Dennison E M, Jameson K A, Edwards M H, Denison H J, Aihie Sayer A, Cooper C
MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Victoria University, Wellington, New Zealand.
MRC Lifecourse Epidemiology Unit, University of Southampton, UK.
Bone. 2014 Jul;64:13-7. doi: 10.1016/j.bone.2014.03.040. Epub 2014 Mar 27.
Peripheral quantitative computed tomography (pQCT) captures novel aspects of bone geometry that may contribute to fracture risk and offers the ability to measure both volumetric bone mineral density (vBMD) and a separation of trabecular and cortical compartments of bone, but longitudinal data relating measures obtained from this technique to incident fractures are lacking. Here we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between measures obtained from pQCT and DXA in 182 men and 202 women aged 60-75 years at baseline with incident fractures over 6 years later. Among women, radial cortical thickness (HR 1.72, 95% CI 1.16, 2.54, p=0.007) and cortical area (HR 1.91, 95% CI 1.27, 2.85, p=0.002) at the 66% slice were both associated with incident fractures; these results remained significant after adjustment for confounders (age, BMI, social class, cigarette smoking and alcohol consumption, physical activity, dietary calcium, HRT and years since menopause). Further adjustment for aBMD made a little difference to the results. At the tibia, cortical area (HR 1.58, 95% CI 1.10, 2.28, p=0.01), thickness (HR 1.49, 95% CI 1.08, 2.07, p=0.02) and density (HR 1.64, 95% CI 1.18, 2.26, p=0.003) at the 38% site were all associated with incident fractures with the cortical area and density relationships remaining robust to adjustment for the confounders listed above. Further adjustment for aBMD at this site did lead to attenuation of relationships. Among men, tibial stress-strain index (SSI) was predictive of incident fractures (HR 2.30, 95% CI 1.28, 4.13, p=0.005). Adjustment for confounding variables and aBMD did not render this association non-significant. In conclusion, we have demonstrated relationships between measures of bone size, density and strength obtained by pQCT and incident fracture. These relationships were attenuated but in some cases remained significant after adjustment for BMD measures obtained by DXA, suggesting that some additional information may be conferred by this assessment.
外周定量计算机断层扫描（pQCT）能够捕捉到骨几何结构的新特征，这些特征可能与骨折风险相关，并且能够测量骨体积密度（vBMD）以及区分骨小梁和皮质骨部分，但缺乏将该技术所获测量值与新发骨折相关联的纵向数据。在此，我们报告来自赫特福德郡队列研究的一项分析，在该研究中，我们能够研究182名男性和202名女性（基线时年龄为60 - 75岁）从pQCT和双能X线吸收法（DXA）获得的测量值与6年后新发骨折之间的关联。在女性中，66%层面处的桡骨皮质厚度（风险比[HR] 1.72，95%置信区间[CI] 1.16, 2.54，p = 0.007）和皮质面积（HR 1.91，95% CI 1.27, 2.85，p = 0.002）均与新发骨折相关；在对混杂因素（年龄、体重指数、社会阶层、吸烟和饮酒、体力活动、膳食钙、激素替代疗法以及绝经后的年限）进行调整后，这些结果仍然显著。进一步对骨密度（aBMD）进行调整对结果影响不大。在胫骨处，38%位点处的皮质面积（HR 1.58，95% CI 1.10, 2.28，p = 0.01）、厚度（HR 1.49，95% CI 1.08, 2.07，p = 0.02）和密度（HR 1.64，95% CI 1.18, 2.26，p = 0.003）均与新发骨折相关，皮质面积和密度之间的关系在对上述混杂因素进行调整后仍然稳健。在此位点进一步对aBMD进行调整确实导致了这种关系的减弱。在男性中，胫骨应力应变指数（SSI）可预测新发骨折（HR 2.30，95% CI 1.28, 4.13，p = 0.005）。对混杂变量和aBMD进行调整并未使这种关联不显著。总之，我们已经证明了通过pQCT获得的骨大小、密度和强度测量值与新发骨折之间的关系。在对通过DXA获得的骨密度测量值进行调整后，这些关系有所减弱，但在某些情况下仍然显著，这表明这种评估可能会提供一些额外信息。
