Calcified Tissue International

, Volume 87, Issue 4, pp 324–332

Evaluation of Compressive Strength Index of the Femoral Neck in Caucasians and Chinese

  • Na Yu
  • Yong-Jun Liu
  • Yufang Pei
  • Lei Zhang
  • Shufeng Lei
  • Niraj R. Kothari
  • Ding-You Li
  • Christopher J. Papasian
  • James Hamilton
  • Ji-Qun Cai
  • Hong-Wen Deng
Article

Abstract

Compressive strength index (CSI) of the femoral neck is a parameter that integrates the information of bone mineral density (BMD), femoral neck width (FNW), and body weight. CSI is considered to have the potential to improve the performance of assessment for hip fracture risk. However, studies on CSI have been rare. In particular, few studies have evaluated the performance of CSI, in comparison with BMD, FNW, and bending geometry, for assessment of hip fracture risk. We studied two large populations, including 1683 unrelated U.S. Caucasians and 2758 unrelated Chinese adults. For all the study subjects, CSI, femoral neck BMD (FN_BMD), FNW, and bending geometry (section modulus [Z]) of the samples were obtained from dual-energy X-ray absorptiometry scans. We investigated the age-related trends of these bone phenotypes and potential sex and ethnic differences. We further evaluated the performance of these four phenotypes for assessment of hip fracture risk by logistic regression models. Chinese had significantly lower FN_BMD, FNW, and Z, but higher CSI than sex-matched Caucasians. Logistic regression analysis showed that higher CSI was significantly associated with lower risk of hip fracture, and the significance remained after adjusting for covariates of age, sex, and height. Each standard deviation (SD) increment in CSI was associated with odds ratios of 0.765 (95% confidence interval, 0.634, 0.992) and 0.724 (95% confidence interval, 0.569, 0.921) for hip fracture risk in Caucasians and Chinese, respectively. The higher CSI in Chinese may partially help explain the lower incidence of hip fractures in this population compared to Caucasians. Further studies in larger cohorts and/or longitudinal observations are necessary to confirm our findings.

Keywords

Osteoporosis Bone mineral density Compressive strength index Femoral neck width Section modulus Hip fracture 

Supplementary material

223_2010_9406_MOESM1_ESM.tif (383 kb)
Fig. 1Properties of compressive strength index (CSI) distribution before and after adjustment for age and by sex in Caucasians. Mean is the average value of CSI; Std. Dev. is the standard deviation; N is the total number in plot. Supplementary material 1 (TIFF 382 kb)
223_2010_9406_MOESM2_ESM.tif (356 kb)
Fig. 2Properties of compressive strength index (CSI) distribution before and after adjustment for age and by sex in Chinese. Mean is the average value of CSI; Std. Dev. is the standard deviation; N is the total number in plot. Supplementary material 2 (TIFF 355 kb)

