Bone turnover markers are associated with higher cortical porosity, thinner cortices, and larger size of the proximal femur and non-vertebral fractures

Shigdel, Rajesh; Osima, Marit; Ahmed, Luai A.; Joakimsen, Ragnar Martin; Eriksen, Erik Fink; Zebaze, Roger; Bjørnerem, Åshild

doi:10.1016/j.bone.2015.06.016

Cited by 54 publications

(84 citation statements)

References 41 publications

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“…As increasing bone size increases crosssectional moment of inertia (CSMI) and resistance to bending, 32 the increased odds for fracture with increasing bone turnover suggests that the positive effect of larger bone size on bone strength does not offset the negative impact of higher porosity and thinning of cortices produced by increased bone remodeling. 24,31,[33][34][35] This first evidence of association of in vivo measurements of proximal femur cortical porosity from clinical CT images with bone remodeling activity as reflected by PINP and CTX 31 confirm a previously reported association between distal tibia cortical porosity with PINP and CTX. 36 Cortical bone loss is the result of unbalanced and accelerated intracortical remodeling on the surfaces formed by the many canals traversing cortical bone.…”

Section: Bone Turnover Markers Cortical Porosity and Fracturesupporting

confidence: 86%

“…8 Higher levels of PINP and CTX are associated with larger total cross-sectional area (CSA) of the femoral subtrochanter. 31,35 In adolescents, increasing CTX is associated with larger mid-tibial bone size, and is suggested to persist into later life. 40 The reason for this may be that genetic factors account for most of the variance in BTM and bone size.…”

Section: Bone Turnover Markers Cortical Porosity and Fracturementioning

confidence: 99%

“…[43][44][45][46] Still, there have been uncertainties over the use of BTM in routine clinical practice to assess fracture risk because of inter-and intra-individual variability. 47,48 Although a recent study suggested that BTM also reflect cortical bone architecture in addition to fracture risk, 31 further studies are needed to evaluate the independent role of BTM in fracture risk prediction. Higher cortical porosity and thinner cortices were independently associated with increased odds for fracture (odds ratio 1.71; 95% confidence interval (CI) 1.38-2.11 and 1.79; 95% CI 1.44-2.23, respectively, both Po0.05) after adjustment for age, height and weight using logistic regression analysis.…”

Section: Bone Turnover Markers Cortical Porosity and Fracturementioning

confidence: 99%

“…26 Another limitation is that finite element analysis is not performed for calculation of strength estimates, 50 and the trauma involved is not accounted for in the statistical analysis of the data in the clinical studies of in vivo measurements of cortical porosity that are presented here. 26,31,35 Although femoral neck aBMD and cortical porosity at the femoral subtrochanter are inversely correlated (r ¼ À 0.37, Po0.01), 27,51 both of these bone traits are statistically independently associated with fracture risk (both Po0.01). 26 The clinical implications of these results are that these two bone traits capture some shared elements of bone strength as well as independent elements that are associated with fracture risk.…”

Section: Associations Of Cortical Porosity and Other Bone Architecturmentioning

confidence: 99%

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The clinical contribution of cortical porosity to fragility fractures

Bjørnerem

2016

BoneKEy Reports

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Cortical bone is not compact; rather it is penetrated by many Haversian and Volkmann canals for blood supply. The lining of these canals are the intracortical bone surfaces available for bone remodeling. Increasing intracortical bone remodeling increases cortical porosity. However, cortical bone loss occurs more slowly than trabecular loss due to the fact that less surface per unit of bone matrix volume is available for bone remodeling. Nevertheless, most of the bone loss over time is cortical because cortical bone constitutes 80% of the skeleton, and the relative proportion of trabecular bone diminishes with advancing age. Higher serum levels of bone turnover markers are associated with higher cortical porosity of the distal tibia and the proximal femur. Greater porosity of the distal radius is associated with higher odds for forearm fracture, and greater porosity of the proximal femur is associated with higher odds for non-vertebral fracture in postmenopausal women. Measurement of cortical porosity contributes to fracture risk independent of areal bone mineral density and Fracture Risk Assessment Tool. On the other hand, antiresorptive treatment reduces porosity at the distal radius and at the proximal femoral shaft. Thus, porosity is a substantial determinant of the bone fragility that underlies the risk of fractures and may be a target for fracture prevention.

