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Erschienen in: Osteoporosis International 10/2020

25.05.2020 | Original Article

Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men

verfasst von: A. K. Stuck, D. Schenk, P. Zysset, L. Bütikofer, A. Mathis, K. Lippuner

Erschienen in: Osteoporosis International | Ausgabe 10/2020

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Abstract

Summary

Reference values for radius and tibia strength using multiple-stack high-resolution peripheral quantitative computed tomography (HR-pQCT) with homogenized finite element analysis are presented in order to derive critical values improving risk prediction models of osteoporosis. Gender and femoral neck areal bone mineral density (aBMD) were independent predictors of bone strength.

Introduction

The purpose was to obtain reference values for radius and tibia bone strength computed by using the homogenized finite element analysis (hFE) using multiple stacks with a HR-pQCT.

Methods

Male and female healthy participants aged 20–39 years were recruited at the University Hospital of Bern. They underwent interview and clinical examination including hand grip, gait speed and DXA of the hip. The nondominant forearm and tibia were scanned with a double and a triple-stack protocol, respectively, using HR-pQCT (XCT II, SCANCO Medical AG). Bone strength was estimated by using the hFE analysis, and reference values were calculated using quantile regression. Multivariable analyses were performed to identify clinical predictors of bone strength.

Results

Overall, 46 women and 41 men were recruited with mean ages of 25.1 (sd 5.0) and 26.2 (sd 5.2) years. Sex-specific reference values for bone strength were established. Men had significantly higher strength for radius (mean (sd) 6640 (1800) N vs. 4110 (1200) N; p < 0.001) and tibia (18,200 (4220) N vs. 11,970 (3150) N; p < 0.001) than women. In the two multivariable regression models with and without total hip aBMD, the addition of neck hip aBMD significantly improved the model (p < 0.001). No clinical predictors of bone strength other than gender and aBMD were identified.

Conclusion

Reference values for radius and tibia strength using multiple HR-pQCT stacks with hFE analysis are presented and provide the basis to help refining accurate risk prediction models. Femoral neck aBMD and gender were significant predictors of bone strength
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Literatur
1.
Zurück zum Zitat Hauger AV, Bergland A, Holvik K, Stahle A, Emaus N, Strand BH (2018) Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromso study. Osteoporos Int 29:2447–2456CrossRef Hauger AV, Bergland A, Holvik K, Stahle A, Emaus N, Strand BH (2018) Osteoporosis and osteopenia in the distal forearm predict all-cause mortality independent of grip strength: 22-year follow-up in the population-based Tromso study. Osteoporos Int 29:2447–2456CrossRef
2.
Zurück zum Zitat Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR, Osteoporotic Fractures Research G (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954CrossRef Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR, Osteoporotic Fractures Research G (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the study of osteoporotic fractures. J Bone Miner Res 18:1947–1954CrossRef
3.
Zurück zum Zitat Siris ES, Brenneman SK, Barrett-Connor E, Miller PD, Sajjan S, Berger ML, Chen YT (2006) The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50-99: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 17:565–574CrossRef Siris ES, Brenneman SK, Barrett-Connor E, Miller PD, Sajjan S, Berger ML, Chen YT (2006) The effect of age and bone mineral density on the absolute, excess, and relative risk of fracture in postmenopausal women aged 50-99: results from the National Osteoporosis Risk Assessment (NORA). Osteoporos Int 17:565–574CrossRef
4.
Zurück zum Zitat Hosseini HS, Dunki A, Fabech J, Stauber M, Vilayphiou N, Pahr D, Pretterklieber M, Wandel J, Rietbergen BV, Zysset PK (2017) Fast estimation of Colles’ fracture load of the distal section of the radius by homogenized finite element analysis based on HR-pQCT. Bone 97:65–75CrossRef Hosseini HS, Dunki A, Fabech J, Stauber M, Vilayphiou N, Pahr D, Pretterklieber M, Wandel J, Rietbergen BV, Zysset PK (2017) Fast estimation of Colles’ fracture load of the distal section of the radius by homogenized finite element analysis based on HR-pQCT. Bone 97:65–75CrossRef
5.
Zurück zum Zitat Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK (2013) Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int 24:1733–1740CrossRef Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK (2013) Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int 24:1733–1740CrossRef
6.
Zurück zum Zitat Stein EM, Liu XS, Nickolas TL et al (2010) Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res 25:2572–2581CrossRef Stein EM, Liu XS, Nickolas TL et al (2010) Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res 25:2572–2581CrossRef
7.
Zurück zum Zitat Wang J, Stein EM, Zhou B, Nishiyama KK, Yu YE, Shane E, Guo XE (2016) Deterioration of trabecular plate-rod and cortical microarchitecture and reduced bone stiffness at distal radius and tibia in postmenopausal women with vertebral fractures. Bone 88:39–46CrossRef Wang J, Stein EM, Zhou B, Nishiyama KK, Yu YE, Shane E, Guo XE (2016) Deterioration of trabecular plate-rod and cortical microarchitecture and reduced bone stiffness at distal radius and tibia in postmenopausal women with vertebral fractures. Bone 88:39–46CrossRef
8.
Zurück zum Zitat Samelson EJ, Broe KE, Xu H, Yang L, Boyd S, Biver E, Szulc P, Adachi J, Amin S, Atkinson E, Berger C, Burt L, Chapurlat R, Chevalley T, Ferrari S, Goltzman D, Hanley DA, Hannan MT, Khosla S, Liu CT, Lorentzon M, Mellstrom D, Merle B, Nethander M, Rizzoli R, Sornay-Rendu E, van Rietbergen B, Sundh D, Wong AKO, Ohlsson C, Demissie S, Kiel DP, Bouxsein ML (2019) Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol 7:34–43CrossRef Samelson EJ, Broe KE, Xu H, Yang L, Boyd S, Biver E, Szulc P, Adachi J, Amin S, Atkinson E, Berger C, Burt L, Chapurlat R, Chevalley T, Ferrari S, Goltzman D, Hanley DA, Hannan MT, Khosla S, Liu CT, Lorentzon M, Mellstrom D, Merle B, Nethander M, Rizzoli R, Sornay-Rendu E, van Rietbergen B, Sundh D, Wong AKO, Ohlsson C, Demissie S, Kiel DP, Bouxsein ML (2019) Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol 7:34–43CrossRef
9.
