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Osteoporosis International

, Volume 14, Issue 7, pp 531–538 | Cite as

Aging bone in men and women: beyond changes in bone mineral density

  • C. R. Russo
  • F. Lauretani
  • S. Bandinelli
  • B. Bartali
  • A. Di Iorio
  • S. Volpato
  • J. M. Guralnik
  • T. Harris
  • L. Ferrucci
Original Article

Abstract

Using peripheral quantitative computed tomography (pQCT) we assessed trabecular and cortical bone density, mass and geometric distribution at the tibia level in 512 men and 693 women, age range 20–102 years, randomly selected from the population living in the Chianti area, Tuscany, Italy. Total, trabecular and cortical bone density decreased linearly with age (p<0.0001 in both sexes), and the slope of age-associated decline was steeper in women than in men. In men, the cortical bone area was similar in different age groups, while in women older than 60 years it was significantly smaller by approximately 1% per year. The total cross-sectional area of the bone became progressively wider with age, but the magnitude of the age-associated increment was significantly higher in men than in women (p<0.001). The minimum moment of inertia, an index of mechanical resistance to bending, remained stable with age in men, while it was significantly lower in older compared with younger women (0.5% per year). The increase in bone cross-sectional area in aging men may contribute to the maintenance of adequate bone mechanical competence in the face of declining bone density. In women this compensatory mechanism appears to be less efficient and, accordingly, the bone mechanical competence declines with age. The geometric adaptation of increasing cross-sectional bone size is an important component in the assessment of bone mechanical resistance which is completely overlooked, and potentially misinterpreted, by traditional planar densitometry.

Keywords

Bone mechanical properties Elderly Osteoporosis pQCT 

Notes

Acknowledgements

Supported as a "targeted project" (ICS 110.1\RS97.71) by the Italian Ministry of Health and in part by the US National Institute on Aging (Contracts 263-MD-9164-13 and 263-MD-821336). We are grateful to Stratec Medizintechnik (Pforzheim, Germany) and Unitrem (Rome, Italy) for their continuous encouragement and support.

