Discriminating value of HR-pQCT for fractures in women with similar FRAX scores:​ a substudy of the FRISBEE cohort

Cappelle, S.I.; Moreau, M.; Karmali, R.; Iconaru, L.; Baleanu, F.; Kinnard, V.; Paesmans, M.; Rozenberg, S.; Rubinstein, M.; Surquin, M.; Blard, P.-H.; Chapurlat, R.; Body, J. J.; Bergmann, P.

Affiliations

¹Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium

²Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

³Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium

⁴Department of Obstetrics and gynaecology, Université Libre de Bruxelles (ULB) and Vrije Universiteit (VUB), Brussels, Belgium

⁵Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium

⁶CNRS, Université de Lorraine, CRPG, F-54000 Nancy, France

⁷INSERM Research Unit 1033-Lyos, Hôpital E. Herriot, Lyon, France

⁸Department of Nuclear Medicine, CHU–Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium

Abstract and keywords

Areal bone mineral density (aBMD) has a low sensitivity to identify women at high fracture risk. The FRAX algorithm, by combining several clinical risk factors, might improve fracture prediction compared to aBMD alone. Several micro-architectural and biomechanical parameters which can be measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with fracture risk. HR-pQCT in combination or not with finite element analysis (FEA) may be used to improve bone strength prediction.

Our aim was to assess whether HR-pQCT measurements (densities, cortical and trabecular microarchitecture, biomechanical proprieties assessed by FEA) had an added value in predicting fractures in a subgroup of women belonging to the Belgian FRISBEE cohort. One hundred nineteen women who sustained a fracture (aged 60 to 85 years) during the initial follow-up of our cohort had a radius and tibia examination by HR-pQCT and were compared with controls matched for their FRAX score at baseline. We found that low distal radius total (OR = 1.41 [1.07–1.86] per SD, p < 0.05) and trabecular densities (OR = 1.45 [1.10–1.90], p < 0.01), trabecular number (OR = 1.32 [1.01–1.72], p < 0.05), intra individual distribution of separation (OR = 0.73 [0.54–0.99], p < 0.05) as several FEA parameters were significantly associated with fractures. At the distal tibia, impaired cortical density (OR = 1.32 [1.03–1.70] per SD, p < 0.05) and thickness (OR = 1.29 [1.01–1.63], p < 0.05) and apparent modulus (OR = 1.30 [1.01–1.66], p < 0.05) were significantly correlated with fractures. A low ultra distal radial aBMD (UDR) measured at the time of HR-pQCT was significantly associated with fractures (OR = 1.67 [1.22–2.28], p < 0.01). Women from both groups were followed further after the realization of the HR-pQCT and 46 new fractures were registered. In this second part of the study, low UDR aBMD (OR = 1.66 [1.18–2.35], p < 0.01), total (OR = 1.48 [1.08–2.03], p < 0.05), cortical (OR = 1.40 [1.04–1.87], p < 0.05) and trabecular (OR = 1.37 [1.01–1.85], p < 0.05) densities or apparent modulus (OR = 1.49 [1.07–2.05], p < 0.05) at the radius were associated with a significant increase of fracture risk. At the tibia, only the cortical density was significantly associated with the fracture risk (OR = 1.34 [1.02–2.76], p < 0.05). These results confirm the interest of HR-pQCT measurements for the evaluation of fracture risk, also in women matched for their baseline FRAX score. They also highlight that UDR aBMD contains pertinent information.

Keywords: Osteoporosis; Fracture prediction; HR-pQCT; FRISBEE; FRAX; UDR aBMD

Links

DOI: 10.1016/j.bone.2020.115613

PubMed: 32871273

WoS: 000604733200010

History

Received: 2020-04-6

Revised: 2020-08-21

Accepted: 2020-08-21

Online: 2020-08-29

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Cited By (2)

Year	Entry
2022	Uppuganti S, Ketsiri T, Zhang Y, Does MD, Nyman JS. HR-pQCT parameters of the distal radius correlate with the bending strength of the radial diaphysis. Bone. August 2022;161:116429.
2021	Whittier DEW. The Assessment of Fragility Fracture Risk Using HR-PQCT as a Novel Tool for Diagnosis of Osteoporosis [PhD thesis]. Calgary, AB: University of Calgary; August 2021.