Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts

• Published in: Journal of bone and mineral research 2024-10, Vol.39 (11), p.1574-1583
• Main Authors: Sarfati, Marine, Chapurlat, Roland, Dufour, Alyssa B, Sornay-Rendu, Elisabeth, Merle, Blandine, Boyd, Steven K, Whittier, Danielle E, Hanley, David A, Goltzman, David, Szulc, Pawel, Wong, Andy Kin On, Lespessailles, Eric, Khosla, Sundeep, Ferrari, Serge, Biver, Emmanuel, Ohlsson, Claes, Lorentzon, Mattias, Mellström, Dan, Nethander, Maria, Samelson, Elizabeth J, Kiel, Douglas P, Hannan, Marian T, Bouxsein, Mary L
• Format: Article
• Language: English
• Subjects: Absorptiometry; Absorptiometry, Photon; Aged; Bone; Bone Density; Cancellous Bone; Cancellous Bone - diagnostic imaging; Cancellous Bone - pathology; