Calcified Tissue International

, Volume 52, Issue 3, pp 199–204

Geometric variables from DXA of the radius predict forearm fracture load in vitro

  • Elizabeth R. Myers
  • Aaron T. Hecker
  • Daniel S. Rooks
  • John A. Hipp
  • Wilson C. Hayes
Clinical Investigations

Summary

The purpose of this investigation was to determine the cross-sectional geometry of the radius in female and male cadaveric specimens using dual-energy X-ray absorptiometry (DXA), to measure the accuracy of this technique compared with a digitizing procedure, and to measure the correlation between these DXA-based geometric variables and the load required to produce a forearm fracture. Paired intact forearms were scanned at a distal site and at a site approximately 30% of the forearm length from the distal end. The cross-sectional area and the moments of inertia of two sections at 10 and 30% of the forearm length were computed from the X-ray attenuation data. One member of each pair was then sectioned at the 30% location, which is mostly cortical bone, and the section was traced on a digitizing pad. The other forearm was loaded to failure in a servohydraulic materials test system. The DXA-based area and moment of inertia at 30% correlated significantly with the digitized results (r2=0.93 for area; r2=0.95 for moment; P<0.001). The conventional bone mineral density from DXA did not associate significantly with failure load, but the minimum moment of inertia and the cross-sectional area at 10% correlated in a strong and significant manner with the forearm fracture force (r2=0.67 for area; r2=0.66 for moment; P<0.001). The determination of radial bone cross-sectional geometry, therefore, should have better discriminatory capabilities than bone mineral density in studies of bone fragility and fracture risk.

Key words

Dual-energy X-ray absorptiometry Colles' fracture Bone mineral density Distal radius Forearm fracture 

