Patella Fractures Are Associated with Bone Fragility - a Retrospective Study

Overview

Journal J Bone Miner Res

Publisher Oxford University Press

Date 2024 Oct 10

PMID 39385460

Authors

Isabella Rosillo

Carmen Germosen

Sanchita Agarwal

Ragyie Rawal

Ivelisse Colon

Mariana Bucovsky

Nayoung Kil

Elizabeth Shane

Marcella Walker

Affiliations

Soon will be listed here.

Abstract

Patella fractures are not typically considered osteoporotic fractures. We compared bone mineral density (BMD) and microstructure in elderly women from a multiethnic population-based study in New York City with any history of a patella fracture (n = 27) to those without historical fracture (n = 384) and those with an adult fragility forearm fracture (n = 28) using dual energy x-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HR-pQCT). Compared to those without fracture, women with patella fracture had 6.5% lower areal BMD (aBMD) by DXA only at the total hip (p=.007), while women with forearm fracture had lower aBMD at multiple sites and lower trabecular bone score (TBS), adjusted for age, body mass index, race and ethnicity (all p<.05). By HR-pQCT, adjusted radial total and trabecular (Tb) volumetric BMD (vBMD) and Tb number were 10%-24% lower while Tb spacing was 12-23% higher (all p<.05) in the fracture groups versus women without fracture. Women with a forearm, but not a patella, fracture also had lower adjusted radial cortical (Ct) area and vBMD and 21.8% (p<.0001) lower stiffness vs. women without fracture. At the tibia, the fracture groups had 9.3%-15.7% lower total and Tb vBMD (all p<.05) compared to the non-fracture group. Women with a forearm fracture also had 10.9, and 14.7% lower tibial Ct area and thickness versus those without fracture. Compared to women without fracture, tibial stiffness was 9.9% and 12% lower in the patella and forearm fracture groups, respectively (all p<.05). By HR-pQCT, the patella vs. forearm fracture group had 36% higher radial Tb heterogeneity (p<.05). In summary, women with patella fracture had Tb deterioration by HR-pQCT associated with lower tibial mechanical competence that was similar to those with fragility forearm fracture, a more universally accepted "osteoporotic" fracture. These data suggest patella fractures are associated with skeletal fragility and warrant skeletal evaluation.

Citing Articles

Mapping of Patellar Fracture Patterns: A Multicenter Study of 237 Patients.

Lenz J, Schraag A, Plank L, von Ruden C, Alt V, Weber J J Clin Med. 2025; 14(4).

PMID: 40004864 PMC: 11856370. DOI: 10.3390/jcm14041335.

References

Samelson E, Broe K, Xu H, Yang L, Boyd S, Biver E . Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol. 2018; 7(1):34-43. PMC: 6354581. DOI: 10.1016/S2213-8587(18)30308-5. View

Sundh D, Nilsson A, Nilsson M, Johansson L, Mellstrom D, Lorentzon M . Increased cortical porosity in women with hip fracture. J Intern Med. 2017; 281(5):496-506. DOI: 10.1111/joim.12587. View

Agarwal S, Germosen C, Bucovsky M, Colon I, Kil N, Walker M . Skeletal Microstructure in Caribbean Hispanic Women. JBMR Plus. 2023; 7(5):e10725. PMC: 10184017. DOI: 10.1002/jbm4.10725. View

Washburn R, Smith K, Jette A, Janney C . The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993; 46(2):153-62. DOI: 10.1016/0895-4356(93)90053-4. View

Hans D, Barthe N, Boutroy S, Pothuaud L, Winzenrieth R, Krieg M . Correlations between trabecular bone score, measured using anteroposterior dual-energy X-ray absorptiometry acquisition, and 3-dimensional parameters of bone microarchitecture: an experimental study on human cadaver vertebrae. J Clin Densitom. 2011; 14(3):302-12. DOI: 10.1016/j.jocd.2011.05.005. View

