title: Assessing forearm fracture risk in postmenopausal women.
abstract: A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.
  
  
  BACKGROUND
  This study seeks to test the clinical utility of approaches for assessing forearm fracture risk.
  
  
  METHODS
  Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (microFE) models.
  
  
  RESULTS
  Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (microFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall / microFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71).
  
  
  CONCLUSIONS
  Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA. melton.j@mayo.edu
authors.forename: L J
authors.initials: LJ
authors.lastname: Melton
authors.forename: D
authors.initials: D
authors.lastname: Christen
authors.forename: B L
authors.initials: BL
authors.lastname: Riggs
authors.forename: S J
authors.initials: SJ
authors.lastname: Achenbach
authors.forename: R
authors.initials: R
authors.lastname: Müller
authors.forename: G H
authors.initials: GH
authors.lastname: van Lenthe
authors.forename: S
authors.initials: S
authors.lastname: Amin
authors.forename: E J
authors.initials: EJ
authors.lastname: Atkinson
authors.forename: S
authors.initials: S
authors.lastname: Khosla
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D001696:Biomechanical Phenomena; D015519:Bone Density / Q000502:physiology; D016022:Case-Control Studies; D003100:Colles' Fracture / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D017698:Postmenopause / Q000502:physiology; D011884:Radius / Q000473:pathology; D018570:Risk Assessment / Q000379:methods