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Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations

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Abstract

Summary

In a cross-sectional analysis in postmenopausal women, prior ankle fractures were associated with lower areal bone mineral density (BMD) and trabecular bone alterations compared to no fracture history. Compared to women with forearm fractures, microstructure alterations were of lower magnitude. These data suggest that ankle fractures are another manifestation of bone fragility.

Introduction

Whether ankle fractures represent fragility fractures associated with low areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) and/or bone microstructure alterations remains unclear, in contrast to the well-recognised association between forearm fractures and osteoporosis. The objective of this study was to investigate aBMD, vBMD and bone microstructure in postmenopausal women with prior ankle fracture in adulthood, compared with women without prior fracture or with women with prior forearm fractures, considered as typically of osteoporotic origin.

Methods

In a cross-sectional analysis in the Geneva Retirees Cohort study, 63 women with ankle fracture and 59 with forearm fracture were compared to 433 women without fracture (mean age, 65 ± 1 years). aBMD was measured by dual-energy X-ray absorptiometry; distal radius and tibia vBMD and bone microstructure were measured by high-resolution peripheral quantitative computed tomography.

Results

Compared with women without fracture, those with ankle fractures had lower aBMD, radius vBMD (−7.9 %), trabecular density (−10.7 %), number (−7.3 %) and thickness (−4.6 %) and higher trabecular spacing (+14.5 %) (P < 0.05 for all). Tibia trabecular variables were also altered. For 1 standard deviation decrease in total hip aBMD or radius trabecular density, odds ratios for ankle fractures were 2.2 and 1.6, respectively, vs 2.2 and 2.7 for forearm fracture, respectively (P ≤ 0.001 for all). Compared to women with forearm fractures, those with ankle fractures had similar spine and hip aBMD, but microstructure alterations of lower magnitude.

Conclusion

Women with ankle fractures have lower aBMD and vBMD and trabecular bone alterations, suggesting that ankle fractures are another manifestation of bone fragility.

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Acknowledgments

We thank Ms. F. Merminod, RD; M.-A. Schaad, RN; and A. Sigaud, RN, for the management of participants; Ms. C. Genet and Mr. G. Conicella for DXA and HR-pQCT measurements; and Ms. R. Sudan for manuscript editing. We thank the Swiss Foundation for Research in Ageing AETAS for the kind supply of its mobile osteodensitometer, the Geneva University Hospitals and Faculty of Medicine Clinical Research Center and the BNP-Paribas Foundation for their support.

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Authors and Affiliations

  1. Division of Bone Diseases, Department of Internal Medicine Specialties, Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    E. Biver, C. Durosier, T. Chevalley, F. R. Herrmann, S. Ferrari & R. Rizzoli

  2. Division of Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    T. Chevalley & F. R. Herrmann

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  1. E. Biver
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  2. C. Durosier
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  3. T. Chevalley
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  4. F. R. Herrmann
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  5. S. Ferrari
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  6. R. Rizzoli
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Correspondence to E. Biver.

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Biver, E., Durosier, C., Chevalley, T. et al. Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations. Osteoporos Int 26, 2147–2155 (2015). https://doi.org/10.1007/s00198-015-3119-9

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  • DOI: https://doi.org/10.1007/s00198-015-3119-9

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