Predicting the failure load of the distal radius

The distal radius is an important site for the early detection of patients at risk for fracture. Since measuring bone strength in vivo is not possible, we evaluated which bone assessment method of the forearm would best predict failure load of the distal radius and computed a factor of risk for wrist fracture (Φ_wrist). Thirty-eight cadaveric forearm specimens were measured by five different techniques to assess bone density, bone mineral content, geometry and trabecular structure at the distal forearm. The bone assessment techniques included dual-energy X-ray absorptiometry (DXA) of the radius, peripheral quantitative computed tomography (pQCT) of the 4% and 20% distal sites of the radius, DXA of the phalanges, digital X-ray radiogrammetry of the forearm (DXR-BMD), and quantitative ultrasound of the radius. The failure load of each excised radius was determined by simulating a fall on an outstretched hand. The pQCT measurements of polar stress-strain index and cortical content explained the greatest portion of variance in failure load (r ²=0.82–0.85). Bone mineral content measures were generally better predictors of failure load (r ²=0.53–0.85) than the corresponding volumetric or areal bone mineral density values (r ²=0.22–0.69) measured by either pQCT or DXA. Multiple regression analysis showed that the addition of a bone geometry measure improved the ability of a bone density measure alone to predict failure load. There was high variability in the ability of different techniques and different variables within a given technique to predict failure load. Estimates of the factor of risk for wrist fracture (Φ_wrist) revealed that the women in this study would have been likely to fracture their distal radius upon falling from a standing height (Φ_wrist=1.04), whereas the men would have likely withstood the impact without fracturing their wrist (Φ_wrist=0.79).