Skip to main content
Top
Published in: Clinical Orthopaedics and Related Research® 6/2012

01-06-2012 | Basic Research

A Correlation Exists Between Subchondral Bone Mineral Density of the Distal Radius and Systemic Bone Mineral Density

Authors: Seung Hwan Rhee, MD, PhD, Goo Hyun Baek, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2012

Login to get access

Abstract

Background

Intraarticular distal radius fractures are common and risk articular congruity owing to disruption of the subchondral bone. Studies regarding microstructure and mechanical properties of the distal radius, however, focus only on the cortical and trabecular bones in the metaphysis and not on the subchondral bone.

Questions/purposes

This study was conducted to (1) quantify the regional bone mineral density of the subchondral plate in the distal radius; (2) analyze the topographic distribution pattern of the subchondral bone mineral density; and (3) evaluate the correlation between the subchondral bone mineral density and the potentially related clinical factors of age, height, weight, BMI, systemic bone mineral densities, socio-occupational classification, and hand osteoarthritis grading.

Methods

Eighty postmenopausal women with a mean age of 68 years (range, 52–88 years) were enrolled in this study. Digital images of the distal radii of the subjects were scanned by conventional CT and processed to provide the regional bone mineral density of the subchondral plate using a CT osteoabsorptiometry technique. The estimated subchondral bone mineral density was analyzed to evaluate the topographic pattern and its correlation with various clinical factors, including age, height, weight, BMI, degree of hand osteoarthritis, socio-occupational class, and systemic bone mineral density measured in the lumbar spine and hip.

Results

During topographic analysis of a densitometric map, a bicentric distribution of the subchondral bone mineral density was found. Among the clinical factors, only the systemic bone mineral density measured by dual-energy x-ray absorptiometry in the femur neck and lumbar spine had a significant correlation with the subchondral bone mineral density of the distal radius.

Conclusion

Systemic bone mineral density correlates substantially with the subchondral bone mineral density of the distal radius as a constitutional factor, whereas other local factors arising from the gravitational load or joint reaction force are not associated with the subchondral bone mineral density of the distal radius.

