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      The association between prevalent vertebral fractures and bone quality of the distal radius and distal tibia as measured with HR-pQCT in postmenopausal women with a recent non-vertebral fracture at the Fracture Liaison Service

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          Abstract

          Summary

          We evaluated the association between prevalent vertebral fractures and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women with a recent non-vertebral fracture visiting the Fracture Liaison Service. The presence and severity of prevalent vertebral fracture reflect generalized bone deterioration.

          Introduction

          We evaluated the association between prevalent vertebral fractures (VFs) and bone micro-architecture and strength measured using HR-pQCT in postmenopausal women visiting the Fracture Liaison Service.

          Methods

          In this cross-sectional study in women aged 50–90 with a recent non-vertebral fracture (NVF), VFs were identified on lateral spine images by dual-energy X-ray absorptiometry. Bone micro-architecture and strength were measured at the non-dominant distal radius and distal tibia using HR-pQCT. Linear regression analyses were used to estimate the association between prevalent VFs and HR-pQCT parameters.

          Results

          We included 338 women of whom 74 (21.9%) women had at least one prevalent VF. After adjustment for femoral neck aBMD (FN aBMD) and other parameters, women with at least one prevalent vertebral fracture had significantly lower total and trabecular vBMD and trabecular number ( β − 16.7, − 11.8, and − 7.8 in the radius and − 21.4, − 16.6, and − 7.2 in the tibia, respectively), higher trabecular separation at the radius and tibia ( β 9.0 and 9.3, respectively), and lower cortical thickness and calculated ultimate failure load and compressive bone strength at the tibia ( β − 5.9, − 0.6, and − 10.9, respectively) as compared with those without prevalent VFs. Furthermore, more severe prevalent VFs were associated with even lower total and trabecular vBMD and lower ultimate failure load and compressive stiffness at the radius and tibia, and lower trabecular number and higher trabecular separation at the radius.

          Conclusion

          This study indicates that the presence and severity of prevalent VFs reflect generalized bone deterioration in women with a recent NVF, independently of FN aBMD.

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          Most cited references26

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          Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989.

          Vertebral fractures are the classic hallmark of osteoporosis, yet little is known of their epidemiology. The incidence of clinically diagnosed vertebral fractures was therefore directly assessed in the predominantly white (European descent) population of Rochester, Minnesota. Altogether, 341 Rochester residents were radiologically diagnosed for the first time with one or more vertebral fractures in the 5 year study period, 1985-1989. The overall age- and sex-adjusted incidence rate was 117 per 100,000 person-years (95% CI, 105 to 130). The age-adjusted rate in women (145 per 100,000 person-years) was almost twice that in men (73 per 100,000 person-years). Of all fractures, 47 (14%) followed severe trauma, 282 (83%) followed moderate or no trauma, and 12 (3%) were pathologic. Incidence rates for fractures following moderate trauma were higher in women than in men and rose steeply with age in both genders. In contrast, fractures following severe trauma were more frequent in men, and their incidence increased less with age. These Rochester rates are greater than those previously reported from studies in Britain and Sweden but lower than the incidence rates extrapolated from a prevalence study in this population.
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            Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group.

            Although vertebral deformities are known to predict future vertebral deformities, little is known about their ability to predict other osteoporotic fractures. We examined the association between prevalent vertebral deformities and incident osteoporotic fractures in the Study of Osteoporotic Fractures, a prospective study of 9704 women aged 65 years and older. Prevalent vertebral deformities were determined morphometrically from spinal radiographs at baseline and incident deformities from repeat spinal radiographs after a mean of 3.7 years. Appendicular fractures were collected by postcard every 4 months for a mean of 8.3 years. During follow-up, 389 women with new vertebral deformities, 464 with hip fractures, and 574 with wrist fractures were identified. Prevalent vertebral deformities were associated with a 5-fold increased risk (relative risk 5.4, 95% confidence interval [CI] 4.4, 6.6) of sustaining a further vertebral deformity; the risk increased dramatically with both the number and severity of the prevalent deformities. Similarly, the risks of hip and any nonvertebral fractures were increased with baseline prevalent deformity, with relative risks of 2.8 (95% CI 2.3, 3.4) and 1.9 (95% CI 1.7, 2.1), respectively. Risk increased with number and severity of deformities. These associations remained significant after adjustment for age and calcaneal bone mineral density (BMD). Although there was a small increased risk of wrist fracture, this was not significant after adjusting for age and BMD. In conclusion, the presence of prevalent morphometrically defined vertebral deformities predicts future vertebral and nonvertebral fractures, including hip but not wrist fractures. Spinal radiographs identifying prevalent vertebral deformities may be a useful additional measurement to classify further a woman's risk of future fracture.
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              Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study

