Bone Material Strength as Measured by Microindentation In Vivo Is Decreased in Patients With Fragility Fractures Independently of Bone Mineral Density
Bone Material Strength as Measured by Microindentation In Vivo Is Decreased in Patients With Fragility Fractures Independently of Bone Mineral Density
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DOI：
10.1210/jc.2014-4346
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发表时间：
2015-05-01
影响因子：
5.8
通讯作者：
Appelman-Dijkstra, Natasha M.
中科院分区：
文献类型：
--
作者：
Malgo, Frank;Hamdy, Neveen A. T.;Appelman-Dijkstra, Natasha M.
内容：骨密度（BMD）不能完全反映骨折风险，因为大多数骨折发生在骨量减少的患者中，这表明骨材料性质的改变和微结构的变化可能有助于骨折风险。目的：本研究旨在评估骨材料强度（BMS）与低骨量患者骨折之间的关系。在90例低骨量伴或不伴脆性骨折的患者（平均年龄61.0岁，范围40.4-85.5岁）中测量BMS。63例患者有一处或多处脆性骨折。结果：年龄与BMS呈显著负相关（r = -0.539; P < .001），10年骨折概率（包括和不包括股骨颈BMD，由FRAX计算）（分别为r = -0.383; P < .001和r = -0.426; P < .001）。尽管BMD相似，但脆性骨折患者的BMS值低于非骨折患者（79.9 ± 0.6 vs 82.4 ± 1.0; P = 0.032）。在脆性骨折患者中，无论是骨质减少还是骨质疏松，BMS都是相似的（79.8 +/- 0.8 vs 78.7 +/- 1.1; P = 0.456）。在骨量减少的患者中，骨折患者的BMS显著低于非骨折患者（80.3 +/- 0.7 vs 83.9 +/- 1.2; P = 0.015）。结论：这些数据表明，骨折患者的骨材料特性发生了改变，而这些改变未被BMD捕获。需要更多的研究来确定BMS在预测骨折风险方面的价值，特别是在骨质减少患者中。
Context: Bonemineral density(BMD) does not fully capture fracture risk as the majority of fractures occur in patients with osteopenia, suggesting that altered bone material properties and changes in microarchitecture may contribute to fracture risk.Objective: This study aimed to evaluate the relationship between bone material strength (BMS), measured by microindentation in vivo, and fracture in patients with low bone mass.Methods: BMS was measured in 90 patients (mean age, 61.0 y; range, 40.4-85.5 y) with low bone mass with or without a fragility fracture. Sixty-three patients had sustained one or more fragility fractures.Results: There was a significant negative correlation between age and BMS (r = -0.539; P < .001) and with the 10-year fracture probability with and without inclusion of femoral neck BMD as calculated by FRAX (r = -0.383; P < .001 and r = -0.426; P < .001, respectively). BMS values were lower in patients with a fragility fracture compared with nonfracture patients (79.9 +/- 0.6 vs 82.4 +/- 1.0; P = .032) despite similar BMD. BMS was comparable in patients with a fragility fracture whether they had osteopenia or osteoporosis(79.8 +/- 0.8 vs 78.7 +/- 1.1; P = .456). In patients with osteopenia, BMS was significantly lower in fracture patients than in nonfracture patients (80.3 +/- 0.7 vs 83.9 +/- 1.2; P = .015).Conclusion: These data suggest that patients with fractures have altered material properties of bone that are not captured by BMD. Additional studies are required to establish the value of BMS in the prediction of fracture risk, especially in patients with osteopenia.