Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women

Jaiswal, Raju<sup>1,*</sup>; Zoulakis, Michail<sup>1,2,*</sup>; Axelsson, Kristian F.<sup>1,3</sup>; Darelid, Anna<sup>1</sup>; Rudäng, Robert<sup>1</sup>; Sundh, Daniel<sup>1</sup>; Litsne, Henrik<sup>1</sup>; Johansson, Lisa<sup>1,4</sup>; Lorentzon, Mattias<sup>1,2,5</sup>

Affiliations

¹Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden

²Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden

³Region Västra Götaland, Närhälsan Norrmalm, Health Centre, Skövde, Sweden

⁴Region Västra Götaland, Department of Orthopedic Surgery, Sahlgrenska University Hospital, Mölndal, Sweden

⁵Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

Abstract and keywords

No previous studies have investigated the association between the bone material strength index (BMSi; an indicator of bone material properties obtained by microindentation) and the risk of incident fracture. The primary purpose of this prospective cohort study was to evaluate if BMSi is associated with incident osteoporotic fracture in older women and, secondarily, with prevalent fractures, anthropometric traits, or measurements of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA). In a population-based cohort, 647 women aged 75 to 80 years underwent bone microindentation using the OsteoProbe device. Data on clinical risk factors (CRFs), prevalent fractures, and incident fractures were collected using questionnaires, medical records, and a regional X-ray archive. BMD and vertebral fracture assessment (VFA) were assessed by DXA (Hologic, Discovery A). Associations between BMSi, anthropometrics, BMD, and prevalent fractures were investigated using correlation and linear and logistic regression. Cox proportional hazards and competing risks analysis by Fine and Gray were used to study the association between BMSi and the risk of fracture and mortality. BMSi was weakly associated with age (r = −0.13, p < 0.001) and BMI (r = −0.21, p < 0.001) and with BMD of lumbar spine (β = 0.09, p = 0.02) and total hip (β = 0.08, p = 0.05), but only after adjustments. No significant associations were found between BMSi and prevalent fractures (self-reported and/or VFA identified, n = 332). During a median follow-up time of 6.0 years, 121 major osteoporotic fractures (MOF), 151 any fractures, and 50 deaths occurred. Increasing BMSi (per SD) was associated with increased risk of MOF (hazard ratio [HR] = 1.29, 95% confidence interval [CI] 1.07–1.56), any fracture (HR = 1.29, 95% CI 1.09–1.53), and mortality (HR = 1.44, 95% CI 1.07–1.93). The risk of fracture did not materially change with adjustment for confounders, CRFs, femoral neck BMD, or when considering the competing risk of death. In conclusion, unexpectedly increasing BMSi was associated with greater fracture risk. The clinical relevance and potential mechanisms of this finding require further study.

Keywords: OSTEOPOROSIS; BONE MICROINDENTATION; DXA; FRACTURE RISK ASSESSMENT

Links

DOI: 10.1002/jbmr.4816

PubMed: 37088885

History

Received: 2022-12-13

Revised: 2023-04-04

Accepted: 2023-04-16

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Cited By (2)

Year	Entry
2023	Diez-Perez A, Cordomí CT, Eriksen EF, Pasco JA. Increased BMSi association with risk of incident osteoporotic fractures. J Bone Miner Res. October 2023;38(10):1541-1542.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Sundh D, Litsne H, Johansson L, Lorentzon M. Reply to the submitted comment regarding our publication "Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women". J Bone Miner Res. October 2023;38(10):1543-1544.