Measurement of Cortical Porosity of the Proximal Femur Improves Identification of Women with Nonvertebral Fragility Fractures

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2015 Apr 17

PMID 25876879

Citations 29

Authors

L A Ahmed

R Shigdel

R M Joakimsen

O P Eldevik

E F Eriksen

A Ghasem-Zadeh

Y Bala

R Zebaze

E Seeman

A Bjornerem

Affiliations

Soon will be listed here.

Abstract

Unlabelled: We tested whether cortical porosity of the proximal femur measured using StrAx1.0 software provides additional information to areal bone mineral density (aBMD) or Fracture Risk Assessment Tool (FRAX) in differentiating women with and without fracture. Porosity was associated with fracture independent of aBMD and FRAX and identified additional women with fractures than by osteoporosis or FRAX thresholds.

Introduction: Neither aBMD nor the FRAX captures cortical porosity, a major determinant of bone strength. We therefore tested whether combining porosity with aBMD or FRAX improves identification of women with fractures.

Methods: We quantified femoral neck (FN) aBMD using dual-energy X-ray absorptiometry, FRAX score, and femoral subtrochanteric cortical porosity using StrAx1.0 software in 211 postmenopausal women aged 54-94 years with nonvertebral fractures and 232 controls in Tromsø, Norway. Odds ratios (ORs) were calculated using logistic regression analysis.

Results: Women with fractures had lower FN aBMD, higher FRAX score, and higher cortical porosity than controls (all p < 0.001). Each standard deviation higher porosity was associated with fracture independent of FN aBMD (OR 1.39; 95% confidence interval 1.11-1.74) and FRAX score (OR 1.58; 1.27-1.97) in all women combined. Porosity was also associated with fracture independent of FRAX score in subgroups with normal FN aBMD (OR 1.88; 1.21-2.94), osteopenia (OR 1.40; 1.06-1.85), but not significantly in those with osteoporosis (OR 1.48; 0.68-3.23). Of the 211 fracture cases, only 18 women (9%) were identified using FN aBMD T-score < -2.5, 45 women (21%) using FRAX threshold >20%, whereas porosity >80th percentile identified 61 women (29%). Porosity identified 26% additional women with fractures than identified by the osteoporosis threshold and 21% additional women with fractures than by this FRAX threshold.

Conclusions: Cortical porosity is a risk factor for fracture independent of aBMD and FRAX and improves identification of women with fracture.

Citing Articles

Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts.

Sarfati M, Chapurlat R, Dufour A, Sornay-Rendu E, Merle B, Boyd S J Bone Miner Res. 2024; 39(11):1574-1583.

PMID: 39236248 PMC: 11523184. DOI: 10.1093/jbmr/zjae143.

Axial Transmission: Techniques, Devices and Clinical Results.

Bochud N, Laugier P Adv Exp Med Biol. 2022; 1364:55-94.

PMID: 35508871 DOI: 10.1007/978-3-030-91979-5_4.

Cortical bone density by quantitative computed tomography mirrors disorders of bone structure in bone biopsy of non-dialysis CKD patients.

Bittencourt A, Canziani M, Costa L, Rochitte C, Carvalho A Bone Rep. 2022; 16:101166.

PMID: 35118180 PMC: 8792406. DOI: 10.1016/j.bonr.2022.101166.

Cortical Bone Loss Following Gastric Bypass Surgery Is Not Primarily Endocortical.

Sadoughi S, Pasco C, Joseph G, Wu P, Schafer A, Kazakia G J Bone Miner Res. 2022; 37(4):753-763.

PMID: 35067981 PMC: 9071182. DOI: 10.1002/jbmr.4512.

Computed Tomography Osteodensitometry for Assessment of Bone Mineral Density of the Canine Head-Preliminary Results.

Woods G, Israeliantz Gunz N, Handel I, Liuti T, Mellanby R, Schwarz T Animals (Basel). 2021; 11(5).

PMID: 34069215 PMC: 8156747. DOI: 10.3390/ani11051413.