              Although areal bone mineral density (aBMD) assessed by dual-energy x-ray absorptiometry (DXA) is the clinical standard for determining fracture risk, most older adults who sustain a fracture have T scores greater than -2·5 and thus do not meet the clinical criteria for osteoporosis. Importantly, bone fragility is due to low BMD and deterioration in bone structure. We assessed whether indices of high-resolution peripheral quantitative CT (HR-pQCT) were associated with fracture risk independently of femoral neck aBMD and the Fracture Risk Assessment Tool (FRAX) score.
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                Author and article information

                Contributors
                +31-773205555 , jvdbergh@viecuri.nl
                Journal
                Osteoporos Int
                Osteoporos Int
                Osteoporosis International
                Springer London (London )
                0937-941X
                1433-2965
                17 July 2019
                17 July 2019
                2019
                : 30
                : 9
                : 1789-1797
                Affiliations
                [1 ]ISNI 0000 0004 0477 5022, GRID grid.416856.8, Department of Internal Medicine, , VieCuri Medical Center, ; P.O. Box 1926, 5900 BX Venlo, The Netherlands
                [2 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of Internal Medicine, , Maastricht University Medical Center +, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [3 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, NUTRIM School of Nutrition and Translational Research in Metabolism, , Maastricht University, ; Maastricht, The Netherlands
                [4 ]ISNI 0000 0004 0398 8763, GRID grid.6852.9, Faculty of Biomedical Engineering, , Eindhoven University of Technology, ; Eindhoven, The Netherlands
                [5 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of Orthopaedic Surgery, , Maastricht University Medical Center +, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [6 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of Clinical Pharmacy and Toxicology, , Maastricht University Medical Center +, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [7 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, CAPHRI School for Public Health and Primary Care, , Maastricht University, ; Maastricht, The Netherlands
                [8 ]ISNI 0000 0004 0480 1382, GRID grid.412966.e, Department of Internal Medicine, Subdivision Rheumatology, , Maastricht University Medical Center +, ; P.O. Box 616, 6200 MD Maastricht, The Netherlands
                [9 ]ISNI 0000 0001 0604 5662, GRID grid.12155.32, Biomedical Research Center, , Hasselt University, ; Agoralaan, Gebouw D, 3590 Diepenbeek, Belgium
                [10 ]ISNI 0000 0004 0477 5022, GRID grid.416856.8, Department of Surgery, , VieCuri Medical Center, ; P.O. Box 1926, 5900 BX Venlo, The Netherlands
                Author information
                http://orcid.org/0000-0001-7662-3990
                Article
                5081
                10.1007/s00198-019-05081-9
                6719323
                31312863
                a65000ab-c748-4450-8454-1ea23d1d82ba
                © The Author(s) 2019

                Open Access This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 17 October 2018
                : 3 July 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100009709, Stichting De Weijerhorst;
                Award ID: na
                Categories
                Original Article
                Custom metadata
                © International Osteoporosis Foundation and National Osteoporosis Foundation 2019

                Orthopedics
                fracture liaison service,hr-pqct,vertebral fractures
                Orthopedics
                fracture liaison service, hr-pqct, vertebral fractures

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