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. 2010 Jul;21(7):1161-9.
doi: 10.1007/s00198-009-1047-2. Epub 2009 Aug 28.

Assessing forearm fracture risk in postmenopausal women

L J Melton 3rd  1 , D Christen, B L Riggs, S J Achenbach, R Müller, G H van Lenthe, S Amin, E J Atkinson, S Khosla
Affiliations

Assessing forearm fracture risk in postmenopausal women

L J Melton 3rd et al. Osteoporos Int. 2010 Jul.

Abstract

A diverse array of bone density, structure, and strength parameters were significantly associated with distal forearm fractures in postmenopausal women, but most of them were also correlated with femoral neck areal bone mineral density (aBMD), which provides an adequate measure of bone fragility at the wrist for routine clinical purposes.

Introduction: This study seeks to test the clinical utility of approaches for assessing forearm fracture risk.

Methods: Among 100 postmenopausal women with a distal forearm fracture (cases) and 105 with no osteoporotic fracture (controls), we measured aBMD and assessed radius volumetric bone mineral density, geometry, and microstructure; ultradistal radius failure load was evaluated in microfinite element (microFE) models.

Results: Fracture cases had inferior bone density, geometry, microstructure, and strength. The most significant determinant of fracture in five categories were bone density (femoral neck aBMD; odds ratio (OR) per standard deviation (SD), 2.0; 95% confidence interval (CI), 1.4-2.8), geometry (cortical thickness; OR, 1.5; 95% CI, 1.1-2.1), microstructure (structure model index (SMI); OR, 0.5; 95% CI, 0.4-0.7), and strength (microFE failure load; OR, 1.8; 95% CI, 1.3-2.5); the factor-of-risk (applied load in a forward fall / microFE failure load) was 15% worse in cases (OR, 1.9; 95% CI, 1.4-2.6). Areas under receiver operating characteristic curves (AUC) ranged from 0.62 to 0.68. The predictors of forearm fracture risk that entered a multivariable model were femoral neck aBMD and SMI (combined AUC, 0.71).

Conclusions: Detailed bone structure and strength measurements provide insight into forearm fracture pathogenesis, but femoral neck aBMD performs adequately for routine clinical risk assessment.

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Conflict of interest statement

Conflict of interests None

Figures

Fig. 1
Fig. 1
Representation of the orientation of the fall that precipitated the Colles’ fracture (orientation was uncertain in one woman) among 100 postmenopausal Rochester, MN women. Adapted from Palvanen M, et al. Osteoporos Int 11:822–31, 2000.
See this image and copyright information in PMC

References

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    1. Melton LJ, III, Riggs BL, van Lenthe GH, et al. Contribution of in vivo structural measurements and load/strength ratios to the determination of forearm fracture risk in postmenopausal women. J Bone Miner Res. 2007;22:1442–1448. - PubMed
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    1. Arbenz P, van Lenthe GH, Mennel U, et al. A scalable multi-level preconditioner for matrix-free micro-finite element analysis of human bone structures. International Journal for Numerical Methods in Engineering. 2008;73:927–947.

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