Level of Evidence

Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Literature
1.
go back to reference Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;206:202–210.PubMed Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986;206:202–210.PubMed
2.
go back to reference Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH. Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med. 2003;163:2052–2057.PubMedCrossRef Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH. Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med. 2003;163:2052–2057.PubMedCrossRef
3.
go back to reference Burghardt AJ, Kazakia GJ, Link TM, Majumdar S. Automated simulation of areal bone mineral density assessment in the distal radius from high-resolution peripheral quantitative computed tomography. Osteoporos Int. 2009;20:2017–2024.PubMedCrossRef Burghardt AJ, Kazakia GJ, Link TM, Majumdar S. Automated simulation of areal bone mineral density assessment in the distal radius from high-resolution peripheral quantitative computed tomography. Osteoporos Int. 2009;20:2017–2024.PubMedCrossRef
4.
go back to reference Carlson KJ, Patel BA. Habitual use of the primate forelimb is reflected in the material properties of subchondral bone in the distal radius. J Anat. 2006;208:659–670.PubMedCrossRef Carlson KJ, Patel BA. Habitual use of the primate forelimb is reflected in the material properties of subchondral bone in the distal radius. J Anat. 2006;208:659–670.PubMedCrossRef
5.
go back to reference Cavelaars AE, Kunst AE, Geurts JJ, Helmert U, Lundberg O, Mielck A, Matheson J, Mizrahi A, Mizrahi A, Rasmussen N, Spuhler T, Mackenbach JP. Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme. Int J Epidemiol. 1998;27:222–230.PubMedCrossRef Cavelaars AE, Kunst AE, Geurts JJ, Helmert U, Lundberg O, Mielck A, Matheson J, Mizrahi A, Mizrahi A, Rasmussen N, Spuhler T, Mackenbach JP. Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme. Int J Epidemiol. 1998;27:222–230.PubMedCrossRef
6.
go back to reference Cesana G, Ferrario M, Gigante S, Sega R, Toso C, Achilli F. Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population. Int J Epidemiol. 2001;30(suppl 1):S53–58.PubMedCrossRef Cesana G, Ferrario M, Gigante S, Sega R, Toso C, Achilli F. Socio-occupational differences in acute myocardial infarction case-fatality and coronary care in a northern Italian population. Int J Epidemiol. 2001;30(suppl 1):S53–58.PubMedCrossRef
7.
go back to reference Chaisson CE, Zhang Y, Sharma L, Felson DT. Higher grip strength increases the risk of incident radiographic osteoarthritis in proximal hand joints. Osteoarthritis Cartilage. 2000;8(suppl A):S29–32.PubMed Chaisson CE, Zhang Y, Sharma L, Felson DT. Higher grip strength increases the risk of incident radiographic osteoarthritis in proximal hand joints. Osteoarthritis Cartilage. 2000;8(suppl A):S29–32.PubMed
8.
go back to reference Chaisson CE, Zhang Y, Sharma L, Kannel W, Felson DT. Grip strength and the risk of developing radiographic hand osteoarthritis: results from the Framingham Study. Arthritis Rheum. 1999;42:33–38.PubMedCrossRef Chaisson CE, Zhang Y, Sharma L, Kannel W, Felson DT. Grip strength and the risk of developing radiographic hand osteoarthritis: results from the Framingham Study. Arthritis Rheum. 1999;42:33–38.PubMedCrossRef
9.
go back to reference Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91:613–619.PubMedCrossRef Clayton RA, Gaston MS, Ralston SH, Court-Brown CM, McQueen MM. Association between decreased bone mineral density and severity of distal radial fractures. J Bone Joint Surg Am. 2009;91:613–619.PubMedCrossRef
10.
go back to reference Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O’Fallon WM, Melton LJ 3rd. Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med. 2002;162:421–426.PubMedCrossRef Cuddihy MT, Gabriel SE, Crowson CS, Atkinson EJ, Tabini C, O’Fallon WM, Melton LJ 3rd. Osteoporosis intervention following distal forearm fractures: a missed opportunity? Arch Intern Med. 2002;162:421–426.PubMedCrossRef
11.
go back to reference Engelke K, Libanati C, Liu Y, Wang H, Austin M, Fuerst T, Stampa B, Timm W, Genant HK. Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone. 2009;45:110–118.PubMedCrossRef Engelke K, Libanati C, Liu Y, Wang H, Austin M, Fuerst T, Stampa B, Timm W, Genant HK. Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone. 2009;45:110–118.PubMedCrossRef
12.
go back to reference Erikson R, Goldthorpe JH, Portocarero L. Intergenerational class mobility in three Western European Societies: England, France and Sweden. Br J Sociol. 1979;30:415–441.CrossRef Erikson R, Goldthorpe JH, Portocarero L. Intergenerational class mobility in three Western European Societies: England, France and Sweden. Br J Sociol. 1979;30:415–441.CrossRef
13.
