Skip to main content

Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men

Osteoporosis International volume 31, pages 1913–1923 (2020)Cite this article

Abstract

Summary

Reference values for radius and tibia strength using multiple-stack high-resolution peripheral quantitative computed tomography (HR-pQCT) with homogenized finite element analysis are presented in order to derive critical values improving risk prediction models of osteoporosis. Gender and femoral neck areal bone mineral density (aBMD) were independent predictors of bone strength.

Introduction

The purpose was to obtain reference values for radius and tibia bone strength computed by using the homogenized finite element analysis (hFE) using multiple stacks with a HR-pQCT.

Methods

Male and female healthy participants aged 20–39 years were recruited at the University Hospital of Bern. They underwent interview and clinical examination including hand grip, gait speed and DXA of the hip. The nondominant forearm and tibia were scanned with a double and a triple-stack protocol, respectively, using HR-pQCT (XCT II, SCANCO Medical AG). Bone strength was estimated by using the hFE analysis, and reference values were calculated using quantile regression. Multivariable analyses were performed to identify clinical predictors of bone strength.

Results

Overall, 46 women and 41 men were recruited with mean ages of 25.1 (sd 5.0) and 26.2 (sd 5.2) years. Sex-specific reference values for bone strength were established. Men had significantly higher strength for radius (mean (sd) 6640 (1800) N vs. 4110 (1200) N; p < 0.001) and tibia (18,200 (4220) N vs. 11,970 (3150) N; p < 0.001) than women. In the two multivariable regression models with and without total hip aBMD, the addition of neck hip aBMD significantly improved the model (p < 0.001). No clinical predictors of bone strength other than gender and aBMD were identified.

Conclusion

Reference values for radius and tibia strength using multiple HR-pQCT stacks with hFE analysis are presented and provide the basis to help refining accurate risk prediction models. Femoral neck aBMD and gender were significant predictors of bone strength

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Hauger AV, Bergland A, Holvik K, Stahle A, Emaus N, Strand BH (2018) Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromso study. Osteoporos Int 29:2447–2456

    CAS  Article  Google Scholar 

  2. Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR, Osteoporotic Fractures Research G (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 18:1947–1954

    Article  Google Scholar 

  3. Siris ES, Brenneman SK, Barrett-Connor E, Miller PD, Sajjan S, Berger ML, Chen YT (2006) The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50-99: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 17:565–574

    CAS  Article  Google Scholar 

  4. Hosseini HS, Dunki A, Fabech J, Stauber M, Vilayphiou N, Pahr D, Pretterklieber M, Wandel J, Rietbergen BV, Zysset PK (2017) Fast estimation of Colles’ fracture load of the distal section of the radius by homogenized finite element analysis based on HR-pQCT. Bone 97:65–75

    Article  Google Scholar 

  5. Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK (2013) Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int 24:1733–1740

    CAS  Article  Google Scholar 

  6. Stein EM, Liu XS, Nickolas TL et al (2010) Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res 25:2572–2581

    Article  Google Scholar 

  7. Wang J, Stein EM, Zhou B, Nishiyama KK, Yu YE, Shane E, Guo XE (2016) Deterioration of trabecular plate-rod and cortical microarchitecture and reduced bone stiffness at distal radius and tibia in postmenopausal women with vertebral fractures. Bone 88:39–46

    Article  Google Scholar 

  8. Samelson EJ, Broe KE, Xu H, Yang L, Boyd S, Biver E, Szulc P, Adachi J, Amin S, Atkinson E, Berger C, Burt L, Chapurlat R, Chevalley T, Ferrari S, Goltzman D, Hanley DA, Hannan MT, Khosla S, Liu CT, Lorentzon M, Mellstrom D, Merle B, Nethander M, Rizzoli R, Sornay-Rendu E, van Rietbergen B, Sundh D, Wong AKO, Ohlsson C, Demissie S, Kiel DP, Bouxsein ML (2019) Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol 7:34–43

    Article  Google Scholar 

  9. Kroker A, Plett R, Nishiyama KK, McErlain DD, Sandino C, Boyd SK (2017) Distal skeletal tibia assessed by HR-pQCT is highly correlated with femoral and lumbar vertebra failure loads. J Biomech 59:43–49

    Article  Google Scholar 

  10. Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, Peterson JM, Melton LJ 3rd (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res 21:124–131

    Article  Google Scholar 

  11. Macdonald HM, Nishiyama KK, Kang J, Hanley DA, Boyd SK (2011) Age-related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population-based HR-pQCT study. J Bone Miner Res 26:50–62

    Article  Google Scholar 

  12. Burt LA, Macdonald HM, Hanley DA, Boyd SK (2014) Bone microarchitecture and strength of the radius and tibia in a reference population of young adults: an HR-pQCT study. Arch Osteoporos 9:183

    Article  Google Scholar 

  13. Baumbach SF, Schmidt R, Varga P, Heinz T, Vecsei V, Zysset PK (2011) Where is the distal fracture line location of dorsally displaced distal radius fractures? J Orthop Res 29:489–494

