Top

Osteoporosis International

Published in:

01-06-2018 | Original Article

Bone mineral density averaged over a region of interest on femur is affected by age-related change of bone geometry

Author: Y. Luo

Published in: Osteoporosis International | Issue 6/2018

Abstract

Summary

Femur expansion occurs during normal aging in both men and women. Average bone mineral density (BMD) over a region of interest (ROI) on the femur may considerably decrease with age even in healthy people, and therefore, it is inaccurate if used to monitor treatment-induced bone change.

Introduction

Areal bone mineral density (BMD), averaged over a region of interest (ROI) on the femur, is widely used in the diagnosis of osteoporosis, assessment of fracture risk, and monitoring of treatment effectiveness. We studied the effect of age-related change in femur geometry on average BMD.

Methods

The effect of age-related bone geometric change on averaged BMD was investigated by a cross-sectional study. Total 83 healthy subjects were selected for this study. For each subject, QCT of left femur was scanned using clinical scanner. For each standard volume of interest (VOI), integral/cortical/trabecular bone volume, volumetric BMD (vBMD), and bone mass were measured using QCT Pro; the corresponding areal BMD (aBMD) was projected using CTXA-Hip. Both QCT Pro and CTXA-Hip are commercial software. Correlations between bone volume/density/mass and age were studied.

Results

In the studied population, there was no association between body weight/BMI (body mass index) and age, correlation between normalized femoral neck width and age was 0.24 (p < 0.05). Both aBMD and integral vBMD decreased with age (after adjusted by BMI, for aBMD, r = − 0.21 to − 0.24, p ≤ 0.05 except at trochanter; for vBMD, r = − 0.20 to − 0.31, p < 0.05); cortical vBMD had no significant change; trabecular vBMD decreased at all VOIs except at trochanter (after adjusted by BMI, r = − 0.22 to 0.32, p ≤ 0.05). Integral volume showed slight increase but only significant at the trochanter after adjusted by body size, cortical volume showed insignificant decrease, and trabecular volume considerably increased with age in all VOIs (after adjusted by body size, r = 0.27–0.40, p < 0.05). Integral, cortical, and trabecular mass had no significant change in all VOIs, except that at the trochanter trabecular mass slightly increased with age (r = 0.31, p < 0.05).

Conclusions

Even though there is no change in bone mass, average BMD may considerably decrease with age due to bone expansion. Comparatively, aBMD is less affected than vBMD.

Available only for authorised users

Kling JM, Clarke BL, Sandhu NP (2014) Osteoporosis prevention, screening, and treatment: a review. J Women's Health 23:563–572CrossRef

Jeremiah MP, Unwin BK, Greenawald MH (2015) Diagnosis and management of osteoporosis. Am Fam Physician 92:261–268PubMed

World Health Organization Collaborating Centre for Metabolic Bone Diseases. FRAX®: WHO Fracture Risk Assessment Tool. http://www.shef.ac.uk/FRAX/. University of Sheffield, UK

Kanis JA, Odén A, Johansson H, Borgström F, Ström O, McCloskey EV (2010) FRAX®, a new tool for assessing fracture risk: clinical applications and intervention thresholds. Medicographia 32:33–40

J.H. Krege, X. Wan, B.C. Lentle, C. Berger, L. Langsetmo, J.D. Adachi, J.C. Prior, A. Tenenhouse, J. P. Brown, N. Kreiger, W.P. Olszynski, R.G. Josse, and D. Goltzman (on behalf of the CaMos Research Group) (2013). Fracture risk prediction: importance of age, BMD and spine fracture status. BoneKey Rep 2 . doi:https://doi.org/10.1038/bonekey.2013.138.

Carballido-Gamio J, Harnish R, Saeed I et al (2013) Proximal femoral density distribution and structure in relation to age and hip fracture risk in women. J Bone Miner Res 28:537–546CrossRefPubMedPubMedCentral

Lewiecki EM (2010) Bone density testing to monitor osteoporosis therapy in clinical practice. Am Fam Physician 82:749–750PubMed

McNabb BL, Vittinghoff E, Schwartz AV, Eastell R, Bauer DC, Ensrud K, Rosenberg E, Santora A, Barrett-Connor E, Black DM (2013) BMD changes and predictors of increased bone loss in postmenopausal women after a 5-year course of alendronate. J Bone Miner Res 28:1319–1327CrossRefPubMed

Barrett-Connor E, Siris ES, Wehren LE, Miller PD, Abbott TA, Berger ML, Santora AC, Sherwood LM (2005) Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res 20:185–194CrossRefPubMed

10.

