Volumetric Bone Mineral Density and Failure Load of Distal Limbs Predict Incident Clinical Fracture Independent HR-pQCT BMD and Failure Load Predicts Incident Clinical Fracture of FRAX and Clinical Risk Factors Among Older Men

for the Osteoporotic Fractures in Men (MrOS) Study Research Group

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Our objective was to determine the associations of peripheral bone strength and microarchitecture with incident clinical and major osteoporotic fracture among older men after adjusting for major clinical risk factors. We used a prospective cohort study design with data from 1794 men (mean age 84.4 years) in the Osteoporotic Fractures in Men (MrOS) study. Eligible men attended the year 14 visit, had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal or diaphyseal tibia, DXA measured BMD, and were followed for mean 1.7 years for incident fracture. Failure load was estimated using finite element analysis. We used Cox proportional hazards models with standardized HR-pQCT parameters as exposure variables. Primary outcome was clinical fracture (n = 108). Covariates included either Fracture Risk Assessment Tool (FRAX) major osteoporotic fracture probability calculated with BMD (FRAX-BMD), or individual clinical risk factors (CRF) including age, total hip BMD, race, falls, and prevalent fracture after age 50 years. Lower failure load was associated with higher risk of incident clinical fracture and incident major osteoporotic fracture. For clinical fracture with FRAX-BMD adjustment, the associations ranged from hazard ratio (HR) 1.58 (95% CI, 1.25 to 2.01) to 2.06 (95% CI, 1.60 to 2.66) per SD lower failure load at the diaphyseal tibia and distal radius. These associations were attenuated after adjustment for individual CRFs, but remained significant at the distal sites. Associations of volumetric BMD with these outcomes were similar to those for failure load. At the distal radius, lower trabecular BMD, number, and thickness, and lower cortical BMD, thickness, and area were all associated with higher risk of clinical fracture, but cortical porosity was not. Among community-dwelling older men, HR-pQCT measures including failure load, volumetric BMD, and microstructure parameters at peripheral sites (particularly distal radius) are robust independent predictors of clinical and major osteoporotic fracture.

Original languageEnglish (US)
Pages (from-to)1302-1311
Number of pages10
JournalJournal of Bone and Mineral Research
Volume33
Issue number7
DOIs
StatePublished - Jul 2018

Bibliographical note

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128, R01 AR060700. This article is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government. Authors? roles: Study concept and design: LL, AJB, KEE, JAC, and ESO. Data collection: KEE, JAC, EBC, and ESO. Data analysis and interpretation: LL and KWP. Drafting manuscript: LL. Critical review and final approval of manuscript content: LL, KWP, AJB, KEE, HAF, PMC, JAC, JTS, EBC, and ESO. Statistical analysis: LL and KWP performed the statistical analyses and are independent of any commercial funder. LL had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses.

Funding Information:
The Osteoporotic Fractures in Men (MrOS) Study is supported by NIH funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128, R01 AR060700. This article is the result of work supported with resources and use of facilities of the Minneapolis VA Health Care System. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Publisher Copyright:
© 2018 American Society for Bone and Mineral Research

Keywords

  • BONE MICROARCHITECTURE
  • BONE STRENGTH
  • FRACTURE
  • FRAX
  • OLDER MEN
  • OSTEOPOROSIS

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