Microarchitecture and Peripheral BMD are Impaired in Postmenopausal White Women With Fracture Independently of Total Hip T-Score: An International Multicenter Study

Abstract

Because single-center studies have reported conflicting associations between microarchitecture and fracture prevalence, we included HR-pQCT data from 5 centers worldwide into a large multicenter analysis of postmenopausal women with and without fracture. Volumetric density (vBMD) and microarchitecture were assessed at the distal radius and tibia in 1379 Caucasian postmenopausal women (67±8 yr); 470 (34%) had at least one fracture including 349 with a major fragility fracture. Age, height, weight, and total hip T-score differed across centers and were employed as covariates in analyses. Women with fracture had higher BMI, were older, and had lower total hip T-score but lumbar spine T-score was similar between groups. At the radius, total and trabecular vBMD and cortical thickness were significantly lower in fractured women in 3 out of 5 centers, and trabecular number in 2 centers. Similar results were found at the tibia. When data from 5 centers were combined, however, women with fracture had significantly lower total, trabecular and cortical vBMD (2%–7%), lower trabecular number (4%–5%) and thinner cortices (5%–6%) than women without fracture after adjustment for covariates. Results were similar at the radius and tibia. Similar results were observed with analysis restricted to major fragility fracture, vertebral and hip fractures and peripheral fracture (at the radius). When focusing on osteopenic women, each SD decrease of total and trabecular vBMD was associated with a significantly increased risk of major fragility fracture (OR=1.55–1.88, p<0.01) after adjustment for covariates. Moreover, trabecular architecture modestly improved fracture discrimination beyond peripheral total vBMD. In conclusion, we observed differences by center in the magnitude of fracture/non fracture differences at both the distal radius and tibia. However, when data were pooled across centers and the sample size increased, we observed significant and consistent deficits in vBMD and microarchitecture independent of total hip T-score in all postmenopausal Caucasian women with fracture and in the subgroup of osteopenic women, compared to women who never had a fracture.

Prediction of Fractures in Men Using Bone Microarchitectural Parameters Assessed by High-Resolution Peripheral Quantitative Computed Tomography—The Prospective STRAMBO Study

“…Distal radius HR‐pQCT parameters were more strongly associated with the fracture risk compared with distal tibia. This is in line with some, but not all, studies. However, these results cannot be extrapolated on ours.…”

“…It may also contribute to bone strength in the meta‐ and epiphysis, eg, in fractures of proximal humerus and proximal or distal tibia. In cross‐sectional studies, both poor cortical and trabecular measures were found in subjects with fragility fractures . In some studies, the links were stronger for cortical than trabecular measures .…”

Volumetric Bone Mineral Density and Failure Load of Distal Limbs Predict Incident Clinical Fracture Independent of FRAX and Clinical Risk Factors Among Older Men

“…Again, there was no assessment as to whether these associations were independent of major individual clinical risk factors. An international multicenter cross‐sectional study in older women found that HR‐pQCT measures of the distal radius and distal tibia had similar associations with history of fragility fracture . In the current study, associations of HR‐pQCT parameters at the distal radius with fracture risk appeared to be more robust than those at the tibial sites suggesting improved fracture prediction using radial parameters.…”

“…Previous retrospective studies based on analysis of prevalent fracture cases have suggested that parameters of HR‐pQCT, including bone strength as measured by failure load, volumetric BMD, and compartment‐specific BMD, are related to clinical fracture outcomes . These studies have been primarily conducted in postmenopausal women, but a few have evaluated older men.…”

Serum Levels of a Cathepsin-K Generated Periostin Fragment Predict Incident Low-Trauma Fractures in Postmenopausal Women Independently of BMD and FRAX

“…Hence new tools are needed to evaluate bone quality in order to improve prediction of fracture risk. Ongoing studies evaluating bone microarchitecture at high resolution and derived strength estimated by finite element analysis (FEA) may be helpful; however, they are not broadly available . Another approach would be the development of new biochemical markers of bone quality …”