title: Cortical Bone Area Predicts Incident Fractures Independently of Areal Bone Mineral Density in Older Men.
abstract: Areal bone mineral density (aBMD) measured using dual-energy X-ray absorptiometry (DXA) is used clinically to predict fracture but does not discriminate between trabecular and cortical bone assessment.
  
  
  
  This study aimed to investigate whether information on cortical and trabecular bone predict fracture risk independently of aBMD and clinical risk factors.
  
  
  
  Cortical area, bone mass, porosity, and trabecular bone volume fraction (BVTV) were measured at the tibia using high-resolution peripheral quantitative computed tomography (HR-pQCT) in 456 men (80.2 ± 3.5 years) recruited from the general population in Gothenburg, Sweden. aBMD was measured using DXA. Incident fractures (71 men) were X-ray verified. Associations were evaluated using Cox regression.
  
  
  
  Cortical area [hazard ratio (HR) per standard deviation (SD) decrease, 2.05; 95% confidence interval (CI), 1.58 to 2.65], cortical bone mass (HR, 2.07; 95% CI, 1.58 to 2.70), and BVTV (HR, 1.62; 95% CI, 1.26 to 2.07), but not cortical porosity, were independently associated with fracture risk. These associations remained after adjustment for femoral neck aBMD and Fracture Risk Assessment risk factors (area: HR 1.96, 95% CI, 1.44 to 2.66; mass: HR 1.99, 95% CI, 1.45 to 2.74; BV/TV: HR 1.46, 95% CI, 1.09 to 1.96). After entering BV/TV and cortical area or bone mass simultaneously in the adjusted models, only the cortical parameters remained important predictors of fracture.
  
  
  
  HR-pQCT measurement of cortical area and mass might add clinically useful information for the evaluation of fracture risk.
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.
authors.forename: Claes
authors.initials: C
authors.lastname: Ohlsson
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Sundh
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wallerek
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, 221 00 Lund, Sweden.|Department of Orthopaedics, Skåne University Hospital, 205 02 Malmö, Sweden; and.
authors.forename: Magnus
authors.initials: M
authors.lastname: Karlsson
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.|Institute for Health and Ageing, Catholic University of Australia, Melbourne 3000, Australia.
authors.forename: Helena
authors.initials: H
authors.lastname: Johansson
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Mellström
authors.affiliation: Center for Bone Research at the Sahlgrenska Academy, Institute of Medicine, and.|Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden.
authors.forename: Mattias
authors.initials: M
authors.lastname: Lorentzon
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015519:Bone Density / Q000502:physiology*; D000071538:Cortical Bone / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008297:Male; D058866:Osteoporotic Fractures / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed