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Low width of tubular bones is associated with increased risk of fragility fracture in elderly men--the MINOS study.
Bone. 2006 Apr; 38(4):595-602.BONE

Abstract

The risk of fragility fractures in elderly men is only partly explained by areal bone mineral density (aBMD) measured by dual X-ray absorptiometry (DXA). Several studies suggest the importance of bone morphology for the risk of fracture. The aim of this study was to assess the value of bone size and estimated structural parameters for the prediction of incident fractures in a large cohort of men. This study was made in 759 men aged 50-85 from the MINOS cohort. During a 90-month follow-up, 74 men sustained incident vertebral and peripheral fractures. Areal BMD was measured by DXA at femoral neck, distal radius and distal ulna. Estimates of structural bone parameters and volumetric BMD (vBMD) were derived from aBMD measured by DXA. Given the limited number of fractures, the predictive value of investigated parameters was assessed for peripheral and vertebral fractures jointly by using logistic regression. Men who sustained the fractures had, at baseline, lower aBMD (3.5-6.5%), lower bone mineral content (BMC 5.4-8.7%) and lower cortical thickness (3.5-6.9%) compared with the men without fracture. At all the three skeletal sites, aBMD, BMC, width, cortical area and thickness, cross-sectional moment of inertia (CSMI), and section modulus predicted incident fractures (O.R. = 1.28-1.92 per 1 SD decrease, P < 0.05-0.0001). Fracture risk was weakly associated with vBMD for ulna (O.R. = 1.25 per 1 SD decrease, P < 0.05) but not for femoral neck or radius. After adjustment for aBMD, bone width remained a significant predictor of fractures (O.R. = 1.37-1.48 per 1 SD decrease, P < 0.02-0.01). Men with osteopenia (BMD T score < -1) and low bone width (T score < -1) had the fracture incidence similar to that observed in men with BMD T score < -2. Bone width and aBMD of the femoral neck and radius were predictive of fractures in 49 men with the incident peripheral fractures, whereas their O.R. did not attain the level of statistical significance in 25 men with the incident vertebral fractures. Men, who had both low aBMD and low CSMI (both T scores < -1), had the fracture risk 3.8 to 4.2 higher than the reference group (both T scores >or= -1). Men, who had both low aBMD and low section modulus (both T scores < -1), had the fracture risk 2.1 to 4.1 higher than the reference group (both T scores >or= -1). In conclusion, men who sustained a fragility fracture during a 90-month follow-up had, at baseline, lower BMC because they had narrower bones but not necessarily less dense. In elderly men, small bone width, low BMC and poor resistance to bending may increase bone fragility. Low bone width seems to be associated with an increased fracture risk in elderly men regardless of aBMD.

Authors+Show Affiliations

INSERM 403 Research Unit, Hôpital Edouard Herriot, 69437 Lyon, France. szulc@lyon.inserm.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16249130

Citation

Szulc, Pawel, et al. "Low Width of Tubular Bones Is Associated With Increased Risk of Fragility Fracture in Elderly Men--the MINOS Study." Bone, vol. 38, no. 4, 2006, pp. 595-602.
Szulc P, Munoz F, Duboeuf F, et al. Low width of tubular bones is associated with increased risk of fragility fracture in elderly men--the MINOS study. Bone. 2006;38(4):595-602.
Szulc, P., Munoz, F., Duboeuf, F., Marchand, F., & Delmas, P. D. (2006). Low width of tubular bones is associated with increased risk of fragility fracture in elderly men--the MINOS study. Bone, 38(4), 595-602.
Szulc P, et al. Low Width of Tubular Bones Is Associated With Increased Risk of Fragility Fracture in Elderly Men--the MINOS Study. Bone. 2006;38(4):595-602. PubMed PMID: 16249130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low width of tubular bones is associated with increased risk of fragility fracture in elderly men--the MINOS study. AU - Szulc,Pawel, AU - Munoz,Françoise, AU - Duboeuf,François, AU - Marchand,François, AU - Delmas,Pierre D, Y1 - 2005/10/24/ PY - 2005/07/09/received PY - 2005/08/22/revised PY - 2005/09/14/accepted PY - 2005/10/27/pubmed PY - 2006/6/22/medline PY - 2005/10/27/entrez SP - 595 EP - 602 JF - Bone JO - Bone VL - 38 IS - 4 N2 - The risk of fragility fractures in elderly men is only partly explained by areal bone mineral density (aBMD) measured by dual X-ray absorptiometry (DXA). Several studies suggest the importance of bone morphology for the risk of fracture. The aim of this study was to assess the value of bone size and estimated structural parameters for the prediction of incident fractures in a large cohort of men. This study was made in 759 men aged 50-85 from the MINOS cohort. During a 90-month follow-up, 74 men sustained incident vertebral and peripheral fractures. Areal BMD was measured by DXA at femoral neck, distal radius and distal ulna. Estimates of structural bone parameters and volumetric BMD (vBMD) were derived from aBMD measured by DXA. Given the limited number of fractures, the predictive value of investigated parameters was assessed for peripheral and vertebral fractures jointly by using logistic regression. Men who sustained the fractures had, at baseline, lower aBMD (3.5-6.5%), lower bone mineral content (BMC 5.4-8.7%) and lower cortical thickness (3.5-6.9%) compared with the men without fracture. At all the three skeletal sites, aBMD, BMC, width, cortical area and thickness, cross-sectional moment of inertia (CSMI), and section modulus predicted incident fractures (O.R. = 1.28-1.92 per 1 SD decrease, P < 0.05-0.0001). Fracture risk was weakly associated with vBMD for ulna (O.R. = 1.25 per 1 SD decrease, P < 0.05) but not for femoral neck or radius. After adjustment for aBMD, bone width remained a significant predictor of fractures (O.R. = 1.37-1.48 per 1 SD decrease, P < 0.02-0.01). Men with osteopenia (BMD T score < -1) and low bone width (T score < -1) had the fracture incidence similar to that observed in men with BMD T score < -2. Bone width and aBMD of the femoral neck and radius were predictive of fractures in 49 men with the incident peripheral fractures, whereas their O.R. did not attain the level of statistical significance in 25 men with the incident vertebral fractures. Men, who had both low aBMD and low CSMI (both T scores < -1), had the fracture risk 3.8 to 4.2 higher than the reference group (both T scores >or= -1). Men, who had both low aBMD and low section modulus (both T scores < -1), had the fracture risk 2.1 to 4.1 higher than the reference group (both T scores >or= -1). In conclusion, men who sustained a fragility fracture during a 90-month follow-up had, at baseline, lower BMC because they had narrower bones but not necessarily less dense. In elderly men, small bone width, low BMC and poor resistance to bending may increase bone fragility. Low bone width seems to be associated with an increased fracture risk in elderly men regardless of aBMD. SN - 8756-3282 UR - https://www.unboundmedicine.com/medline/citation/16249130/Low_width_of_tubular_bones_is_associated_with_increased_risk_of_fragility_fracture_in_elderly_men__the_MINOS_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S8756-3282(05)00380-7 DB - PRIME DP - Unbound Medicine ER -