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Contributions of bone density and structure to fracture risk assessment in men and women

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Abstract

Although bone mineral density (BMD) is a strong predictor of fractures, it is only a surrogate for bone strength. Bone structural parameters can now be measured on BMD scans, but it is unclear whether they would be more useful for risk assessment. We measured structural parameters using the Hip Structural Analysis Program and evaluated their association, compared with standard hip BMD, with fracture risk in a population-based sample of 213 postmenopausal women and 200 men ≥50 years of age. Altogether, 38% of the women and 27% of the men had experienced a fracture due to moderate trauma (half involved hip, spine or distal forearm), while 23% and 36%, respectively, had a previous fracture due to severe trauma. In logistic regression analyses adjusted for age, the hip BMD and structural parameters were all associated with moderate trauma fractures generally, and osteoporotic fractures specifically, in women, but the best predictor in a multivariate model was femoral neck BMD (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.9–4.0). BMD and the structural parameters were strongly correlated, however, and could be interchanged with little reduction in predictive power. These variables were less predictive of moderate trauma fractures in men. The best model included age (OR per 10 years, 1.5; 95% CI, 1.1–2.1), femoral neck section modulus (OR, 1.6; 95% CI, 1.1–2.5) and intertrochanteric buckling ratio (OR, 1.6; 95% CI, 1.3–2.0). Correction for body size did not alter these relationships. Fractures due to severe trauma were best predicted by structural parameters: in women, femoral neck buckling ratio (OR, 1.2; 95% CI, 1.04–1.5) and, in men, intertrochanteric buckling ratio (OR, 1.4; 95% CI, 1.2–1.6). These data suggest that selected structural variables as assessed by dual-energy X-ray absorptiometry would be as good as standard BMD measurements for predicting fracture risk. Because of the strong correlations, however, some judgment can be used in selecting the variables easiest to measure.

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References

  1. Marshall D, Johnell O, Wedel H (1996) Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 312:1254–1259

    CAS  PubMed  Google Scholar 

  2. Ammann P, Rizzoli R (2003) Bone strength and its determinants. Osteoporos Int 14 [Suppl 3]:S13–18

    Google Scholar 

  3. Bouxsein ML (2001) Biomechanics of age-related fractures. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis, 2nd edn, vol 1. Academic Press, San Diego, pp 509–531

  4. Kanis JA, Glüer CC (2000) An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 11:192–202

    Article  CAS  PubMed  Google Scholar 

  5. Seeman E (1998) Growth in bone mass and size—are racial and gender differences in bone mineral density more apparent than real? J Clin Endocrinol Metab 83:1414–1419

    Article  CAS  PubMed  Google Scholar 

  6. Melton LJ III, Atkinson EJ, O’Connor MK, O’Fallon WM, Riggs BL (1998) Bone density and fracture risk in men. J Bone Miner Res 13:1915–1923

    PubMed  Google Scholar 

  7. Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304

    CAS  PubMed  Google Scholar 

  8. Melton LJ III (1996) History of the Rochester Epidemiology Project. Mayo Clin Proc 71:266–274

    PubMed  Google Scholar 

  9. Beard CM, Melton LJ III, Cedel SL, Richelson LS, Riggs BL (1990) Ascertainment of risk factors for osteoporosis: Comparison of interview data with medical record review. J Bone Miner Res 5:691–699

    Google Scholar 

  10. Katzman DK, Bachrach LK, Carter DR, Marcus R (1991) Clinical and anthropometric correlates of bone mineral acquisition in healthy adolescent girls. J Clin Endocrinol Metab 73:1332-1339

    CAS  PubMed  Google Scholar 

  11. Beck TJ, Oreskovic TL, Stone KL et al (2001) Structural adaptation to changing skeletal load in the progression toward hip fragility: the Study of Osteoporotic Fractures. J Bone Miner Res 16:1108–1119

    CAS  PubMed  Google Scholar 

  12. 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 18:1766–1774

    PubMed  Google Scholar 

  13. Looker AC, Beck TJ, Orwoll ES (2001) Does body size account for gender differences in femur bone density and geometry? J Bone Miner Res 16:1291–1299

    CAS  PubMed  Google Scholar 

  14. Harrell FE, Lee KL, Mark DB (1996) Multivariable prognostic models: Issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387

    Article  PubMed  Google Scholar 

  15. Melton LJ III, Chao EYS, Lane J (1988) Biomechanical aspects of fractures. In: Riggs BL, Melton LJ III (eds) Osteoporosis: etiology, diagnosis, and management. Raven Press, New York, pp 111–131

  16. Cummings SR, Marcus R, Palermo L, Ensrud KE, Genant HK (1994) Does estimating volumetric bone density of the femoral neck improve the prediction of hip fracture? A prospective study. Study of Osteoporotic Fractures Research Group. J Bone Miner Res 9:1429–1432

