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01-12-2023 | Osteoporosis | Original Article

Bone mineral density of the ultra-distal radius: are we ignoring valuable information?

Authors: Yair Schwarz, Inbal Goldshtein, Yehudit Eden Friedman, Naama Peltz-Sinvani, Michal Brodavka, David Kowal, Iris Vered, Liana Tripto-Shkolnik

Published in: Archives of Osteoporosis | Issue 1/2023

Abstract

Summary

The current study explored the possible utilization in dual-X-ray-absorptiometry scanning (DXA) of the ultra-distal radius (UDR). This region of interest is currently unused and mostly unstudied in this context. The study findings suggest UDR as potential useful region of interest in DXA scanning and warrant further study of the site.

Purpose

Bone mineral density (BMD) measurement of a non-dominant arm is not routinely performed during dual-X-ray-absorptiometry (DXA) test, and the possible utility of ultra-distal (UDR) radius BMD is not well-studied. We evaluated in women, correlations of UDR BMD with fracture prevalence, fracture risk prediction by the fracture risk assessment tool (FRAX), and osteoporosis diagnosed by traditional sites.

Methods

Women who underwent a routine DXA (including their non-dominant forearm and including UDR BMD) in a tertiary medical center were included. Risk factors relevant to FRAX calculation were assessed via a self-administered questionnaire. Spearman correlations of UDR BMD to 10-year risks of major osteoporotic and hip fractures (assessed by FRAX) were explored. The possible added value of UDR BMD in explaining prevalent osteoporotic fractures was assessed using a multivariable regression model incorporating age and traditional osteoporosis diagnosis.

Results

The study included 1245 women with a median age of 66 years (interquartile range: 59–73), of whom 298 (24%) had UDR T-score ≤ − 2.5 and 154 (12%) reported prior fractures. UDR BMD was significantly negatively correlated with FRAX risk score for hip and major osteoporotic fractures (R = − 0.5 and R = − 0.41, respectively; P < 0.001). UDR T-score ≤ − 2.5 was associated with higher fracture prevalence (19% vs 10%; P < 0.001) and remained significant after adjusting for traditional BMD and age (OR 1.49, 1.01–2.19; P = 0.043).

Conclusion

UDR BMD correlates both with prior fractures and with predicted fracture risks and might pose added value over traditional DXA sites.

Camacho PM, Petak SM, Binkley N et al (2020) American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis- 2020 update executive summary. Endocr Pract 26:564–570. https://doi.org/10.4158/GL-2020-0524CrossRefPubMed

Kanis JA, Norton N, Harvey NC et al (2021) SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos. https://doi.org/10.1007/s11657-020-00871-9

ISCD (2019) 2019 ISCD Official Positions – Adult. https://iscd.org/wp-content/uploads/2021/09/2019-Official-Positions-Adult-1.pdf

Schuit SCE, Van Der Klift M, Weel AEAM et al (2004) Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone. https://doi.org/10.1016/j.bone.2003.10.001

Biver E, Durosier-Izart C, Chevalley T et al (2018) Evaluation of radius microstructure and areal bone mineral density improves fracture prediction in postmenopausal women. J Bone Miner Res 33:328–337. https://doi.org/10.1002/jbmr.3299CrossRefPubMed

Bonnick S Lou, Miller P (2013) Clinical use of bone densitometry. Osteoporos Fourth Ed. https://doi.org/10.1016/B978-0-12-415853-5.00066-2

Compston JE (2002) Bone marrow and bone: a functional unit. J Endocrinol. https://doi.org/10.1677/joe.0.1730387

Kiebzak GM, Lewiecki EM, Petak SM (2004) Impact of using the ultradistal radius region of interest on diagnostic classification. J Clin Densitom. https://doi.org/10.1385/JCD:7:2:143

Miyamura S, Kuriyama K, Ebina K et al (2020) Utility of distal forearm DXA as a screening tool for primary osteoporotic fragility fractures of the distal radius. JBJS Open Access. https://doi.org/10.2106/jbjs.oa.19.00036

10.

Mancuso ME, Johnson JE, Ahmed SS et al (2018) Distal radius microstructure and finite element bone strain are related to site-specific mechanical loading and areal bone mineral density in premenopausal women. Bone Rep 8:187–194. https://doi.org/10.1016/j.bonr.2018.04.001CrossRefPubMedPubMedCentral

11.