Cheung W, Hung V, Cheuk K, Chau W, Tsoi K, Wong R . Best Performance Parameters of HR-pQCT to Predict Fragility Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res. 2021; 36(12):2381-2398. PMC: 9298023. DOI: 10.1002/jbmr.4449. View

Gehlbach S, Saag K, Adachi J, Hooven F, Flahive J, Boonen S . Previous fractures at multiple sites increase the risk for subsequent fractures: the Global Longitudinal Study of Osteoporosis in Women. J Bone Miner Res. 2011; 27(3):645-53. PMC: 4881741. DOI: 10.1002/jbmr.1476. View

Toumi H, Larguech G, Filaire E, Pinti A, Lespessailles E . Regional variations in human patellar trabecular architecture and the structure of the quadriceps enthesis: a cadaveric study. J Anat. 2012; 220(6):632-7. PMC: 3390516. DOI: 10.1111/j.1469-7580.2012.01500.x. View

Jorgenson B, Buie H, McErlain D, Sandino C, Boyd S . A comparison of methods for in vivo assessment of cortical porosity in the human appendicular skeleton. Bone. 2014; 73:167-75. DOI: 10.1016/j.bone.2014.11.023. View

10.

Stein E, Liu X, Nickolas T, Cohen A, Thomas V, McMahon D . Abnormal microarchitecture and stiffness in postmenopausal women with ankle fractures. J Clin Endocrinol Metab. 2011; 96(7):2041-8. PMC: 3135193. DOI: 10.1210/jc.2011-0309. View

11.

Bonaretti S, Majumdar S, Lang T, Khosla S, Burghardt A . The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int. 2017; 28(7):2115-2128. PMC: 5526099. DOI: 10.1007/s00198-017-4010-7. View

12.

Seeley D, Browner W, Nevitt M, Genant H, Scott J, Cummings S . Which fractures are associated with low appendicular bone mass in elderly women? The Study of Osteoporotic Fractures Research Group. Ann Intern Med. 1991; 115(11):837-42. DOI: 10.7326/0003-4819-115-11-837. View

13.

Mikolajewicz N, Bishop N, Burghardt A, Folkestad L, Hall A, Kozloff K . HR-pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res. 2019; 35(3):446-459. DOI: 10.1002/jbmr.3901. View

14.

Mackey D, Lui L, Cawthon P, Bauer D, Nevitt M, Cauley J . High-trauma fractures and low bone mineral density in older women and men. JAMA. 2007; 298(20):2381-8. DOI: 10.1001/jama.298.20.2381. View

15.

Sornay-Rendu E, Cabrera-Bravo J, Boutroy S, Munoz F, Delmas P . Severity of vertebral fractures is associated with alterations of cortical architecture in postmenopausal women. J Bone Miner Res. 2008; 24(4):737-43. DOI: 10.1359/jbmr.081223. View

16.

LeBoff M, Greenspan S, Insogna K, Lewiecki E, Saag K, Singer A . The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022; 33(10):2049-2102. PMC: 9546973. DOI: 10.1007/s00198-021-05900-y. View

17.

Garita B, Maligro J, Sadoughi S, Wu P, Liebenberg E, Horvai A . Microstructural abnormalities are evident by histology but not HR-pQCT at the periosteal cortex of the human tibia under CVD and T2D conditions. Med Nov Technol Devices. 2023; 10. PMC: 10306320. DOI: 10.1016/j.medntd.2021.100062. View

18.

Whittier D, Boyd S, Burghardt A, Paccou J, Ghasem-Zadeh A, Chapurlat R . Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int. 2020; 31(9):1607-1627. PMC: 7429313. DOI: 10.1007/s00198-020-05438-5. View

19.

Kanis J, Oden A, Johnell O, Jonsson B, De Laet C, Dawson A . The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001; 12(5):417-27. DOI: 10.1007/s001980170112. View

20.

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