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Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC) : A prospective study
Samelson, Elizabeth J. Broe, Kerry E. Xu, Hanfei Yang, Laiji Boyd, Steven Biver, Emmanuel Szulc, Pawel Adachi, Jonathan Amin, Shreyasee Atkinson, Elizabeth
Samelson, Elizabeth J.
Broe, Kerry E.
Xu, Hanfei
Yang, Laiji
Boyd, Steven
Biver, Emmanuel
Szulc, Pawel
Adachi, Jonathan
Amin, Shreyasee
Atkinson, Elizabeth
Author
Samelson, Elizabeth J.
Broe, Kerry E.
Xu, Hanfei
Yang, Laiji
Boyd, Steven
Biver, Emmanuel
Szulc, Pawel
Adachi, Jonathan
Amin, Shreyasee
Atkinson, Elizabeth
Berger, Claudie
Burt, Lauren
Chapurlat, Roland
Chevalley, Thierry
Ferrari, Serge
Goltzman, David
Hanley, David A.
Hannan, Marian T.
Khosla, Sundeep
Liu, Ching-Ti
Lorentzon, Mattias
Mellstrom, Dan
Merle, Blandine
Nethander, Maria
Rizzoli, René
Sornay-Rendu, Elisabeth
Van Rietbergen, Bert
Sundh, Daniel
Wong, Andy Kin On
Ohlsson, Claes
Demissie, Serkalem
Kiel, Douglas P.
Bouxsein, Mary L.
Broe, Kerry E.
Xu, Hanfei
Yang, Laiji
Boyd, Steven
Biver, Emmanuel
Szulc, Pawel
Adachi, Jonathan
Amin, Shreyasee
Atkinson, Elizabeth
Berger, Claudie
Burt, Lauren
Chapurlat, Roland
Chevalley, Thierry
Ferrari, Serge
Goltzman, David
Hanley, David A.
Hannan, Marian T.
Khosla, Sundeep
Liu, Ching-Ti
Lorentzon, Mattias
Mellstrom, Dan
Merle, Blandine
Nethander, Maria
Rizzoli, René
Sornay-Rendu, Elisabeth
Van Rietbergen, Bert
Sundh, Daniel
Wong, Andy Kin On
Ohlsson, Claes
Demissie, Serkalem
Kiel, Douglas P.
Bouxsein, Mary L.
Abstract
Background
Although areal bone mineral density (aBMD) assessed by dual-energy x-ray absorptiometry (DXA) is the clinical standard for determining fracture risk, most older adults who sustain a fracture have T scores greater than −2·5 and thus do not meet the clinical criteria for osteoporosis. Importantly, bone fragility is due to low BMD and deterioration in bone structure. We assessed whether indices of high-resolution peripheral quantitative CT (HR-pQCT) were associated with fracture risk independently of femoral neck aBMD and the Fracture Risk Assessment Tool (FRAX) score.
Methods
We assessed participants in eight cohorts from the USA (Framingham, Mayo Clinic), France (QUALYOR, STRAMBO, OFELY), Switzerland (GERICO), Canada (CaMos), and Sweden (MrOS). We used Cox proportional hazard ratios (HRs) to estimate the association between HR-pQCT bone indices (per 1 SD of deficit) and incident fracture, adjusting for age, sex, height, weight, and cohort, and then additionally for femoral neck DXA aBMD or FRAX.
Findings
7254 individuals (66% women and 34% men) were assessed. Mean baseline age was 69 years (SD 9, range 40–96). Over a mean follow-up of 4·63 years (SD 2·41) years, 765 (11%) participants had incident fractures, of whom 633 (86%) had femoral neck T scores greater than −2·5. After adjustment for age, sex, cohort, height, and weight, peripheral skeleton failure load had the greatest association with risk of fracture: tibia HR 2·40 (95% CI 1·98–2·91) and radius 2·13 (1·77–2·56) per 1 SD decrease. HRs for other bone indices ranged from 1·12 (95% CI 1·03–1·23) per 1 SD increase in tibia cortical porosity to 1·58 (1·45–1·72) per 1 SD decrease in radius trabecular volumetric bone density. After further adjustment for femoral neck aBMD or FRAX score, the associations were reduced but remained significant for most bone parameters. A model including cortical volumetric bone density, trabecular number, and trabecular thickness at the distal radius and a model including these indices plus cortical area at the tibia were the best predictors of fracture.
Interpretation
HR-pQCT indices and failure load improved prediction of fracture beyond femoral neck aBMD or FRAX scores alone. Our findings from a large international cohort of men and women support previous reports that deficits in trabecular and cortical bone density and structure independently contribute to fracture risk. These measurements and morphological assessment of the peripheral skeleton might improve identification of people at the highest risk of fracture.
Funding
National Institutes of Health National Institute of Arthritis Musculoskeletal and Skin Diseases.
Keywords
Date
2019
Type
Journal article
Journal
The Lancet Diabetes & Endocrinology
Book
Volume
7
Issue
1
Page Range
34-43
Article Number
ACU Department
Mary MacKillop Institute for Health Research
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled