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J Clin Endocrinol Metab, 2017; 102(2): 516-524, PMID: 27875059

Cortical bone area predicts incident fractures independently of areal bone mineral density in older men.

Year: 2017

Ohlsson C, Sundh D, Wallerek A, Nilsson M, Karlsson M, Johansson H, Mellstrom D, Lorentzon M
1 Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Sweden.


CONTEXT: Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not allow discrimination between the trabecular and cortical bone compartments or assessment of cortical porosity. OBJECTIVE: To investigate if distinct information on cortical and trabecular bone parameters predict fracture risk independently of aBMD and clinical risk factors. DESIGN & PARTICIPANTS: Cortical area, cortical bone mass, trabecular bone volume fraction, and cortical porosity were measured at the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) in 456 men (80.2+/-3.5 years) recruited from the general population in Gothenburg, Sweden. aBMD was measured using DXA. Incident fractures (71 men with fracture) were X-ray verified. The associations with incident fracture were evaluated using Cox proportional hazard models. RESULTS: In models adjusted for age and BMI, cortical area (HR per SD decrease, 2.05; 95% CI, 1.58-2.65), cortical bone mass (HR per SD decrease, 2.07; 95% CI, 1.58-2.70), and trabecular BV/TV (HR, 1.62; 1.26-2.07) but not cortical porosity, were independently associated with fracture risk. These association remained essentially unaffected after adjustment for femoral neck aBMD and FRAX risk factors (area: HR 1.96 (1.44-2.66); cortical bone mass: HR 1.99 (1.45-2.74); trabecular BV/TV: HR 1.46 (1.09-1.96)). In all adjusted models, inclusion of both BV/TV and cortical area or cortical bone mass entered simultantously, only the cortical parameters remained significant predictors of fracture. CONCLUSION: We propose that HR-pQCT measurment of cortical area or cortical bone mass might add clinically useful information for the evaluation of fracture risk.

GID: 4301; Last update: 29.11.2016