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References

  1. 1.
    Melton LJ III (1988) Epidemiology of fractures. In: Riggs BL, Melton LJ III (eds) Osteoporosis: etiology, diagnosis, and management. New York, Raven Press, pp 133–154Google Scholar
  2. 2.
    Melton LJ, Kan SH, Frye MA, Wahner HW, O'Fallen WM, Riggs BL (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011Google Scholar
  3. 3.
    Owen RA, Melton LJ III, Johnson KA, Ilstrup DM, Riggs BL (1982) Incidence of Colles' fracture in a North American community. Am J Public Health 72:605–607Google Scholar
  4. 4.
    Genant HK, Block JE, Steiger P, Glueer CC, Ettinger B, Harris ST (1989) Appropriate use of bone densitometry. Radiology 170:817–822Google Scholar
  5. 5.
    Mazess RB (1990) Bone densitometry of the axial skeleton. Orthop Clin N Am 21:51–63Google Scholar
  6. 6.
    Wahner HW (1989) Measurements of bone mass and bone density. Endocrinol Metab Clin N Am 18:995–1013Google Scholar
  7. 7.
    Lotz JC, Hayes WC (1990) Estimates of hip fracture risk from falls using quantitative computed tomography. J Bone Joint Surg [Am] 72:689–700Google Scholar
  8. 8.
    Myers ER, Hecker AT, Rooks DS, Hayes WC (1992) Correlations of the failure load of the femur with densitometric and geometric properties from QDR. Trans 38th ORS, 17:115Google Scholar
  9. 9.
    Beck TJ, Ruff CB, Warden KE, Scott WW, Rao GU (1990) Predicting femoral neck strength from bone mineral data. Invest Radiol 25:6–18Google Scholar
  10. 10.
    Sartoris DJ, Sommer FG, Kosek J, Gies A, Carter D (1985) Dual-energy projection radiography in the evaluation of femoral neck strength, density, and mineralization. Invest Radiol 20: 476–485Google Scholar
  11. 11.
    Dalen N, Hellstrom LG, Jacobson B (1976) Bone mineral content and mechanical strength of the femoral neck. Acta Orthop Scand 47:503–508Google Scholar
  12. 12.
    Leichter I, Margulies JY, Weinreb A, Mizrahi J, Robin GC, Conforty B, Makin M, Bloch B (1982) The relationship between bone density, mineral content, and mechanical strength in the femoral neck. Clin Orthop 163:272–281Google Scholar
  13. 13.
    McBroom RJ, Hayes WC, Edwards WT, Goldberg RP, White AA III (1985) Prediction of vertebral body compressive fracture using quantitative computed tomography. J Bone Joint Surg [AM] 67:1206–1214Google Scholar
  14. 14.
    Mosekilde L, Bentzen SM, Ortoft G, Jorgensen J (1989) The predictive value of quantitative computed tomography for vertebral body compressive strength and ash density. Bone 10:465–470Google Scholar
  15. 15.
    Myers ER, Sebeny EA, Hecker AT, Corcoran TA, Hipp JA, Greenspan SL, Hayes WC (1991) Correlations between photon absorption properties and failure load of the distal radius in vitro. Calcif Tissue Int 49:292–297Google Scholar
  16. 16.
    Martin BR, Burr DB (1984) Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 17:195–201Google Scholar
  17. 17.
    Horsman A, Currey JD (1983) Estimation of mechanical properties of the distal radius from bone mineral content and cortical width. Clin Orthop 176:298–304Google Scholar
  18. 18.
    Jurist JM, Foltz AS (1977) Human ulnar bending stiffness, mineral content, geometry and strength. J Biomech 10:455–459Google Scholar
  19. 19.
    Cameron JR, Sorenson JA (1963) Measurement of bone mineral in vivo: an improved method. Science 142:230–232Google Scholar
  20. 20.
    Weinstein RS, New KD, Sappington LJ (1991) Dual-energy x-ray absorptiometry versus single photon absorptiometry of the radius. Calcif Tissue Int 49:313–316Google Scholar
  21. 21.
    Larcos G, Wahner HW (1991) An evaluation of forearm bone mineral measurement with dual-energy x-ray absorptiometry. J Nucl Med 32:2101–2106Google Scholar
  22. 22.
    Overton TR, Wheeler GD (1992) Bone mass measurements in the distal forearm using dual-energy x-ray absorptiometry and x-ray computed tomography: a longitudinal, in vivo comparative study. J Bone Miner Res 7:375–381Google Scholar
  23. 23.
    Carter DR, Bouxsein ML, Marcus R (1992) New approaches for interpreting projected bone densitometry data. J Bone Miner Res 7:137–144Google Scholar
  24. 24.
    Ho CP, Kim RW, Schaffler MB, Sartoris DJ (1990) Accuracy of dual-energy radiographic absorptiometry of the lumbar spine: cadaver study. Radiology 176:171–173Google Scholar
  25. 25.
    Overgaard K, Hansen MA, Riis BJ, Christiansen C (1992) Discriminatory ability of bone mass measurements (SPA and DEXA) for fractures in elderly post-menopausal women. Calcif Tissue Int 50:30–35Google Scholar
  26. 26.
    Hui SL, Slemenda CW, Johnston CC Jr (1989) Baseline measurement of bone mass predicts fracture in white women. Ann Int Med 111:355–361Google Scholar