Zurück zum Zitat Kroker A, Plett R, Nishiyama KK, McErlain DD, Sandino C, Boyd SK (2017) Distal skeletal tibia assessed by HR-pQCT is highly correlated with femoral and lumbar vertebra failure loads. J Biomech 59:43–49CrossRef Kroker A, Plett R, Nishiyama KK, McErlain DD, Sandino C, Boyd SK (2017) Distal skeletal tibia assessed by HR-pQCT is highly correlated with femoral and lumbar vertebra failure loads. J Biomech 59:43–49CrossRef
10.
Zurück zum Zitat Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, Peterson JM, Melton LJ 3rd (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res 21:124–131CrossRef Khosla S, Riggs BL, Atkinson EJ, Oberg AL, McDaniel LJ, Holets M, Peterson JM, Melton LJ 3rd (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res 21:124–131CrossRef
11.
Zurück zum Zitat Macdonald HM, Nishiyama KK, Kang J, Hanley DA, Boyd SK (2011) Age-related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population-based HR-pQCT study. J Bone Miner Res 26:50–62CrossRef Macdonald HM, Nishiyama KK, Kang J, Hanley DA, Boyd SK (2011) Age-related patterns of trabecular and cortical bone loss differ between sexes and skeletal sites: a population-based HR-pQCT study. J Bone Miner Res 26:50–62CrossRef
12.
Zurück zum Zitat Burt LA, Macdonald HM, Hanley DA, Boyd SK (2014) Bone microarchitecture and strength of the radius and tibia in a reference population of young adults: an HR-pQCT study. Arch Osteoporos 9:183CrossRef Burt LA, Macdonald HM, Hanley DA, Boyd SK (2014) Bone microarchitecture and strength of the radius and tibia in a reference population of young adults: an HR-pQCT study. Arch Osteoporos 9:183CrossRef
13.
Zurück zum Zitat Baumbach SF, Schmidt R, Varga P, Heinz T, Vecsei V, Zysset PK (2011) Where is the distal fracture line location of dorsally displaced distal radius fractures? J Orthop Res 29:489–494CrossRef Baumbach SF, Schmidt R, Varga P, Heinz T, Vecsei V, Zysset PK (2011) Where is the distal fracture line location of dorsally displaced distal radius fractures? J Orthop Res 29:489–494CrossRef
14.
Zurück zum Zitat Mueller TL, van Lenthe GH, Stauber M, Gratzke C, Eckstein F, Muller R (2009) Regional, age and gender differences in architectural measures of bone quality and their correlation to bone mechanical competence in the human radius of an elderly population. Bone 45:882–891CrossRef Mueller TL, van Lenthe GH, Stauber M, Gratzke C, Eckstein F, Muller R (2009) Regional, age and gender differences in architectural measures of bone quality and their correlation to bone mechanical competence in the human radius of an elderly population. Bone 45:882–891CrossRef
15.
Zurück zum Zitat Varga P, Pahr DH, Baumbach S, Zysset PK (2010) HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles’ fracture load in vitro. Bone 47:982–988CrossRef Varga P, Pahr DH, Baumbach S, Zysset PK (2010) HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles’ fracture load in vitro. Bone 47:982–988CrossRef
16.
Zurück zum Zitat Hars M, Audet MC, Herrmann F, De Chassey J, Rizzoli R, Reny JL, Gold G, Ferrari S, Trombetti A (2018) Functional performances on admission predict in-hospital falls, injurious falls, and fractures in older patients: a prospective study. J Bone Miner Res 33:852–859CrossRef Hars M, Audet MC, Herrmann F, De Chassey J, Rizzoli R, Reny JL, Gold G, Ferrari S, Trombetti A (2018) Functional performances on admission predict in-hospital falls, injurious falls, and fractures in older patients: a prospective study. J Bone Miner Res 33:852–859CrossRef
17.
Zurück zum Zitat Bonaretti S, Majumdar S, Lang TF, Khosla S, Burghardt AJ (2017) The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int Bonaretti S, Majumdar S, Lang TF, Khosla S, Burghardt AJ (2017) The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int
18.
Zurück zum Zitat Pauchard Y, Liphardt AM, Macdonald HM, Hanley DA, Boyd SK (2012) Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone 50:1304–1310CrossRef Pauchard Y, Liphardt AM, Macdonald HM, Hanley DA, Boyd SK (2012) Quality control for bone quality parameters affected by subject motion in high-resolution peripheral quantitative computed tomography. Bone 50:1304–1310CrossRef
19.
Zurück zum Zitat Arias-Moreno AJ, Hosseini HS, Bevers M, Ito K, Zysset P, van Rietbergen B (2019) Validation of distal radius failure load predictions by homogenized- and micro-finite element analyses based on second-generation high-resolution peripheral quantitative CT images. Osteoporos Int 30:1433–1443CrossRef Arias-Moreno AJ, Hosseini HS, Bevers M, Ito K, Zysset P, van Rietbergen B (2019) Validation of distal radius failure load predictions by homogenized- and micro-finite element analyses based on second-generation high-resolution peripheral quantitative CT images. Osteoporos Int 30:1433–1443CrossRef
