Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
J Bone Miner Res. 2018 Apr;33(4):621-626. doi: 10.1002/jbmr.3338. Epub 2017 Dec 5.
We tested whether cortical bone tissue properties assessed by in vivo impact microindentation would distinguish postmenopausal women with recent distal radius (DRF) or hip fracture (HF) from nonfracture controls (CONT). We enrolled postmenopausal women with recent DRF (n = 57), HF (n = 41), or CONT (n = 93), and used impact microindentation to assess bone material strength index (BMSi) at the anterior surface of the mid-tibia diaphysis. Areal bone mineral density (aBMD) (g/cm ) of the femoral neck (FN), total hip (TH), and lumbar spine (LS) were measured by dual-energy X-ray absorptiometry (DXA). HF and DRF subjects had significantly lower BMD than CONT at all sites (-5.6% to -8.2%, p < 0.001 for all). BMSi was 4% lower in DRF compared to CONT (74.36 ± 8.77 versus 77.41 ± 8.79, p = 0.04). BMSi was similarly lower in HF versus CONT, but the difference did not reach statistical significance (74.62 ± 8.47 versus 77.41 ± 8.79, p = 0.09). Lower BMSi was associated with increased risk of DRF (unadjusted OR, 1.43; 95% CI, 1.02 to 2.00, per SD decrease, p = 0.04), and remained statistically significant after adjustment for age, age and BMI, and age, BMI, and FN BMD (OR = 1.48 to 1.55). Lower BMSi tended to be associated with HF, but only reached borderline significance (unadjusted OR = 1.39; 95% CI, 0.96 to 2.01, p = 0.08). These results provide strong rationale for future investigations aimed at assessing whether BMSi can predict fracture in prospective studies and improve identification of women at risk for fragility fractures. © 2017 American Society for Bone and Mineral Research.
我们通过体内冲击微压痕来评估皮质骨组织特性，以确定绝经后妇女中近期发生桡骨远端（DRF）或髋部骨折（HF）与非骨折对照组（CONT）之间是否存在差异。我们招募了近期发生桡骨远端骨折（DRF）（n=57）、髋部骨折（HF）（n=41）或对照组（CONT）（n=93）的绝经后妇女，并使用冲击微压痕来评估胫骨骨干前表面的骨材料强度指数（BMSi）。股骨颈（FN）、全髋（TH）和腰椎（LS）的面积骨密度（aBMD）（g/cm ）通过双能 X 射线吸收法（DXA）进行测量。HF 和 DRF 患者在所有部位的 BMD 均显著低于 CONT（所有部位均降低了 5.6%至 8.2%，p<0.001）。与 CONT 相比，DRF 患者的 BMSi 降低了 4%（74.36±8.77 与 77.41±8.79，p=0.04）。HF 患者与 CONT 相比，BMSi 也较低，但差异无统计学意义（74.62±8.47 与 77.41±8.79，p=0.09）。BMSi 降低与 DRF 风险增加相关（未校正的 OR，1.43；95%CI，1.02 至 2.00，每标准差降低，p=0.04），并且在调整年龄、年龄和 BMI 以及年龄、BMI 和 FN BMD 后仍然具有统计学意义（OR=1.48 至 1.55）。BMSi 与 HF 的相关性也有趋势，但仅达到边缘显著性（未校正的 OR=1.39；95%CI，0.96 至 2.01，p=0.08）。这些结果为未来旨在评估 BMSi 是否可以预测前瞻性研究中的骨折并改善对脆性骨折风险妇女的识别的研究提供了有力的依据。 © 2017 美国骨骼与矿物质研究协会。
