Top

Published in:

Open Access 01-04-2016 | Original Article

Bone material strength is associated with areal BMD but not with prevalent fractures in older women

Authors: R. Rudäng, M. Zoulakis, D. Sundh, H. Brisby, A. Diez-Perez, L. Johansson, D. Mellström, A. Darelid, M. Lorentzon

Published in: Osteoporosis International | Issue 4/2016

Abstract

Summary

Reference point indentation is a novel method to assess bone material strength index (BMSi) in vivo. We found that BMSi at the mid-tibia was weakly associated with spine and hip areal bone mineral density but not with prevalent fracture in a population-based cohort of 211 older women.

Introduction

Reference point indentation is a novel method to assess BMSi in vivo. Lower BMSi has been observed in patients with prior fracture than in controls, but no association between BMSi and areal bone mineral density (aBMD) has been found. Population-based association studies and prospective studies with BMSi and fractures are lacking. We hypothesized that BMSi would be associated with prevalent fractures in older Swedish women. The aim was to investigate the associations between BMSi, aBMD, and prevalent fracture in older women.

Methods

Two hundred eleven women, mean age 78.3 ± 1.1 years, were included in this cross-sectional, population-based study. BMSi was assessed using the OsteoProbe device at the mid-tibia. Areal BMD of the hip, spine, and non-dominant radius was measured using dual-energy X-ray absorptiometry (DXA). Fracture history was retrieved using questionnaires, and vertebral fractures were identified using vertebral fracture assessment (VFA) by DXA.

Results

One hundred ninety-eight previous fractures in 109 subjects were reported. A total of 106 women had a vertebral fracture, of which 58 women had moderate or severe fractures. An inverse correlation between BMSi and weight (r = −0.14, p = 0.04) was seen, and BMSi differed according to operator (ANOVA p < 0.01). Adjusting for weight and operator in a linear regression model, we found that BMSi was positively associated with aBMD of the total hip (β = 0.14, p = 0.04), non-dominant radius (β = 0.17, p = 0.02), and lumbar spine (L1–L4) (β = 0.14, p < 0.05). Using logistic regression, we could not find any association in crude or adjusted BMSi (for age, weight, height, walking speed, calcium intake, smoking, bisphosphonate and glucocorticoid use, and operator) with prevalent fractures.

Conclusion

We conclude that BMSi is associated with aBMD but not with prevalent fracture in a population-based cohort of 211 older women.

Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, De Laet C, Jonsson B (2000) Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int 11:669–674CrossRefPubMed

Kanis JA, Melton LJ 3rd, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141CrossRefPubMed

Stone KL, Seeley DG, Lui LY, Cauley JA, Ensrud K, Browner WS, Nevitt MC, Cummings SR (2003) BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures. J Bone Miner Res 18:1947–1954CrossRefPubMed

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397CrossRefPubMedPubMedCentral

Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E (2009) FRAX and its applications to clinical practice. Bone 44:734–743CrossRefPubMed

Boutroy S, Van Rietbergen B, Sornay-Rendu E, Munoz F, Bouxsein ML, Delmas PD (2008) 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 23:392–399CrossRefPubMed

Kopperdahl DL, Aspelund T, Hoffmann PF, Sigurdsson S, Siggeirsdottir K, Harris TB, Gudnason V, Keaveny TM (2014) Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans. J Bone Miner Res 29:570–580CrossRefPubMedPubMedCentral

Diez-Perez A, Guerri R, Nogues X et al (2010) Microindentation for in vivo measurement of bone tissue mechanical properties in humans. J Bone Miner Res 25:1877–1885CrossRefPubMedPubMedCentral

Guerri-Fernandez RC, Nogues X, Quesada Gomez JM, Torres Del Pliego E, Puig L, Garcia-Giralt N, Yoskovitz G, Mellibovsky L, Hansma PK, Diez-Perez A (2013) Microindentation for in vivo measurement of bone tissue material properties in atypical femoral fracture patients and controls. J Bone Miner Res 28:162–168CrossRefPubMed

10.

Bridges D, Randall C, Hansma PK (2012) A new device for performing reference point indentation without a reference probe. Rev Sci Instrum 83:044301CrossRefPubMedPubMedCentral

11.

Randall C, Bridges D, Guerri R et al (2013) Applications of a new handheld reference point indentation instrument measuring bone material strength. J Med Devices 7:410051–410056CrossRef

12.

Malgo F, Hamdy NA, Papapoulos SE, Appelman-Dijkstra NM (2015) Bone material strength as measured by microindentation in vivo is decreased in patients with fragility fractures independently of bone mineral density. J Clin Endocrinol Metab 100:2039–2045CrossRefPubMed

13.

Farr JN, Drake MT, Amin S, Melton LJ 3rd, McCready LK, Khosla S (2014) In vivo assessment of bone quality in postmenopausal women with type 2 diabetes. J Bone Miner Res 29:787–795CrossRefPubMedPubMedCentral

14.

