Rapid cortical bone loss at the distal radius is associated with higher risk of fracture in older men:​ the STRAMBO study

Gunsing, Elina; Wagner, Philippe P.; Whittier, Danielle E.; Boyd, Steven K.; Chapurlat, Roland; Szulc, Pawel

Affiliations

¹INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France

²McCaig Institute for Bone and Joint Health, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

Abstract and keywords

Rapid loss of areal bone mineral density (aBMD) is associated with higher fracture risk after adjustment for confounders including initial aBMD. However, the link between bone microarchitecture decline and fracture is not clear. We studied the association between bone microarchitecture deterioration assessed prospectively over 4 years and the subsequent fracture risk in older men. Bone microarchitecture at the distal radius and tibia was assessed by high-resolution peripheral QCT (HR-pQCT; XtremeCT, Scanco Medical) (baseline, 4 years) in 732 men aged 60–87 years. During the 8-year follow-up, 109 men had fragility fractures. Areal BMD was assessed by dual-energy X-ray absorptiometry. After adjustment for age, weight, prior falls and fractures, distal radius aBMD (baseline, slope), and baseline distal radius total volumetric BMD (Tt.BMD), a faster decrease in distal radius Tt.BMD was associated with higher fracture risk (hazard ratio [HR] = 1.54/SD, 95% confidence interval: 1.20–1.95, p < .005). Rapid cortical bone loss was associated with higher fracture risk (cortical thickness: HR = 1.48; 1.15–1.90, p < .01; cortical BMD: HR = 1.38; 1.11–1.72, p < .01). The rate of trabecular bone loss at the distal radius and the rate of bone microarchitecture decline at the distal tibia were not associated with fracture risk. After adjustment for aBMD and distal radius HR-pQCT measures assessed after 4 years, changes in Tt.BMD were associated with higher fracture risk (e.g., Tt.BMD: HR = 1.37; 1.11–1.69, p < .005). Compared with the reference model (age, weight, prior fractures and falls, baseline and slope of aBMD, baseline HR-pQCT value), further addition of the slope of the HR-pQCT measure did not improve the fracture prediction. Thus, rapid cortical bone loss at the distal radius is associated with higher fracture risk in the multivariable models including baseline values of the HR-pQCT measure. However, repeated HR-pQCT measurements did not improve the assessment of the fracture risk in older men (compared with the reference model defined earlier).

Keywords: osteoporosis; HR-pQCT; fracture risk assessment; aging; DXA

Links

DOI: 10.1002/jbmr.4811

PubMed: 36987872

WoS: 000976802700001

History

Received: 2022-10-19

Revised: 2023-03-10

Accepted: 2023-03-25

Cited Works (11)

Year	Entry
2007	Buie HR, Campbell GM, Klinck RJ, MacNeil JA, Boyd SK. Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone. October 2007;41(4):505-515.
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	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.
2004	Pistoia W, van Rietbergen B, Lochmüller E-M, Lill CA, Eckstein F, Rüegsegger P. Image-based micro-finite-element modeling for improved distal radius strength diagnosis: moving from "bench" to "bedside". J Clin Densitom. Summer 2004;7(2):153-160.
2022	Bolger MW, Romanowicz GE, Bigelow EMR, Ward FS, Ciarelli A, Jepsen KJ, Kohn DH. Divergent mechanical properties of older human male femora reveal unique combinations of morphological and compositional traits contributing to low strength. Bone. October 2022;163:116481.
2022	Whittier DE, Samelson EJ, Hannan MT, Burt LA, Hanley DA, Biver E, Szulc P, Sornay-Rendu E, Merle B, Chapurlat R, Lespessailles E, Wong AKO, Goltzman D, Khosla S, Ferrari S, Bouxsein ML, Kiel DP, Boyd SK. Bone microarchitecture phenotypes identified in older adults are associated with different levels of osteoporotic fracture risk. J Bone Miner Res. March 2022;37(3):428-439.
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.
2020	Mikolajewicz N, Bishop N, Burghardt AJ, Folkestad L, Hall A, Kozloff KM, Lukey PT, Molloy‐Bland M, Morin SN, Offiah AC, Shapiro J, van Rietbergen B, Wager K, Willie BM, Komarova SV, Glorieux FH. HR‐pQCT measures of bone microarchitecture predict fracture: systematic review and meta‐analysis. J Bone Miner Res. March 2020;35(3):446-459.
2012	Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S. Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone. January 2012;50(1):111-118.
2020	Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int. September 2020;31(9):1607-1627.
2011	Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: now and the future. Lancet. April 9, 2011;377(9773):1276-1287.