References

  1. 1.
    Wasnich RD (1998) Perspective on fracture risk and phalangeal bone mineral density. J Clin Densitom 1:259–268Google Scholar
  2. 2.
    Kanis JA, Delmas P, Burckhardt P, Cooper C, Torgerson D (1997) Guidelines for diagnosis and management of osteoporosis. Osteoporos Int 7:390–406PubMedGoogle Scholar
  3. 3.
    Parfitt AM (1998) A structural approach to renal bone disease. J Bone Miner Res 13:1213–1220Google Scholar
  4. 4.
    Guglielmi G, Schneider P, Lang TF, Giannatempo GM, Cammisa M, Genant HK (1997) Quantitative computed tomography at the axial and peripheral skeleton. Eur Radiol 7:32–42PubMedGoogle Scholar
  5. 5.
    Augat P, Gordon CL, Lang TF, Iida H, Genant HK (1998) Accuracy of cortical and trabecular bone measurements with peripheral quantitative computed tomography (pQCT). Phys Med Biol 43:2873–2883Google Scholar
  6. 6.
    Russo CR, Ricca M, Ferrucci L (2000) True osteoporosis and frailty-related osteopenia: two different clinical entities. J Am Geriatr Soc 48:1738–1739Google Scholar
  7. 7.
    Ferretti JL, Frost HM, Gasser JA, High WB, Jee WS, Jerome C, et al (1995) Perspectives on osteoporosis research: its focus and some insights from a new paradigm. Calcif Tissue Int 57:399–404PubMedGoogle Scholar
  8. 8.
    Augat P, Reeb H, Claes LE (1996) Prediction of fracture load at different skeletal sites by geometric properties of the cortical shell. J Bone Miner Res 11:1356–1363PubMedGoogle Scholar
  9. 9.
    Schneider P, Butz S, Allolio B, Borner W, Klein K, Lehmann R, et al (1995) Multicenter German reference data base for peripheral quantitative computer tomography. Technol Health Care 3:69–73PubMedGoogle Scholar
  10. 10.
    Ruff CB, Hayes WC (1982) Subperiosteal expansion and cortical remodeling of the human femur and tibia with aging. Science 217:945–948PubMedGoogle Scholar
  11. 11.
    McCreadie BR, Goldstein SA (2000) Biomechanics of fracture: is bone mineral density sufficient to assess risk? J Bone Miner Res 15:2305–2308PubMedGoogle Scholar
  12. 12.
    Forwood MR (2001) Mechanical effects on the skeleton: are there clinical implications? Osteoporos Int 12:77–83CrossRefPubMedGoogle Scholar
  13. 13.
    Ferrucci L, Bandinelli S, Benvenuti E, Di Iorio A, Macchi C, Harris TB, et al (2000) Subsystems contributing to the decline in ability to walk: bridging the gap between epidemiology and geriatric practice in the InCHIANTI study. J Am Geriatr Soc 48:1618–1625PubMedGoogle Scholar
  14. 14.
    Louis O, Boulpaep F, Willnecker J, Van den Winkel P, Osteaux M (1995) Cortical mineral content of the radius assessed by peripheral QCT predicts compressive strength on biomechanical testing. Bone 16:375–379CrossRefPubMedGoogle Scholar
  15. 15.
    Rittweger J, Beller G, Ehrig J, Jung C, Koch U, Ramolla J, et al (2000) Bone-muscle strength indices for the human lower leg. Bone 27:319–326Google Scholar
  16. 16.
    Cheng S, Toivanen JA, Suominen H, Toivanen JT, Timonen J (1995) Estimation of structural and geometrical properties of cortical bone by computerized tomography in 78-year-old women. J Bone Miner Res 10:139–148PubMedGoogle Scholar
  17. 17.
    Bouxsein ML, Myburgh KM, van der Meulen MCH, Lindenberger E, Marcus R (1994) Age-related differences in cross-sectional geometry of the forearm bones in healthy women. Calcif Tissue Int 54:113–118PubMedGoogle Scholar
  18. 18.
    Sievanen H, Koskue V, Rauhio A, Kannus P, Heinonen A, Vuori I (1998) Peripheral quantitative computed tomography in human long bones: evaluation of in vitro and in vivo precision. J Bone Miner Res 13:871–882Google Scholar
  19. 19.
    Ruff C (1984) Allometry between length and cross-sectional dimensions of the femur and tibia in Homo sapiens. Am J Phys Anthropol 65:347–358PubMedGoogle Scholar
  20. 20.
    Armitage P, Berry G (1994) In: Statistical methods in medical research, 3rd edn. Oxford: Blackwell Scientific:312–341Google Scholar
  21. 21.
    Russo CR (1998) Correlation of radial SPA and pQCT with the femoral DEXA measurement in elderly women. J Intern Med 244:358–359Google Scholar
  22. 22.
    Guglielmi G, Grimston SK, Fischer KC, Pacifici R (1994) Osteoporosis: diagnosis with lateral and postero-anterior dual x-ray absorptiometry compared with quantitative CT. Radiology 192:845–850PubMedGoogle Scholar
  23. 23.
    Andresen R, Haidekker MA, Radmer S, Banzer D (1999) CT determination of bone mineral density and structural investigations on the axial skeleton for estimating the osteoporosis-related fracture risk by means of a risk score. Br J Radiol 72:569–578PubMedGoogle Scholar
  24. 24.
    Bolotin HH (1998) A new perspective on the causal influence of soft tissue composition on DXA-measured in vivo bone mineral density. J Bone Miner Res 13:1739–1746PubMedGoogle Scholar
  25. 25.
    Bolotin HH, Sievanen H, Grashuis JL, Kuiper JW, Jarvinen TL (2001) Inaccuracies inherent in patient-specific dual-energy X-ray absorptiometry bone mineral density measurements: comprehensive phantom-based evaluation. J Bone Miner Res 16:417–426PubMedGoogle Scholar
  26. 26.
    Bolotin HH, Sievanen H (2001) Inaccuracies inherent in dual-energy X-ray absorptiometry in vivo bone mineral density can seriously mislead diagnostic/prognostic interpretations of patient-specific bone fragility. J Bone Miner Res 16:799–805PubMedGoogle Scholar
  27. 27.
    Mosekilde L (2000) Age-related changes in bone mass, structure, and strength: effects of loading. Z Rheumatol 59(Suppl 1):1–9Google Scholar
  28. 28.
    Duan Y, Turner CH, Kim BT, Seeman E (2001) Sexual dimorphism in vertebral fragility is more the result of gender differences in age-related bone gain than bone loss. J Bone Miner Res 16:2267–2275PubMedGoogle Scholar
  29. 29.
    Hangartner TN, Gilsanz V (1996) Evaluation of cortical bone by computed tomography. J Bone Miner Res 11:1518–1525Google Scholar
  30. 30.
    Ferrucci L, Russo CR, Lauretani F, Bandinelli S, Guralnik JM (2002) A role for sarcopenia in late life osteoporosis. Aging Clin Exp Res 14:1–4PubMedGoogle Scholar
  31. 31.
    Siris ES, Miller PD, Barrett-Connor E, Faulkner KG, Wehner KG, Abbott TA, et al (2001) Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment. JAMA 28:2815–2822Google Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2003

Authors and Affiliations

  • C. R. Russo
    • 1
  • F. Lauretani
    • 2
  • S. Bandinelli
    • 1
  • B. Bartali
    • 1
  • A. Di Iorio
    • 3
  • S. Volpato
    • 4
  • J. M. Guralnik
    • 4
  • T. Harris
    • 4
  • L. Ferrucci
    • 1
    • 5
  1. 1.Laboratory of Clinical EpidemiologyINRCA Geriatric DepartmentFlorenceItaly
  2. 2.Department of Critical Care Medicine and Surgery, Section of Gerontology and Geriatric MedicineUniversity of FlorenceFlorenceItaly
  3. 3.Department of Medicine and AgingUniversity of ChietiChietiItaly
  4. 4.Laboratory of EpidemiologyDemography and BiometryBethesdaUSA
  5. 5.Clinical Research BranchNational Institute on Aging (NIH)BaltimoreUSA

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