High cortico-trabecular transitional zone porosity and reduced trabecular density in men and women with stress fractures

Zendeli, Afrodite; Bui, Minh; Fischer, Lukas; Ghasem-Zadeh, Ali; Schima, Wolfgang; Seeman, Ego

Affiliations

¹Medical Department of Internal Medicine, Rheumatology and Endocrinology at Krankenhaus Herz Jesu, 1030 Vienna, Austria

²Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3000, Australia

³Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria

⁴Software Competence Center Hagenberg GmbH (SCCH), 4232 Hagenberg, Austria

⁵Departments Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne 3084, Australia

⁶Department of Diagnostic and Interventional Radiology–Barmherzige Schwestern Krankenhaus, Goettlicher Heiland Krankenhaus und Sankt Josef Krankenhaus, 1060 Vienna, Austria

Abstract and keywords

To determine whether stress fractures are associated with bone microstructural deterio- ration we quantified distal radial and the unfractured distal tibia using high resolution peripheral quantitative computed tomography in 26 cases with lower limb stress fractures (15 males, 11 females; mean age 37.1 ± 3.1 years) and 62 age-matched healthy controls (24 males, 38 females; mean age 35.0 ± 1.6 years). Relative to controls, in men, at the distal radius, cases had smaller cortical cross sectional area (CSA) (p = 0.012), higher porosity of the outer transitional zone (OTZ) (p = 0.006), inner transitional zone (ITZ) (p = 0.043) and the compact-appearing cortex (CC) (p = 0.023) while trabecular vBMD was lower (p = 0.002). At the distal tibia, cases also had a smaller cortical CSA (p = 0.008). Cortical porosity was not higher, but trabecular vBMD was lower (p = 0.001). Relative to controls, in women, cases had higher distal radial porosity of the OTZ (p = 0.028), ITZ (p = 0.030) not CC (p = 0.054). Trabecular vBMD was lower (p = 0.041). Distal tibial porosity was higher in the OTZ (p = 0.035), ITZ (p = 0.009), not CC. Stress fractures are associated with compromised cortical and trabecular microstructure.

Keywords: bone microstructural deterioration; cortical porosity; high resolution peripheral quantitative computed tomography; stress fracture

Links

DOI: 10.3390/jcm10051123

WoS: 000628277800001

History

Received: 2021-02-09

Revised: 2021-02-23

Accepted: 2021-03-01

Online: 2021-03-08

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