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Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk, Independent of FRAX, Falls and BMD : A Meta-Analysis in the Osteoporotic Fractures in Men (MrOS) Study

Harvey, Nicholas C. ; Orwoll, Eric ; Cauley, Jane A. ; Kwok, Timothy ; Karlsson, Magnus K. LU ; Rosengren, Björn E. LU ; Ribom, Eva ; Cawthon, Peggy M. ; Ensrud, Kristine and Liu, Enwu , et al. (2022) In JBMR Plus 6(12).
Abstract

We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as... (More)

We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72–1.0 and 0.78; 95% CI, 0.66–0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88–1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59–0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk.

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type
Contribution to journal
publication status
published
subject
keywords
EPIDEMIOLOGY, FRACTURE, FRAX, OSTEOPOROSIS, PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY, PQCT, SARCOPENIA
in
JBMR Plus
volume
6
issue
12
article number
e10696
publisher
Wiley-Blackwell
external identifiers
  • scopus:85142376136
  • pmid:36530188
ISSN
2473-4039
DOI
10.1002/jbm4.10696
language
English
LU publication?
yes
id
43291e8a-0b25-46b2-97bc-94687cbec80f
date added to LUP
2023-01-20 12:02:50
date last changed
2024-06-13 23:23:29
@article{43291e8a-0b25-46b2-97bc-94687cbec80f,
  abstract     = {{<p>We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72–1.0 and 0.78; 95% CI, 0.66–0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88–1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59–0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk.</p>}},
  author       = {{Harvey, Nicholas C. and Orwoll, Eric and Cauley, Jane A. and Kwok, Timothy and Karlsson, Magnus K. and Rosengren, Björn E. and Ribom, Eva and Cawthon, Peggy M. and Ensrud, Kristine and Liu, Enwu and Laskou, Faidra and Ward, Kate A. and Dennison, Elaine M. and Cooper, Cyrus and Kanis, John A. and Vandenput, Liesbeth and Lorentzon, Mattias and Ohlsson, Claes and Mellström, Dan and Johansson, Helena and McCloskey, Eugene}},
  issn         = {{2473-4039}},
  keywords     = {{EPIDEMIOLOGY; FRACTURE; FRAX; OSTEOPOROSIS; PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY; PQCT; SARCOPENIA}},
  language     = {{eng}},
  number       = {{12}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{JBMR Plus}},
  title        = {{Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk, Independent of FRAX, Falls and BMD : A Meta-Analysis in the Osteoporotic Fractures in Men (MrOS) Study}},
  url          = {{http://dx.doi.org/10.1002/jbm4.10696}},
  doi          = {{10.1002/jbm4.10696}},
  volume       = {{6}},
  year         = {{2022}},
}