  27. 27.
    Hui SL, Slemenda CW, Johnston CC (1988) Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809Google Scholar
  28. 28.
    Eastell R, Wahner HW, O'Fallen M, Amadio PC, Melton LJ III, Riggs BL (1989) Unequal decrease in bone density of lumbar spine and ultradistal radius in Colles' and vertebral fracture syndromes. J Clin Invest 83:168–174Google Scholar
  29. 29.
    Hesp R, Klenerman L, Page L (1984) Decreased radial bone mass in Colles' fracture. Acta Orthop Scand 55:573–575Google Scholar
  30. 30.
    Nilsson BE, Westlin NE (1974) The bone mineral content in the forearm of women with Colles' fracture. Acta Orthop Scand 45:836–844Google Scholar
  31. 31.
    Harma M, Karjalainen P (1986) Trabecular osteopenia in Colles' fracture. Acta Orthop Scand 57:38–40Google Scholar
  32. 32.
    Gardsell P, Johnell O, Nilsson BE (1989) Predicting fractures in women by using forearm bone densitometry. Calcif Tissue Int 44:235–242Google Scholar
  33. 33.
    Lester GE, Anderson JJB, Tylavsky FA, Sutton WR, Stinnett SS, DeMasi RA, Talmage RV (1990) Update on the use of distal radial bone density measurements in prediction of hip and Colles' fracture risk. J Orthop Res 8:220–226Google Scholar
  34. 34.
    Eastell R, Riggs BL, Wahner HW, O'Fallon WM, Amadio PC, Melton LJ (1989) Colles' fracture and bone density of the ultradistal radius. J Bone Miner Res 4:607–613Google Scholar
  35. 35.
    Smith DA, Hosie CJ, Deacon AD, Hamblen DL (1990) Quantitative x-ray computed tomography of the radius in normal subjects and osteoporotic patients. Br J Radiol 63:776–782Google Scholar
  36. 36.
    Smith DA, Johnston CC, Yu P-L (1972) In vivo measurement of bone mass. Its use in demineralized states such as osteoporosis. JAMA 219:325–329Google Scholar
  37. 37.
    Grubb SA, Jacobson PC, Awbrey BJ, McCartney WH, Vincent LM, Talmage RV (1984) Bone density in osteopenic women: a modified distal radius density measurement procedure to develop an “at risk” value for use in screening women. J Orthop Res 2:322–327Google Scholar
  38. 38.
    Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Preexisting fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923Google Scholar
  39. 39.
    Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC (1990) Appendicular bone density and age predict hip fracture in women. JAMA 263:665–668Google Scholar
  40. 40.
    Voort J, Taconis WK, Schaik CL, Silberbusch J (1990) The relationship between densitometry of the radius and vertebral fractures. Neth J Med 37:53–57Google Scholar
  41. 41.
    Black DM, Cummings SR, Genant HK, Nevitt MC, Palermo L, Browner W (1992) Axial and appendicular bone density predict fractures in older women. J Bone Miner Res 7:633–638Google Scholar
  42. 42.
    Hayes WC, Gerhart TN (1985) Biomechanics of bone: applications for assessment of bone strength. In: Peck WA (ed) Bone and mineral research, annual III. Elsevier Science Publishers, Amsterdam, pp 259–294Google Scholar
  43. 43.
    Shames IH (1967) Engineering mechanics: statics and dynamics. Prentice-Hall, Englewood CliffsGoogle Scholar
  44. 44.
    Ruff CB, Hayes WC (1984) Bone mineral content in the lower limb: relationship to cross-sectional geometry. J Bone Joint Surg [Am] 66:1024–1031Google Scholar
  45. 45.
    Schlenker RA, VonSeggen WW (1976) The distribution of cortical and trabecular bone mass along the lengths of the radius and ulna and the implications for in vivo bone mass measurements. Calcif Tissue Int 20:41–52Google Scholar
  46. 46.
    Nagurka ML, Hayes WC (1980) Technical note: an interactive graphics package for calculating cross-sectional properties of complex shapes. J Biomech 13:59–64Google Scholar
  47. 47.
    Dixon WJ (1990) BMDP statistical software manual. University of California Press, BerkeleyGoogle Scholar
  48. 48.
    Frykman G (1967) Fracture of the distal radius including sequelae-shoulder-hand-finger syndrome: disturbance in the distal radio-ulmar joint and impairment of nerve function. A clinical and experimental study. Acta Orthop Scand 108:1–153Google Scholar
  49. 49.
    Spadaro JA, Werner FW, Brenner RA, Fay LA, Fortino MD (1992) The contribution of cortical bone to osteopenic distal radius strength. Trans 38th ORS 17:113Google Scholar

Copyright information

© Springer-Verlag New York Inc. 1993

Authors and Affiliations

  • Elizabeth R. Myers
    • 1
  • Aaron T. Hecker
    • 1
  • Daniel S. Rooks
    • 1
  • John A. Hipp
    • 1
  • Wilson C. Hayes
    • 1
  1. 1.Orthopaedic Biomechanics Laboratory, Department of Orthopaedic Surgery, Charles A. Dana Research InstituteBeth Israel HospitalBostonUSA

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