Quantifying sex, race, and age specific differences in bone microstructure requires measurement of anatomically equivalent regions

Ghasem-Zadeh, Ali; Burghardt, Andrew; Wang, Xiao-Fang; Iuliano, Sandra; Bonaretti, Serena; Bui, Minh; Zebaze, Roger; Seeman, Ego

Affiliations

¹Department of Endocrinology and Medicine, Austin Health, University of Melbourne, Melbourne, Australia

²Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA

³Department of Radiology, Stanford University, Stanford, CA, USA

⁴Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia

⁵Institute for Health and Aging, Australian Catholic University, Melbourne, Australia

Abstract and keywords

Introduction: Individuals differ in forearm length. As microstructure differs along the radius, we hypothesized that errors may occur when sexual and racial dimorphisms are quantified at a fixed distance from the radio-carpal joint.

Methods: Microstructure was quantified ex vivo in 18 cadaveric radii using high resolution peripheral quantitative computed tomography and in vivo in 158 Asian and Caucasian women and men at a fixed region of interest (ROI), a corrected ROI positioned at 4.5–6% of forearm length and using the fixed ROI adjusted for cross sectional area (CSA), forearm length or height. Secular effects of age were assessed by comparing 38 younger and 33 older women.

Results: Ex vivo, similar amounts of bone mass fashioned adjacent cross sections. Larger distal cross sections had thinner porous cortices of lower matrix mineral density (MMD), a larger medullary CSA and higher trabecular density. Smaller proximal cross-sections had thicker less porous cortices of higher MMD, a small medullary canal with little trabecular bone. Taller persons had more distally positioned fixed ROIs which moved proximally when corrected. Shorter persons had more proximally positioned fixed ROIs which moved distally when corrected, so dimorphisms lessened. In the corrected ROIs, in Caucasians, women had 0.6 SD higher porosity and 0.6 SD lower trabecular density than men (p < 0.01). In Asians, women had 0.25 SD higher porosity (NS) and 0.5 SD lower trabecular density than men (p < 0.05). In women, Asians had 0.8 SD lower porosity and 0.3 SD higher trabecular density than Caucasians (p < 0.01). In men, Asians and Caucasians had similar porosity and trabecular density. Results were similar using an adjusted fixed ROI. Adjusting for secular effects of age on forearm length resulted in the age-related increment in porosity increasing from 2.08 SD to 2.48 SD (p < 0.05).

Conclusion: Assessment of sex, race and age related differences in microstructure requires measurement of anatomically equivalent regions.

Keywords: Age; Cortical porosity; HR-pQCT; Microstructure; Race; Site variation; Sex

Links

DOI: 10.1016/j.bone.2017.05.010

PubMed: 28502884

History

Received: 2016-11-27

Revised: 2017-04-29

Accepted: 2017-05-10

Online: 2017-05-11

Cited Works (8)

Year	Entry
2008	Vico L, Zouch M, Amirouche A, Frère D, Laroche N, Koller B, Laib A, Thomas T, Alexandre C. High‐resolution pQCT analysis at the distal radius and tibia discriminates patients with recent wrist and femoral neck fractures. J Bone Miner Res. November 2008;23(11):1741-1750.
2008	Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, Felsenberg D, Ito M, Prevrhal S, Hans DB, Lewiecki EM. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD official positions. J Clin Densitom. January–March 2008;11(1):123-162.
2002	Currey JD. Bones: Structure and Mechanics. Princeton, NJ: Princeton University Press; 2002.
2008	Boyd SK. Site-specific variation of bone micro-architecture in the distal radius and tibia. J Clin Densitom. July–September 2008;11(3):424-430.
2014	Bala Y, Zebaze R, Ghasem-Zadeh A, Atkinson EJ, Iuliano S, Peterson JM, Amin S, Bjørnerem Å, Melton LJ III, Johansson H, Kanis JA, Khosla S, Seeman E. Cortical porosity identifies women with osteopenia at increased risk for forearm fractures. J Bone Miner Res. June 2014;29(6):1356-1362.
2006	Seeman E, Delmas PD. Bone quality: the material and structural basis of bone strength and fragility. NEJM. May 25, 2006;354(21):2250-2261.
2013	Zebaze R, Ghasem-Zadeh A, Mbala A, Seeman E. A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone. May 2013;54(1):8-20.
2008	Riggs BL, Melton LJ, Robb RA, Camp JJ, Atkinson EJ, McDaniel L, Amin S, Rouleau PA, Khosla S. A population‐based assessment of rates of bone loss at multiple skeletal sites: evidence for substantial trabecular bone loss in young adult women and men. J Bone Miner Res. February 2008;23(2):205-214.

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2021	Ghasem-Zadeh A, Galea MP, Nunn A, Panisset M, Wang X-F, Iuliano S, Boyd SK, Forwood MR, Seeman E. Heterogeneity in microstructural deterioration following spinal cord injury. Bone. January 2021;142:115778.
2021	Mikolajewicz N, Zimmermann EA, Rummler M, Hosseinitabatabaei S, Julien C, Glorieux FH, Rauch F, Willie BM. Multisite longitudinal calibration of HR-pQCT scanners and precision in osteogenesis imperfecta. Bone. June 2021;147:115880.
2021	Okazaki N, Chiba K, Burghardt AJ, Kondo C, Doi M, Yokota K, Yonekura A, Tomita M, Osaki M. Differences in bone mineral density and morphometry measurements by fixed versus relative offset methods in high-resolution peripheral quantitative computed tomography. Bone. August 2021;149:115973.
2022	Hu YJ, Chines A, Shi Y, Seeman E, Guo XE. The effect of denosumab and alendronate on trabecular plate and rod microstructure at the distal tibia and radius: a post-hoc HR-pQCT study. Bone. January 2022;154:116187.
2022	Simon M, Indermaur M, Schenk D, Hosseinitabatabaei S, Willie BM, Zysset P. Fabric-elasticity relationships of tibial trabecular bone are similar in osteogenesis imperfecta and healthy individuals. Bone. February 2022;155:116282.
2019	Zebaze R, Atkinson EJ, Peng Y, Bui M, Ghasem‐Zadeh A, Khosla S, Seeman E. Increased cortical porosity and reduced trabecular density are not necessarily synonymous with bone loss and microstructural deterioration. JMBR Plus. July 2019;3(4):e10078.
2020	Chapurlat R, Bui M, Sornay‐Rendu E, Zebaze R, Delmas PD, Liew D, Lespessailles E, Seeman E. Deterioration of cortical and trabecular microstructure identifies women with osteopenia or normal bone mineral density at imminent and long‐term risk for fragility fracture: a prospective study. J Bone Miner Res. May 2020;35(5):833-844.
2020	Wang W, Nie M, Jiang Y, Li M, Meng X, Xing X, Wang O, Xia W. Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism. Osteoporos Int. January 2020;31(1):165-173.
2020	Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int. September 2020;31(9):1607-1627.
2019	Ó Breasail M. The Quantification of Pregnancy-Induced Bone Mineral Mobilisation in the Maternal Appendicular Skeleton With Novel Peripheral Quantitative Computed Tomography (pQCT) Techniques [PhD thesis]. Cambridge, UK: University of Cambridge; 2019.
2018	Metcalf LM. HR-PQCT Scanning of the Human Calcaneus: Early Development and Validation of Assessment of Calcaneal Trabecular Microstructure [PhD thesis]. University of Sheffield; March 2018.