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Cortical bone area predicts incident fractures independently of areal bone mineral density in older men

Ohlsson, Claes; Sundh, Daniel; Wallerek, Andreas; Nilsson, Martin; Karlsson, Magnus LU ; Johansson, Helena; Mellström, Dan and Lorentzon, Mattias (2017) In Journal of Clinical Endocrinology and Metabolism 102(2). p.516-524
Abstract

Context: Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not discriminate between trabecular and cortical bone assessment. Objective: This study aimed to investigate whether information on cortical and trabecular bone predict fracture risk independently of aBMD and clinical risk factors. Design and Participants: Cortical area, bonemass, porosity, and trabecular bone volume fraction (BVTV) were measured at the tibia using high-resolution peripheral quantitative computed tomography (HRpQCT) in 456 men (80.2 ± 3.5 years) recruited from the general population in Gothenburg, Sweden. ABMD was measured using DXA. Incident fractures (71 men) were X-ray... (More)

Context: Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not discriminate between trabecular and cortical bone assessment. Objective: This study aimed to investigate whether information on cortical and trabecular bone predict fracture risk independently of aBMD and clinical risk factors. Design and Participants: Cortical area, bonemass, porosity, and trabecular bone volume fraction (BVTV) were measured at the tibia using high-resolution peripheral quantitative computed tomography (HRpQCT) in 456 men (80.2 ± 3.5 years) recruited from the general population in Gothenburg, Sweden. ABMD was measured using DXA. Incident fractures (71 men) were X-ray verified. Associations were evaluated using Cox regression. Results: Cortical area [hazard ratio (HR) per standard deviation (SD) decrease, 2.05; 95% confidence interval (CI), 1.58 to 2.65], cortical bone mass (HR, 2.07; 95% CI, 1.58 to 2.70), and BVTV (HR, 1.62; 95% CI, 1.26 to 2.07), but not cortical porosity, were independently associated with fracture risk. These associations remained after adjustment for femoral neck aBMD and Fracture Risk Assessment risk factors (area: HR 1.96, 95% CI, 1.44 to 2.66; mass: HR 1.99, 95% CI, 1.45 to 2.74; BV/TV: HR 1.46, 95% CI, 1.09 to 1.96). After entering BV/TV and cortical area or bone mass simultaneously in the adjusted models, only the cortical parameters remained important predictors of fracture. Conclusion: HR-pQCT measurement of cortical area and mass might add clinically useful information for the evaluation of fracture risk.

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author
organization
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type
Contribution to journal
publication status
published
subject
in
Journal of Clinical Endocrinology and Metabolism
volume
102
issue
2
pages
9 pages
publisher
The Endocrine Society
external identifiers
  • scopus:85012081819
  • wos:000397240900023
ISSN
0021-972X
DOI
10.1210/jc.2016-3177
language
English
LU publication?
yes
id
97dd5c51-1fee-468d-b28d-772baf6fb0c6
date added to LUP
2017-02-28 07:46:40
date last changed
2018-04-22 04:26:57
@article{97dd5c51-1fee-468d-b28d-772baf6fb0c6,
  abstract     = {<p>Context: Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not discriminate between trabecular and cortical bone assessment. Objective: This study aimed to investigate whether information on cortical and trabecular bone predict fracture risk independently of aBMD and clinical risk factors. Design and Participants: Cortical area, bonemass, porosity, and trabecular bone volume fraction (BVTV) were measured at the tibia using high-resolution peripheral quantitative computed tomography (HRpQCT) in 456 men (80.2 ± 3.5 years) recruited from the general population in Gothenburg, Sweden. ABMD was measured using DXA. Incident fractures (71 men) were X-ray verified. Associations were evaluated using Cox regression. Results: Cortical area [hazard ratio (HR) per standard deviation (SD) decrease, 2.05; 95% confidence interval (CI), 1.58 to 2.65], cortical bone mass (HR, 2.07; 95% CI, 1.58 to 2.70), and BVTV (HR, 1.62; 95% CI, 1.26 to 2.07), but not cortical porosity, were independently associated with fracture risk. These associations remained after adjustment for femoral neck aBMD and Fracture Risk Assessment risk factors (area: HR 1.96, 95% CI, 1.44 to 2.66; mass: HR 1.99, 95% CI, 1.45 to 2.74; BV/TV: HR 1.46, 95% CI, 1.09 to 1.96). After entering BV/TV and cortical area or bone mass simultaneously in the adjusted models, only the cortical parameters remained important predictors of fracture. Conclusion: HR-pQCT measurement of cortical area and mass might add clinically useful information for the evaluation of fracture risk.</p>},
  author       = {Ohlsson, Claes and Sundh, Daniel and Wallerek, Andreas and Nilsson, Martin and Karlsson, Magnus and Johansson, Helena and Mellström, Dan and Lorentzon, Mattias},
  issn         = {0021-972X},
  language     = {eng},
  month        = {02},
  number       = {2},
  pages        = {516--524},
  publisher    = {The Endocrine Society},
  series       = {Journal of Clinical Endocrinology and Metabolism},
  title        = {Cortical bone area predicts incident fractures independently of areal bone mineral density in older men},
  url          = {http://dx.doi.org/10.1210/jc.2016-3177},
  volume       = {102},
  year         = {2017},
}