Determinants of Transitional Zone Area and Porosity of the Proximal Femur Quantified In Vivo in Postmenopausal Women.

Published on Apr 1, 2016in Journal of Bone and Mineral Research5.854
· DOI :10.1002/JBMR.2751
Rajesh Shigdel6
Estimated H-index: 6
,
Marit Osima6
Estimated H-index: 6
+ 4 AuthorsÅshild Bjørnerem19
Estimated H-index: 19
Sources
Abstract
Bone architecture as well as size and shape is important for bone strength and risk of fracture. Most bone loss is cortical and occurs by trabecularization of the inner part of the cortex. We therefore wanted to identify determinants of the bone architecture, especially the area and porosity of the transitional zone, an inner cortical region with a large surface/matrix volume available for intracortical remodeling. In 211 postmenopausal women aged 54 to 94 years with nonvertebral fractures and 232 controls from the Tromso Study, Norway, we quantified femoral subtrochanteric architecture in CT images using StrAx1.0 software, and serum levels of bone turnover markers (BTM, procollagen type I N-terminal propeptide and C-terminal cross-linking telopeptide of type I collagen). Multivariable linear and logistic regression analyses were used to quantify associations of age, weight, height, and bone size with bone architecture and BTM, and odds ratio (OR) for fracture. Increasing age, height, and larger total cross-sectional area (TCSA) were associated with larger transitional zone CSA and transitional zone CSA/TCSA (standardized coefficients [STB] = 0.11 to 0.80, p ≤ 0.05). Increasing weight was associated with larger TCSA, but smaller transitional zone CSA/TCSA and thicker cortices (STB = 0.15 to 0.22, p < 0.01). Increasing height and TCSA were associated with higher porosity of the transitional zone (STB = 0.12 to 0.46, p < 0.05). Increasing BTM were associated with larger TCSA, larger transitional zone CSA/TCSA, and higher porosity of each of the cortical compartments (p < 0.01). Fracture cases exhibited larger transitional zone CSA and higher porosity than controls (p < 0.001). Per SD increasing CSA and porosity of the transitional zone, OR for fracture was 1.71 (95% CI, 1.37 to 2.14) and 1.51 (95% CI, 1.23 to 1.85), respectively. Cortical bone architecture is determined mainly by bone size as built during growth and is modified by lifestyle factors throughout life through bone turnover. Fracture cases exhibited larger transitional zone area and porosity, highlighting the importance of cortical bone architecture for fracture propensity.
📖 Papers frequently viewed together
124 Citations
48 Citations
201060.39The Lancet
8 Authors (Roger Zebaze, ..., Ego Seeman)
592 Citations
References41
Newest
#1Rajesh ShigdelH-Index: 6
#2Marit OsimaH-Index: 6
Last. Åshild BjørneremH-Index: 19
view all 7 authors...
article i nfo Bone turnover markers (BTM) predict bone loss and fragility fracture. Although cortical porosity and cortical thinning are important determinants of bone strength, the relationship between BTM and cortical porosity has, however, remained elusive. We therefore wanted to examine the relationship of BTM with cortical porosity and risk of non-vertebral fracture. In 211 postmenopausal women aged 54-94 years with non-vertebral fractures and 232 age-matched fracture- free controls from th...
39 CitationsSource
#1Yohann Bala (INSA Lyon: Institut national des sciences Appliquées de Lyon)H-Index: 21
#2Roger Zebaze (University of Melbourne)H-Index: 27
Last. Ego Seeman (University of Melbourne)H-Index: 109
view all 3 authors...
Purpose of reviewTrabecular bone loss and vertebral fractures are historical hallmarks of osteoporosis. During the past 70 years, this view has dominated research aiming to understand the structural basis of bone fragility. We suggest this notion needs to be revised to recognize and include the role
73 CitationsSource
#1Luai A. AhmedH-Index: 27
#2Rajesh ShigdelH-Index: 6
Last. Åshild BjørneremH-Index: 19
view all 10 authors...
Summary We tested whether cortical porosity of the proximal femur measured using StrAx1.0 software provides additional information to areal bone mineral density (aBMD) or Fracture Risk Assessment Tool (FRAX) in differentiating women with and without fracture. Porosity was associated with fracture independent of aBMD and FRAX and identified additional women with fractures than by osteoporosis or FRAX thresholds.
48 CitationsSource
#1Åshild BjørneremH-Index: 19
#2Q Minh Bui (University of Melbourne)H-Index: 1
Last. Ego Seeman (University of Melbourne)H-Index: 109
view all 7 authors...
All genetic and environmental factors contributing to differences in bone structure between individuals mediate their effects through the final common cellular pathway of bone modeling and remodeling. We hypothesized that genetic factors account for most of the population variance of cortical and trabecular microstructure, in particular intracortical porosity and medullary size – void volumes (porosity), which establish the internal bone surface areas or interfaces upon which modeling and remode...
32 CitationsSource
#1Yohann BalaH-Index: 21
#2Roger ZebazeH-Index: 27
Last. Ego SeemanH-Index: 109
view all 13 authors...
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 ...
124 CitationsSource
#1Piet Geusens (Maastricht University Medical Centre)H-Index: 80
#2Roland Chapurlat (University of Lyon)H-Index: 72
Last. Joop P. W. van den Bergh (Maastricht University Medical Centre)H-Index: 27
view all 7 authors...
High-resolution peripheral quantitative CT (HR pQCT) has emerged as a unique way to evaluate bone and joints, by producing high-resolution, 3D images of cortical and trabecular bone in vivo. In this Review, the authors describe how HR pQCT is used in the evaluation of bone and joint diseases, together with an evaluation of its technical features, advantages, limitations, and potential in basic research, clinical trials and clinical practice.
92 CitationsSource
#1John P. Kemp (UoB: University of Bristol)H-Index: 56
#2Adrian Sayers (UoB: University of Bristol)H-Index: 32
Last. Jonathan H Tobias (UoB: University of Bristol)H-Index: 51
view all 22 authors...
We hypothesized that bone resorption acts to increase bone strength through stimulation of periosteal expansion. Hence, we examined whether bone resorption, as reflected by serum β-C-telopeptides of type I collagen (CTX), is positively associated with periosteal circumference (PC), in contrast to inverse associations with parameters related to bone remodeling such as cortical bone mineral density (BMDC). CTX and mid-tibial peripheral quantitative computed tomography (pQCT) scans were available i...
22 CitationsSource
Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral nec...
292 CitationsSource
All factors influencing the material composition and structure of bone do so through the final common cellular pathways of modeling and remodeling. During growth, modeling, the formation of new bone in different locations without prior bone resorption, deposits matrix upon the periosteum, enlarging the cross-sectional area of bone. Concurrently, endocortical resorption excavates the medullary canal while remodeling, the resorption and deposition of bone in the same location, assembles cortical o...
115 CitationsSource
#1Luai A. AhmedH-Index: 27
#3Åshild BjørneremH-Index: 19
Last. Nina EmausH-Index: 30
view all 14 authors...
The risk of subsequent fracture is increased after initial fractures; however, proper understanding of its magnitude is lacking. This population-based study examines the subsequent fracture risk in women and men by age and type of initial incident fracture. All incident nonvertebral fractures between 1994 and 2009 were registered in 27,158 participants in the Tromso Study, Norway. The analysis included 3108 subjects with an initial incident fracture after the age of 49 years. Subsequent fracture...
55 CitationsSource
Cited By12
Newest
#1Roger Zebaze (Monash University)H-Index: 27
#2Marit Osima (UNN: University Hospital of North Norway)H-Index: 6
Last. Åshild Bjørnerem (UNN: University Hospital of North Norway)H-Index: 19
view all 12 authors...
This is the peer reviewed version of the following article: Zebaze, R., Osima, M., Bui, M., Lukic, M., Wang, X., Ghasem-Zadeh, A. ... Bjornerem, A. (2019). Adding marrow adiposity and cortical porosity to femoral neck areal bone mineral density improves the discrimination of women with nonvertebral fractures from controls. Journal of Bone and Mineral Research, 34(8), 1451-1460, which has been published in final form at https://doi.org/10.1002/jbmr.3721. This article may be used for non-commercia...
7 CitationsSource
#1Tove Tveitan Borgen (University of Oslo)H-Index: 5
#2Åshild Bjørnerem (UNN: University Hospital of North Norway)H-Index: 19
Last. Erik Fink Eriksen (University of Oslo)H-Index: 93
view all 19 authors...
: The location of osteoporotic fragility fractures adds crucial information to post-fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross-sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substud...
7 CitationsSource
#1Elena Nebot (Medical University of Vienna)H-Index: 8
#2Patrick Heimel (Medical University of Vienna)H-Index: 11
Last. Peter Pietschmann (Medical University of Vienna)H-Index: 50
view all 9 authors...
