TY - JOUR
T1 - Assessing forearm fracture risk in postmenopausal women
AU - Melton, L. J.
AU - Christen, D.
AU - Riggs, B. L.
AU - Achenbach, S. J.
AU - Müller, R.
AU - Van Lenthe, G. H.
AU - Amin, S.
AU - Atkinson, E. J.
AU - Khosla, S.
N1 - Funding Information:
This work was supported by research grants R01-AR027065 and UL1-RR024150 (Center for Translational Science Activities) from the National Institutes of Health, U.S. Public Health Service. Supercomputer time was granted by the Swiss National Supercomputing Centre.
PY - 2010/7
Y1 - 2010/7
N2 - Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.
AB - Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.
KW - Bone density
KW - Bone quality
KW - Colles' fracture
KW - Epidemiology
KW - Risk assessment
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U2 - 10.1007/s00198-009-1047-2
DO - 10.1007/s00198-009-1047-2
M3 - Article
C2 - 19714390
AN - SCOPUS:78649563885
SN - 0937-941X
VL - 21
SP - 1161
EP - 1169
JO - Osteoporosis International
JF - Osteoporosis International
IS - 7
ER -