title: Diminished bone strength is observed in adult women and men who sustained a mild trauma distal forearm fracture during childhood.
abstract: Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health.
authors.affiliation: Division of Endocrinology, Metabolism, Nutrition and Diabetes, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Farr
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Achenbach
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Atkinson
authors.forename: Salman
authors.initials: S
authors.lastname: Kirmani
authors.forename: Louise K
authors.initials: LK
authors.lastname: McCready
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
mesh_terms: D015502:Absorptiometry, Photon; D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D015519:Bone Density; D001842:Bone and Bones / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D003276:Contraceptives, Oral; D005260:Female; D020342:Finite Element Analysis; D006728:Hormones / Q000378:metabolism; D006801:Humans; D008297:Male; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013977:Tibia / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult
chemical_list: D003276:Contraceptives, Oral; D006728:Hormones
keywords: BONE ANALYSIS/QUANTITATION; BONE DENSITOMETRY; BONE STRENGTH; BONE STRUCTURE; DISTAL FOREARM FRACTURE; GENERAL POPULATION STUDIES, EPIDEMIOLOGY; HRPQCT; YOUNG ADULTS
references.citation: Curr Osteoporos Rep. 2005 Sep;3(3):75-83
references.pmid: 16131426
references.citation: Med Eng Phys. 2007 Dec;29(10):1096-105
references.pmid: 17229586
references.citation: J Bone Miner Res. 2010 Oct;25(10):2229-38
references.pmid: 20499344
references.citation: Osteoporos Int. 1994 Nov;4(6):382-98
references.pmid: 7696836
references.citation: J Bone Miner Res. 2000 Oct;15(10):2011-8
references.pmid: 11028455
references.citation: J Bone Miner Res. 2013 Feb;28(2):351-9
references.pmid: 22915380
references.citation: J Clin Endocrinol Metab. 2000 Oct;85(10):3908-18
references.pmid: 11061556
references.citation: J Bone Miner Res. 2006 Sep;21(9):1489-95
references.pmid: 16939408
references.citation: J Bone Miner Res. 2009 Jul;24(7):1314-8
references.pmid: 19335219
references.citation: Acta Orthop Scand. 1988 Oct;59(5):557-9
references.pmid: 3188862
references.citation: Osteoporos Int. 2014 Oct;25(10):2359-81
references.pmid: 25182228
references.citation: J Clin Endocrinol Metab. 2010 Apr;95(4):1681-9
references.pmid: 20157194
references.citation: Bone. 2009 Sep;45(3):480-6
references.pmid: 19481189
references.citation: J Bone Miner Res. 1998 Jan;13(1):143-8
references.pmid: 9443800
references.citation: J Bone Miner Res. 2000 Apr;15(4):721-39
references.pmid: 10780864
references.citation: N Engl J Med. 1997 Nov 13;337(20):1466-70
references.pmid: 9380105
references.citation: J Bone Miner Res. 2014 Jun;29(6):1356-62
references.pmid: 24519558
references.citation: J Bone Miner Res. 2007 Mar;22(3):425-33
references.pmid: 17181395
references.citation: Mayo Clin Proc. 2012 Dec;87(12):1202-13
references.pmid: 23199802
references.citation: J Clin Endocrinol Metab. 2011 Sep;96(9):E1380-7
references.pmid: 21752879
references.citation: J Clin Endocrinol Metab. 2012 Nov;97(11):4219-27
references.pmid: 22948767
references.citation: J Bone Miner Res. 2006 Jan;21(1):124-31
references.pmid: 16355281
references.citation: Osteoporos Int. 2013 Jan;24(1):23-57
references.pmid: 23079689
references.citation: J Bone Miner Res. 2006 Apr;21(4):501-7
references.pmid: 16598368
references.citation: Bone. 2013 Mar;53(1):34-41
references.pmid: 23238122
references.citation: J Bone Miner Res. 2002 Jun;17(6):1065-72
references.pmid: 12054162
references.citation: J Bone Miner Res. 2007 Sep;22(9):1442-8
references.pmid: 17539738
references.citation: J Bone Miner Res. 2012 Mar;27(3):637-44
references.pmid: 22095490
references.citation: J Bone Miner Res. 2012 Oct;27(10):2159-69
references.pmid: 22623219
references.citation: Bone. 2004 Aug;35(2):375-82
references.pmid: 15268886
references.citation: Bone. 2009 Sep;45(3):455-9
references.pmid: 19450717
references.citation: J Biomech. 1998 Dec;31(12):1169-76
references.pmid: 9882050
references.citation: Horm Res Paediatr. 2010;74(5):312-8
references.pmid: 20395668
references.citation: J Bone Miner Res. 2012 Feb;27(2):263-72
references.pmid: 22072446
references.citation: J Bone Joint Surg Am. 2013 Apr 3;95(7):633-42
references.pmid: 23553299
references.citation: Contraception. 2003 Sep;68(3):177-82
references.pmid: 14561537
references.citation: J Clin Endocrinol Metab. 2009 May;94(5):1555-61
references.pmid: 19223517
references.citation: Acta Orthop Scand Suppl. 1983;202:1-109
references.pmid: 6574687
references.citation: JAMA. 2003 Sep 17;290(11):1479-85
references.pmid: 13129988
references.citation: J Bone Miner Res. 2008 Feb;23(2):173-9
references.pmid: 17922615
references.citation: Contraception. 2012 Oct;86(4):332-6
references.pmid: 22364818
references.citation: Bone. 2013 Aug;55(2):377-83
references.pmid: 23659831
references.citation: Contraception. 2012 Dec;86(6):606-21
references.pmid: 22717184
references.citation: J Bone Miner Res. 2010 Jun;25(6):1433-40
references.pmid: 20200932
references.citation: Bone. 2002 Jun;30(6):842-8
references.pmid: 12052451
references.citation: Bone. 2010 Sep;47(3):519-28
references.pmid: 20561906
references.citation: J Bone Miner Res. 2013 Aug;28(8):1751-9
references.pmid: 23456800
references.citation: Osteoporos Int. 2000;11(12):985-1009
references.pmid: 11256898
references.citation: J Bone Miner Res. 2010 May;25(5):983-93
references.pmid: 19888900
references.citation: J Bone Miner Res. 2004 Dec;19(12):1945-54
references.pmid: 15537436
references.citation: J Bone Joint Surg Am. 1989 Sep;71(8):1225-31
references.pmid: 2777851
references.citation: J Bone Miner Res. 2005 Dec;20(12):2090-6
references.pmid: 16294262
references.citation: J Clin Endocrinol Metab. 1998 Feb;83(2):358-61
references.pmid: 9467541
references.citation: Am J Epidemiol. 1978 Sep;108(3):161-75
references.pmid: 707484
references.citation: J Bone Miner Res. 2010 Dec;25(12):2572-81
references.pmid: 20564238
references.citation: Bone. 2011 May 1;48(5):1103-8
references.pmid: 21241839
references.citation: J Bone Miner Res. 2014 Mar;29(3):590-9
references.pmid: 23959563
references.citation: J Bone Miner Res. 2013 Nov;28(11):2305-16
references.pmid: 23658040
references.citation: Contraception. 2010 Mar;81(3):209-14
references.pmid: 20159176
references.citation: Contraception. 2010 Jan;81(1):35-40
references.pmid: 20004271
references.citation: J Bone Miner Res. 2011 Jun;26(6):1358-67
references.pmid: 21611974