HR-pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Meta-Analysis

Abstract

High‐resolution peripheral quantitative computed tomography (HR‐pQCT) is a noninvasive imaging modality for assessing volumetric bone mineral density (vBMD) and microarchitecture of cancellous and cortical bone. The objective was to (1) assess fracture‐associated differences in HR‐pQCT bone parameters; and (2) to determine if HR‐pQCT is sufficiently precise to reliably detect these differences in individuals. We systematically identified 40 studies that used HR‐pQCT (39/40 used XtremeCT scanners) to assess 1291 to 3253 and 3389 to 10,687 individuals with and without fractures, respectively, ranging in age from 10.9 to 84.7 years with no comorbid conditions. Parameters describing radial and tibial bone density, microarchitecture, and strength were extracted and percentage differences between fracture and control subjects were estimated using a random effects meta‐analysis. An additional meta‐analysis of short‐term in vivo reproducibility of bone parameters assessed by XtremeCT was conducted to determine whether fracture‐associated differences exceeded the least significant change (LSC) required to discern measured differences from precision error. Radial and tibial HR‐pQCT parameters, including failure load, were significantly altered in fracture subjects, with differences ranging from −2.6% (95% confidence interval [CI] −3.4 to −1.9) in radial cortical vBMD to −12.6% (95% CI −15.0 to −10.3) in radial trabecular vBMD. Fracture‐associated differences reported by prospective studies were consistent with those from retrospective studies, indicating that HR‐pQCT can predict incident fracture. Assessment of study quality, heterogeneity, and publication biases verified the validity of these findings. Finally, we demonstrated that fracture‐associated deficits in total and trabecular vBMD and certain tibial cortical parameters can be reliably discerned from HR‐pQCT‐related precision error and can be used to detect fracture‐associated differences in individual patients. Although differences in other HR‐pQCT measures, including failure load, were significantly associated with fracture, improved reproducibility is needed to ensure reliable individual cross‐sectional screening and longitudinal monitoring. In conclusion, our study supports the use of HR‐pQCT in clinical fracture prediction. © 2019 American Society for Bone and Mineral Research.

The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions

“…In older men, the presence of fragility fractures was also associated with lower Tb.N, Ct.Th, and Ct.BMD and increased Ct.Po [ 50 , 51 ] and a conversion from plates into rods [ 52 ]. In a recent systematic review and meta-analysis, radial and tibial HR-pQCT parameters, including failure load, were significantly lower, ranging from − 2.6 to − 12.6%, in subjects with a prior fracture [ 53 ].…”

Bone Geometry, Density, and Microarchitecture in the Distal Radius and Tibia in Adults With Marfan Syndrome Assessed by HR-pQCT

“…There is a paucity of data on bone microarchitecture assessed invasively or noninvasively using imaging modalities in patients with MFS. In a systematic review and meta‐analysis including 40 studies using HR‐pQCT and evaluating fracture risk, Mikolajewicz and colleagues ( 22 ) reported that total vBMD, trabecular vBMD, as well as cortical vBMD and cortical thickness were reliable predictors of fractures. Furthermore, Hansen and colleagues ( 23 ) found that trabecular number and spacing, cortical thickness, and cortical area correlates moderately to very highly with the maximum compressive strength of the hip.…”

Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT

“…( 2 ) In the past decade, application of HR‐pQCT for clinical research has grown rapidly, with a strong focus on the assessment of osteoporotic fracture risk. ( 3,4 ) This is in large part because HR‐pQCT provides additive information to dual‐energy X‐ray absorptiometry (DXA), ( 4,5 ) by including the assessment of bone microarchitecture, an important determinant in bone strength.…”