Journal Article

Assessing forearm fracture risk in postmenopausal women

Amin, S, van Lenthe, G. H, Melton, L. J. III, Achenbach, S. J, Christen, D, Riggs, B. L, Atkinson, E. J, Müller, R, Khosla, S

2010

Overview

Summary A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes. Introduction This study seeks to test the clinical utility of approaches for assessing forearm fracture risk. Methods Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (μFE) models. Results Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (µFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall ÷ μFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71). Conclusions Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

• Publisher: London : Springer-Verlag,Springer-Verlag,Springer,Springer Nature B.V
• Subject: Absorptiometry, Photon / Absorptiometry, Photon - methods / Aged / Biological and medical sciences / Biomechanical Phenomena / Biomechanics / Bone density / Bone Density - physiology / Bone quality / Case-Control Studies / Colles' Fracture / Colles' Fracture - etiology / Colles' Fracture - pathology / Colles' Fracture - physiopathology / complications / Diseases of the osteoarticular system / Endocrinology / Epidemiology / etiology / Female / Femur Neck / Femur Neck - physiopathology / Fractures / Geometry / Health sciences / Humans / Injuries of the limb. Injuries of the spine / Internal medicine / Investigative techniques, diagnostic techniques (general aspects) / Load / Medical schools / Medical sciences / Medicine / Medicine & Public Health / methods / Middle Aged / Original Article / Orthopedics / Osteoarticular system. Muscles / Osteoporosis / Osteoporosis, Postmenopausal / Osteoporosis, Postmenopausal - complications / Osteoporosis, Postmenopausal - pathology / Osteoporosis, Postmenopausal - physiopathology / Osteoporosis. Osteomalacia. Paget disease / Osteoporotic Fractures / Osteoporotic Fractures - etiology / Osteoporotic Fractures - pathology / Osteoporotic Fractures - physiopathology / pathology / physiology / physiopathology / Postmenopause / Postmenopause - physiology / Radiodiagnosis. Nmr imagery. Nmr spectrometry / Radius / Radius - pathology / Rheumatology / Risk assessment / Risk Assessment - methods / Tomography / Traumas. Diseases due to physical agents