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Section: Bone Turnover Markers Cortical Porosity and Fracturesupporting

confidence: 86%

Section: Bone Turnover Markers Cortical Porosity and Fracturementioning

confidence: 99%

Section: Bone Turnover Markers Cortical Porosity and Fracturementioning

confidence: 99%

Section: Associations Of Cortical Porosity and Other Bone Architecturmentioning

confidence: 99%

See 2 more Smart Citations

The clinical contribution of cortical porosity to fragility fractures

Bjørnerem

2016

BoneKEy Reports

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“…Increased cortical porosity of distal radius or distal tibia has been invoked as one possible factor [11][12][13]. However, it is hard to explain how individuals with T2DM can exhibit high porosity [14][15][16][17], since increased cortical porosity reflects increased bone turnover from intracortical surfaces lining the Haversian canals and the endocortical surfaces adjacent to the marrow cavity [18,19]. As T2DM is a condition with low bone turnover [20,21], patients with T2DM would rather be expected to exhibit reduced cortical porosity.…”

Section: Introductionmentioning

confidence: 99%

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Osima

Kral

Borgen

et al. 2017

Bone

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Increased cortical porosity has been suggested as a possible factor increasing fracture propensity in patients with type 2 diabetes mellitus (T2DM). This is a paradox because cortical porosity is generally associated with high bone turnover, while bone turnover is reduced in patients with T2DM. We therefore wanted to test the hypothesis that women with T2DM have lower bone turnover markers (BTM) and lower cortical porosity than those without diabetes, and that higher serum glucose and body mass index (BMI) are associated with lower BTM, and with lower cortical porosity. Increasing glucose and BMI were associated with lower bone turnover suggesting that reduced intracortical and endocortical remodeling leads to reduced porosity and thicker cortices. Using low-resolution clinical CT, cortical porosity was lower in women with T2DM compared to 3 women without diabetes. This indicates that other changes in bone qualities, not increased cortical porosity, are likely to explain the increased fracture propensity in patients with T2DM.

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Quantification and comparison of the regional acceleratory phenomenon in bone following piezosurgery or bur osteotomy: A pilot study in rats

Battista

Kernitsky

Exarchos

et al. 2022

Clinical & Exp Dental Res

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Background/Objective: The Regional Acceleratory Phenomenon (RAP) can be induced surgically via decortication (selective cortical penetrations) of bone to accelerate orthodontic tooth movement. Few studies have compared the impact and efficiency of different decortication methods to induce the RAP. The aim of this study was to determine if there is a significant difference in the intensity of the RAP induced by a surgical defect created either using a piezoelectric knife or a rotary bur.Methods: Twenty-two Sprague-Dawley rats were divided into two treatment groups (each n = 8) and a control group (n = 6). The treatment groups were subjected to transcortical penetrations (TP) of the right tibia using either a piezoelectric knife (PTP) or a rotary bur (BTP). The right tibias of the control group animals had reflection of tissues (SHAM) and the left legs were kept for comparison (INTACT).The animals were killed at 7 and 14 days after the operation in an equally distributed manner. Microcomputed tomography images were obtained and analyzed utilizing artificial intelligence for bone cortical porosity (Ct.Po) locally and regionally.Results/Conclusion: Regionally, TP using a PTP induced significantly (p < .05, Kruskal-Wallis test) more Ct.Po than BTP or INTACT for both the 7-and 14-day time points. PTP was not found to induce significantly more Ct.Po than SHAM at any time point. However, PTP induced significantly more Ct.Po than the INTACT group for each time point, while SHAM did not. The local analysis did not reveal any relevant significant differences between groups.

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Bone turnover markers are associated with higher cortical porosity, thinner cortices, and larger size of the proximal femur and non-vertebral fractures

Cited by 54 publications

References 41 publications

The clinical contribution of cortical porosity to fragility fractures

The clinical contribution of cortical porosity to fragility fractures

Women with type 2 diabetes mellitus have lower cortical porosity of the proximal femoral shaft using low-resolution CT than nondiabetic women, and increasing glucose is associated with reduced cortical porosity

Quantification and comparison of the regional acceleratory phenomenon in bone following piezosurgery or bur osteotomy: A pilot study in rats

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