    CAS  PubMed  Google Scholar 

  17. Hui SL, Slemenda CW, Carey MA, Johnston CC Jr (1995) Choosing between predictors of fractures. J Bone Miner Res 10:1816–1822

    Google Scholar 

  18. Glüer CC, Cummings SR, Pressman A et al (1994) Prediction of hip fractures from pelvic radiographs: the Study of Osteoporotic Fractures. J Bone Miner Res 9:671–677

    CAS  PubMed  Google Scholar 

  19. Peacock M, Turner CH, Liu G, Manatunga AK, Timmerman L, Johnston CC Jr (1995) Better discrimination of hip fracture using bone density, geometry and architecture. Osteoporos Int 5:167–173

    CAS  PubMed  Google Scholar 

  20. Duboeuf F, Hans D, Schott AM et al (1997) Different morphometric and densitometric parameters predict cervical and trochanteric hip fracture: the EPIDOS Study. J Bone Miner Res 12:1895–1902

    Google Scholar 

  21. Gnudi S, Ripamonti C, Lisi L, Fini M, Giardino R, Giavaresi G (2002) Proximal femur geometry to detect and distinguish femoral neck fractures from trochanteric fractures in postmenopausal women. Osteoporos Int 13:69–73

    Article  Google Scholar 

  22. Alonso C, Curiel MD, Carranza FH, Cano RP, Pérez 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 11:714–720

    Article  PubMed  Google Scholar 

  23. Bergot C, Bousson V, Meunier A, Laval-Jeantet M, Laredo JD (2002) Hip fracture risk and proximal femur geometry from DXA scans. Osteoporos Int 13:542–550

    Article  CAS  PubMed  Google Scholar 

  24. Faulkner RA, McCulloch RG, Fyke SL et al (1995) Comparison of areal and estimated volumetric bone mineral density values between older men and women. Osteoporos Int 5:271–275

    CAS  PubMed  Google Scholar 

  25. Melton LJ III, Khosla S, Achenbach SJ, O’Connor MK, O’Fallon WM, Riggs BL (2000) Effects of body size and skeletal site on the estimated prevalence of osteoporosis in women and men. Osteoporos Int 11:977–983

    Article  PubMed  Google Scholar 

  26. McCalden RW, McGeough JA, Barker MB, Court-Brown CM (1993) Age-related changes in the tensile properties of cortical bone. The relative importance of changes in porosity, mineralization, and microstructure. J Bone Joint Surg Am 75:1193–1205

    Google Scholar 

  27. Myers ER, Hecker AT, Rooks DS, Hipp JA, Hayes WC (1993) Geometric variables from DXA of the radius predict forearm fracture load in vitro. Calcif Tissue Int 52:199–204

    Article  Google Scholar 

  28. 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 11:1356–1363

    Google Scholar 

  29. Kaptoge S, Dalzell N, Loveridge N, Beck TJ, Khaw KT, Reeve J (2003) Effects of gender, anthropomorphic variables and aging on the evolution of hip strength in men and women over 65. Bone 32:561–570

    Article  PubMed  Google Scholar 

  30. Garn SM, Rohmann CG, Wagner B, Ascoli W (1967) Continuing bone growth throughout life: a general phenomenon. Am J Phys Anthropol 26:313–318

    Google Scholar 

  31. Melton LJ III, Orwoll ES, Wasnich RD (2001) Does bone density predict fractures comparably in men and women? Osteoporos Int 12:707–709

    Google Scholar 

  32. De Laet CEDH, van der Klift M, Hofman A, Pols HAP (2002) Osteoporosis in men and women: A story about bone mineral density thresholds and hip fracture risk. J Bone Miner Res 17:2231–2236

    PubMed  Google Scholar 

  33. European Prospective Osteoporosis Study (EPOS) Group (2002) The relationship between bone density and incident vertebral fracture in men and women. J Bone Miner Res 17:2214–2221

    PubMed  Google Scholar 

  34. Eckstein F, Lochmüller EM, Lill CA et al (2002) Bone strength at clinically relevant sites displays substantial heterogeneity and is best predicted from site-specific bone densitometry. J Bone Miner Res 17:162–171

    PubMed  Google Scholar 

  35. Crawford RP, Cann CE, Keaveny TM (2003) Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33:744–750

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank Veronica Gathje, R.N., and Margaret Holets for help with data collection, Gloria Ware for processing the structural analysis and Mary Roberts for help in preparing the manuscript. This work was supported by research grant AR27065 from the National Institute of Arthritis, Musculoskeletal and Skin Diseases, U.S. Public Health Service

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Correspondence to L. Joseph Melton III.

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Melton, L.J., Beck, T.J., Amin, S. et al. Contributions of bone density and structure to fracture risk assessment in men and women. Osteoporos Int 16, 460–467 (2005). https://doi.org/10.1007/s00198-004-1820-1

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  • DOI: https://doi.org/10.1007/s00198-004-1820-1

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