Bone strength measured by peripheral quantitative computed tomography and the risk of nonvertebral fractures: The osteoporotic fractures in men (MrOS) study

• Published in: Journal of bone and mineral research Vol. 26; no. 1; pp. 63 - 71
• Main Authors: Sheu, Yahtyng, Zmuda, Joseph M, Boudreau, Robert M, Petit, Moira A, Ensrud, Kristine E, Bauer, Douglas C, Gordon, Christopher L, Orwoll, Eric S, Cauley, Jane A
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2011; Wiley; Oxford University Press
• Subjects: Aged; Area Under Curve; Biological and medical sciences; Bone and Bones - diagnostic imaging; Bone and Bones - pathology; Bone and Bones - physiopathology; bone strength; Follow-Up Studies; fracture; Fundamental and applied biological sciences. Psychology; Humans; Male; men; Original; osteoporosis; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - physiopathology; peripheral QCT; Proportional Hazards Models; Radius - diagnostic imaging; Radius - physiopathology; Risk Factors; Skeleton and joints; Spine - diagnostic imaging; Spine - physiopathology; Tibia - diagnostic imaging; Tibia - physiopathology; Tomography, X-Ray Computed - methods; Vertebrates: osteoarticular system, musculoskeletal system; Human; Diseases of the osteoarticular system; Fracture; Trauma; Osteoarticular system; Osteoporosis; BONE STRENGTH; Vertebrata; Mammalia; PERIPHERAL QCT; MEN; Tomography; Bone; Strength
• ISSN: 0884-0431; 1523-4681; 1523-4681
• DOI: 10.1002/jbmr.172

Many fractures occur in individuals without osteoporosis defined by areal bone mineral density (aBMD). Inclusion of other aspects of skeletal strength may be useful in identifying at‐risk subjects. We used surrogate measures of bone strength at the radius and tibia measured by peripheral quantitative computed tomography (pQCT) to evaluate their relationships with nonvertebral fracture risk. Femoral neck (FN) aBMD, measured by dual‐energy X‐ray absorptiometry (DXA), also was included. The study population consisted of 1143 white men aged 69+ years with pQCT measures at the radius and tibia from the Minneapolis and Pittsburgh centers of the Osteoporotic Fractures in Men (MrOS) study. Principal‐components analysis and Cox proportional‐hazards modeling were used to identify 21 of 58 pQCT variables with a major contribution to nonvertebral incident fractures. After a mean 2.9 years of follow‐up, 39 fractures occurred. Men without incident fractures had significantly greater bone mineral content, cross‐sectional area, and indices of bone strength than those with fractures by pQCT. Every SD decrease in the 18 of 21 pQCT parameters was significantly associated with increased fracture risk (hazard ration ranged from 1.4 to 2.2) independent of age, study site, body mass index (BMI), and FN aBMD. Using area under the receiver operation characteristics curve (AUC), the combination of FN aBMD and three radius strength parameters individually increased fracture prediction over FN aBMD alone (AUC increased from 0.73 to 0.80). Peripheral bone strength measures are associated with fracture risk and may improve our ability to identify older men at high risk of fracture. © 2011 American Society for Bone and Mineral Research.