title: Smoking is a predictor of worse trabecular mechanical performance in hip fragility fracture patients.
abstract: Clinical risk factors (CRFs) are established predictors of fracture events. However, the influence of individual CRFs on trabecular mechanical fragility is still a subject of debate. In this study, we aimed to assess differences, adjusted for CRFs, between bone macrostructural parameters measured in ex-vivo specimens from hip fragility fracture patients and osteoarthritis patients, and to determine whether individual CRFs could predict trabecular bone mechanical behavior in hip fragility fractures. Additionally, we also looked for associations between the 10-year risk of major and hip fracture calculated by FRAX and trabecular bone mechanical performance. In this case-control study, a group of fragility fracture patients were compared with a group of osteoarthritis patients, both having undergone hip replacement surgery. A clinical protocol was applied in order to collect CRFs [body mass index (BMI), prior fragility fracture, parental history of hip fracture, long-term use of oral glucocorticoids, rheumatoid arthritis, current smoking, alcohol consumption, age and gender]. The 10-year probability of fracture was calculated. Serum bone turnover markers were determined and dual X-ray absorptiometry performed. Femoral head diameter was evaluated and trabecular bone cylinders were drilled for mechanical testing to determine bone strength, stiffness and toughness. We evaluated 40 hip fragility fracture and 52 osteoarthritis patients. Trabecular bone stiffness was significantly lower (p = 0.042) in hip fragility fracture patients when compared to osteoarthritic individuals, adjusted for age, gender and BMI. No other macrostructural parameter was statistically different between the groups. In hip fragility fracture patients, smoking habits (β = -0.403; p = 0.018) and female gender (β = -0.416; p = 0.008) were independently associated with lower stiffness. In addition, smoking was also independently associated with worse trabecular strength (β = -0.323; p = 0.045), and toughness (β = -0.403; p = 0.018). In these patients, the 10-year risk of major (r = -0.550; p = 0.012) and hip fracture (r = -0.513; p = 0.021) calculated using only CRFs was strongly correlated with femoral neck bone mineral density but not with mechanical performance. Our data showed that among fragility fracture patients active smoking is a predictor of worse intrinsic trabecular mechanical performance, and female gender is also independently associated with lower stiffness. In this population, the 10-year risk of fracture using CRFs with different weights only reflects bone mass loss but not trabecular mechanical properties.
authors.affiliation: Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Rodrigues
authors.forename: Joana
authors.initials: J
authors.lastname: Caetano-Lopes
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Vale
authors.forename: Inês
authors.initials: I
authors.lastname: Aleixo
authors.forename: Ana Sofia
authors.initials: AS
authors.lastname: Pena
authors.forename: Alexandra
authors.initials: A
authors.lastname: Faustino
authors.forename: Alexandre
authors.initials: A
authors.lastname: Sepriano
authors.forename: Joaquim
authors.initials: J
authors.lastname: Polido-Pereira
authors.forename: Elsa
authors.initials: E
authors.lastname: Vieira-Sousa
authors.forename: Raquel
authors.initials: R
authors.lastname: Lucas
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Romeu
authors.forename: Jacinto
authors.initials: J
authors.lastname: Monteiro
authors.forename: Maria Fátima
authors.initials: MF
authors.lastname: Vaz
authors.forename: João Eurico
authors.initials: JE
authors.lastname: Fonseca
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D015519:Bone Density; D001847:Bone Diseases / Q000150:complications* / Q000503:physiopathology; D016022:Case-Control Studies; D005260:Female; D005272:Femur Neck / Q000473:pathology / Q000503:physiopathology; D006620:Hip Fractures / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D010003:Osteoarthritis / Q000150:complications; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*