References

  1. 1.
    Cummings SR, Karpf DB, Harris F, Genant HK, Ensrud K, LaCroix AZ, Black DM (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289CrossRefPubMedGoogle Scholar
  2. 2.
    Lauritzen JB (1997) Hip fractures. Epidemiology, risk factors, falls, energy absorption, hip protectors, and prevention. Dan Med Bull 44:155–168PubMedGoogle Scholar
  3. 3.
    Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, Van Kuijk C (1994) Universal standardization for dual X-ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514CrossRefPubMedGoogle Scholar
  4. 4.
    Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475CrossRefPubMedGoogle Scholar
  5. 5.
    Siris ES, Chen YT, Abbott TA, Barrett-Connor E, Miller PD, Wehren LE, Berger ML (2004) Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med 164:1108–1112CrossRefPubMedGoogle Scholar
  6. 6.
    Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954CrossRefPubMedGoogle Scholar
  7. 7.
    Babbar RK, Handa AB, Lo CM, Guttmacher SJ, Shindledecker R, Chung W, Fong C, Ho-Asjoe H, Chan-Ting R, Dixon LB (2006) Bone health of immigrant Chinese women living in New York City. J Community Health 31:7–23CrossRefPubMedGoogle Scholar
  8. 8.
    Lau EM, Lynn H, Woo J, Melton LJ 3rd (2003) Areal and volumetric bone density in Hong Kong Chinese: a comparison with Caucasians living in the United States. Osteoporos Int 14:583–588CrossRefPubMedGoogle Scholar
  9. 9.
    Roy D, Swarbrick C, King Y, Pye S, Adams J, Berry J, Silman A, O’Neill T (2005) Differences in peak bone mass in women of European and South Asian origin can be explained by differences in body size. Osteoporos Int 16:1254–1262CrossRefPubMedGoogle Scholar
  10. 10.
    Black DM, Bouxsein ML, Marshall LM, Cummings SR, Lang TF, Cauley JA, Ensrud KE, Nielson CM, Orwoll ES (2008) Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using QCT. J Bone Miner Res 23:1326–1333CrossRefPubMedGoogle Scholar
  11. 11.
    Bergot C, Bousson V, Meunier A, Laval-Jeantet M, Laredo JD (2002) Hip fracture risk and proximal femur geometry from DXA scans. Osteoporos Int 13:542–550CrossRefPubMedGoogle Scholar
  12. 12.
    Calis HT, Eryavuz M, Calis M (2004) Comparison of femoral geometry among cases with and without hip fractures. Yonsei Med J 45:901–907PubMedGoogle Scholar
  13. 13.
    Faulkner KG, Cummings SR, Black D, Palermo L, Gluer CC, Genant HK (1993) Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 8:1211–1217CrossRefPubMedGoogle Scholar
  14. 14.
    Karlsson KM, Sernbo I, Obrant KJ, Redlund-Johnell I, Johnell O (1996) Femoral neck geometry and radiographic signs of osteoporosis as predictors of hip fracture. Bone 18:327–330CrossRefPubMedGoogle Scholar
  15. 15.
    Michelotti J, Clark J (1999) Femoral neck length and hip fracture risk. J Bone Miner Res 14:1714–1720CrossRefPubMedGoogle Scholar
  16. 16.
    Brownbill RA, Ilich JZ (2003) Hip geometry and its role in fracture: what do we know so far? Curr Osteoporos Rep 1:25–31CrossRefPubMedGoogle Scholar
  17. 17.
    Karlamangla AS, Barrett-Connor E, Young J, Greendale GA (2004) Hip fracture risk assessment using composite indices of femoral neck strength: the Rancho Bernardo Study. Osteoporos Int 15:62–70CrossRefPubMedGoogle Scholar
  18. 18.
    Xiong DH, Shen H, Zhao LJ, Xiao P, Yang TL, Guo Y, Wang W, Guo YF, Liu YJ, Recker RR, Deng HW (2006) Robust and comprehensive analysis of 20 osteoporosis candidate genes by very high-density single-nucleotide polymorphism screen among 405 white nuclear families identified significant association and gene–gene interaction. J Bone Miner Res 21:1678–1695CrossRefPubMedGoogle Scholar
  19. 19.
    Xiao P, Shen H, Guo YF, Xiong DH, Liu YZ, Liu YJ, Zhao LJ, Long JR, Guo Y, Recker RR, Deng HW (2006) Genomic regions identified for BMD in a large sample including epistatic interactions and gender-specific effects. J Bone Miner Res 21:1536–1544CrossRefPubMedGoogle Scholar
  20. 20.
    Deng HW, Shen H, Xu FH, Deng HY, Conway T, Zhang HT, Recker RR (2002) Tests of linkage and/or association of genes for vitamin D receptor, osteocalcin, and parathyroid hormone with bone mineral density. J Bone Miner Res 17:678–686CrossRefPubMedGoogle Scholar
  21. 21.
    Rivadeneira F, Houwing-Duistermaat JJ, Beck TJ, Janssen JA, Hofman A, Pols HA, Van Duijn CM, Uitterlinden AG (2004) The influence of an insulin-like growth factor I gene promoter polymorphism on hip bone geometry and the risk of nonvertebral fracture in the elderly: the Rotterdam Study. J Bone Miner Res 19:1280–1290CrossRefPubMedGoogle Scholar
