Journal of Bone and Mineral Metabolism

, Volume 30, Issue 6, pp 692–699

Smoking is a predictor of worse trabecular mechanical performance in hip fragility fracture patients

  • Ana Maria Rodrigues
  • Joana Caetano-Lopes
  • Ana Catarina Vale
  • Inês Aleixo
  • Ana Sofia Pena
  • Alexandra Faustino
  • Alexandre Sepriano
  • Joaquim Polido-Pereira
  • Elsa Vieira-Sousa
  • Raquel Lucas
  • José Carlos Romeu
  • Jacinto Monteiro
  • Maria Fátima Vaz
  • João Eurico Fonseca
  • Helena Canhão
Original Article

DOI: 10.1007/s00774-012-0370-4

Cite this article as:
Rodrigues, A.M., Caetano-Lopes, J., Vale, A.C. et al. J Bone Miner Metab (2012) 30: 692. doi:10.1007/s00774-012-0370-4

Abstract

Clinical risk factors (CRFs) are established predictors of fracture events. However, the influence of individual CRFs on trabecular mechanical fragility is still a subject of debate. In this study, we aimed to assess differences, adjusted for CRFs, between bone macrostructural parameters measured in ex-vivo specimens from hip fragility fracture patients and osteoarthritis patients, and to determine whether individual CRFs could predict trabecular bone mechanical behavior in hip fragility fractures. Additionally, we also looked for associations between the 10-year risk of major and hip fracture calculated by FRAX and trabecular bone mechanical performance. In this case–control study, a group of fragility fracture patients were compared with a group of osteoarthritis patients, both having undergone hip replacement surgery. A clinical protocol was applied in order to collect CRFs [body mass index (BMI), prior fragility fracture, parental history of hip fracture, long-term use of oral glucocorticoids, rheumatoid arthritis, current smoking, alcohol consumption, age and gender]. The 10-year probability of fracture was calculated. Serum bone turnover markers were determined and dual X-ray absorptiometry performed. Femoral head diameter was evaluated and trabecular bone cylinders were drilled for mechanical testing to determine bone strength, stiffness and toughness. We evaluated 40 hip fragility fracture and 52 osteoarthritis patients. Trabecular bone stiffness was significantly lower (p = 0.042) in hip fragility fracture patients when compared to osteoarthritic individuals, adjusted for age, gender and BMI. No other macrostructural parameter was statistically different between the groups. In hip fragility fracture patients, smoking habits (β = −0.403; p = 0.018) and female gender (β = −0.416; p = 0.008) were independently associated with lower stiffness. In addition, smoking was also independently associated with worse trabecular strength (β = −0.323; p = 0.045), and toughness (β = −0.403; p = 0.018). In these patients, the 10-year risk of major (r = −0.550; p = 0.012) and hip fracture (r = −0.513; p = 0.021) calculated using only CRFs was strongly correlated with femoral neck bone mineral density but not with mechanical performance. Our data showed that among fragility fracture patients active smoking is a predictor of worse intrinsic trabecular mechanical performance, and female gender is also independently associated with lower stiffness. In this population, the 10-year risk of fracture using CRFs with different weights only reflects bone mass loss but not trabecular mechanical properties.

Keywords

OsteoporosisFracture riskFRAXMechanical properties

Copyright information

© The Japanese Society for Bone and Mineral Research and Springer 2012

Authors and Affiliations

  • Ana Maria Rodrigues
    • 1
    • 2
  • Joana Caetano-Lopes
    • 1
  • Ana Catarina Vale
    • 3
  • Inês Aleixo
    • 1
  • Ana Sofia Pena
    • 1
  • Alexandra Faustino
    • 1
  • Alexandre Sepriano
    • 1
  • Joaquim Polido-Pereira
    • 1
    • 2
  • Elsa Vieira-Sousa
    • 1
    • 2
  • Raquel Lucas
    • 5
    • 6
  • José Carlos Romeu
    • 2
  • Jacinto Monteiro
    • 4
  • Maria Fátima Vaz
    • 3
  • João Eurico Fonseca
    • 1
    • 2
  • Helena Canhão
    • 1
    • 2
  1. 1.Rheumatology Research UnitInstituto de Medicina Molecular, Faculdade de Medicina da Universidade de LisboaLisbonPortugal
  2. 2.Rheumatology and Bone Metabolic Diseases DepartmentHospital de Santa MariaLisbonPortugal
  3. 3.Department of Mechanical EngineeringInstituto Superior TécnicoLisbonPortugal
  4. 4.Ortopaedics DepartmentHospital de Santa MariaLisbonPortugal
  5. 5.Department of Hygiene and EpidemiologyUniversity of Porto Medical SchoolPortoPortugal
  6. 6.Institute of Public Health of University of PortoPortoPortugal