The online version of this article (https://doi.org/10.1007/s00223-019-00564-7) contains supplementary material, which is available to authorized users.
Leo D. Westbury and Clare Shere have contributed equally to the manuscript.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
High-resolution peripheral quantitative computed tomography (HRpQCT) is increasingly used for exploring associations between bone microarchitectural and finite element analysis (FEA) parameters and fracture. We hypothesised that combining bone microarchitectural parameters, geometry, BMD and FEA estimates of bone strength from HRpQCT may improve discrimination of fragility fractures. The analysis sample comprised of 359 participants (aged 72–81 years) from the Hertfordshire Cohort Study. Fracture history was determined by self-report and vertebral fracture assessment. Participants underwent HRpQCT scans of the distal radius and DXA scans of the proximal femur and lateral spine. Poisson regression with robust variance estimation was used to derive relative risks for the relationship between individual bone microarchitectural and FEA parameters and previous fracture. Cluster analysis of these parameters was then performed to identify phenotypes associated with fracture prevalence. Receiver operating characteristic analysis suggested that bone microarchitectural parameters improved fracture discrimination compared to aBMD alone, whereas further inclusion of FEA parameters resulted in minimal improvements. Cluster analysis (k-means) identified four clusters. The first had lower Young modulus, cortical thickness, cortical volumetric density and Von Mises stresses compared to the wider sample; fracture rates were only significantly greater among women (relative risk [95%CI] compared to lowest risk cluster: 2.55 [1.28, 5.07], p = 0.008). The second cluster in women had greater trabecular separation, lower trabecular volumetric density and lower trabecular load with an increase in fracture rate compared to lowest risk cluster (1.93 [0.98, 3.78], p = 0.057). These findings may help inform intervention strategies for the prevention and management of osteoporosis.
Supplementary material 1 (DOCX 15 kb)223_2019_564_MOESM1_ESM.docx
Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, Burckhardt P, Cooper C, Christiansen C, Cummings S, Eisman JA, Fujiwara S, Gluer C, Goltzman D, Hans D, Krieg MA, La Croix A, McCloskey E, Mellstrom D, Melton LJ 3rd, Pols H, Reeve J, Sanders K, Schott AM, Silman A, Torgerson D, van Staa T, Watts NB, Yoshimura N (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18(8):1033–1046. https://doi.org/10.1007/s00198-007-0343-y CrossRefPubMed
Jiang X, Gruner M, Tremollieres F, Pluskiewicz W, Sornay-Rendu E, Adamczyk P, Schnatz PF (2017) Diagnostic accuracy of FRAX in predicting the 10-year risk of osteoporotic fractures using the USA treatment thresholds: a systematic review and meta-analysis. Bone 99:20–25. https://doi.org/10.1016/j.bone.2017.02.008 CrossRefPubMed
Fink HA, Langsetmo L, Vo TN, Orwoll ES, Schousboe JT, Ensrud KE (2018) Association of high-resolution peripheral quantitative computed tomography (HR-pQCT) bone microarchitectural parameters with previous clinical fracture in older men: the osteoporotic fractures in men (MrOS) study. Bone 113:49–56. https://doi.org/10.1016/j.bone.2018.05.005 CrossRefPubMedPubMedCentral
Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD (2007) Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res 22(3):425–433. https://doi.org/10.1359/jbmr.061206 CrossRefPubMed
Boutroy S, Khosla S, Sornay-Rendu E, Zanchetta MB, McMahon DJ, Zhang CA, Chapurlat RD, Zanchetta J, Stein EM, Bogado C, Majumdar S, Burghardt AJ, Shane E (2016) Microarchitecture and peripheral BMD are impaired in postmenopausal white women with fracture independently of total hip T-Score: an International Multicenter Study. J Bone Miner Res 31(6):1158–1166. https://doi.org/10.1002/jbmr.2796 CrossRefPubMedPubMedCentral
Edwards M, Robinson D, Ward K, Javaid M, Walker-Bone K, Cooper C, Dennison E (2016) Cluster analysis of bone microarchitecture from high resolution peripheral quantitative computed tomography demonstrates two separate phenotypes associated with high fracture risk in men and women. Bone 88:131–137 CrossRefPubMedPubMedCentral
Office of Population Censuses and Surveys (1990) Standard occupational classification, Vol 1 Structure and definition of major, minor and unit groups. HMSO. London
Laib A, Hauselmann HJ, Ruegsegger P (1998) In vivo high resolution 3D-QCT of the human forearm. Technol Health Care 6(5–6):329–337 PubMed
Seeman E (2002) Pathogenesis of bone fragility in women and men. Lancet 359(9320):1841–1850. https://doi.org/10.1016/s0140-6736(02)08706-8 CrossRefPubMed
Langsetmo L, Peters KW, Burghardt AJ, Ensrud KE, Fink HA, Cawthon PM, Cauley JA, Schousboe JT, Barrett-Connor E, Orwoll ES (2018) Volumetric bone mineral density and failure load of distal limbs predict incident clinical fracture independent HR-pQCT BMD and failure load predicts incident clinical fracture of FRAX and clinical risk factors among older men. J Bone Miner Res 33(7):1302–1311. https://doi.org/10.1002/jbmr.3433 CrossRefPubMedPubMedCentral
Szulc P, Boutroy S, Chapurlat R (2018) Prediction of fractures in men using bone microarchitectural parameters assessed by high-resolution peripheral quantitative computed tomography-the prospective STRAMBO Study. J Bone Miner Res 33(8):1470–1479. https://doi.org/10.1002/jbmr.3451 CrossRefPubMed
- Cluster Analysis of Finite Element Analysis and Bone Microarchitectural Parameters Identifies Phenotypes with High Fracture Risk
Leo D. Westbury
Mark H. Edwards
Elaine M. Dennison
Kate A. Ward
- Springer US
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
e.Med Kampagnen-Visual, Mail Icon II