Although Paget’s disease of bone (PDB) is the second most common metabolic bone disease, there is only limited information about the microarchitecture of affected bones. Therefore, the aim of this study was to determine cortical and trabecular bone properties in clinically relevant locations by microcomputed tomography (µCT). Ten femora and ten tibiae affected by Paget’s disease taken from the Natural History Museum Vienna were compared to 13 femora and 10 tibiae of non-affected body donors. Dig...
2 CitationsSource
#1Rita Kral (UNN: University Hospital of North Norway)H-Index: 2
#2Marit Osima (UNN: University Hospital of North Norway)H-Index: 1
Last. Åshild Bjørnerem (UNN: University Hospital of North Norway)H-Index: 19
view all 5 authors...
Abstract The Fracture Risk Assessment Tool (FRAX) is widely used to identify individuals at increased risk for fracture. However, cortical porosity is associated with risk for fracture independent of FRAX and is reported to improve the net reclassification of fracture cases. We wanted to test the hypothesis that women with fracture who are unidentified by high FRAX score, but identified by high cortical porosity, have a set of characteristics that contribute to their fracture risk beyond high FR...
1 CitationsSource
#1Min Chen (PKU: Peking University)H-Index: 9
#2Huishu Yuan (PKU: Peking University)H-Index: 12
Purpose To measure the porosity index (PI) by ultrashort echo-time magnetic resonance imaging (UTE MRI) of the femoral neck and tibia; assess its correlations with age, gender, and body mass index (BMI); and analyze the PI correlations between both sites to assess whether tibial PI can reflect changes of femoral neck PI. Materials and Methods In all, 68 healthy men and women (mean age, 45.7 ± 15.9 years) underwent 3D UTE MRI (3.0T) of the hip and mid-shaft tibia. PI of the inferior femoral neck ...
2 CitationsSource
#1Robert Brommage (University of Gothenburg)H-Index: 3
#2Claes Ohlsson (University of Gothenburg)H-Index: 116
Abstract Increasing attention is being focused on the important contributions of cortical bone to bone strength, fractures and osteoporosis therapies. Recent progress in human genome wide association studies in combination with high-throughput mouse gene knock out phenotyping efforts of multiple genes and advanced conditional gene inactivation in mouse models have successfully identified genes with crucial roles in cortical bone homeostasis. Particular attention in this review is given to genes,...
12 CitationsSource
#2Leon Fisher (Frankston Hospital)H-Index: 4
#3Wichat Srikusalanukul (Canberra Hospital)H-Index: 9
Last. Paul N. Smith (Canberra Hospital)H-Index: 36
view all 4 authors...
Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness. Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic...
12 CitationsSource
#1Marit Osima (UNN: University Hospital of North Norway)H-Index: 6
#2Tove Tveitan Borgen (Vestre Viken Hospital Trust)H-Index: 5
Last. Åshild Bjørnerem (UNN: University Hospital of North Norway)H-Index: 19
view all 7 authors...
Summary Serum parathyroid hormone (PTH) was associated with increased bone turnover markers and cortical porosity of the inner transitional zone at the proximal femur. These results suggest that PTH through increased intracortical bone turnover leads to trabecularisation of inner cortical bone in postmenopausal women.
13 CitationsSource
Severe burn injury triggers massive alterations in stress hormone levels with a dose-dependent hypermetabolic status including increased bone resorption. This study evaluated bone microarchitecture measured by non-invasive high resolution peripheral quantitative computed tomography (HR-pQCT). Changes of serum bone turnover markers (BTM) as well as regulators of bone signaling pathways involved in skeletal health were assessed. Standardized effect sizes as a quantitative measure regarding the imp...
4 CitationsSource
#1Rita Kral (UNN: University Hospital of North Norway)H-Index: 2
#2Marit Osima (UNN: University Hospital of North Norway)H-Index: 6
Last. Åshild Bjørnerem (UNN: University Hospital of North Norway)H-Index: 19
view all 6 authors...
The Fracture Risk Assessment Tool (FRAX) and Garvan Calculator have improved the individual prediction of fracture risk. However, additional bone measurements that might enhance the predictive ability of these tools are the subject of research. There is increasing interest in cortical parameters, especially cortical porosity. Neither FRAX nor Garvan include measurements of cortical architecture, important for bone strength, and providing independent information beyond the conventional approaches...
12 CitationsSource