  22. 22.
    Duan Y, Beck TJ, Wang XF, Seeman E (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774CrossRefPubMedGoogle Scholar
  23. 23.
    Malkin I, Ginsburg E (2003) Program package for Mendelian analysis of pedigree data (MAN, version 6 technical report). Tel Aviv: Tel Aviv University, Department of Anatomy and AnthropologyGoogle Scholar
  24. 24.
    Malkin I, Karasik D, Livshits G, Kobyliansky E (2002) Modelling of age-related bone loss using cross-sectional data. Ann Hum Biol 29:256–270CrossRefPubMedGoogle Scholar
  25. 25.
    Omsland TK, Schei B, Gronskag AB, Langhammer A, Forsen L, Gjesdal CG, Meyer HE (2009) Weight loss and distal forearm fractures in postmenopausal women: the Nord-Trondelag Health Study, Norway. Osteoporos Int 20:2009–2016CrossRefPubMedGoogle Scholar
  26. 26.
    Meyer HE, Sogaard AJ, Falch JA, Jorgensen L, Emaus N (2008) Weight change over three decades and the risk of osteoporosis in men: the Norwegian Epidemiological Osteoporosis Studies (NOREPOS). Am J Epidemiol 168:454–460CrossRefPubMedGoogle Scholar
  27. 27.
    van der Voort DJ, Geusens PP, Dinant GJ (2001) Risk factors for osteoporosis related to their outcome: fractures. Osteoporos Int 12:630–638CrossRefPubMedGoogle Scholar
  28. 28.
    Wu XP, Liao EY, Huang G, Dai RC, Zhang H (2003) A comparison study of the reference curves of bone mineral density at different skeletal sites in native Chinese, Japanese, and American Caucasian women. Calcif Tissue Int 73:122–132CrossRefPubMedGoogle Scholar
  29. 29.
    Bhudhikanok GS, Wang MC, Eckert K, Matkin C, Marcus R, Bachrach LK (1996) Differences in bone mineral in young Asian and Caucasian Americans may reflect differences in bone size. J Bone Miner Res 11:1545–1556CrossRefPubMedGoogle Scholar
  30. 30.
    Cundy T, Cornish J, Evans MC, Gamble G, Stapleton J, Reid IR (1995) Sources of interracial variation in bone mineral density. J Bone Miner Res 10:368–373CrossRefPubMedGoogle Scholar
  31. 31.
    Taaffe DR, Lang TF, Harris TB (2003) Poor correlation of mid-femoral measurements by CT and hip measurements by DXA in the elderly. Aging Clin Exp Res 15:131–135PubMedGoogle Scholar
  32. 32.
    Seeman E, Duan Y, Fong C, Edmonds J (2001) Fracture site-specific deficits in bone size and volumetric density in men with spine or hip fractures. J Bone Miner Res 16:120–127CrossRefPubMedGoogle Scholar
  33. 33.
    Alonso CG, Curiel MD, Carranza FH, Cano RP, Perez AD (2000) Femoral bone mineral density, neck-shaft angle and mean femoral neck width as predictors of hip fracture in men and women. Multicenter Project for Research in Osteoporosis. Osteoporos Int 11:714–720CrossRefPubMedGoogle Scholar
  34. 34.
    Filardi S, Zebaze RM, Duan Y, Edmonds J, Beck T, Seeman E (2004) Femoral neck fragility in women has its structural and biomechanical basis established by periosteal modeling during growth and endocortical remodeling during aging. Osteoporos Int 15:103–107CrossRefPubMedGoogle Scholar
  35. 35.
    Rivadeneira F, Zillikens MC, De Laet CE, Hofman A, Uitterlinden AG, Beck TJ, Pols HA (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790CrossRefPubMedGoogle Scholar
  36. 36.
    Kaptoge S, Beck TJ, Reeve J, Stone KL, Hillier TA, Cauley JA, Cummings SR (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the study of osteoporotic fractures. J Bone Miner Res 23:1892–1904CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Na Yu
    • 1
    • 2
  • Yong-Jun Liu
    • 2
  • Yufang Pei
    • 2
  • Lei Zhang
    • 2
  • Shufeng Lei
    • 2
    • 3
  • Niraj R. Kothari
    • 2
  • Ding-You Li
    • 4
  • Christopher J. Papasian
    • 2
  • James Hamilton
    • 2
  • Ji-Qun Cai
    • 1
  • Hong-Wen Deng
    • 2
    • 3
    • 5
  1. 1.Department of Pharmaceutical Toxicology, School of Pharmaceutical ScienceChina Medical UniversityShenyangPeople’s Republic of China
  2. 2.School of MedicineUniversity of Missouri-Kansas CityKansas CityUSA
  3. 3.Laboratory of Molecular and Statistical Genetics, College of Life SciencesHunan Normal UniversityChangshaPeople’s Republic of China
  4. 4.Section of GastroenterologyChildren’s Mercy HospitalKansas CityUSA
  5. 5.Departments of Basic Medical Science and Orthopedic SurgeryUniversity of Missouri-Kansas CityKansas CityUSA

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