Cortical bone area predicts incident fractures independently of areal bone mineral density in older men.

• Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not allow discrimination between the trabecular and cortical bone compartments or assessment of cortical porosity.To investigate if distinct information on cortical and trabecular bone parameters predict fracture risk independently of aBMD and clinical risk factors.Cortical area, cortical bone mass, trabecular bone volume fraction, and cortical porosity were measured at the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) in 456 men (80.2±3.5 years) recruited from the general population in Gothenburg, Sweden. aBMD was measured using DXA. Incident fractures (71 men with fracture) were X-ray verified. The associations with incident fracture were evaluated using Cox proportional hazard models.In models adjusted for age and BMI, cortical area (HR per SD decrease, 2.05; 95% CI, 1.58-2.65), cortical bone mass (HR per SD decrease, 2.07; 95% CI, 1.58-2.70), and trabecular BV/TV (HR, 1.62; 1.26-2.07) but not cortical porosity, were independently associated with fracture risk. These association remained essentially unaffected after adjustment for femoral neck aBMD and FRAX risk factors (area: HR 1.96 (1.44-2.66); cortical bone mass: HR 1.99 (1.45-2.74); trabecular BV/TV: HR 1.46 (1.09-1.96)). In all adjusted models, inclusion of both BV/TV and cortical area or cortical bone mass entered simultantously, only the cortical parameters remained significant predictors of fracture.We propose that HR-pQCT measurment of cortical area or cortical bone mass might add clinically useful information for the evaluation of fracture risk.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Ortopedi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Orthopaedics (hsv//eng)

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