title: Microarchitecture and Peripheral BMD are Impaired in Postmenopausal White Women With Fracture Independently of Total Hip T-Score: An International Multicenter Study.
abstract: Because single-center studies have reported conflicting associations between microarchitecture and fracture prevalence, we included high-resolution peripheral quantitative computed tomography (HR-pQCT) data from five centers worldwide into a large multicenter analysis of postmenopausal women with and without fracture. Volumetric BMD (vBMD) and microarchitecture were assessed at the distal radius and tibia in 1379 white postmenopausal women (age 67 ± 8 years); 470 (34%) had at least one fracture including 349 with a major fragility fracture. Age, height, weight, and total hip T-score differed across centers and were employed as covariates in analyses. Women with fracture had higher BMI, were older, and had lower total hip T-score, but lumbar spine T-score was similar between groups. At the radius, total and trabecular vBMD and cortical thickness were significantly lower in fractured women in three out of five centers, and trabecular number in two centers. Similar results were found at the tibia. When data from five centers were combined, however, women with fracture had significantly lower total, trabecular, and cortical vBMD (2% to 7%), lower trabecular number (4% to 5%), and thinner cortices (5% to 6%) than women without fracture after adjustment for covariates. Results were similar at the radius and tibia. Similar results were observed with analysis restricted to major fragility fracture, vertebral and hip fractures, and peripheral fracture (at the radius). When focusing on osteopenic women, each SD decrease of total and trabecular vBMD was associated with a significantly increased risk of major fragility fracture (OR = 1.55 to 1.88, p < 0.01) after adjustment for covariates. Moreover, trabecular architecture modestly improved fracture discrimination beyond peripheral total vBMD. In conclusion, we observed differences by center in the magnitude of fracture/nonfracture differences at both the distal radius and tibia. However, when data were pooled across centers and the sample size increased, we observed significant and consistent deficits in vBMD and microarchitecture independent of total hip T-score in all postmenopausal white women with fracture and in the subgroup of osteopenic women, compared to women who never had a fracture. © 2016 American Society for Bone and Mineral Research.
authors.affiliation: College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.|INSERM UMR1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boutroy
authors.affiliation: Endocrine Research Unit, College of Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.affiliation: INSERM UMR1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Sornay-Rendu
authors.affiliation: Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Maria Belen
authors.initials: MB
authors.lastname: Zanchetta
authors.affiliation: College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.affiliation: College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Chiyuan A
authors.initials: CA
authors.lastname: Zhang
authors.affiliation: INSERM UMR1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France.
authors.forename: Roland D
authors.initials: RD
authors.lastname: Chapurlat
authors.affiliation: Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Jose
authors.initials: J
authors.lastname: Zanchetta
authors.affiliation: College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stein
authors.affiliation: Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina.
authors.forename: Cesar
authors.initials: C
authors.lastname: Bogado
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Majumdar
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Burghardt
authors.affiliation: College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
mesh_terms: D000368:Aged; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000378:metabolism* / Q000473:pathology; D000071556:Cancellous Bone / Q000378:metabolism* / Q000473:pathology; D005260:Female; D050723:Fractures, Bone / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000378:metabolism*; D011884:Radius / Q000378:metabolism* / Q000473:pathology; D013977:Tibia / Q000378:metabolism* / Q000473:pathology
keywords: BONE MICROSTRUCTURE; FRACTURE RISK; HR-PQCT; MULTICENTER STUDIES; OSTEOPOROSIS
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