de Jong Joost J A, Heyer Frans L, Arts Jacobus J C, Poeze Martijn, Keszei András P, Willems Paul C, van Rietbergen Bert, Geusens Piet P, van den Bergh Joop P W
NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.
J Bone Miner Res. 2016 May;31(5):1114-22. doi: 10.1002/jbmr.2766. Epub 2016 Jan 5.
Fracture healing is characterized by an intense increase in modeling and remodeling of bone, which allows removal of the cast after a stable distal radius fracture within 3 to 5 weeks. However, at that time, bone strength has not recovered yet. We studied the changes in bone mineral density (BMD), microarchitecture, and bone stiffness after a distal radius fracture during a 2-year follow-up in comparison to the contralateral side and the association between the 2-year stiffness and baseline BMD, microarchitecture, and early changes in these parameters. The fractured side of 14 postmenopausal women (mean age 64 ± 8 years) with a conservatively treated distal radius fracture was scanned by high-resolution peripheral quantitative computed tomography (HRpQCT) at 1 to 2, 3 to 4, 6 to 8, and 12 weeks and 2 years postfracture. The same region contralaterally was scanned as well at the 2-year visit. BMD, microarchitecture, and stiffness parameters were determined and the fracture side was compared with the contralateral side using a linear mixed-effect model. Spearman's correlation was used to correlate the 2-year bone stiffness with baseline BMD, microarchitecture, and early 3-month changes in these parameters. Two years postfracture, cortical and trabecular thickness and torsional and bending stiffness were significantly higher at the fractured side compared with the nonfractured side (21%, 55%, 31%, and 29%, respectively, p < 0.05), whereas BMD was similar. Two-year torsional and bending stiffness correlated significantly with baseline BMD and cortical perimeter (|rho| ≥ 0.63, p < 0.016) but not with early changes in bone parameters. Using HRpQCT, this study illustrates that fracture healing is not completed by the time the cast is removed. We showed that from 6 weeks to 2 years postfracture, large changes occur in BMD, microarchitecture, and biomechanical parameters at the fractured side, which were fully recovered after 2 years in comparison to the nonfractured contralateral side. Interestingly, higher 2-year torsional and bending stiffness were associated with lower BMD and higher cortical perimeter at baseline. © 2015 American Society for Bone and Mineral Research.
骨折愈合的特点是骨骼的塑形和重塑显著增加,这使得在3至5周内稳定的桡骨远端骨折后可以拆除石膏。然而,在那个时候,骨强度尚未恢复。我们研究了桡骨远端骨折后2年随访期间骨密度(BMD)、微观结构和骨硬度的变化,并与对侧进行比较,以及2年时的硬度与基线BMD、微观结构以及这些参数的早期变化之间的关联。对14名绝经后女性(平均年龄64±8岁)保守治疗的桡骨远端骨折的患侧,在骨折后1至2周、3至4周、6至8周、12周和2年时用高分辨率外周定量计算机断层扫描(HRpQCT)进行扫描。在2年随访时也对同一区域的对侧进行扫描。测定BMD、微观结构和硬度参数,并使用线性混合效应模型将患侧与对侧进行比较。采用Spearman相关性分析将2年时的骨硬度与基线BMD、微观结构以及这些参数在3个月时的早期变化进行关联。骨折后2年,患侧的皮质骨和小梁骨厚度以及扭转和弯曲刚度显著高于未骨折侧(分别为21%、55%、31%和29%,p<0.05),而BMD相似。2年时的扭转和弯曲刚度与基线BMD和皮质骨周长显著相关(|rho|≥0.63,p<0.016),但与骨参数的早期变化无关。使用HRpQCT,本研究表明在拆除石膏时骨折愈合尚未完成。我们发现,骨折后6周至2年,患侧的BMD、微观结构和生物力学参数发生了很大变化,与未骨折的对侧相比,2年后这些变化完全恢复。有趣的是,2年时较高的扭转和弯曲刚度与较低的BMD和较高的基线皮质骨周长相关。©2015美国骨与矿物质研究学会。