Upper Limb Bone Health: Cadaveric, Imaging and Clinical Studies With Special Emphasis on Peripheral Quantitative Computed Tomography

Introduction

Osteoporotic fractures are a major health care problem. A radial fracture is an important risk factor for osteoporosis that should initiate the assessment of bone health.

Purpose

To validate pQCT measures of bone in aged cadaveric radii.
To examine side-side differences in radial bone variables after disuse.
To test a novel intervention for secondary prevention of osteoporosis after an index radial fracture.

Methods

Study Design: Part I: Parts IA and IB are descriptive cadaveric studies. Part 2: Cross-sectional observational studies of bone response to disuse; Part 3: Part 3A is a 6-month intervention of secondary prevention of osteoporosis following a fragility fracture. Part 3B uses a questionnaire to ascertain barriers to investigation after fracture.

Participants: Part I: Cadaveric specimens from women (73 to 88 years) for Parts IA and IB. Part 2A: Women (52-87 years) who sustained a distal radius fracture and Part 2B: women and men (52 to 79 years) who had suffered a stroke. Part 3A: Women and men (50-90 years) with a fragility fracture; and Part 3B: physicians in British Columbia.

Results Part I: With different pQCT acquisition-analysis protocols, total bone area varied by 3-34%; cortical area varied by 3-30% and total content by 6-45% from a criterion standard. Total bone content of the distal radius explained between 74 and 81% of bone strength. Part 2: There was a significant decrease in bone strength in participants who had upper limb disuse because of stroke or fracture. Part 3: A patient and physician intervention improved bone health investigation rate by a factor of 3.1 times (RR) after fragility fracture. BC doctors reported few barriers to investigating osteoporosis.

Summary: Peripheral QCT acquisition and analysis protocols significantly influenced outcome variables. Patients do not have "normal" bone strength after fracture or stroke. In particular, there is an increased risk for non-dominant radial fractures to have lower bone strength and be associated with poorer limb function, compared with a dominant radial fracture. Physicians report no barriers to investigation after a fragility radial fracture and a systematic intervention may best address secondary prevention of osteoporosis.

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Year

Entry

1998

Einhorn TA. The cell and molecular biology of fracture healing. Clin Orthop Relat Res. October 1998;355(suppl):S7-S21.

2003

Ahlborg HG, Johnell O, Turner CH, Rannevik G, Karlsson MK. Bone loss and bone size after menopause. NEJM. July 24, 2003;349(4):327-334.

1994

Parfitt AM. Osteonal and hemi‐osteonal remodeling: the spatial and temporal framework for signal traffic in adult human bone. J Cell Biochem. July 1994;55(3):273-286.

2002

Currey JD. Bones: Structure and Mechanics. Princeton, NJ: Princeton University Press; 2002.

1996

Müller R, Hahn M, Vogel M, Delling G, Rüegsegger P. Morphometric analysis of noninvasively assessed bone biopsies: comparison of high-resolution computed tomography and histologic sections. Bone. March 1996;18(3):215-220.