title: Cortical porosity identifies women with osteopenia at increased risk for forearm fractures.
abstract: Most fragility fractures arise among the many women with osteopenia, not the smaller number with osteoporosis at high risk for fracture. Thus, most women at risk for fracture assessed only by measuring areal bone mineral density (aBMD) will remain untreated. We measured cortical porosity and trabecular bone volume/total volume (BV/TV) of the ultradistal radius (UDR) using high-resolution peripheral quantitative computed tomography, aBMD using densitometry, and 10-year fracture probability using the country-specific fracture risk assessment tool (FRAX) in 68 postmenopausal women with forearm fractures and 70 age-matched community controls in Olmsted County, MN, USA. Women with forearm fractures had 0.4 standard deviations (SD) higher cortical porosity and 0.6 SD lower trabecular BV/TV. Compact-appearing cortical porosity predicted fracture independent of aBMD; odds ratio (OR) = 1.92 (95% confidence interval [CI] 1.10–3.33). In women with osteoporosis at the UDR, cortical porosity did not distinguish those with fractures from those without because high porosity was present in 92% and 86% of each group, respectively. By contrast, in women with osteopenia at the UDR, high porosity of the compact-appearing cortex conferred an OR for fracture of 4.00 (95% CI 1.15–13.90). In women with osteoporosis, porosity is captured by aBMD, so measuring UDR cortical porosity does not improve diagnostic sensitivity. However, in women with osteopenia, cortical porosity was associated with forearm fractures.
authors: Yohann
authors: Y
authors: Bala
authors: Roger
authors: R
authors: Zebaze
authors: Ali
authors: A
authors: Ghasem-Zadeh
authors: Elizabeth J
authors: EJ
authors: Atkinson
authors: Sandra
authors: S
authors: Iuliano
authors: James M
authors: JM
authors: Peterson
authors: Shreyasee
authors: S
authors: Amin
authors: Åshild
authors: Å
authors: Bjørnerem
authors: L Joseph
authors: LJ
authors: Melton
authors: Helena
authors: H
authors: Johansson
authors: John A
authors: JA
authors: Kanis
authors: Sundeep
authors: S
authors: Khosla
authors: Ego
authors: E
authors: Seeman
mesh_terms: D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016001:Confidence Intervals; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D016017:Odds Ratio; D016062:Porosity; D011859:Radiography; D011885:Radius Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors