Lower Bone Density, Impaired Microarchitecture, and Strength Predict Future Fragility Fracture in Postmenopausal Women: 5-Year Follow-up of the Calgary CaMos Cohort
Lower Bone Density, Impaired Microarchitecture, and Strength Predict Future Fragility Fracture in Postmenopausal Women: 5-Year Follow-up of the Calgary CaMos Cohort
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DOI：
10.1002/jbmr.3347
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发表时间：
2018-04-01
影响因子：
6.2
通讯作者：
Boyd, Steven K.
中科院分区：
文献类型：
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作者：
Burt, Lauren A.;Manske, Sarah L.;Boyd, Steven K.
这项前瞻性研究的目的是使用高分辨率外周定量计算机断层扫描 (HR-pQCT) 来确定基线骨骼参数是否可以预测女性发生脆性骨折的情况，其次确定骨折女性是否比未骨折的女性骨质流失速度更快。将在 5 年随访期间经历过脆性骨折的 60 岁以上女性（意外骨折组，n=22）与研究期间未经历脆性骨折的女性（n=127）进行比较。在基线和后续测量之间进行图像配准后，进行标准和皮质形态分析。计算 HR-pQCT 和有限元变量的基线值和年化百分比变化的优势比。在桡骨处，基线 HR-pQCT 结果显示，与未骨折的女性相比，骨折女性的总骨矿物质密度 (Tt.BMD; 19%)、小梁骨矿物质密度 (Tb.BMD; 25%) 和小梁数量 (Tb.N; 14%) 较低，小梁分离度较高 (Tb.Sp; 19%)。在胫骨处，与未发生骨折的女性相比，发生骨折的女性的 Tt.BMD (15%)、Tb.BMD (12%)、皮质厚度 (Ct.Th; 14%)、皮质面积 (Ct.Ar; 12%) 和失效载荷 (10%) 较低，总面积 (Tt.Ar; 7%) 和小梁面积 (Tb.Ar; 10%) 较高。桡骨的比值比 (OR) 显示，Tt.BMD (OR=2.1)、Tb.BMD (OR=2.0) 和 Tb.N (OR=1.7) 每一个 SD 降低都与脆性骨折的可能性显着增加相关。在胫骨，Tt.BMD (OR=2.1)、Tb.BMD (OR=1.7)、Ct.Th (OR=2.2)、Ct.Ar (OR=1.9) 和失效载荷 (OR=1.7) 的每一个 SD 降低都与脆性骨折的可能性显着增加相关。无论扫描方式如何，骨折组之间的骨丢失年化百分比率没有差异。结果表明，基线骨密度、微结构和强度，而不是这些变量的变化，与 60 岁以上女性发生脆性骨折有关。此外，无论脆性骨折状况如何，女性骨骼健康状况的变化率相似。 (c) 2017 年美国骨与矿物质研究学会。
The aim of this prospective study was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) to determine if baseline skeletal parameters can predict incident fragility fracture in women and, secondly, to establish if women that fracture lose bone at a faster rate than those who do not fracture. Women older than 60 years who experienced a fragility fracture during the 5-year follow-up period (incident fracture group, n=22) were compared with those who did not experience a fragility fracture during the study (n=127). After image registration between baseline and follow-up measures, standard and cortical morphological analyses were conducted. Odds ratios were calculated for baseline values and annualized percent change of HR-pQCT and finite element variables. At the radius, baseline HR-pQCT results show women who fractured had lower total bone mineral density (Tt.BMD; 19%), trabecular bone mineral density (Tb.BMD; 25%), and trabecular number (Tb.N; 14%), with higher trabecular separation (Tb.Sp; 19%) than women who did not fracture. At the tibia, women with incident fracture had lower Tt.BMD (15%), Tb.BMD (12%), cortical thickness (Ct.Th; 14%), cortical area (Ct.Ar; 12%), and failure load (10%) with higher total area (Tt.Ar; 7%) and trabecular area (Tb.Ar; 10%) than women who did not fracture. Odds ratios (ORs) at the radius revealed every SD decrease of Tt.BMD (OR=2.1), Tb.BMD (OR=2.0), and Tb.N (OR=1.7) was associated with a significantly increased likelihood of fragility fracture. At the tibia, every SD decrease in Tt.BMD (OR=2.1), Tb.BMD (OR=1.7), Ct.Th (OR=2.2), Ct.Ar (OR=1.9), and failure load (OR=1.7) were associated with a significantly increased likelihood of fragility fracture. Irrespective of scanning modality, the annualized percent rate of bone loss was not different between fracture groups. The results suggest baseline bone density, microarchitecture, and strength rather than change in these variables are associated with incident fragility fractures in women older than 60 years. Furthermore, irrespective of fragility fracture status, women experienced changes in skeletal health at a similar rate. (c) 2017 American Society for Bone and Mineral Research.