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J Clin Densitom. 2018 Jan - Mar;21(1):140-147. doi: 10.1016/j.jocd.2017.02.003. Epub 2017 Mar 9.

Peripheral Quantitative Computed Tomography (pQCT) Measures Contribute to the Understanding of Bone Fragility in Older Patients With Low-trauma Fracture.

Author information

1
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
2
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
3
Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia.
4
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Orthopaedics, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
5
Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia. Electronic address: jdwark@unimelb.edu.au.

Abstract

Dual-energy X-ray absorptiometry (DXA) as currently used has limitations in identifying patients with osteoporosis and predicting occurrence of fracture. We aimed to express peripheral quantitative computed tomography (pQCT) variables of patients with low-trauma fracture as T-scores by using T-score scales obtained from healthy young women, and to evaluate the potential clinical utility of pQCT for the assessment of bone fragility. Fracture patients were recruited from a fracture liaison service at the Royal Melbourne Hospital. Reference pQCT data were obtained from studies on women's health conducted by our group. A study visit was arranged with fracture patients, during which DXA and pQCT were applied to measure their bone strength. A total of 59 fracture patients were recruited, and reference data were obtained from 78 healthy young females. All DXA variables and most pQCT variables were significantly different between healthy young females and fracture patients (p < 0.05), except polar stress-strain index (p = 0.34) and cortical bone density (p = 0.19). Fracture patients were divided into osteoporosis and non-osteoporosis groups according to their DXA T-scores. Significant differences were observed in most pQCT variables (p < 0.05), except trabecular area and cortical density (p > 0.9 and p = 0.5, respectively). By applying pQCT T-scores, 11 (27%) of patients who were classified as having low or medium risk of osteoporosis on DXA T-scores alone were reclassified as high risk. Results of logistic regression suggested trabecular bone density as an independent predictor of osteoporosis status. More patients can be identified with osteoporosis by applying pQCT T-score variables in older people with low-trauma fracture. Peripheral QCT T-scores contribute to the understanding of bone fragility in this population.

KEYWORDS:

DXA; T-score; low-trauma fracture; pQCT

PMID:
28285742
DOI:
10.1016/j.jocd.2017.02.003
[Indexed for MEDLINE]

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