绝经后骨密度正常但发生骨折的女性存在骨微观结构恶化:来自 OFELY 研究的前瞻性分析。

Postmenopausal women with normal BMD who have fractures have deteriorated bone microarchitecture: A prospective analysis from The OFELY study.

机构信息

INSERM UMR 1033 and Université de Lyon, France.

出版信息

Bone. 2024 May;182:117072. doi: 10.1016/j.bone.2024.117072. Epub 2024 Mar 15.

Abstract

Most postmenopausal women who sustain fragility fracture (Fx) have their areal bone mineral density (BMD) above the osteoporosis threshold. A sizeable proportion of them have normal aBMD. This study aimed to prospectively investigate the association of fragility Fx with bone microarchitecture (MA) assessed by high-resolution peripheral computed tomography (HR-pQCT) in postmenopausal women without low BMD. At the 14th annual follow-up of the OFELY study, we measured bone MA at the distal radius and tibia with HR-pQCT in addition to areal BMD with DXA, in 586 postmenopausal women. Among them, 166 (29 %) women, mean (SD) age 65 (8) yr, had normal BMD defined as a T score ≥ -1 at the lumbar spine, femoral neck, and total hip. During a median [IQR] 15 [14-15] yr of follow-up, 46 of those women sustained incident fragility Fx, including 19 women with a major osteoporotic Fx (clinical spine, forearm, proximal humerus, hip). Women who sustained Fx did not differ for age, BMI, tobacco and alcohol use, diabetes, falls, FRAX®, aBMD, and TBS compared with women without incident Fx. In contrast, they had significant impairment of volumetric densities, cortical area (Ct. Ar) and thickness (Ct. Th), stiffness (K), and estimated failure load (FL) at the radius compared with women without incident Fx. At the radius, each SD decrease of volumetric densities, Ct.Ar, Ct.Th, K, and estimated FL were significantly associated with an increased risk of all fragility fractures with hazard ratios (HR) from 1.44 to 1.56 and of major osteoporotic fractures (HR from 1.66 to 2.57). Lesser impairment of bone MA was seen at the tibia. We conclude that even in women with normal areal BMD fragility fractures are associated with deterioration of bone microarchitecture.

摘要

大多数发生脆性骨折(Fx)的绝经后妇女的骨密度(BMD)都高于骨质疏松阈值。相当一部分患者的 BMD 正常。本研究旨在前瞻性研究骨密度正常的绝经后妇女发生脆性 Fx 与通过高分辨率外周计算机断层扫描(HR-pQCT)评估的骨微结构(MA)之间的关系。在 OFELY 研究的第 14 次年度随访中,我们用 HR-pQCT 测量了 586 名绝经后妇女的桡骨远端和胫骨 MA,并用 DXA 测量了 BMD。其中,166 名(29%)女性年龄 65(8)岁,BMD 正常定义为腰椎、股骨颈和全髋 T 评分≥-1。在中位数 [IQR] 为 15 [14-15] 年的随访期间,这些女性中有 46 人发生了新发脆性 Fx,包括 19 名发生了主要骨质疏松性 Fx(临床脊柱、前臂、近端肱骨、髋部)的女性。与未发生 Fx 的女性相比,发生 Fx 的女性在年龄、BMI、吸烟和饮酒、糖尿病、跌倒、FRAX®、BMD 和 TBS 方面没有差异。相比之下,与未发生 Fx 的女性相比,她们的桡骨体积密度、皮质面积(Ct.Ar)和厚度(Ct.Th)、刚度(K)和估计的失效载荷(FL)显著降低。在桡骨中,体积密度、Ct.Ar、Ct.Th、K 和估计的 FL 每减少一个标准差,所有脆性骨折的风险增加 1.44 至 1.56 倍,主要骨质疏松性骨折的风险增加 1.66 至 2.57 倍。在胫骨中,骨 MA 的损伤较小。我们得出结论,即使在 BMD 正常的女性中,脆性骨折也与骨微结构恶化有关。

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