Fracture Repair in the Distal Radius in Postmenopausal Women: A Follow‐Up 2 Years Postfracture Using HRpQCT. (5th January 2016)

• Record Type: Journal Article
• Authors: de Jong, Joost JA; Heyer, Frans L; Arts, Jacobus JC; Poeze, Martijn; Keszei, András P; Willems, Paul C; van Rietbergen, Bert; Geusens, Piet P; van den Bergh, Joop PW
• Is Part Of: Journal of bone and mineral research. Volume 31:Number 5(2016:May)
• Page Start: 1114
• Page End: 1122
• Publication Date: 2016-01-05
• Subjects: FRACTURE REPAIR -- DISTAL RADIUS -- POSTMENOPAUSAL WOMEN -- HRpQCT; Bones -- Metabolism -- Periodicals; Mineral metabolism -- Periodicals; 612.392
• DOI: 10.1002/jbmr.2766
• Languages: English
• ISSNs: 0884-0431

Abstract

ABSTRACT: Fracture healing is characterized by an intense increase in modeling and remodeling of bone, which allows removal of the cast after a stable distal radius fracture within 3 to 5 weeks. However, at that time, bone strength has not recovered yet. We studied the changes in bone mineral density (BMD), microarchitecture, and bone stiffness after a distal radius fracture during a 2‐year follow‐up in comparison to the contralateral side and the association between the 2‐year stiffness and baseline BMD, microarchitecture, and early changes in these parameters. The fractured side of 14 postmenopausal women (mean age 64 ± 8 years) with a conservatively treated distal radius fracture was scanned by high‐resolution peripheral quantitative computed tomography (HRpQCT) at 1 to 2, 3 to 4, 6 to 8, and 12 weeks and 2 years postfracture. The same region contralaterally was scanned as well at the 2‐year visit. BMD, microarchitecture, and stiffness parameters were determined and the fracture side was compared with the contralateral side using a linear mixed‐effect model. Spearman's correlation was used to correlate the 2‐year bone stiffness with baseline BMD, microarchitecture, and early 3‐month changes in these parameters. Two years postfracture, cortical and trabecular thickness and torsional and bending stiffness were significantly higher at the fractured side compared with the nonfractured side (21%, 55%, 31%, and 29%, respectively, p < 0.05), whereas BMD was similar. Two‐year torsional and bending stiffness correlated significantly with baseline BMD and cortical perimeter (|rho| ≥ 0.63, p < 0.016) but not with early changes in bone parameters. Using HRpQCT, this study illustrates that fracture healing is not completed by the time the cast is removed. We showed that from 6 weeks to 2 years postfracture, large changes occur in BMD, microarchitecture, and biomechanical parameters at the fractured side, which were fully recovered after 2 years in comparison to the nonfractured contralateral side. Interestingly, higher 2‐year torsional and bending stiffness were associated with lower BMD and higher cortical perimeter at baseline. © 2015 American Society for Bone and Mineral Research.