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Deterioration of trabecular bone found in premenopausal women with fractures
Investigators compared women younger than 45 years old with distal radius fractures to those without a history of fracture.
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 Tamara D. Rozental |
A study comparing premenopausal women with distal radius fractures to a control group of women without fractures revealed deterioration in trabecular and cortical bone microarchitecture in those with fractures, despite similar bone density by dual-energy X-ray absorptiometry scan.
“We know from the pediatric literature that children with fractures, have lower [bone mineral density] BMD, and that individuals with fractures at a young age have a higher rate of refracture,” study author Tamara D. Rozental, MD, said during her presentation at the 2011 Annual Meeting of the American Society for Surgery of the Hand. “Idenifying patients at a young age who are at risk for future fracture would provide us with a unique opportunity to initiate early treatment intervention.”
Early identification
Rozental and her colleagues hope that detecting bone deterioration early in premenopausal women will help treat osteoporosis in the future. According to Rozental, most studies have focused on postmenopausal women with existing low bone density and increased fracture risk.
“There have been few studies that have examined whether fractures at a young age predispose to future fractures,” Rozental said. “A new approach that would target premenopausal women would ideally identify early signs of skeletal fragility and allow a lifestyle or pharmacologic interventions to prevent future bone loss.”
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This is a 3-D reconstruction of high-resolution peripheral CT image of the distal radius in a representative premenopausal woman with distal radius fracture (left) and a similarly aged woman with no history of fracture (right). Note the trabecular and cortical bone deficits in the fracture case compared to the control. Images: Rozental TD |
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High resolution peripheral CT
Rozental and colleagues compared female patients between 18 years and 45 years old who had distal radius fractures to a control group with no fracture history. The investigators first measured patients’ BMD at the wrist, hip and lumbar spine using dual-energy X-ray absorptiometry (DXA).
“To date, measurement by DXA is the gold standard,” Rozental said. “But, bone density by DXA does not always absolutely reflect fracture risk. For this reason, there has been a recent focus toward alternative imaging modalities that can look at bone fracture risk.”
Therefore, the team used high-resolution peripheral quantitative computerized tomography (hr-pQCT) (Scanco Medical, Bassersdorf, Switzerland) as to further quantify trabecular and cortical microarchitecture after distal radius fracture. Differences in architecture by HR-pQCT have been proven to be associated with fragility fractures independently of BMD by DXA, according to Rozental.
In this study, hr-pQCT revealed lower total bone density, lower trabecular density and thickness in the fracture group compared to controls. Cortical density and cortical thickness was also lower in the fracture group. No differences in BMD were detected with traditional DXA scanning. Rozental noted that the results suggest that fractures at a young age may be risk factors for future fractures. – by Renee Blisard
Reference:
- Rozental TD, Bouxsein M, Day CS, et al. Premenopausal women with distal radius fractures have deteriorated trabecular bone density and morphology compared to non-fracture controls. Paper #14. Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. Sept. 8-10. Las Vegas.
- Tamara D. Rozental, MD, can be reached at the Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Stoneman 10, Boston, MA 02215; 617-667-2464; email: trozenta@bidmc.harvard.edu.
- Disclosure: Rozental has no relevant financial disclosures. The work was funded with grants from the Ruth Jackson Orthopaedic Society and Sanofi Aventis.