Value of Measuring Bone Microarchitecture in Fracture Discrimination in Older Women with Recent Hip Fracture: A Case control Study with HR pQCT
We aimed to determine whether loss of volumetric bone mineral density (vBMD) and deterioration of microarchitecture imaged by high resolution peripheral quantitative computed tomography at the distal radius/tibia provided additional information in fracture discrimination in postmenopausal women with recent hip fracture. This case control study involved 24 postmenopausal Chinese women with unilateral femoral neck fracture (average [SD] age: 79.6[5.6] and 24 age matched women without any history of fracture. Each SD decrease in T score at femoral neck (FN) was associated with a higher fracture risk (odds ratio: 6.905, p 0.001) At the distal radius, fracture women had significantly lower total vBMD 17.5% fewer 20.3% and more unevenly spaced (81.4% trabeculae, and thinner cortices 14.0% (all p 0.05) At the distal tibia, vBMD was on average 4.7% (cortical) to 25.4% (total) lower, trabecular microarchitecture was on average 19.8% (number) to 102% (inhomogeneity) inferior, cortices were thinner 21.1% and more porous (18.2% (all p 0.05) Adding parameters of vBMD and microarchitecture in multivariate models did not offer additional discriminative capacity of fracture status compared with using T score at FN. In old postmenopausal women with already excessive loss of bone mass, measuring bone microarchitecture may provide limited added value to improve identification of risk of femoral neck fracture.
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