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

Stuck, A. K.; Schenk, D.; Zysset, P.; Bütikofer, L.; Mathis, A.; Lippuner, K.

Affiliations

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

²ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland

³CTU Bern, University of Bern, Bern, Switzerland

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

Abstract and keywords

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

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

Links

DOI: 10.1007/s00198-020-05405-0

PubMed: 32451557

WoS: 000535432000001

History

Received: 2019-11-05

Accepted: 2020-03-27

Online: 2020-05-25

Cited Works (16)

Year	Entry
2006	Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, .Peterson JM, Melton LJ III. Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res. January 2006;21(1):124-131.
2017	Bonaretti S, Majumdar S, Lang TF, Khosla S, Burghardt AJ. The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int. July 2017;28(7):2115-2128.
2016	Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK. Sex‐ and site‐specific normative data curves for HR‐pQCT. J Bone Miner Res. November 2016;31(11):2041-2047.
2012	Pauchard Y, Liphardt A-M, Macdonald HM, Hanley DA, Boyd SK. Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone. June 2012;50(6):1304-1310.
2009	Mueller TL, van Lenthe GH, Stauber M, Gratzke C, Eckstein F, Müller R. 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. November 2009;45(5):882-891.
2003	Stone KL, Seeley DG, Lui L-Y, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR; The Study of Osteoporotic Fractures research group. BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res. November 2003;18(11):1947-1954.
2008	MacNeil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. June 2008;42(6):1203-1213.
2011	Macdonald HM, Nishiyama KK, Kang J, Hanley DA, Boyd SK. Age‐related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population‐based HT‐pQCT study. J Bone Miner Res. January 2011;26(1):50-62.
2001	Seeman E. Sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab. October 2001;86(10):4576-4584.
2010	Stein EM, Liu XS, Nickolas TL, Cohen A, Thomas V, McMahon DJ, Zhang C, Yin PT, Cosman F, Nieves J, Guo XE, Shane E. Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res. December 2010;25(12):2572-2581.
2009	Dalzell N, Kaptoge S, Morris N, Berthier A, Koller B, Braak L, van Rietbergen B, Reeve J. 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. October 2009;20(10):1683-1694.
2010	Sode M, Burghardt AJ, Kazakia GJ, Link TM, Majumdar S. Regional variations of gender-specific and age-related differences in trabecular bone structure of the distal radius and tibia. Bone. June 2010;46(6):1652-1660.
2013	Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK. Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int. May 2013;24(5):1733-1740.
2014	Hansen S, Shanbhogue V, Folkestad L, Nielsen MMF, Brixen K. 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 Tiss Int. March 2014;94(3):269-281.
2010	Varga P, Pahr DH, Baumbach S, Zysset PK. HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles' fracture load in vitro. Bone. November 2010;47(5):982-988.
2019	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 C-T, 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. 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. January 2019;7(1):34-43.

Cited By (3)

Year	Entry
2021	Hunter RL, Haverfield Z, Agnew AM. Investigation of sex-specific effects on variation in cortical bone morphometrics of the radius. In: Proceedings of the 2021 International IRCOBI Conference on the Biomechanics of Injury. September 8-10, 2021; Online.268-307.
2020	Schenk D, Mathis A, Lippuner K, Zysset P. In vivo repeatability of homogenized finite element analysis based on multiple HR-pQCT sections for assessment of distal radius and tibia strength. Bone. December 2020;141:115575.
2021	Du J, Hartley C, Brooke-Wavell K, Paggiosi MA, Walsh JS, Li S, Silberschmidt VV. High-impact exercise stimulated localised adaptation of microarchitecture across distal tibia in postmenopausal women. Osteoporos Int. May 2021;32(5):907-919.