绝经前女性桡骨远端骨折患者的小梁骨微观结构特征。
Characterization of trabecular bone microstructure in premenopausal women with distal radius fractures.
机构信息
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, 330 Brookline Avenue - Stoneman 10, Boston, MA, 02215, USA.
Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Orthopedic Biomechanics Laboratory, RN 119, 330 Brookline Avenue, Boston, MA, 02215, USA.
出版信息
Osteoporos Int. 2018 Feb;29(2):409-419. doi: 10.1007/s00198-017-4293-8. Epub 2017 Nov 3.
UNLABELLED
Individual trabecular segmentation was utilized to identify differences in trabecular bone structure in premenopausal women with wrist fractures and non-fracture controls. Fracture subjects had reduced trabecular plate volume, number, thickness, and connectivity. Identifying altered trabecular microarchitecture in young women offers opportunities for counseling and lifestyle modifications to reduce fracture risk.
INTRODUCTION
Premenopausal women with distal radius fractures (DRF) have worse trabecular bone microarchitecture than non-fracture controls (CONT), yet the characteristics of their trabecular bone structure are unknown.
METHODS
Premenopausal women with DRF (n = 40) and CONT (n = 80) were recruited. Primary outcome variables included trabecular structure at the distal radius and tibia, assessed by volumetric decomposition of individual trabecular plates and rods from high-resolution peripheral quantitative CT images. Trabecular morphology included plate and rod number, volume, thickness, and connectivity. Areal bone mineral density (aBMD) of the femoral neck (FN aBMD), and ultradistal radius (UDR aBMD) were measured by DXA.
RESULTS
Trabecular morphology differed between DRF and CONT at the radius and tibia (OR per SD decline 1.58-2.7). At the radius, associations remained significant when adjusting for age and FN aBMD (ORs = 1.76-3.26) and age and UDR aBMD (ORs = 1.72-3.97). Plate volume fraction, number and axially aligned trabeculae remained associated with DRF after adjustment for trabecular density (ORs = 2.55-2.85). Area under the curve (AUC) for discriminating DRF was 0.74 for the proportion of axially aligned trabeculae, compared with 0.60 for FN aBMD, 0.65 for UDR aBMD, and 0.69 for trabecular density. Plate number, plate-plate junction, and axial bone volume fraction remained associated with DRF at the tibia (ORs = 2.14-2.77) after adjusting for age, FN aBMD, or UDR aBMD. AUC was 0.72 versus 0.61 for FNaBMD, 0.66 for UDRaBMD, and 0.70 for trabecular density.
CONCLUSION
Premenopausal women with DRF have lower trabecular plate volume, number, thickness, and connectivity than CONT. Identification of young women with altered microarchitecture offers opportunities for lifestyle modifications to reduce fracture risk.
目的
利用骨小梁的个体分割，来确定绝经前手腕骨折女性与非骨折对照者之间骨小梁结构的差异。骨折组的骨小梁板体积、数量、厚度和连通性降低。在年轻女性中发现改变的骨小梁微观结构为提供了咨询和生活方式改变的机会，以降低骨折风险。
背景
与非骨折对照者相比，绝经前桡骨远端骨折（DRF）的女性具有更差的骨小梁微观结构，但尚不清楚其骨小梁结构的特征。
方法
招募绝经前桡骨远端骨折（DRF）女性（n=40）和非骨折对照者（CONT）（n=80）。主要观察变量包括通过高分辨率外周定量 CT 图像对个体骨小梁板和杆的体积分解来评估桡骨远端和胫骨的骨小梁结构。骨小梁形态包括板和杆的数量、体积、厚度和连通性。通过 DXA 测量股骨颈（FN aBMD）和桡骨 ultradistal （UDR aBMD）的面积骨密度。
结果
与 CONT 相比，DRF 在桡骨和胫骨的骨小梁形态存在差异（每 SD 下降的 OR 为 1.58-2.7）。在调整年龄和 FN aBMD（ORs=1.76-3.26）以及年龄和 UDR aBMD（ORs=1.72-3.97）后，这种关联仍然显著。在调整骨小梁密度后（ORs=2.55-2.85），板体积分数、数量和轴向排列的小梁仍然与 DRF 相关。用于区分 DRF 的曲线下面积（AUC）为轴向排列的小梁比例为 0.74，而 FN aBMD 为 0.60，UDR aBMD 为 0.65，骨小梁密度为 0.69。在调整年龄、FN aBMD 或 UDR aBMD 后，胫骨的板数量、板-板交界处和轴向骨体积分数仍与 DRF 相关（ORs=2.14-2.77）。AUC 为 0.72 对 FN aBMD 为 0.61，UDRaBMD 为 0.66，骨小梁密度为 0.70。
结论
与 CONT 相比，DRF 的绝经前女性具有较低的骨小梁板体积、数量、厚度和连通性。在年轻女性中发现微观结构改变，为改变生活方式以降低骨折风险提供了机会。
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