Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures:​ a cross-sectional sub-study of NoFRACT

Borgen, T. T.; Bjørnerem, Å.; Solberg, L. B.; Andreasen, C.; Brunborg, C.; Stenbro, M.-B.; Hübschle, L. M.; Figved, W.; Apalset, E. M.; Gjertsen, J.-E.; Basso, T.; Lund, I.; Hansen, A. K.; Stutzer, J.-M.; Dahl, C.; Nordsletten, L.; Frihagen, F.; Eriksen, E. F.

Affiliations

¹Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway

²Department of Clinical Medicine, University of Oslo, Oslo, Norway

³Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway

⁴Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway

⁵Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway

⁶Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway

⁷Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway

⁸Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway

⁹Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway

¹⁰Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway

¹¹Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

¹²Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway

¹³Department of Clinical Medicine, University of Bergen, Bergen, Norway

¹⁴Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway

¹⁵Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway

¹⁶Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway

¹⁷Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway

Abstract and keywords

Summary: Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1–SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1–SQ3 fractures. SQ1–SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS.

Introduction: Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1–SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1–SQ3 fractures.

Methods: This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1–SQ3 fracture assessed.

Results: Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1–SQ3 fractures. In multiple variable analysis, higher age (β_{per SD} = − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (β_{per SD} = 0.34, 95% CI 0.25–0.43) and lumbar spine (β_{per SD} = 0.40, 95% CI 0.31–0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (OR_{per SD} = 1.94, 95% CI 1.51–2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09–2.71) were positively associated with SQ1–SQ3 fractures, while lumbar spine BMD (OR_{per SD} = 0.75 95% CI 0.60–0.95) was negatively associated with SQ1–SQ3 fractures. No association between TBS and SQ1–SQ3 fractures was found.

Conclusion: Since TBS and SQ1–SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

Keywords: Bone mineral density; Fracture risk; Osteoporosis; Trabecular bone score; Vertebral fracture assessment; Vertebral fractures

Links

DOI: 10.1007/s00198-019-05215-z

PubMed: 31754755

WoS: 000497859100003

History

Received: 2019-09-05

Accepted: 2019-10-28

Online: 2019-11-21

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