NEW YORK (Reuters Health)—Baseline measures of bone density, microarchitecture and strength predict the risk of fragility fractures in postmenopausal women, according to results from the Calgary CaMOS cohort.
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Changes in bone health were not associated with fracture risk, however, said Dr. Lauren A. Burt from the University of Calgary, Canada, who worked on the study.
“Irrespective of scanning technique—dual-energy X-ray absorptiometry (DXA) or high-resolution peripheral quantitative computed tomography (HR-pQCT)—there were no identified differences in rate of change for any bone parameter between women who fractured and women who did not fracture,” she tells Reuters Health by email.
HR-pQCT, which can assess three-dimensional bone microarchitecture and predict strength, outperforms DXA, which measures areal bone mineral density, in fracture discrimination. But it has been unclear if changes in these parameters are associated with future fragility fractures.
To investigate, Dr. Burt’s team used data from the Calgary cohort of the Canadian Multicenter Osteoporosis Study (CaMOS). Among the 163 women older than 60 at study completion who were included in the analysis, 22 (14%) developed new fragility fractures during the study (mean follow-up, five years).
Lower baseline total bone-mineral density and trabecular bone-mineral density at the radius and at the tibia significantly predicted incident fracture. So did lower trabecular number and higher trabecular separation at the radius and lower cortical thickness, cortical area and failure load and higher total area and trabecular area at the tibia.
Significant changes in bone microarchitecture were detected in women with or without incident fragility fracture. But the rate of bone loss and other changes did not differ significantly between the groups, the researchers report in the Journal of Bone and Mineral Research, online Jan. 24.1
“This study supports the notion that baseline bone quality rather than change in bone quality is associated with incident fragility fractures in women older than 60 years,” the authors conclude. “Our conclusions suggest peak bone mass and density play an important role in fragility fractures and is more relevant than rate of bone loss.”
“Simply monitoring rate of bone loss may not identify women at greatest risk of fragility fracture,” Dr. Burt says. “Physicians should consider initial bone-quality scores to better predict women likely to fracture.”
- Burt LA, Manske SL, Hanley DA, et al. Lower bone density, impaired microarchitecture and strength predict future fragility fracture in postmenopausal women: 5-year follow-up of the Calgary CaMos cohort. J Bone Miner Res. 2018 Jan 24. doi: 10.1002/jbmr.3347. [Epub ahead of print]