Assessing forearm fracture risk in postmenopausal women

L. J. Melton, D. Christen, B. L. Riggs, S. J. Achenbach, R. Müller, G. H. Van Lenthe, Shreyasee Amin, E. J. Atkinson, Sundeep Khosla

Research output: Contribution to journalArticle

85 Citations (Scopus)

Abstract

Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

Original languageEnglish (US)
Pages (from-to)1161-1169
Number of pages9
JournalOsteoporosis International
Volume21
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Forearm
Bone Density
Odds Ratio
Confidence Intervals
Femur Neck
Area Under Curve
Bone and Bones
Femoral Neck Fractures
Osteoporotic Fractures
Wrist
ROC Curve

Keywords

  • Bone density
  • Bone quality
  • Colles' fracture
  • Epidemiology
  • Risk assessment

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Melton, L. J., Christen, D., Riggs, B. L., Achenbach, S. J., Müller, R., Van Lenthe, G. H., ... Khosla, S. (2010). Assessing forearm fracture risk in postmenopausal women. Osteoporosis International, 21(7), 1161-1169. https://doi.org/10.1007/s00198-009-1047-2

Assessing forearm fracture risk in postmenopausal women. / Melton, L. J.; Christen, D.; Riggs, B. L.; Achenbach, S. J.; Müller, R.; Van Lenthe, G. H.; Amin, Shreyasee; Atkinson, E. J.; Khosla, Sundeep.

In: Osteoporosis International, Vol. 21, No. 7, 07.2010, p. 1161-1169.

Research output: Contribution to journalArticle

Melton, LJ, Christen, D, Riggs, BL, Achenbach, SJ, Müller, R, Van Lenthe, GH, Amin, S, Atkinson, EJ & Khosla, S 2010, 'Assessing forearm fracture risk in postmenopausal women', Osteoporosis International, vol. 21, no. 7, pp. 1161-1169. https://doi.org/10.1007/s00198-009-1047-2
Melton LJ, Christen D, Riggs BL, Achenbach SJ, Müller R, Van Lenthe GH et al. Assessing forearm fracture risk in postmenopausal women. Osteoporosis International. 2010 Jul;21(7):1161-1169. https://doi.org/10.1007/s00198-009-1047-2
Melton, L. J. ; Christen, D. ; Riggs, B. L. ; Achenbach, S. J. ; Müller, R. ; Van Lenthe, G. H. ; Amin, Shreyasee ; Atkinson, E. J. ; Khosla, Sundeep. / Assessing forearm fracture risk in postmenopausal women. In: Osteoporosis International. 2010 ; Vol. 21, No. 7. pp. 1161-1169.
@article{6231a45bd6be47cfa32f39a734aee82e,
title = "Assessing forearm fracture risk in postmenopausal women",
abstract = "Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95{\%} confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95{\%} CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95{\%} CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95{\%} CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15{\%} worse in cases (OR, 1.9; 95{\%} CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.",
keywords = "Bone density, Bone quality, Colles' fracture, Epidemiology, Risk assessment",
author = "Melton, {L. J.} and D. Christen and Riggs, {B. L.} and Achenbach, {S. J.} and R. M{\"u}ller and {Van Lenthe}, {G. H.} and Shreyasee Amin and Atkinson, {E. J.} and Sundeep Khosla",
year = "2010",
month = "7",
doi = "10.1007/s00198-009-1047-2",
language = "English (US)",
volume = "21",
pages = "1161--1169",
journal = "Osteoporosis International",
issn = "0937-941X",
publisher = "Springer London",
number = "7",

}

TY - JOUR

T1 - Assessing forearm fracture risk in postmenopausal women

AU - Melton, L. J.

AU - Christen, D.

AU - Riggs, B. L.

AU - Achenbach, S. J.

AU - Müller, R.

AU - Van Lenthe, G. H.

AU - Amin, Shreyasee

AU - Atkinson, E. J.

AU - Khosla, Sundeep

PY - 2010/7

Y1 - 2010/7

N2 - Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

AB - Summary: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in micro-finite element (μFE) models. Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (μFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall÷μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

KW - Bone density

KW - Bone quality

KW - Colles' fracture

KW - Epidemiology

KW - Risk assessment

UR - http://www.scopus.com/inward/record.url?scp=78649563885&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78649563885&partnerID=8YFLogxK

U2 - 10.1007/s00198-009-1047-2

DO - 10.1007/s00198-009-1047-2

M3 - Article

C2 - 19714390

AN - SCOPUS:78649563885

VL - 21

SP - 1161

EP - 1169

JO - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

IS - 7

ER -