X-ray verified fractures are associated with finite element analysis derived bone strength and trabecular microstructure in young adult men
R Rudäng M.D.1,2, A Darelid M.D.1,2, M Nilsson PhD1,2, D Mellström M.D., PhD1,2, C Ohlsson M.D., PhD2, M Lorentzon M.D., PhD.1,2,*
DOI: 10.1002/jbmr.1974
Copyright © 2013 American Society for Bone and Mineral Research
Keywords:
Population Studies<EPIDEMIOLOGY;Bone densitometry<QUANTITATION;Clinical/Pediatrics<GROWTH AND DEVELOPMENT
Abstract
It has been suggested that fracture during childhood could be a predictor of low peak bone mass, and thereby a potential risk factor for osteoporosis and fragility fractures later in life. The aim of this cross-sectional, population-based study was to investigate whether prevalent fractures, occurring from birth to young adulthood, were related to HR-pQCT derived trabecular and cortical microstructure, and bone strength estimated by finite element (FEA) analysis of the radius and tibia, in 833 young adult men around the time of peak bone mass (23–25 yrs). In total, 292 subjects with prevalent X-ray verified fractures were found. Men with prevalent fractures had lower trabecular bone volume fraction (BV/TV) at the radius (5.5%, p<0.001) and tibia (3.7%, p<0.001), as well as lower cortical thickness (5.1%, p<0.01) and cortical cross-sectional area (4.1%, p<0.01) at the tibia. No significant differences were seen for the cortical porosity or mean pore diameter. Using a logistic regression model (including age, smoking, physical activity, calcium intake, height and weight as covariates), every SD decrease of FEA estimated failure load was associated with an increased prevalence of fractures at both the radius (OR 1.22 (1.03–1.45)) and tibia (OR 1.32 (1.11–1.56)). Including DXA derived radius areal bone mineral density (aBMD), cortical thickness and trabecular BV/TV simultaneously in a logistic regression model (with age, smoking, physical activity, calcium intake, height and weight as covariates), BV/TV was inversely and independently associated with prevalent fractures (OR 1.28 (1.04–1.59)), whereas aBMD and cortical thickness were not (OR 1.19 (0.92–1.55) and OR 0.91 (0.73–1.12), respectively). In conclusion, prevalent fractures in young adult men were associated with impaired trabecular BV/TV at the radius, independently of aBMD and cortical thickness, indicating that primarily trabecular bone deficits are of greatest importance for prevalent fracture in this population.
R Rudäng M.D.1,2, A Darelid M.D.1,2, M Nilsson PhD1,2, D Mellström M.D., PhD1,2, C Ohlsson M.D., PhD2, M Lorentzon M.D., PhD.1,2,*
DOI: 10.1002/jbmr.1974
Copyright © 2013 American Society for Bone and Mineral Research
Keywords:
Population Studies<EPIDEMIOLOGY;Bone densitometry<QUANTITATION;Clinical/Pediatrics<GROWTH AND DEVELOPMENT
Abstract
It has been suggested that fracture during childhood could be a predictor of low peak bone mass, and thereby a potential risk factor for osteoporosis and fragility fractures later in life. The aim of this cross-sectional, population-based study was to investigate whether prevalent fractures, occurring from birth to young adulthood, were related to HR-pQCT derived trabecular and cortical microstructure, and bone strength estimated by finite element (FEA) analysis of the radius and tibia, in 833 young adult men around the time of peak bone mass (23–25 yrs). In total, 292 subjects with prevalent X-ray verified fractures were found. Men with prevalent fractures had lower trabecular bone volume fraction (BV/TV) at the radius (5.5%, p<0.001) and tibia (3.7%, p<0.001), as well as lower cortical thickness (5.1%, p<0.01) and cortical cross-sectional area (4.1%, p<0.01) at the tibia. No significant differences were seen for the cortical porosity or mean pore diameter. Using a logistic regression model (including age, smoking, physical activity, calcium intake, height and weight as covariates), every SD decrease of FEA estimated failure load was associated with an increased prevalence of fractures at both the radius (OR 1.22 (1.03–1.45)) and tibia (OR 1.32 (1.11–1.56)). Including DXA derived radius areal bone mineral density (aBMD), cortical thickness and trabecular BV/TV simultaneously in a logistic regression model (with age, smoking, physical activity, calcium intake, height and weight as covariates), BV/TV was inversely and independently associated with prevalent fractures (OR 1.28 (1.04–1.59)), whereas aBMD and cortical thickness were not (OR 1.19 (0.92–1.55) and OR 0.91 (0.73–1.12), respectively). In conclusion, prevalent fractures in young adult men were associated with impaired trabecular BV/TV at the radius, independently of aBMD and cortical thickness, indicating that primarily trabecular bone deficits are of greatest importance for prevalent fracture in this population.
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