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
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
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DOI：
10.1016/j.bone.2016.04.025
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发表时间：
2016-07-01
期刊：
影响因子：
4.1
通讯作者：
Dennison, E. M.
中科院分区：
文献类型：
--
作者：
Edwards, M. H.;Robinson, D. E.;Dennison, E. M.
骨质疏松症是一个主要的医疗保健问题，通常通过双能X射线吸收法（DXA）进行评估。高分辨率外周定量计算机断层扫描（HRpQCT）等新技术也可预测骨折风险。HRpQCT测量了许多骨特征，这些骨特征可以告知骨缺损的特定模式。我们使用聚类分析来定义不同的骨表型及其与骨折患病率和区域骨密度（BMD）的关系。通过自我报告和椎体骨折评估确定骨折史的177名男性和159名女性接受了桡骨远端和股骨颈DXA的HRpQCT。得出了五个聚类，其中两个聚类与骨折风险升高相关。第1组包括26名女性（50.0%骨折）和30名男性（50.0%骨折），平均皮质厚度和皮质体积BMD较低，仅男性的平均总面积和小梁面积大于性别特异性队列的平均值。“第2组”包括20名女性（50.0%骨折）和14名男性（35.7%骨折），平均骨小梁密度和骨小梁数量低于性别特异性队列的平均值。Logistic回归显示，这些组的骨折率显著高于最低骨折风险组[5]（p < 0.05）。第1组和第2组女性的平均股骨颈区域BMD显著低于第5组（均为p < 0.001），第2组男性的平均股骨颈区域BMD显著低于第5组（p < 0.001），但第1组男性的平均股骨颈区域BMD不低于第5组（p = 0.220）。总之，这项研究表明，男性和女性有两个不同的高风险群，其病因和治疗反应可能不同。由于男性中的第1组不具有低区域BMD，这些男性可能无法单独通过常规DXA确定为高风险。(C)2016由Elsevier Inc.出版
Osteoporosis is a major healthcare problem which is conventionally assessed by dual energy X-ray absorptiometry (DXA). New technologies such as high resolution peripheral quantitative computed tomography (HRpQCT) also predict fracture risk. HRpQCT measures a number of bone characteristics that may inform specific patterns of bone deficits. We used cluster analysis to define different bone phenotypes and their relationships to fracture prevalence and areal bone mineral density (BMD). 177 men and 159 women, in whom fracture history was determined by self-report and vertebral fracture assessment, underwent HRpQCT of the distal radius and femoral neck DXA. Five clusters were derived with two clusters associated with elevated fracture risk. "Cluster 1" contained 26 women (50.0% fractured) and 30 men (50.0% fractured) with a lower mean cortical thickness and cortical volumetric BMD, and in men only, a mean total and trabecular area more than the sex-specific cohort mean. "Cluster 2" contained 20 women (50.0% fractured) and 14 men (35.7% fractured) with a lower mean trabecular density and trabecular number than the sex-specific cohort mean. Logistic regression showed fracture rates in these clusters to be significantly higher than the lowest fracture risk cluster [5] (p < 0.05). Mean femoral neck areal BMD was significantly lower than cluster 5 in women in cluster 1 and 2 (p < 0.001 for both), and in men, in cluster 2 (p < 0.001) but not 1 (p = 0.220). In conclusion, this study demonstrates two distinct high risk clusters in both men and women which may differ in etiology and response to treatment. As cluster 1 in men does not have low areal BMD, these men may not be identified as high risk by conventional DXA alone. (C) 2016 Published by Elsevier Inc.