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J Bone Miner Res. 2018 Feb;33(2):229-240. doi: 10.1002/jbmr.3307. Epub 2017 Nov 6.

Bone Strength in Girls and Boys After a Distal Radius Fracture: A 2-Year HR-pQCT Double Cohort Study.

Author information

1
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada.
2
Department of Family Practice, University of British Columbia, Vancouver, Canada.
3
Department of Orthopedics, University of British Columbia, Vancouver, Canada.
4
Department of Orthopedic Surgery, British Columbia Children's Hospital, Vancouver, Canada.

Abstract

We recently reported impaired bone strength in girls with low- to moderate-energy distal radius fractures (Fx) compared with girls with no history of forearm fractures (Non-Fx). We aimed to determine whether bone strength deficits observed at baseline were still present after 2 years. We assessed bone strength, microarchitecture, and bone mineral density (BMD) of the non-fractured (Fx) and non-dominant (Non-Fx) distal radius (7% site) at baseline, 12, and 24 months using high-resolution pQCT (Scanco Medical, Brüttisellen, Switzerland) in 104 girls (aged 11.0 ± 1.7 years; 47 Fx, 57 Non-Fx) and 157 boys (aged 12.7 ± 1.7 years; 86 Fx, 71 Non-Fx). Bone outcomes included total area (Tt.Ar) and bone mineral density (Tt.BMD), trabecular bone volume ratio (BV/TV), thickness (Tb.Th), separation (Tb.Sp), and number (Tb.N), and cortical BMD (Ct.BMD), thickness (Ct.Th), and porosity (Ct.Po). We used finite element analysis to estimate bone strength (failure load [F.Load]; ultimate stress [U.Stress]; load-to-strength ratio). We used sex-specific mixed-effects models to compare bone outcomes between Fx and Non-Fx over 2 years. In girls, those with fractures had 18% to 24% lower U.Stress and 5% to 9% lower Tt.BMD than Non-Fx at all time points (p < 0.017). In secondary analysis by fracture degree, girls with low-energy (LE) fractures had 19% to 21% lower F.Load, 25% to 47% lower U.Stress, 11% to 14% lower Tt.BMD, and 11% to 15% lower BV/TV than Non-Fx at all time points (p < 0.017). In contrast, boys' bone outcomes were similar between Fx and Non-Fx at all time points. In secondary analysis by fracture degree, boys with LE fractures had 10% lower Tt.BMD and 10% lower Ct.Th compared with Non-Fx at 12 months only. Deficits in distal radius bone strength and trabecular bone microarchitecture appear to track across 2 years after a forearm fracture in girls but not in boys. Longer follow-up is needed to determine whether deficits persist into adulthood in women and how they may influence future risk of fragility fracture.

KEYWORDS:

BONE QCT/MICRO-CT; FRACTURE PREVENTION; GENERAL POPULATION STUDIES

PMID:
29024249
DOI:
10.1002/jbmr.3307
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