Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/20791
Title: Increased Cortical Porosity and Reduced Trabecular Density Are Not Necessarily Synonymous With Bone Loss and Microstructural Deterioration.
Austin Authors: Zebaze, Roger;Atkinson, Elizabeth J;Peng, Yu;Bui, Minh;Ghasem-Zadeh, Ali ;Khosla, Sundeep;Seeman, Ego 
Affiliation: Straxcorp Pty Ltd Melbourne Australia
Mary Mackillop Institute for Health Research Australian Catholic University Melbourne Australia
Mayo Clinic Rochester MN USA
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
Centre for Epidemiology and Biostatistics School of Population and Global Health University of Melbourne Melbourne Australia
Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
Issue Date: Apr-2019
metadata.dc.date: 2018-10-04
Publication information: JBMR plus 2019; 3(4): e10078
Abstract: Absolute values of cortical porosity and trabecular density are used to estimate fracture risk, but these values are the net result of their growth-related assembly and age-related deterioration. Because bone loss affects both cortical and trabecular bone, we hypothesized that a surrogate measure of bone fragility should capture the age-related deterioration of both traits, and should do so independently of their peak values. Accordingly, we developed a structural fragility score (SFS), which quantifies the increment in distal radial cortical porosity and decrement in trabecular density relative to their premenopausal mean values in 99 postmenopausal women with forearm fractures and 105 controls using HR-pQCT. We expressed the results as odds ratios (ORs; 95% CI). Cortical porosity was associated with fractures in the presence of deteriorated trabecular density (OR 2.30; 95% CI, 1.30 to 4.05; p = 0.004), but not if trabecular deterioration was absent (OR 0.96; 95% CI, 0.50 to 1.86; p = 0.91). Likewise, trabecular density was associated with fractures in the presence of high cortical porosity (OR 3.35; 95% CI, 1.85 to 6.07; p < 0.0001), but not in its absence (OR 1.60; 95% CI, 0.78 to 3.28; p = 0.20). The SFS, which captures coexisting cortical and trabecular deterioration, was associated with fractures (OR 4.52; 95% CI, 2.17 to 9.45; p < 0.0001). BMD was associated with fracture before accounting for the SFS (OR 5.79; 95% CI, 1.24 to 27.1; p = 0.026), not after (OR 4.38; 95% CI, 0.48 to 39.9; p = 0.19). The SFS was associated with fracture before (OR 4.67; 95% CI, 2.21 to 9.88) and after (OR 3.94; 95% CI, 1.80 to 8.6) accounting for BMD (both ps < 0.0001). The disease of bone fragility is captured by cortical and trabecular deterioration: A measurement of coexisting cortical and trabecular deterioration is likely to identify women at risk for fracture more robustly than absolute values of cortical porosity, trabecular density, or BMD. © 2018 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
URI: http://ahro.austin.org.au/austinjspui/handle/1/20791
DOI: 10.1002/jbm4.10078
PubMed URL: 31044180
Type: Journal Article
Subjects: BONE MINERAL DENSITY
CORTICAL POROSITY
MICROSTRUCTURAL DETERIORATION
TRABECULAR DENSITY
Appears in Collections:Journal articles

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