Site-Specific Volumetric Skeletal Changes in Women with a Distal Forearm Fracture

Overview

Journal J Osteoporos

Publisher Wiley

Specialty Orthopedics

Date 2021 Oct 11

PMID 34631005

Authors

Axel Wihlborg

Karin Bergstrom

Ingrid Bergstrom

Paul Gerdhem

Affiliations

Soon will be listed here.

Abstract

Purpose: To assess site-specific volumetric bone and muscle changes, as well as demographic and biochemical changes, in postmenopausal women with a low-energy distal forearm fracture.

Methods: In a cross-sectional case-control study, postmenopausal women with a distal forearm fracture were compared with age- and gender-matched controls. In total, 203 postmenopausal women (104 cases and 99 controls), with a mean age of 65 years, were included. Measurements included peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) as well as blood sampling and questionnaires.

Results: Forearm trabecular volumetric BMD and total BMD assessed with pQCT were significantly lower in fracture cases compared to controls ( < 0.001). Significantly higher cross-sectional area, lower cortical BMD, and lower cortical thickness were seen in women with fracture ( < 0.033, < 0.001, and < 0.001, respectively). Postmenopausal women with fracture had significantly lower hip and spine areal BMD assessed with DXA ( < 0.001). Activity level was higher and a history of falling was more frequent in women with fracture ( < 0.019 and < 0.001, respectively). Vertebral fracture was observed in 24 women (22%) with a distal forearm fracture. Muscle area, muscle density, PTH, and 25OHD did not differ between fracture cases and controls.

Conclusion: A distal forearm fracture was associated with site-specific and central bone changes. Postmenopausal women with fracture had a larger bone area in combination with a thinner cortex and lower site-specific total BMD. In addition, women with fracture had a higher activity level, an increased occurrence of previous fall accidents, and a high prevalence of vertebral fractures. Forearm muscle composition, PTH, and 25OHD were not associated with forearm fracture. Fracture preventive measures following a low-energy distal forearm fracture seem beneficial.

References

Crockett K, Arnold C, Farthing J, Chilibeck P, Johnston J, Bath B . Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture. Osteoporos Int. 2015; 26(10):2461-9. DOI: 10.1007/s00198-015-3160-8. View

Muller M, Webber C, Bouxsein M . Predicting the failure load of the distal radius. Osteoporos Int. 2003; 14(4):345-52. DOI: 10.1007/s00198-003-1380-9. View

Kelsey J, Prill M, Keegan T, Tanner H, Bernstein A, Quesenberry Jr C . Reducing the risk for distal forearm fracture: preserve bone mass, slow down, and don't fall!. Osteoporos Int. 2004; 16(6):681-90. DOI: 10.1007/s00198-004-1745-8. View

Earnshaw S, Cawte S, Worley A, Hosking D . Colles' fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int. 1998; 8(1):53-60. DOI: 10.1007/s001980050048. View

Augat P, Iida H, Jiang Y, Diao E, Genant H . Distal radius fractures: mechanisms of injury and strength prediction by bone mineral assessment. J Orthop Res. 1998; 16(5):629-35. DOI: 10.1002/jor.1100160517. View

Cuddihy M, Gabriel S, Crowson C, OFallon W, Melton 3rd L . Forearm fractures as predictors of subsequent osteoporotic fractures. Osteoporos Int. 2000; 9(6):469-75. DOI: 10.1007/s001980050172. View

Vico L, Zouch M, Amirouche A, Frere D, Laroche N, Koller B . High-resolution pQCT analysis at the distal radius and tibia discriminates patients with recent wrist and femoral neck fractures. J Bone Miner Res. 2008; 23(11):1741-50. DOI: 10.1359/jbmr.080704. View

Sherrington C, Michaleff Z, Fairhall N, Paul S, Tiedemann A, Whitney J . Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. Br J Sports Med. 2016; 51(24):1750-1758. DOI: 10.1136/bjsports-2016-096547. View

Kanis J, Johnell O, De Laet C, Johansson H, Oden A, Delmas P . A meta-analysis of previous fracture and subsequent fracture risk. Bone. 2004; 35(2):375-82. DOI: 10.1016/j.bone.2004.03.024. View

10.

Boutroy S, van Rietbergen B, Sornay-Rendu E, Munoz F, Bouxsein M, Delmas P . Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J Bone Miner Res. 2007; 23(3):392-9. DOI: 10.1359/jbmr.071108. View

11.

Engelke K, Adams J, Armbrecht G, Augat P, Bogado C, Bouxsein M . Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom. 2008; 11(1):123-62. DOI: 10.1016/j.jocd.2007.12.010. View

12.

Mallmin H, Ljunghall S, Persson I, Naessen T, Krusemo U, Bergstrom R . Fracture of the distal forearm as a forecaster of subsequent hip fracture: a population-based cohort study with 24 years of follow-up. Calcif Tissue Int. 1993; 52(4):269-72. DOI: 10.1007/BF00296650. View

13.

Ahlborg H, Johnell O, Turner C, Rannevik G, Karlsson M . Bone loss and bone size after menopause. N Engl J Med. 2003; 349(4):327-34. DOI: 10.1056/NEJMoa022464. View

14.

Schneider P, Reiners C, Cointry G, Capozza R, Ferretti J . Bone quality parameters of the distal radius as assessed by pQCT in normal and fractured women. Osteoporos Int. 2001; 12(8):639-46. DOI: 10.1007/s001980170063. View

15.

Marshall D, Johnell O, Wedel H . Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996; 312(7041):1254-9. PMC: 2351094. DOI: 10.1136/bmj.312.7041.1254. View

16.

Bergstrom I, Landgren B, Pyykko I . Training or EPT in perimenopause on balance and flushes. Acta Obstet Gynecol Scand. 2007; 86(4):467-72. DOI: 10.1080/00016340701207575. View

17.

Karlsson M, Vonschewelov T, Karlsson C, Coster M, Rosengen B . Prevention of falls in the elderly: a review. Scand J Public Health. 2013; 41(5):442-54. DOI: 10.1177/1403494813483215. View

18.

Crandall C, Hovey K, Cauley J, Andrews C, Curtis J, Wactawski-Wende J . Wrist Fracture and Risk of Subsequent Fracture: Findings from the Women's Health Initiative Study. J Bone Miner Res. 2015; 30(11):2086-95. PMC: 4615529. DOI: 10.1002/jbmr.2559. View

19.

Frost H . Bone "mass" and the "mechanostat": a proposal. Anat Rec. 1987; 219(1):1-9. DOI: 10.1002/ar.1092190104. View

20.

Wapniarz M, Lehmann R, Reincke M, Schonau E, Klein K, Allolio B . Determinants of radial bone density as measured by PQCT in pre- and postmenopausal women: the role of bone size. J Bone Miner Res. 1997; 12(2):248-54. DOI: 10.1359/jbmr.1997.12.2.248. View