Osteoporosis International

, Volume 21, Issue 7, pp 1161–1169 | Cite as

Assessing forearm fracture risk in postmenopausal women

  • L. J. MeltonIIIEmail author
  • D. Christen
  • B. L. Riggs
  • S. J. Achenbach
  • R. Müller
  • G. H. van Lenthe
  • S. Amin
  • E. J. Atkinson
  • S. Khosla
Original Article



A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.


This study seeks to test the clinical utility of approaches for assessing forearm fracture risk.


Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (μFE) models.


Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4–2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1–2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4–0.7), and strength (µFE failure load; OR, 1.8; 95% CI, 1.3–2.5); the factor-of-risk (applied load in a forward fall ÷ μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4–2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71).


Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.


Bone density Bone quality Colles’ fracture Epidemiology Risk assessment 



The authors would like to thank Margaret Holets for the HRpQCT measurements, Lisa McDaniel, R.N. and Louise McCready, R.N., for their assistance in recruiting and managing the study subjects, James M. Peterson for his assistance with data management and file storage, and Mary Roberts for her assistance in preparing the manuscript.

Conflicts of interest



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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2009

Authors and Affiliations

  • L. J. MeltonIII
    • 1
    • 3
    Email author
  • D. Christen
    • 5
  • B. L. Riggs
    • 3
  • S. J. Achenbach
    • 2
  • R. Müller
    • 5
  • G. H. van Lenthe
    • 5
    • 6
  • S. Amin
    • 1
    • 4
  • E. J. Atkinson
    • 2
  • S. Khosla
    • 3
  1. 1.Division of Epidemiology, Department of Health Sciences ResearchCollege of Medicine, Mayo ClinicRochesterUSA
  2. 2.Division of Biomedical Statistics and Informatics, Department of Health Sciences ResearchCollege of Medicine, Mayo ClinicRochesterUSA
  3. 3.Division of Endocrinology, Metabolism and Nutrition, Department of Internal MedicineCollege of Medicine, Mayo ClinicRochesterUSA
  4. 4.Division of Rheumatology, Department of Internal MedicineCollege of Medicine, Mayo ClinicRochesterUSA
  5. 5.Institute for BiomechanicsETH ZurichZurichSwitzerland
  6. 6.Division of Biomechanics and Engineering DesignK.U. LeuvenLeuvenBelgium

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