Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9 years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ -2.5, whereas 53% had T-scores between -1.0 and -2.5 and 37% had T-scores ≥-1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range.

Authors

Institutions

Publication Details

Journal
Journal of Bone and Mineral Research
Published
2024-09-05
DOI
https://doi.org/10.1093/jbmr/zjae143
Citations
15
Primary Topic
Bone health and osteoporosis research
Type
article
Field-Weighted Citation Impact
7.17

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts

Paweł Szulc, Alyssa B. Dufour, Danielle E. Whittier, Éric Lespessailles et al.
15 citations
Journal of Bone and Mineral Research
Bone health and osteoporosis research
7.17
article

Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts

Paweł Szulc, Alyssa B. Dufour, Danielle E. Whittier, Éric Lespessailles, Douglas P. Kiel, Marine Sarfati, Serge Ferrari, Sundeep Khosla, David Goltzman, Blandine Merle, Mary Bouxsein, Roland Chapurlat, Steven K. Boyd, David A. Hanley, Elizabeth J. Samelson, Elisabeth Sornay‐Rendu, Andy Kin On Wong, Marian T. Hannan, Maria Nethander, Mattias Lorentzon, Emmanuel Biver, Claes Ohlsson, Dan Mellström
article en
15 citations

Abstract

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9 years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ -2.5, whereas 53% had T-scores between -1.0 and -2.5 and 37% had T-scores ≥-1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range.

Journal of Bone and Mineral ResearchVol. 39(11)
Université Claude Bernard Lyon 1 (FR), University of Geneva (CH), Beth Israel Deaconess Medical Center (US), University Health Network (CA), Mayo Clinic (US), 3M (United States) (US), Harvard University (US), Inserm (FR), University of Calgary (CA), University of Toronto (CA), Sahlgrenska University Hospital (SE), Beth Israel Deaconess Hospital (US), McGill University Health Centre (CA), Toronto General Hospital (CA), WinnMed (US), Region Västra Götaland (SE), Alberta Bone and Joint Health Institute (CA), Hôpital Edouard Herriot (FR), Hebrew SeniorLife (US), AstraZeneca (Italy) (IT), Centre hospitalier universitaire d'Orléans (FR), Geneva College (US), University of Gothenburg (SE)
Amgen, Agence Nationale de la Recherche, Hospices Civils de Lyon, National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute
Good health and well-being
Openalex Percentile: Top 2%
Bone health and osteoporosis research
7.17
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.