title: Remodeling markers are associated with larger intracortical surface area but smaller trabecular surface area: a twin study.
abstract: All postmenopausal women become estrogen deficient but not all remodel their skeleton rapidly or lose bone rapidly. As remodeling requires a surface to be initiated upon, we hypothesized that a volume of mineralized bone assembled with a larger internal surface area is more accessible to being remodeled, and so decayed, after menopause. We measured intracortical, endocortical and trabecular bone surface area and microarchitecture of the distal tibia and distal radius in 185 healthy female twin pairs aged 40 to 61 years using high-resolution peripheral quantitative computed tomography (HR-pQCT). We used generalized estimation equations to analyze (i) the trait differences across menopause, (ii) the relationship between remodeling markers and bone surface areas, and (iii) robust regression to estimate associations between within-pair differences. Relative to premenopausal women, postmenopausal women had higher remodeling markers, larger intracortical and endocortical bone surface area, higher intracortical porosity, smaller trabecular bone surface area and fewer trabeculae at both sites (all p<0.01). Postmenopausal women had greater deficits in cortical than trabecular bone mass at the distal tibia (-0.98 vs. -0.12 SD, p<0.001), but similar deficits at the distal radius (-0.45 vs. -0.39 SD, p=0.79). A 1 SD higher tibia intracortical bone surface area was associated with 0.22-0.29 SD higher remodeling markers, about half the 0.53-0.67 SD increment in remodeling markers across menopause (all p<0.001). A 1 SD higher porosity was associated with 0.20-0.30 SD higher remodeling markers. A 1 SD lower trabecular bone surface area was associated with 0.15-0.18 SD higher remodeling markers (all p<0.01). Within-pair differences in intracortical and endocortical bone surface areas at both sites and porosity at the distal tibia were associated with within-pair differences in some remodeling markers (p=0.05 to 0.09). We infer intracortical remodeling may be self perpetuating by creating intracortical porosity and so more bone surface for remodeling to occur upon, while remodeling upon the trabecular bone surface is self limiting because it removes trabeculae with their surface.
authors.affiliation: Department of Clinical Medicine, University of Tromsø, Norway. ashild.bjornerem@uit.no
authors.forename: Åshild
authors.initials: Å
authors.lastname: Bjørnerem
authors.forename: Ali
authors.initials: A
authors.lastname: Ghasem-Zadeh
authors.forename: Minh
authors.initials: M
authors.lastname: Bui
authors.forename: Xiaofang
authors.initials: X
authors.lastname: Wang
authors.forename: Christian
authors.initials: C
authors.lastname: Rantzau
authors.forename: Tuan V
authors.initials: TV
authors.lastname: Nguyen
authors.forename: John L
authors.initials: JL
authors.lastname: Hopper
authors.forename: Roger
authors.initials: R
authors.lastname: Zebaze
authors.forename: Ego
authors.initials: E
authors.lastname: Seeman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism; D016723:Bone Remodeling / Q000502:physiology*; D024042:Collagen Type I / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D010455:Peptides / Q000097:blood; D017698:Postmenopause / Q000502:physiology; D017697:Premenopause / Q000502:physiology; D011347:Procollagen / Q000097:blood; D011859:Radiography; D011884:Radius / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology; D013499:Surface Properties; D013977:Tibia / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000502:physiology; D014427:Twins
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010446:Peptide Fragments; D010455:Peptides; D011347:Procollagen; C052929:collagen type I trimeric cross-linked peptide; C047202:procollagen Type I N-terminal peptide; D015675:Osteocalcin