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Measurement of Trabecular Bone Microstructure Does Not Improve Prediction of Mechanical Failure Loads at the Distal Radius Compared with Bone Mass Alone

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Abstract

Bone mass predicts a high proportion of variability in bone failure strength but is known to overlap among subjects with and without fractures. Here, we tested the hypothesis that trabecular bone microstructure, determined with micro-computed tomography (μCT), can improve the prediction of experimental failure loads in the distal forearm compared with bone mass alone. The right forearm and left distal radius of 130 human specimens were examined. Bone mineral density (BMD) was measured with peripheral dual energy X-ray absorptiometry (DXA). The specimens were mechanically tested to failure in a fall configuration, with the hand, elbow, ligaments, and tendons intact. Cylindrical bone samples from the metaphysis of the contralateral distal radius were obtained adjacent to the subchondral bone plate and scanned with μCT. When analyzing the total sample, BMD of the distal radius displayed a correlation of r = 0.82 with mechanical failure loads. After excluding 21 specimens with no obvious radiological sign of fracture after the test, the correlation increased to r = 0.85. When only including 79 specimens with loco typico fractures, the correlation was r = 0.82. The microstructural parameters showed correlation coefficients with the failure loads of ≤0.55 and did not add significant information to DXA in predicting failure loads in multiple regression models. These findings suggest that, under experimental conditions of mechanically testing entire bones, measurement of bone microstructure does not improve the prediction of distal radius bone strength. Determination of bone microstructure may thus be less promising in improving the prediction of fractures than commonly assumed.

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Acknowledgement

We thank Mathias Priemel (Department of Trauma Surgery, Hamburg University School of Medicine, Hamburg, Germany) for the histological examination of iliac crest specimens and Stephan Metz (Institute for Diagnostic Radiology, Klinikum rechts der Isar, Technical University München, Munich, Germany) for the forearm fracture readings. Gudrun Goldmann is acknowledged for her help with radiography and with preparing the iliac crest specimens for histological examination. This work was supported by a grant from the German Research Society (Deutsche Forschungsgemeinschaft, DFG LO 730/3-1).

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Authors and Affiliations

  1. Universitätsfrauenklinik der Ludwig-Maximilians-Universität München, Innenstadt, Maistr. 11, 80337, Munich, Germany

    E.-M. Lochmüller, J. Kristin, M. Matsuura & V. Kuhn

  2. Institute of Anatomy and Musculoskeletal Research, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria

    E.-M. Lochmüller, M. Hudelmaier & F. Eckstein

  3. Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universität München, Pettenkoferstr. 11, 80336, Munich, Germany

    J. Kristin, M. Matsuura, V. Kuhn, M. Hudelmaier & F. Eckstein

  4. Institute for Diagnostic Radiology, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, Munich, Germany

    T. M. Link

  5. Department of Radiology, University of California, San Francisco, CA, USA

    T. M. Link

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  1. E.-M. Lochmüller
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  2. J. Kristin
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  3. M. Matsuura
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  4. V. Kuhn
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  5. M. Hudelmaier
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  7. F. Eckstein
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Correspondence to F. Eckstein.

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Lochmüller, EM., Kristin, J., Matsuura, M. et al. Measurement of Trabecular Bone Microstructure Does Not Improve Prediction of Mechanical Failure Loads at the Distal Radius Compared with Bone Mass Alone. Calcif Tissue Int 83, 293–299 (2008). https://doi.org/10.1007/s00223-008-9172-z

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