Premenopausal Women with a Distal Radial Fracture Have Deteriorated Trabecular Bone Density and Morphology Compared with Controls without a Fracture
Premenopausal Women with a Distal Radial Fracture Have Deteriorated Trabecular Bone Density and Morphology Compared with Controls without a Fracture
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DOI：
10.2106/jbjs.l.00588
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发表时间：
2013-04-03
影响因子：
5.3
通讯作者：
Bouxsein, Mary L.
中科院分区：
文献类型：
--
作者：
Rozental, Tamara D.;Deschamps, Laura N.;Bouxsein, Mary L.
背景：双能X线骨密度仪结合临床危险因素测量骨密度是目前诊断骨质疏松症的金标准。先进的成像技术显示，老年脆性骨折患者的骨骼微结构较差，通常与低骨矿密度无关。我们假设，与未发生骨折的对照组相比，有桡骨远端骨折的绝经前妇女具有相似的骨密度，但骨微结构发生了改变。方法：前瞻性地招募40名有近期发生的桡骨远端骨折的绝经前妇女，并与80名未骨折的对照组进行配对。主要结果变量包括高分辨率外周定量计算机断层扫描显示的桡骨和胫骨远端的骨小梁和皮质微结构。结果：骨折组和对照组在年龄、种族和体重指数方面没有差异。股骨颈、腰椎和桡骨远端1/3处的骨密度相似，但骨折组髋部和桡骨远端的骨密度较低(p=0.06)。与对照组相比，骨折组的小梁微结构在桡骨远端和胫骨远端均有恶化。在桡骨远端，骨折组的总密度和骨小梁密度、数量和厚度均低于对照组(-6%~14%；均P<；0.05)。在胫骨远端，骨折组的总密度、骨小梁密度、骨小梁厚度和皮质厚度低于对照组(-7%~14%；p<；0.01)。条件Logistic回归分析显示，在调整年龄和超长径向骨密度后，骨小梁密度、厚度、间隔和小梁分离的分布与骨折显著相关(调整后的优势比[OR]：2.01至2.98；p<；0.05)。在胫骨，总密度、骨小梁密度、厚度、皮质面积和皮质厚度在调整年龄和股骨颈骨密度后仍与骨折显著相关(调整后OR：1.62至2.40；p<；0.05)。结论：尽管双X射线骨密度仪的骨密度值相似，但绝经前有放射状远端骨折的妇女与未骨折的对照组相比，其桡骨和胫骨远端的骨微结构明显较差。及早发现骨骼健康状况不佳的妇女，为旨在防止进一步恶化和降低骨折风险的干预措施提供了机会。
Background: Measurement of bone mineral density by dual x-ray absorptiometry combined with clinical risk factors is currently the gold standard in diagnosing osteoporosis. Advanced imaging has shown that older patients with fragility fractures have poor bone microarchitecture, often independent of low bone mineral density. We hypothesized that premenopausal women with a fracture of the distal end of the radius have similar bone mineral density but altered bone microarchitecture compared with control subjects without a fracture.Methods: Forty premenopausal women with a recent distal radial fracture were prospectively recruited and matched with eighty control subjects without a fracture. Primary outcome variables included trabecular and cortical microarchitecture at the distal end of the radius and tibia by high-resolution peripheral quantitative computed tomography. Bone mineral density at the wrist, hip, and lumbar spine was also measured by dual x-ray absorptiometry.Results: The fracture and control groups did not differ with regard to age, race, or body mass index. Bone mineral density was similar at the femoral neck, lumbar spine, and distal one-third of the radius, but tended to be lower in the fracture group at the hip and ultradistal part of the radius (p = 0.06). Trabecular microarchitecture was deteriorated in the fracture group compared with the control group at both the distal end of the radius and distal end of the tibia. At the distal end of the radius, the fracture group had lower total density and lower trabecular density, number, and thickness compared with the control group (-6% to 14%; p < 0.05 for all). At the distal end of the tibia, total density, trabecular density, trabecular thickness, and cortical thickness were lower in the fracture group than in the control group (-7% to 14%; p < 0.01). Conditional logistic regression showed that trabecular density, thickness, separation, and distribution of trabecular separation remained significantly associated with fracture after adjustment for age and ultradistal radial bone mineral density (adjusted odds ratios [OR]: 2.01 to 2.98; p < 0.05). At the tibia, total density, trabecular density, thickness, cortical area, and cortical thickness remained significantly associated with fracture after adjustment for age and femoral neck bone mineral density (adjusted OR:1.62 to 2.40; p < 0.05).Conclusions: Despite similar bone mineral density values by dual x-ray absorptiometry, premenopausal women with a distal radial fracture have significantly poorer bone microarchitecture at the distal end of the radius and tibia compared with control subjects without a fracture. Early identification of women with poor bone health offers opportunities for interventions aimed at preventing further deterioration and reducing fracture risk.