    Article  Google Scholar 

  14. Mueller TL, van Lenthe GH, Stauber M, Gratzke C, Eckstein F, Muller R (2009) Regional, age and gender differences in architectural measures of bone quality and their correlation to bone mechanical competence in the human radius of an elderly population. Bone 45:882–891

    Article  Google Scholar 

  15. Varga P, Pahr DH, Baumbach S, Zysset PK (2010) HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles’ fracture load in vitro. Bone 47:982–988

    Article  Google Scholar 

  16. Hars M, Audet MC, Herrmann F, De Chassey J, Rizzoli R, Reny JL, Gold G, Ferrari S, Trombetti A (2018) Functional performances on admission predict in-hospital falls, injurious falls, and fractures in older patients: a prospective study. J Bone Miner Res 33:852–859

    Article  Google Scholar 

  17. Bonaretti S, Majumdar S, Lang TF, Khosla S, Burghardt AJ (2017) The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int

  18. Pauchard Y, Liphardt AM, Macdonald HM, Hanley DA, Boyd SK (2012) Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone 50:1304–1310

    Article  Google Scholar 

  19. Arias-Moreno AJ, Hosseini HS, Bevers M, Ito K, Zysset P, van Rietbergen B (2019) Validation of distal radius failure load predictions by homogenized- and micro-finite element analyses based on second-generation high-resolution peripheral quantitative CT images. Osteoporos Int 30:1433–1443

    CAS  Article  Google Scholar 

  20. Harrigan TP, Mann, R. W. Characterization of microstructural anisotropy in cancellous bone using a second rank tensor. Journal of Materials Science 19:761–767

  21. Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK (2016) Sex- and site-specific normative data curves for HR-pQCT. J Bone Miner Res 31:2041–2047

    Article  Google Scholar 

  22. Dalzell N, Kaptoge S, Morris N, Berthier A, Koller B, Braak L, van Rietbergen B, Reeve J (2009) Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT. Osteoporos Int 20:1683–1694

    CAS  Article  Google Scholar 

  23. Sode M, Burghardt AJ, Kazakia GJ, Link TM, Majumdar S (2010) Regional variations of gender-specific and age-related differences in trabecular bone structure of the distal radius and tibia. Bone 46:1652–1660

    Article  Google Scholar 

  24. Hansen S, Shanbhogue V, Folkestad L, Nielsen MM, Brixen K (2014) Bone microarchitecture and estimated strength in 499 adult Danish women and men: a cross-sectional, population-based high-resolution peripheral quantitative computed tomographic study on peak bone structure. Calcif Tissue Int 94:269–281

    CAS  Article  Google Scholar 

  25. Hung VW, Zhu TY, Cheung WH, Fong TN, Yu FW, Hung LK, Leung KS, Cheng JC, Lam TP, Qin L (2015) Age-related differences in volumetric bone mineral density, microarchitecture, and bone strength of distal radius and tibia in Chinese women: a high-resolution pQCT reference database study. Osteoporos Int 26:1691–1703

    CAS  Article  Google Scholar 

  26. Macneil JA, Boyd SK (2008) Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone 42:1203–1213

    Article  Google Scholar 

  27. Gordon CL, Halton JM, Atkinson SA, Webber CE (1991) The contributions of growth and puberty to peak bone mass. Growth Dev Aging 55:257–262

    CAS  PubMed  Google Scholar 

  28. Seeman E (2001) Clinical review 137: sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab 86:4576–4584

    CAS  Article  Google Scholar 

  29. Burrows M, Liu D, Moore S, McKay H (2010) Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: an HR-pQCT study. J Bone Miner Res 25:1423–1432

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank all the participants who graciously devoted time to participate in the study. We thank Furkan Gazozcu for scan acquisition and participant recruitment, and collaborators of the Department of Osteoporosis at the University Hospital Bern for DXA measurements and performance of quality protocols.

Funding

This work was in part supported by the „Forschungsfonds der Geriatrischen Universitätsklinik“, Bern/Switzerland. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Bern, 3010, Switzerland

    A. K. Stuck

  2. ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, 3010, Bern, Switzerland

    D. Schenk, P. Zysset & A. Mathis

  3. CTU Bern, University of Bern, 3010, Bern, Switzerland

    L. Bütikofer

  4. Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, 3010, Switzerland

    K. Lippuner

Authors
  1. A. K. Stuck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Schenk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Zysset
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Bütikofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Mathis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Lippuner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Lippuner.

Ethics declarations

The present study was conducted with the approval no. 2017-00882 of the ethics committee of the canton of Bern, Switzerland. All participants provided written informed consent.

Conflict of interest

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(PDF 606 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stuck, A.K., Schenk, D., Zysset, P. et al. Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men. Osteoporos Int 31, 1913–1923 (2020). https://doi.org/10.1007/s00198-020-05405-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05405-0

Keywords

  • Bone strength
  • Clinical predictors
  • Failure load
  • Finite element analysis
  • HR-pQCT
  • Multiple stacks
  • Reference values