Eastell R, Rosen CJ, Black DM et al (2019) Pharmacological management of osteoporosis in postmenopausal women: an endocrine society* clinical practice guideline. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2019-00221

12.

Martineau P, Silva BC, Leslie WD (2017) Utility of trabecular bone score in the evaluation of osteoporosis. Curr Opin Endocrinol Diabetes Obes 24:402–410. https://doi.org/10.1097/MED.0000000000000365CrossRefPubMed

13.

Jones A, Goh M, Milat F et al (2021) Dual energy X-ray absorptiometry reports fail to adhere to international guidelines. J Clin Densitom 24:453–459. https://doi.org/10.1016/J.JOCD.2020.10.002CrossRefPubMed

14.

Kruger IM, Kruger MC, Doak CM, Kruger A (2012) Cut-off values of distal forearm bone density for the diagnosis of central osteoporosis in black postmenopausal South African women. J Endocrinol Metab Diabetes S Afr. https://doi.org/10.1080/22201009.2012.10872281

15.

Nayak S, Greenspan SL (2018) How can we improve osteoporosis care? A systematic review and meta-analysis of the efficacy of quality improvement strategies for osteoporosis. J Bone Miner Res. https://doi.org/10.1002/jbmr.3437

16.

Fitt NS, Mitchell SL, Cranney A et al (2001) Influence of bone densitometry results on the treatment of osteoporosis. CMAJ 164:777–781PubMedPubMedCentral

17.

Miller PD (2016) Underdiagnoses and undertreatment of osteoporosis: the battle to be won. J Clin Endocrinol Metab. https://doi.org/10.1210/jc.2015-3156

18.

Tripto-Shkolnik L, Vered I, Peltz-Sinvani N et al (2021) Bone mineral density of the 1/3 radius refines osteoporosis diagnosis, correlates with prevalent fractures, and enhances fracture risk estimates. Endocr Pract. https://doi.org/10.1016/j.eprac.2020.12.010

19.

Gautam KP, Cherian KE, Kapoor N et al (2022) Utility and validation of bone mineral density measurements at forearm in predicting trabecular microarchitecture and central-site osteoporosis in aging Indian postmenopausal women—a promising surrogate? Aging Med. https://doi.org/10.1002/agm2.12191

20.

Kanterewicz E, Yañez A, Pérez-Pons A et al (2002) Association between Colles’ fracture and low bone mass: age-based differences in postmenopausal women. Osteoporos Int. https://doi.org/10.1007/s001980200114

21.

Van Der Poest Clement E, Patka P, Vandormael K et al (2000) The effect of alendronate on bone mass after distal forearm fracture. J Bone Miner Res. https://doi.org/10.1359/jbmr.2000.15.3.586

22.

Watts NB, Dore RK, Baim S et al (2021) Forearm bone mineral density and fracture incidence in postmenopausal women with osteoporosis: results from the ACTIVExtend phase 3 trial. Osteoporos Int. https://doi.org/10.1007/s00198-020-05555-1

23.

Watts NB, Hattersley G, Fitzpatrick LA et al (2019) Abaloparatide effect on forearm bone mineral density and wrist fracture risk in postmenopausal women with osteoporosis. Osteoporos Int. https://doi.org/10.1007/s00198-019-04890-2

24.

Khosla S, Riggs BL, Atkinson EJ et al (2006) Effects of sex and age on bone microstructure at the ultradistal radius: a population-based noninvasive in vivo assessment. J Bone Miner Res. https://doi.org/10.1359/JBMR.050916

25.

Choksi P, Jepsen KJ, Clines GA (2018) The challenges of diagnosing osteoporosis and the limitations of currently available tools. Clin Diabetes Endocrinol. https://doi.org/10.1186/s40842-018-0062-7

Title: Bone mineral density of the ultra-distal radius: are we ignoring valuable information?
Authors: Yair Schwarz
Inbal Goldshtein
Yehudit Eden Friedman
Naama Peltz-Sinvani
Michal Brodavka
David Kowal
Iris Vered
Liana Tripto-Shkolnik
Publication date: 01-12-2023
Publisher: Springer London
Keywords: Osteoporosis
Osteoporosis
Published in: Archives of Osteoporosis / Issue 1/2023
Print ISSN: 1862-3522
Electronic ISSN: 1862-3514
DOI: https://doi.org/10.1007/s11657-023-01218-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Bone mineral density of the ultra-distal radius: are we ignoring valuable information?

Abstract

Summary

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Purpose

Methods

Results

Conclusion

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