go back to reference Fernandez JJ, Gruen GS, Herndon JH. Outcome of distal radius fractures using the short form 36 health survey. Clin Orthop Relat Res. 1997;341:36–41.PubMedCrossRef Fernandez JJ, Gruen GS, Herndon JH. Outcome of distal radius fractures using the short form 36 health survey. Clin Orthop Relat Res. 1997;341:36–41.PubMedCrossRef
14.
go back to reference Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2000;82:1063–1070.PubMed Freedman KB, Kaplan FS, Bilker WB, Strom BL, Lowe RA. Treatment of osteoporosis: are physicians missing an opportunity? J Bone Joint Surg Am. 2000;82:1063–1070.PubMed
15.
go back to reference Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff’s law: the bone modeling problem. Anat Rec. 1990;226:403–413. Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff’s law: the bone modeling problem. Anat Rec. 1990;226:403–413.
16.
go back to reference Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 2. Redefining Wolff’s law: the remodeling problem. Anat Rec. 1990;226:414–422. Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 2. Redefining Wolff’s law: the remodeling problem. Anat Rec. 1990;226:414–422.
17.
go back to reference Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am. 1951;33:895–907.PubMed Gartland JJ Jr, Werley CW. Evaluation of healed Colles’ fractures. J Bone Joint Surg Am. 1951;33:895–907.PubMed
18.
go back to reference Hollevoet N, Verdonk R. Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg. 2003;69:510–514.PubMed Hollevoet N, Verdonk R. Outcome of distal radius fractures in relation to bone mineral density. Acta Orthop Belg. 2003;69:510–514.PubMed
19.
go back to reference Itoh S, Tomioka H, Tanaka J, Shinomiya K. Relationship between bone mineral density of the distal radius and ulna and fracture characteristics. J Hand Surg Am. 2004;29:123–130.PubMedCrossRef Itoh S, Tomioka H, Tanaka J, Shinomiya K. Relationship between bone mineral density of the distal radius and ulna and fracture characteristics. J Hand Surg Am. 2004;29:123–130.PubMedCrossRef
20.
go back to reference Kanterewicz E, Yanez A, Perez-Pons A, Codony I, Del Rio L, Diez-Perez A. Association between Colles’ fracture and low bone mass: age-based differences in postmenopausal women. Osteoporos Int. 2002;13:824–828.PubMedCrossRef Kanterewicz E, Yanez A, Perez-Pons A, Codony I, Del Rio L, Diez-Perez A. Association between Colles’ fracture and low bone mass: age-based differences in postmenopausal women. Osteoporos Int. 2002;13:824–828.PubMedCrossRef
21.
go back to reference Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med. 2001;161:1309–1312.PubMedCrossRef Khan SA, de Geus C, Holroyd B, Russell AS. Osteoporosis follow-up after wrist fractures following minor trauma. Arch Intern Med. 2001;161:1309–1312.PubMedCrossRef
22.
go back to reference Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–659.PubMed Knirk JL, Jupiter JB. Intra-articular fractures of the distal end of the radius in young adults. J Bone Joint Surg Am. 1986;68:647–659.PubMed
23.
go back to reference Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg Br. 1993;18:45–49.PubMedCrossRef Kopylov P, Johnell O, Redlund-Johnell I, Bengner U. Fractures of the distal end of the radius in young adults: a 30-year follow-up. J Hand Surg Br. 1993;18:45–49.PubMedCrossRef
24.
go back to reference Macneil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. 2008;42:1203–1213.PubMedCrossRef Macneil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. 2008;42:1203–1213.PubMedCrossRef
25.
go back to reference Mehlum IS, Kristensen P, Kjuus H, Wergeland E. Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain? Scand J Work Environ Health. 2008;34:250–259.PubMedCrossRef Mehlum IS, Kristensen P, Kjuus H, Wergeland E. Are occupational factors important determinants of socioeconomic inequalities in musculoskeletal pain? Scand J Work Environ Health. 2008;34:250–259.PubMedCrossRef
26.
go back to reference Misch CE, ed. Bone density; a key determinant for clinical success. Contemporary Implant Dentistry. St Louis, MO: Mosby Publishing Inc; 1999:109–118. Misch CE, ed. Bone density; a key determinant for clinical success. Contemporary Implant Dentistry. St Louis, MO: Mosby Publishing Inc; 1999:109–118.
27.
go back to reference Morin S, Tsang JF, Leslie WD. Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years. Osteoporos Int. 2009;20:363–370.PubMedCrossRef Morin S, Tsang JF, Leslie WD. Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years. Osteoporos Int. 2009;20:363–370.PubMedCrossRef
28.
go back to reference Patel BA, Carlson KJ. Bone density spatial patterns in the distal radius reflect habitual hand postures adopted by quadrupedal primates. J Hum Evol. 2007;52:130–141.PubMedCrossRef Patel BA, Carlson KJ. Bone density spatial patterns in the distal radius reflect habitual hand postures adopted by quadrupedal primates. J Hum Evol. 2007;52:130–141.PubMedCrossRef
