Cortical porosity identifies women with osteopenia at increased risk for forearm fractures

Yohann Bala, Roger Zebaze, Ali Ghasem-Zadeh, Elizabeth J. Atkinson, Sandra Iuliano, James M. Peterson, Shreyasee Amin, Åshild Bjørnerem, L. Joseph Melton, Helena Johansson, John A. Kanis, Sundeep Khosla, Ego Seeman

Research output: Contribution to journalArticle

100 Scopus citations

Abstract

Most fragility fractures arise among the many women with osteopenia, not the smaller number with osteoporosis at high risk for fracture. Thus, most women at risk for fracture assessed only by measuring areal bone mineral density (aBMD) will remain untreated. We measured cortical porosity and trabecular bone volume/total volume (BV/TV) of the ultradistal radius (UDR) using high-resolution peripheral quantitative computed tomography, aBMD using densitometry, and 10-year fracture probability using the country-specific fracture risk assessment tool (FRAX) in 68 postmenopausal women with forearm fractures and 70 age-matched community controls in Olmsted County, MN, USA. Women with forearm fractures had 0.4 standard deviations (SD) higher cortical porosity and 0.6 SD lower trabecular BV/TV. Compact-appearing cortical porosity predicted fracture independent of aBMD; odds ratio (OR) = 1.92 (95% confidence interval [CI] 1.10-3.33). In women with osteoporosis at the UDR, cortical porosity did not distinguish those with fractures from those without because high porosity was present in 92% and 86% of each group, respectively. By contrast, in women with osteopenia at the UDR, high porosity of the compact-appearing cortex conferred an OR for fracture of 4.00 (95% CI 1.15-13.90). In women with osteoporosis, porosity is captured by aBMD, so measuring UDR cortical porosity does not improve diagnostic sensitivity. However, in women with osteopenia, cortical porosity was associated with forearm fractures.

Original languageEnglish (US)
Pages (from-to)1356-1362
Number of pages7
JournalJournal of Bone and Mineral Research
Volume29
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • BONE MINERAL DENSITY
  • CORTICAL POROSITY
  • FOREARM FRACTURES
  • MICROARCHITECTURE
  • TRABECULAR BONE

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

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    Bala, Y., Zebaze, R., Ghasem-Zadeh, A., Atkinson, E. J., Iuliano, S., Peterson, J. M., Amin, S., Bjørnerem, Å., Melton, L. J., Johansson, H., Kanis, J. A., Khosla, S., & Seeman, E. (2014). Cortical porosity identifies women with osteopenia at increased risk for forearm fractures. Journal of Bone and Mineral Research, 29(6), 1356-1362. https://doi.org/10.1002/jbmr.2167