Duarte Sosa D, Vilaplana L, Guerr IR, Nogues X, Wang-Fagerland M, Diez-Perez A, Eriksen FE (2015) Are the high hip fracture rates among Norwegian women explained by impaired bone material properties? J Bone Miner Res 30(10):1784–9CrossRefPubMed

15.

Genant HK, Li J, Wu CY, Shepherd JA (2000) Vertebral fractures in osteoporosis: a new method for clinical assessment. J Clin Densitom 3:281–290CrossRefPubMed

16.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148CrossRefPubMed

17.

Hermanussen M, Danker-Hopfe H, Weber GW (2001) Body weight and the shape of the natural distribution of weight, in very large samples of German, Austrian and Norwegian conscripts. Int J Obes Relat Metab Disord 25:1550–1553CrossRefPubMed

18.

Portier K, Tolson JK, Roberts SM (2007) Body weight distributions for risk assessment. Risk analysis. Off Publ Soc Risk Anal 27:11–26CrossRef

19.

Cheng XG, Lowet G, Boonen S, Nicholson PH, Brys P, Nijs J, Dequeker J (1997) Assessment of the strength of proximal femur in vitro: relationship to femoral bone mineral density and femoral geometry. Bone 20:213–218CrossRefPubMed

20.

Farr JN, Tomas R, Chen Z, Lisse JR, Lohman TG, Going SB (2011) Lower trabecular volumetric BMD at metaphyseal regions of weight-bearing bones is associated with prior fracture in young girls. J Bone Miner Res 26:380–387CrossRefPubMed

21.

Mellibovsky L, Prieto-Alhambra D, Mellibovsky F, Guerri-Fernandez R, Nogues X, Randall C, Hansma PK, Diez-Perez A (2015) Bone tissue properties measurement by reference point indentation in glucocorticoid-induced osteoporosis. J Bone Miner Res 30(9):1651–6CrossRefPubMed

22.

Darelid A, Ohlsson C, Rudang R, Kindblom JM, Mellstrom D, Lorentzon M (2010) Trabecular volumetric bone mineral density is associated with previous fracture during childhood and adolescence in males: the GOOD study. J Bone Miner Res 25:537–544CrossRefPubMed

23.

Nevitt MC, Cummings SR, Browner WS, Seeley DG, Cauley JA, Vogt TM, Black DM (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. Am J Epidemiol 135:490–499CrossRefPubMed

24.

Mackey DC, Lui LY, Cawthon PM, Bauer DC, Nevitt MC, Cauley JA, Hillier TA, Lewis CE, Barrett-Connor E, Cummings SR (2007) High-trauma fractures and low bone mineral density in older women and men. Jama 298:2381–2388CrossRefPubMed

25.

Sanders KM, Pasco JA, Ugoni AM, Nicholson GC, Seeman E, Martin TJ, Skoric B, Panahi S, Kotowicz MA (1998) The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. J Bone Miner Res 13:1337–1342CrossRefPubMed

26.

Hasserius R, Redlund-Johnell I, Mellstrom D, Johansson C, Nilsson BE, Johnell O (2001) Vertebral deformation in urban Swedish men and women: prevalence based on 797 subjects. Acta Orthop Scand 72:273–278CrossRefPubMed

27.

O’Neill TW, Felsenberg D, Varlow J, Cooper C, Kanis JA, Silman AJ (1996) The prevalence of vertebral deformity in European men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018CrossRefPubMed

28.

Kanis JA, Johnell O, De Laet C, Jonsson B, Oden A, Ogelsby AK (2002) International variations in hip fracture probabilities: implications for risk assessment. J Bone Miner Res 17:1237–1244CrossRefPubMed

Title: Bone material strength is associated with areal BMD but not with prevalent fractures in older women
Authors: R. Rudäng
M. Zoulakis
D. Sundh
H. Brisby
A. Diez-Perez
L. Johansson
D. Mellström
A. Darelid
M. Lorentzon
Publication date: 01-04-2016
Publisher: Springer London
Published in: Osteoporosis International / Issue 4/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-015-3419-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bone material strength is associated with areal BMD but not with prevalent fractures in older women

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2016

Fracture risk and bone mineral density levels in patients with systemic lupus erythematosus: a systematic review and meta-analysis

Osteoporosis in the adult solid organ transplant population: underlying mechanisms and available treatment options

Proton pump inhibitors and fracture: they impair bone quality and increase fall risk?

A combination of low serum concentrations of vitamins K1 and D is associated with increased risk of hip fractures in elderly Norwegians: a NOREPOS study

Greater serum carotenoid concentration associated with higher bone mineral density in Chinese adults

Proton pump inhibitors and fracture: do they do what it says on the tin?