatest plasticity to physical activity-related mechanical loads during youth but is more at risk for failure during aging. Do the skeletal benefits of physical activity during youth persist with aging? To address this question, we used a uniquely controlled cross-sectional study design in which we compared the throwing-to-nonthrowing arm differences in humeral diaphysis bone properties in professional baseball players at different stages of their careers (n = 103) with dominant-to-nondominant arm differences in controls (n = 94). Throwing-related physical activity introduced extreme loading to the humeral diaphysis and nearly doubled its strength. Once throwing activities ceased, the cortical bone mass, area, and thickness benefits of physical activity during youth were gradually lost because of greater medullary expansion and cortical trabecularization. However, half of the bone size (total cross-sectional area) and one-third of the bone strength (polar moment of inertia) benefits of throwing-related physical activity during youth were maintained lifelong. In players who continued throwing during aging, some cortical bone mass and more strength benefits of the physical activity during youth were maintained as a result of less medullary expansion and cortical trabecularization. These data indicate that the old adage of "use it or lose it" is not entirely applicable to the skeleton and that physical activity during youth should be encouraged for lifelong bone health, with the focus being optimization of bone size and strength rather than the current paradigm of increasing mass. The data also indicate that physical activity should be encouraged during aging to reduce skeletal structural decay.exercise | intracortical remodeling | osteoporosis | peak bone mass

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Section: Discussionsupporting

confidence: 53%

Physical activity when young provides lifelong benefits to cortical bone size and strength in men

Warden

Roosa

Kersh

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

204

157

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“…Furthermore, both radiographic measurements correlated moderately to patient age. Mantila Roosa et al [15] described the osseous changes of the humeral shaft with age. They stated that the outer cortical diameter grows owing to periosteal bone apposition but the inner diameter grows even faster.…”

Section: Discussionmentioning

confidence: 99%

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Spross

Kaestle

Benninger

et al. 2015

Clinical Orthopaedics &Amp; Related Research

102

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Background Osteoporosis may complicate surgical fixation and healing of proximal humerus fractures and should be assessed preoperatively. Peripheral quantitative CT (pQCT) and the Tingart measurement are helpful methods, but both have limitations in clinical use because of limited availability (pQCT) or fracture lines crossing the area of interest (Tingart measurement). The aim of our study was to introduce and validate a simple cortical index to assess the quality of bone in proximal humerus fractures using AP radiographs. Questions/purposes We asked: (1) How do the deltoid tuberosity index and Tingart measurement correlate with each other, with patient age, and local bone mineral density (BMD) of the humeral head, measured by pQCT? (2) Which threshold values for the deltoid tuberosity index and Tingart measurement optimally discriminate poor local bone quality of the proximal humerus? (3) Are the deltoid tuberosity index and Tingart measurement clinically applicable and reproducible in patients with proximal humerus fractures? Methods The deltoid tuberosity index was measured immediately above the upper end of the deltoid tuberosity. At this position, where the outer cortical borders become parallel, the deltoid tuberosity index equals the ratio between the outer cortical and inner endosteal diameter. In the first part of our study, we retrospectively measured the deltoid tuberosity index on 31 patients (16 women, 15 men; mean age, 65 years; range, 22-83 years) who were scheduled for elective surgery other than fracture repair. Inclusion criteria were available native pQCT scans, AP shoulder radiographs taken in internal rotation, and no previous shoulder surgery. The deltoid tuberosity index and the Tingart measurement were measured on the preoperative internal rotation AP radiograph. The second part of our study was performed by reviewing 40 radiographs of patients with proximal humerus fractures (31 women, nine men; median age, 65 years; range, 22-88 years). Interrater (two surgeons) and intrarater (two readings) reliabilities, applicability, and diagnostic accuracy were assessed. Results The correlations between radiograph measurements and local BMD (pQCT) were strong for the deltoid tuberosity index (r = 0.80; 95% CI, 0.63-0.90; p \ 0.001) and moderate for the Tingart measurement (r = 0.67; 95% CI, 0.42-0.83; p \ 0.001). There was moderate correlation between patient age and the deltoid tuberosity index (r = 0.65; p \ 0.001), patient age and the Tingart measurement (r = 0.69; p \ 0.001), and patient age and pQCT (r = 0.73; p \ 0.001). The correlation between the deltoid tuberosity index and the Tingart measurement was strong (r = 0.84; p \ 0.001). We determined the cutoff value for Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Inte...

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“…This is because there is a deterioration in bone “quality” with aging that is not captured by areal BMD . The idea that simple measurements of proximal humerus morphology might more strongly predict UFL is also indirectly supported by: (1) epidemiological and laboratory studies that have considered simple measurements from radiographs of the humeral diaphysis in terms of correlating with aging, osteoporosis and/or humerus fracture risk, and (2) observations that age‐related changes in the tapered contour and reductions in the proportion (as a percentage of cross‐sectional area) of the cortical bone of fracture prone metaphyseal regions (which is not captured by DXA scans) can strongly influence the risk of fracture in these regions from a ground‐level fall . In these additional perspectives, we hypothesized that simple measurements of bone density and morphology made using standard radiographs of cadaveric proximal humeri will correlate with UFL more strongly than age.…”

mentioning

confidence: 99%

Radiographic morphometry and densitometry predict strength of cadaveric proximal humeri more reliably than age and DXA scan density

Skedros

Knight

Pitts

et al. 2015

Journal Orthopaedic Research

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Methods are needed for identifying poorer quality cadaver proximal humeri to ensure that they are not disproportionately segregated into experimental groups for fracture studies. We hypothesized that measurements made from radiographs of cadaveric proximal humeri are stronger predictors of fracture strength than chronological age or bone density values derived from dual-energy x-ray absorptiometry (DXA) scans. Thirty-three proximal humeri (range: 39-78 years) were analyzed for: (1) bone mineral density (BMD, g/cm 2 ) using DXA, (2) bulk density (g/cm 3 ) using DXA and volume displacement, (3) regional bone density in millimeters of aluminum (mmAl) using radiographs, and (4) regional mean (medialþlateral) cortical thickness and cortical index (CI) using radiographs. The bones were then fractured simulating a fall. Strongest correlations with ultimate fracture load (UFL) were: mean cortical thickness at two diaphyseal locations (r ¼ 0.71; p < 0.001), and mean mmAl in the humeral head (r ¼ 0.70; p < 0.001). Weaker correlations were found between UFL and DXA-BMD (r ¼ 0.60), bulk density (r ¼ 0.43), CI (r ¼ 0.61), and age (r ¼ À0.65) (p values <0.01). Analyses between UFL and the product of any two characteristics showed six combinations with r-values >0.80, but none included DXA-derived density, CI, or age. Radiographic morphometric and densitometric measurements from radiographs are therefore stronger predictors of UFL than age, CI, or DXA-derived density measurements. ß

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Age-related changes in proximal humerus bone health in healthy, white males

Cited by 30 publications

References 36 publications

Physical activity when young provides lifelong benefits to cortical bone size and strength in men

Physical activity when young provides lifelong benefits to cortical bone size and strength in men

Deltoid Tuberosity Index: A Simple Radiographic Tool to Assess Local Bone Quality in Proximal Humerus Fractures

Radiographic morphometry and densitometry predict strength of cadaveric proximal humeri more reliably than age and DXA scan density

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