29.
go back to reference Patel BA, Carlson KJ. Apparent density patterns in subchondral bone of the sloth and anteater forelimb. Biol Lett. 2008;4:486–489.PubMedCrossRef Patel BA, Carlson KJ. Apparent density patterns in subchondral bone of the sloth and anteater forelimb. Biol Lett. 2008;4:486–489.PubMedCrossRef
30.
go back to reference Pongchaiyakul C, Panichkul S, Songpatanasilp T, Nguyen TV. A nomogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement. Osteoporos Int. 2007;18:525–531.PubMedCrossRef Pongchaiyakul C, Panichkul S, Songpatanasilp T, Nguyen TV. A nomogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement. Osteoporos Int. 2007;18:525–531.PubMedCrossRef
31.
go back to reference Porter M, Stockley I. Fractures of the distal radius: intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987;220:241–252.PubMed Porter M, Stockley I. Fractures of the distal radius: intermediate and end results in relation to radiologic parameters. Clin Orthop Relat Res. 1987;220:241–252.PubMed
32.
go back to reference Pugh JW, Radin EL, Rose RM. Quantitative studies of human subchondral cancellous bone: its relationship to the state of its overlying cartilage. J Bone Joint Surg Am. 1974;56:313–321.PubMed Pugh JW, Radin EL, Rose RM. Quantitative studies of human subchondral cancellous bone: its relationship to the state of its overlying cartilage. J Bone Joint Surg Am. 1974;56:313–321.PubMed
33.
go back to reference Radin EL, Paul IL. Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage, synovial fluid, periarticular soft tissues and bone. Arthritis Rheum. 1970;13:139–144.PubMedCrossRef Radin EL, Paul IL. Does cartilage compliance reduce skeletal impact loads? The relative force-attenuating properties of articular cartilage, synovial fluid, periarticular soft tissues and bone. Arthritis Rheum. 1970;13:139–144.PubMedCrossRef
34.
go back to reference Varga P, Pahr DH, Baumbach S, Zysset PK. HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles’ fracture load in vitro. Bone. 2010;47:982–988.PubMedCrossRef Varga P, Pahr DH, Baumbach S, Zysset PK. HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles’ fracture load in vitro. Bone. 2010;47:982–988.PubMedCrossRef
35.
go back to reference Vener MJ, Thompson RC Jr, Lewis JL, Oegema TR Jr. Subchondral damage after acute transarticular loading: an in vitro model of joint injury. J Orthop Res. 1992;10:759–765.PubMedCrossRef Vener MJ, Thompson RC Jr, Lewis JL, Oegema TR Jr. Subchondral damage after acute transarticular loading: an in vitro model of joint injury. J Orthop Res. 1992;10:759–765.PubMedCrossRef
36.
go back to reference Vilayphiou N, Boutroy S, Sornay-Rendu E, Van Rietbergen B, Munoz F, Delmas PD, Chapurlat R. Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in postmenopausal women. Bone. 2010;46:1030–1037.PubMedCrossRef Vilayphiou N, Boutroy S, Sornay-Rendu E, Van Rietbergen B, Munoz F, Delmas PD, Chapurlat R. Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in postmenopausal women. Bone. 2010;46:1030–1037.PubMedCrossRef
37.
go back to reference Wildner M, Peters A, Raghuvanshi VS, Hohnloser J, Siebert U. Superiority of age and weight as variables in predicting osteoporosis in postmenopausal white women. Osteoporos Int. 2003;14:950–956.PubMedCrossRef Wildner M, Peters A, Raghuvanshi VS, Hohnloser J, Siebert U. Superiority of age and weight as variables in predicting osteoporosis in postmenopausal white women. Osteoporos Int. 2003;14:950–956.PubMedCrossRef
38.
go back to reference Young CF, Nanu AM, Checketts RG. Seven-year outcome following Colles’ type distal radial fracture: a comparison of two treatment methods. J Hand Surg Br. 2003;28:422–426.PubMedCrossRef Young CF, Nanu AM, Checketts RG. Seven-year outcome following Colles’ type distal radial fracture: a comparison of two treatment methods. J Hand Surg Br. 2003;28:422–426.PubMedCrossRef
39.
go back to reference Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol. 2002;156:1021–1027.PubMedCrossRef Zhang Y, Niu J, Kelly-Hayes M, Chaisson CE, Aliabadi P, Felson DT. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol. 2002;156:1021–1027.PubMedCrossRef
Metadata
Title
A Correlation Exists Between Subchondral Bone Mineral Density of the Distal Radius and Systemic Bone Mineral Density
Authors
Seung Hwan Rhee, MD, PhD
Goo Hyun Baek, MD, PhD
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Clinical Orthopaedics and Related Research® / Issue 6/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-011-2168-4

Other articles of this Issue 6/2012

Clinical Orthopaedics and Related Research® 6/2012 Go to the issue

Symposium: Injuries in Overhead Athletes

Hip Injuries in the Overhead Athlete