Farr Joshua N, Tomás Rita, Chen Zhao, Lisse Jeffrey R, Lohman Timothy G, Going Scott B
Department of Physiological Sciences, University of Arizona, Tucson, AZ 85721-0093, USA.
J Bone Miner Res. 2011 Feb;26(2):380-7. doi: 10.1002/jbmr.218.
Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump-In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual-energy X-ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1-1.9) and 1.3 (1.0-1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls.
了解生长期间骨骼脆弱的病因对于开发旨在减轻儿童骨折负担的治疗方法和预防策略至关重要。因此，我们评估了年轻女孩既往骨折与骨参数之间的关系。分析了来自“Jump-In：构建更好骨骼”研究的465名8至13岁女孩的数据。使用外周定量计算机断层扫描（pQCT）在非优势股骨和胫骨的干骺端和骨干部位评估骨参数。采用双能X线吸收法（DXA）评估股骨、胫骨、腰椎和全身（不含头部）的骨矿物质含量。使用二元逻辑回归评估既往骨折与骨参数之间的关系，并对成熟度、体重、腿长、种族和身体活动进行控制。既往骨折与骨干部位所有DXA和pQCT骨参数之间的关联均无统计学意义。相比之下，股骨和胫骨远端干骺端部位较低的小梁体积骨密度（vBMD）与既往骨折显著相关。在对协变量进行调整后，股骨和胫骨远端干骺端部位小梁vBMD每降低1个标准差，骨折患病率分别高出1.4（1.1 - 1.9）倍和1.3（1.0 - 1.7）倍。既往骨折与干骺端骨大小（即骨膜周长）无关。总之，女孩的骨折与股骨和胫骨干骺端部位较低的小梁vBMD有关，但与骨大小无关。长骨干骺端部位较低的小梁vBMD可能是女孩骨骼脆弱的早期标志。
