Changes in cortical microarchitecture are independent of areal bone mineral density in patients with fragility fractures. Issue 11 (November 2017)

• Record Type: Journal Article
• Authors: Mussawy, Haider; Ferrari, Gero; Schmidt, Felix N.; Schmidt, Tobias; Rolvien, Tim; Hischke, Sandra; Rüther, Wolfgang; Amling, Michael
• Is Part Of: Injury. Volume 48:Issue 11(2017)
• Page Start: 2461
• Page End: 2465
• Publication Date: 2017-11
• Subjects: Osteoporosis -- HR-pQCT -- DXA -- Bone microstructure -- Fragility fractures; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2017.08.043
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) are commonly used to assess the areal bone mineral density (aBMD) and peripheral microstructure, respectively. While DXA is the standard to diagnose osteoporosis, HR-pQCT provides information about the cortical and trabecular architecture. Many fragility fractures occur in patients who do not meet the osteoporosis criterion (i.e., T-score ≤ −2.5). We hypothesize that patients with T-score above −2.5 and fragility fracture may have abnormal bone microarchitecture. Therefore, in this retrospective clinical study, HR-pQCT data obtained from patients with fragility fractures and T-scores ≥ −2.5 (n = 71) were compared to corresponding data from patients with fragility fractures and T-scores ≤ −3.5 (n = 56). Types of secondary osteoporosis were excluded from the study. To verify the dependency of alterations in bone microarchitecture and T-score, the association between HR-pQCT values and aBMD as reflected by the T-score at both proximal femora, was assessed. At the distal tibia, cortical thickness was lower (p < 0.001), cortical porosity was similar (p = 0.61), trabecular number was higher (p < 0.001), and bone volume fraction (BV/TV) was higher (p < 0.001) in patients with T-scores ≥ −2.5 than in patients with T-scores ≤ −3.5. Trabecular number and BV/TV correlated with T-score (r = 0.68, p < 0.001; r = 0.61, p < 0.001), whereas the cortical values did not. Our results thus demonstrate the importance of bone structure, as assessed by HR-pQCT, in addition to the standard DXA T-score in the diagnosis of osteoporosis.