References

Zebaze R, Libanati C, Austin M, Ghasem-Zadeh A, Hanley D, Zanchetta J . Differing effects of denosumab and alendronate on cortical and trabecular bone. Bone. 2013; 59:173-9. DOI: 10.1016/j.bone.2013.11.016. View

Nishiyama K, Macdonald H, Buie H, Hanley D, Boyd S . Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD: an in vivo HR-pQCT study. J Bone Miner Res. 2009; 25(4):882-90. DOI: 10.1359/jbmr.091020. View

Bala Y, Zebaze R, Ghasem-Zadeh A, Atkinson E, Iuliano S, Peterson J . Cortical porosity identifies women with osteopenia at increased risk for forearm fractures. J Bone Miner Res. 2014; 29(6):1356-62. PMC: 4156822. DOI: 10.1002/jbmr.2167. View

Bjornerem A, Ahmed L, Jorgensen L, Stormer J, Joakimsen R . Breastfeeding protects against hip fracture in postmenopausal women: the Tromsø study. J Bone Miner Res. 2011; 26(12):2843-50. DOI: 10.1002/jbmr.496. View

Jacobsen B, Eggen A, Mathiesen E, Wilsgaard T, Njolstad I . Cohort profile: the Tromso Study. Int J Epidemiol. 2011; 41(4):961-7. PMC: 3429870. DOI: 10.1093/ije/dyr049. View

Zebaze R, Ghasem-Zadeh A, Mbala A, Seeman E . A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone. 2013; 54(1):8-20. DOI: 10.1016/j.bone.2013.01.007. View

Dhainaut A, Hoff M, Syversen U, Haugeberg G . Cortical hand bone porosity and its association with distal radius fracture in middle aged and elderly women. PLoS One. 2013; 8(7):e68405. PMC: 3700909. DOI: 10.1371/journal.pone.0068405. View

Leslie W, Brennan S, Lix L, Johansson H, Oden A, McCloskey E . Direct comparison of eight national FRAX® tools for fracture prediction and treatment qualification in Canadian women. Arch Osteoporos. 2013; 8:145. DOI: 10.1007/s11657-013-0145-0. View

Bell K, Loveridge N, Jordan G, Power J, Constant C, Reeve J . A novel mechanism for induction of increased cortical porosity in cases of intracapsular hip fracture. Bone. 2000; 27(2):297-304. DOI: 10.1016/s8756-3282(00)00318-5. View

10.

Joakimsen R, Fonnebo V, Sogaard A, Tollan A, Stormer J, Magnus J . The Tromsø study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register?. Osteoporos Int. 2002; 12(12):1001-5. DOI: 10.1007/s001980170008. View

11.

Cummings S, Melton L . Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359(9319):1761-7. DOI: 10.1016/S0140-6736(02)08657-9. View

12.

Kanis J, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby A . The components of excess mortality after hip fracture. Bone. 2003; 32(5):468-73. DOI: 10.1016/s8756-3282(03)00061-9. View

13.

Schuit S, van der Klift M, Weel A, de Laet C, Burger H, Seeman E . Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone. 2004; 34(1):195-202. DOI: 10.1016/j.bone.2003.10.001. View

14.

Siris E, Chen Y, Abbott T, Barrett-Connor E, Miller P, Wehren L . Bone mineral density thresholds for pharmacological intervention to prevent fractures. Arch Intern Med. 2004; 164(10):1108-12. DOI: 10.1001/archinte.164.10.1108. View

15.

Schaffler M, Burr D . Stiffness of compact bone: effects of porosity and density. J Biomech. 1988; 21(1):13-6. DOI: 10.1016/0021-9290(88)90186-8. View

16.

Kanis J . Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994; 4(6):368-81. DOI: 10.1007/BF01622200. View

17.

Bell K, Loveridge N, Power J, Garrahan N, Stanton M, Lunt M . Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res. 1999; 14(1):111-9. DOI: 10.1359/jbmr.1999.14.1.111. View

18.

Bell K, Loveridge N, Power J, Garrahan N, Meggitt B, Reeve J . Regional differences in cortical porosity in the fractured femoral neck. Bone. 1999; 24(1):57-64. DOI: 10.1016/s8756-3282(98)00143-4. View

19.

Cheng X, Li J, Lu Y, Keyak J, Lang T . Proximal femoral density and geometry measurements by quantitative computed tomography: association with hip fracture. Bone. 2006; 40(1):169-74. DOI: 10.1016/j.bone.2006.06.018. View

20.

Sornay-Rendu E, Boutroy S, Munoz F, Delmas P . Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res. 2006; 22(3):425-33. DOI: 10.1359/jbmr.061206. View