Bergot C, Bousson V, Meunier A, Laval-Jeantet M, Laredo JD (2002) Hip fracture risk and proximal femur geometry from DXA scans. Osteoporos Int 13:542–550CrossRefPubMed

11.

Kanis JA, Johansson H, Oden A, McCloskey EV (2009) Assessment of fracture risk. Eur J Radiol 71:392–397CrossRefPubMed

12.

Bruyere O, Reginster J-Y (2014) Monitoring of osteoporosis therapy. Best Pract Res Clin Endocrinol Metab 28:835–841CrossRefPubMed

13.

Watts NB, Lewiecki EM, Bonnick SL et al (2009) Clinical value of monitoring BMD in patients treated with bisphosphonates for osteoporosis. J Bone Miner Res 24:1643–1646CrossRefPubMed

14.

Clarke B (2008) Normal bone anatomy and physiology. Clin J Am Soc Nephrol 3(Suppl 3):S131–S139CrossRefPubMedPubMedCentral

15.

Ruff CB, Hayes WC (1982) Subperiosteal expansion and cortical remodeling of the human femur and tibia with aging. Science 217:945–948CrossRefPubMed

16.

Cann CE, Adams JE, Brown JK, Brett AD (2014) CTXA hip—an extension of classical DXA measurements using quantitative CT. PLoS One 9(3):e91904CrossRefPubMedPubMedCentral

17.

Cox M, Mays S (2000) Human osteology in archaeology and forensic science. Cambridge University Press, Cambridge

18.

Osterhoff G, Morgan EF, Shefelbine SJ, Karim L, McNamara LM, Augatg P (2016) Bone mechanical properties and changes with osteoporosis. Injury 47:S11–S20CrossRefPubMedPubMedCentral

19.

Arden E, Arden N, Hunter D (2008) Osteoarthritis. Oxford University Press, New York

20.

Berger C, Langsetmo L, Joseph L et al (2008) Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents. CMAJ 178:1660–1668CrossRefPubMedPubMedCentral

21.

Warming L, Hassager C, Christiansen C (2002) Changes in bone mineral density with age in men and women: a longitudinal study. Osteoporos Int 13:105–112CrossRefPubMed

22.

Beck TJ, Looker AC, Ruff CB, Sievanen H, Wahner HW (2000) Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data. J Bone Miner Res 15:2297–2304CrossRefPubMed

23.

Ito M, Nakata T, Nishida A, Uetani M (2011) Age-related changes in bone density, geometry and biomechanical properties of the proximal femur: CT-based 3D hip structure analysis in normal postmenopausal women. Bone 48:627–630CrossRefPubMed

24.

Engelke K (2017) Quantitative computed tomography-current status and new developments. J Clin Densitom 20:309–321CrossRefPubMed

25.

Treece GM, Gee AH (2015) Independent measurement of femoral cortical thickness and cortical bone density using clinical CT. Med Image Anal 20:249–264CrossRefPubMed

26.

Museyko O, Gerner B, Engelke K (2017) A new method to determine cortical bone thickness in CT images using a hybrid approach of parametric profile representation and local adaptive thresholds: accuracy results. PLoS One 12(11):e0187097. https://doi.org/10.1371/journal.pone.0187097 CrossRefPubMedPubMedCentral

Title: Bone mineral density averaged over a region of interest on femur is affected by age-related change of bone geometry
Author: Y. Luo
Publication date: 01-06-2018
Publisher: Springer London
Published in: Osteoporosis International / Issue 6/2018
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-018-4461-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bone mineral density averaged over a region of interest on femur is affected by age-related change of bone geometry

Abstract

Summary

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2018

Teriparatide treatment exerts differential effects on the central and peripheral skeleton: results from the MOAT study

Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis

Correction to: Using self-reports of pain and other variables to distinguish between older women with back pain due to vertebral fractures and those with back pain due to degenerative changes

The relationship between maternal and child bone density in Nigerian children with and without nutritional rickets

The trabecular bone score is associated with bone mineral density, markers of bone turnover and prevalent fracture in patients with end stage kidney disease

Increased rate of osteoporosis, low lean mass, and fragility fractures in COPD patients: association with disease severity