20.
Zurück zum Zitat Harrigan TP, Mann, R. W. Characterization of microstructural anisotropy in cancellous bone using a second rank tensor. Journal of Materials Science 19:761–767 Harrigan TP, Mann, R. W. Characterization of microstructural anisotropy in cancellous bone using a second rank tensor. Journal of Materials Science 19:761–767
21.
Zurück zum Zitat Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK (2016) Sex- and site-specific normative data curves for HR-pQCT. J Bone Miner Res 31:2041–2047CrossRef Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK (2016) Sex- and site-specific normative data curves for HR-pQCT. J Bone Miner Res 31:2041–2047CrossRef
22.
Zurück zum Zitat Dalzell N, Kaptoge S, Morris N, Berthier A, Koller B, Braak L, van Rietbergen B, Reeve J (2009) Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT. Osteoporos Int 20:1683–1694CrossRef Dalzell N, Kaptoge S, Morris N, Berthier A, Koller B, Braak L, van Rietbergen B, Reeve J (2009) Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT. Osteoporos Int 20:1683–1694CrossRef
23.
Zurück zum Zitat Sode M, Burghardt AJ, Kazakia GJ, Link TM, Majumdar S (2010) Regional variations of gender-specific and age-related differences in trabecular bone structure of the distal radius and tibia. Bone 46:1652–1660CrossRef Sode M, Burghardt AJ, Kazakia GJ, Link TM, Majumdar S (2010) Regional variations of gender-specific and age-related differences in trabecular bone structure of the distal radius and tibia. Bone 46:1652–1660CrossRef
24.
Zurück zum Zitat Hansen S, Shanbhogue V, Folkestad L, Nielsen MM, Brixen K (2014) Bone microarchitecture and estimated strength in 499 adult Danish women and men: a cross-sectional, population-based high-resolution peripheral quantitative computed tomographic study on peak bone structure. Calcif Tissue Int 94:269–281CrossRef Hansen S, Shanbhogue V, Folkestad L, Nielsen MM, Brixen K (2014) Bone microarchitecture and estimated strength in 499 adult Danish women and men: a cross-sectional, population-based high-resolution peripheral quantitative computed tomographic study on peak bone structure. Calcif Tissue Int 94:269–281CrossRef
25.
Zurück zum Zitat Hung VW, Zhu TY, Cheung WH, Fong TN, Yu FW, Hung LK, Leung KS, Cheng JC, Lam TP, Qin L (2015) Age-related differences in volumetric bone mineral density, microarchitecture, and bone strength of distal radius and tibia in Chinese women: a high-resolution pQCT reference database study. Osteoporos Int 26:1691–1703CrossRef Hung VW, Zhu TY, Cheung WH, Fong TN, Yu FW, Hung LK, Leung KS, Cheng JC, Lam TP, Qin L (2015) Age-related differences in volumetric bone mineral density, microarchitecture, and bone strength of distal radius and tibia in Chinese women: a high-resolution pQCT reference database study. Osteoporos Int 26:1691–1703CrossRef
26.
Zurück zum Zitat Macneil JA, Boyd SK (2008) Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone 42:1203–1213CrossRef Macneil JA, Boyd SK (2008) Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone 42:1203–1213CrossRef
27.
Zurück zum Zitat Gordon CL, Halton JM, Atkinson SA, Webber CE (1991) The contributions of growth and puberty to peak bone mass. Growth Dev Aging 55:257–262PubMed Gordon CL, Halton JM, Atkinson SA, Webber CE (1991) The contributions of growth and puberty to peak bone mass. Growth Dev Aging 55:257–262PubMed
28.
Zurück zum Zitat Seeman E (2001) Clinical review 137: sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab 86:4576–4584CrossRef Seeman E (2001) Clinical review 137: sexual dimorphism in skeletal size, density, and strength. J Clin Endocrinol Metab 86:4576–4584CrossRef
29.
Zurück zum Zitat Burrows M, Liu D, Moore S, McKay H (2010) Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: an HR-pQCT study. J Bone Miner Res 25:1423–1432PubMed Burrows M, Liu D, Moore S, McKay H (2010) Bone microstructure at the distal tibia provides a strength advantage to males in late puberty: an HR-pQCT study. J Bone Miner Res 25:1423–1432PubMed
Metadaten
Titel
Reference values and clinical predictors of bone strength for HR-pQCT-based distal radius and tibia strength assessments in women and men
verfasst von
A. K. Stuck
D. Schenk
P. Zysset
L. Bütikofer
A. Mathis
K. Lippuner
Publikationsdatum
25.05.2020
Verlag
Springer London
Erschienen in
Osteoporosis International / Ausgabe 10/2020
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-020-05405-0

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