Jain Rajesh K, López Picazo Mirella, Humbert Ludovic, Dickens Laura, Vokes Tamara
Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, The University of Chicago, Chicago, Illinois.
3D-Shaper Medical, Barcelona, Spain.
Endocr Pract. 2025 Feb;31(2):152-158. doi: 10.1016/j.eprac.2024.10.015. Epub 2024 Nov 7.
Black patients fracture less often than White patients at any given bone mineral density (BMD). This may be related to superior bone structure; however, bone structure is challenging to measure in clinical practice. Advances in 3-dimensional (3D) modeling have allowed for the measurement of trabecular and cortical parameters from dual-energy x-ray absorptiometry (DXA). This technology, known as 3D-DXA, may provide a way to assess hitherto unexplained differences in bone structure between Black and White patients.
This is a secondary analysis of 775 women (368 Black and 407 White) previously recruited from an osteoporosis clinic. All women had undergone DXA and vertebral fracture assessment, and 3D-DXA was run retrospectively on the proximal femur BMD scan. Participants were classified as having a prior fracture if there was a fracture on vertebral fracture assessment or a self-reported history of fragility fracture.
Black women had generally superior 3D-DXA parameters, with the largest differences in cortical thickness of the femoral neck (FN) and buckling ratio of the FN. There were substantial differences in associations between fracture and 3D-DXA parameters in Black women compared with White women. After adjusting for age, glucocorticoids, and areal BMD T-score, cortical thickness of the FN was significantly associated with prior fracture (odds ratio, 1.4 per standard deviation decline; 95% CI, 1.0-1.9; P = .04) in Black women but not White women.
3D-DXA parameters were superior in Black women than in White women, and cortical thickness of the FN was associated with fractures only in Black women. 3D-DXA may improve fracture risk assessment in Black patients.
在任何给定的骨矿物质密度（BMD）下，黑人患者骨折的发生率低于白人患者。这可能与更优的骨骼结构有关；然而，在临床实践中测量骨骼结构具有挑战性。三维（3D）建模技术的进步使得能够从双能X线吸收法（DXA）测量小梁和皮质参数。这项被称为3D-DXA的技术可能提供一种方法来评估黑人和白人患者之间迄今无法解释的骨骼结构差异。
这是对先前从一家骨质疏松诊所招募的775名女性（368名黑人女性和407名白人女性）进行的二次分析。所有女性均接受了DXA和椎体骨折评估，并对近端股骨BMD扫描进行了回顾性3D-DXA分析。如果在椎体骨折评估中有骨折或有自我报告的脆性骨折病史，则将参与者分类为有既往骨折。
黑人女性的3D-DXA参数总体上更优，股骨颈（FN）皮质厚度和FN屈曲比的差异最大。与白人女性相比，黑人女性骨折与3D-DXA参数之间存在显著差异。在调整年龄、糖皮质激素和面积BMD T评分后，黑人女性中FN皮质厚度与既往骨折显著相关（优势比，每标准差下降1.4；95%CI，1.0-1.9；P = 0.04），而白人女性则不然。
黑人女性3D-DXA参数优于白人女性，且仅在黑人女性中FN皮质厚度与骨折相关。3D-DXA可能改善黑人患者的骨折风险评估。
