title: Prior ankle fractures in postmenopausal women are associated with low areal bone mineral density and bone microstructure alterations.
abstract: In a cross-sectional analysis in postmenopausal women, prior ankle fractures were associated with lower areal bone mineral density (BMD) and trabecular bone alterations compared to no fracture history. Compared to women with forearm fractures, microstructure alterations were of lower magnitude. These data suggest that ankle fractures are another manifestation of bone fragility.
  
  
  BACKGROUND
  Whether ankle fractures represent fragility fractures associated with low areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) and/or bone microstructure alterations remains unclear, in contrast to the well-recognised association between forearm fractures and osteoporosis. The objective of this study was to investigate aBMD, vBMD and bone microstructure in postmenopausal women with prior ankle fracture in adulthood, compared with women without prior fracture or with women with prior forearm fractures, considered as typically of osteoporotic origin.
  
  
  METHODS
  In a cross-sectional analysis in the Geneva Retirees Cohort study, 63 women with ankle fracture and 59 with forearm fracture were compared to 433 women without fracture (mean age, 65 ± 1 years). aBMD was measured by dual-energy X-ray absorptiometry; distal radius and tibia vBMD and bone microstructure were measured by high-resolution peripheral quantitative computed tomography.
  
  
  RESULTS
  Compared with women without fracture, those with ankle fractures had lower aBMD, radius vBMD (-7.9%), trabecular density (-10.7%), number (-7.3%) and thickness (-4.6%) and higher trabecular spacing (+14.5%) (P < 0.05 for all). Tibia trabecular variables were also altered. For 1 standard deviation decrease in total hip aBMD or radius trabecular density, odds ratios for ankle fractures were 2.2 and 1.6, respectively, vs 2.2 and 2.7 for forearm fracture, respectively (P ≤ 0.001 for all). Compared to women with forearm fractures, those with ankle fractures had similar spine and hip aBMD, but microstructure alterations of lower magnitude.
  
  
  CONCLUSIONS
  Women with ankle fractures have lower aBMD and vBMD and trabecular bone alterations, suggesting that ankle fractures are another manifestation of bone fragility.
authors: Division of Bone Diseases, Department of Internal Medicine Specialties, Faculty of Medicine, Geneva University Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland, Emmanuel.Biver@hcuge.ch.
authors: E
authors: E
authors: Biver
authors: C
authors: C
authors: Durosier
authors: T
authors: T
authors: Chevalley
authors: F R
authors: FR
authors: Herrmann
authors: S
authors: S
authors: Ferrari
authors: R
authors: R
authors: Rizzoli
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000209:etiology* / Q000503:physiopathology; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000209:etiology* / Q000503:physiopathology; D011884:Radius / Q000503:physiopathology; D011885:Radius Fractures / Q000209:etiology / Q000503:physiopathology; D013977:Tibia / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014458:Ulna Fractures / Q000209:etiology / Q000503:physiopathology