Reduced trabecular bone mineral density and thinner cortices in men with distal forearm fractures

Tuck, Stephen P.<sup>1,2</sup>; Hanusch, Birgit<sup>1,2</sup>; Prediger, Michael<sup>1,3</sup>; Walker, Julie A.<sup>2</sup>; McNally, Richard<sup>4</sup>; Datta, Harish K.<sup>1,2</sup>

Affiliations

¹Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK

²James Cook University Hospital, Middlesbrough, UK

³Blood Sciences, Royal Victoria Infirmary, Newcastle upon Tyne, UK

⁴Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK

Abstract and keywords

Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of the study was to investigate the structural determinants of these observations using quantitative CT (qCT). Ninety six men with low-trauma distal forearm fracture and 101 age-matched healthy control subjects were recruited. All subjects underwent a quantitative CT on a standard 64-slice whole body CT scanner. These were analysed on Mindways QCT PRO™ Software to generate volumetric and geometric data at the lumbar spine, femoral neck and total hip, ultra-distal and distal 33 % radius. Biochemical investigations, health questionnaires and measurements of bone turnover were made. Men with fracture had significantly lower total and trabecular vBMD at all sites. The greatest percentage reduction was at the ultra-distal radius (13.5 % total and 11.7 % trabecular vBMD). In the fracture group cortical vBMD was significantly higher in the femoral neck (p < 0.001) and maintained at the ultra-distal radius compared with control subjects. However, cortical cross-sectional area (CSA) and thickness were significantly reduced at the femoral neck (p < 0.001 and p = 0.002 respectively) and forearm sites (CSA ultradistal radius p = 0.001, cortical thickness p = 0.002, CSA distal one third radius p = 0.045 and cortical thickness p = 0.005). Cross sectional moment of inertia (CSMI) and section moduli were significantly reduced at the femoral neck (CSMI1 p = 0.002, CSMI2 p = 0.012 and section moduli Z1 p < 0.001, Z2 p = 0.004) and the ultra-distal radius (CSMI1 p = 0.008 and section moduli Z1 p = 0.018, Z2 p = 0.007). In stepwise logistic regression analysis distal forearm fracture showed the strongest association with a model comprising ultra-distal forearm trabecular vBMD (negative), procollagen type I N-terminal propeptide (PINP, positive) and sex hormone binding globulin (SHBG, negative). In conclusion, these observations explain the structural reasons for the increased fracture risk in men with distal forearm fractures.

Keywords: Volumetric bone density; Forearm fracture; Male osteoporosis; Biochemical markers

Links

DOI: 10.1016/j.bone.2022.116513

PubMed: 35944891

WoS: 000840839500002

History

Received: 2021-07-9

Revised: 2022-06-29

Accepted: 2022-08-2

Online: 2022-08-6

Cited Works (11)

Year	Entry
2021	Fuggle NR, Westbury LD, Bevilacqua G, Titcombe P, Ó. Breasail M, Harvey NC, Dennison EM, Cooper C, Ward KA. Level and change in bone microarchitectural parameters and their relationship with previous fracture and established bone mineral density loci. Bone. June 2021;147:115937.
1999	Cuddihy M-T, Gabriel SE, Crowson CS, O’Fallon WM, Melton LJ III. Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int. June 1999;9(6):469-475.
2001	van Staa TP, Dennison EM, Leufkens HGM, Cooper C. Epidemiology of fractures in England and Wales. Bone. January 2001;29(6):517-522.
2011	Szulc P, Boutroy S, Vilayphiou N, Chaitou A, Delmas PD, Chapurlat R. Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: the STRAMBO study. J Bone Miner Res. June 2011;26(6):1358-1367.
2011	Morin S, Lix LM, Azimaee M, Metge C, Caetano P, Leslie WD. Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int. September 2011;22(9):2439-2448.
1999	Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. March 13, 1999;353(9156):878-882.
2001	Seeman E. Sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab. October 2001;86(10):4576-4584.
2011	Sheu Y, Zmuda JM, Boudreau RM, Petit MA, Ensrud KE, Bauer DC, Gordon CL, Orwoll ES, Cauley JA; Osteoporotic Fractures in Men (MrOS) Research Group. Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. January 2011;26(1):63-71.
2018	Langsetmo L, Peters KW, Burghardt AJ, Ensrud KE, Fink HA, Cawthon PM, Cauley JA, Schousboe JT, Barrett-Connor E, Orwoll ES; Osteoporotic Fractures in Men (MrOS) Study Research Group. Volumetric bone mineral density and failure load of distal limbs predict incident clinical fracture independent of FRAX and clinical risk factors among older men. J Bone Miner Res. July 2018;33(7):1302-1311.
2007	Melton LJ, Riggs BL, van Lenthe GH, Achenbach SJ, Müller R, Bouxsein ML, Amin S, Atkinson EJ, Khosla S. Contribution of in vivo structural measurements and load/strength ratios to the determination of forearm fracture risk in postmenopausal women. J Bone Miner Res. September 2007;22(9):1442-1448.
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.