Increased cortical porosity in women with hip fracture

• Published in: Journal of internal medicine 2017-05, Vol.281 (5), p.496-506
• Main Authors: Sundh, D., Nilsson, A. G., Nilsson, M., Johansson, L., Mellström, D., Lorentzon, M.
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; age-related-changes; Aged; Aged, 80 and over; Arthritis; Biocompatibility; Biomedical materials; Body Height - physiology; Body Weight - physiology; Bone Density - physiology; Bone mineral density; Bone strength; Calcium; Clinical Medicine; Computed tomography; Confidence intervals; coronary-artery-disease; cortical porosity; Dual energy X-ray absorptiometry; endothelial dysfunction; Energy measurement; Female; Femur; Fractures; General & Internal Medicine; Glucocorticoids; Health care; High resolution; Hip; hip fracture; Hip Fractures - diagnostic imaging; Hip Fractures - pathology; Hip Fractures - physiopathology; Hip joint; HR-pQCT; Humans; Identification methods; Klinisk medicin; metabolic; Mortality; Multivariable control; necrosis-factor-alpha; nitric-oxide; Osteoporosis; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - pathology; Osteoporotic Fractures - physiopathology; oxidative stress; Physical activity; plaques; Population studies; Porosity; protein s-nitrosylation; Regression analysis; Rheumatoid arthritis; Risk analysis; Risk factors; Smoking; smooth-muscle-cells; Surgical implants; symptomatic carotid; syndrome; Tibia; Tomography, X-Ray Computed; women
• ISSN: 0954-6820; 1365-2796
• DOI: 10.1111/joim.12587

Background Hip fractures cause increased mortality and disability and consume enormous healthcare resources. Only 46% of hip fracture patients have osteoporosis at the total hip according to dual‐energy X‐ray absorptiometry (DXA) measurement. Cortical porosity increases with ageing and is believed to be important for bone strength. Objective To investigate whether older women with hip fracture have higher cortical porosity than controls, and if so whether this difference is independent of clinical risk factors and areal bone mineral density (aBMD). Methods From an ongoing population‐based study, we identified 46 women with a prevalent X‐ray‐verified hip fracture and 361 control subjects without any fractures. aBMD was measured with DXA. High‐resolution peripheral quantitative computed tomography was used to measure bone microstructure at the standard (ultradistal) site and at 14% (distal) of the tibial length. Results Women with a previous hip fracture had lower aBMD at the femoral neck (−11.8%) and total hip (−14.6%) as well as higher cortical porosity at the ultradistal (32.1%) and distal (29.3%) tibia compared with controls. In multivariable logistic regression analysis, with adjustment for covariates (age, height, weight, smoking, calcium intake, physical activity, walk time, oral glucocorticoids, parental hip fracture, rheumatoid arthritis, previous fall, current bisphosphonate treatment and femoral neck aBMD), cortical porosity at the ultradistal [odds ratio per standard deviation increase (95% confidence interval) 2.61 (1.77–3.85)] and distal [1.57 (1.12–2.20)] sites was associated with prevalent hip fracture. Conclusion Cortical porosity was associated with prevalent hip fracture in older women independently of femoral neck aBMD and clinical risk factors.