Fracture Repair in the Distal Radius in Postmenopausal Women: A Follow-Up 2 Years Postfracture Using HRpQCT

Abstract

Fracture healing is characterized by an intense increase in modeling and remodeling of bone, which allows removal of the cast after a stable distal radius fracture within 3 to 5 weeks. However, at that time, bone strength has not recovered yet. We studied the changes in bone mineral density (BMD), microarchitecture, and bone stiffness after a distal radius fracture during a 2-year follow-up in comparison to the contralateral side and the association between the 2-year stiffness and baseline BMD, microarchitecture, and early changes in these parameters. The fractured side of 14 postmenopausal women (mean age 64 AE 8 years) with a conservatively treated distal radius fracture was scanned by high-resolution peripheral quantitative computed tomography (HRpQCT) at 1 to 2, 3 to 4, 6 to 8, and 12 weeks and 2 years postfracture. The same region contralaterally was scanned as well at the 2-year visit. BMD, microarchitecture, and stiffness parameters were determined and the fracture side was compared with the contralateral side using a linear mixed-effect model. Spearman's correlation was used to correlate the 2-year bone stiffness with baseline BMD, microarchitecture, and early 3-month changes in these parameters. Two years postfracture, cortical and trabecular thickness and torsional and bending stiffness were significantly higher at the fractured side compared with the nonfractured side (21%, 55%, 31%, and 29%, respectively, p < 0.05), whereas BMD was similar. Two-year torsional and bending stiffness correlated significantly with baseline BMD and cortical perimeter (|rho| ! 0.63, p < 0.016) but not with early changes in bone parameters. Using HRpQCT, this study illustrates that fracture healing is not completed by the time the cast is removed. We showed that from 6 weeks to 2 years postfracture, large changes occur in BMD, microarchitecture, and biomechanical parameters at the fractured side, which were fully recovered after 2 years in comparison to the nonfractured contralateral side. Interestingly, higher 2-year torsional and bending stiffness were associated with lower BMD and higher cortical perimeter at baseline.

Critical issues and current challenges in osteoporosis and fracture prevention. An overview of unmet needs

“…Recently, HR-pQCT imaging made it possible to monitor the healing process of fractures by a non-invasive manner, as this technique identified differences in cortices and trabeculae during a follow up period of 2 years in the fractured and nonfractured site, whereas BMD was similar at both sites. 85 Moreover, a recent collaboration between different bone specialists showed that HR-pQCT imaging is a promising tool to define erosions in RA patients instead of using plane X-rays. 86 Another interesting observation is that HR-pQCT can measure changes in microarchitecture during treatment for a disease.…”

Resveratrol promotes osteoblastic differentiation in a rat model of postmenopausal osteoporosis by regulating autophagy

“…Additionally, the osteoporosis was significantly reversed when the rats were fed the autophagy agonist rapamycin [18]. In a human study, the gene chip investigation from 984 volunteers showed that the autophagy-related gene (ATG) was the only statistically significant indicator associated with BMD in the distal radius [19]. These results all suggested that the autophagy signaling pathway played an important function in the pathogenesis of osteoporosis.…”

Distal radius plate of CFR-PEEK has minimal effect compared to titanium plates on bone parameters in high-resolution peripheral quantitative computed tomography: a pilot study

“…Recently, it has been shown that the repair process of stable distal radius fractures can be monitored longitudinally in vivo using high-resolution peripheral computed tomography (HRpQCT) [ 6 , 7 ]. For clinical and research purposes, it would be of great interest to monitor the repair process of unstable fractures or the ingrowth of bone graft or bone graft substitutes after corrective osteotomy as well.…”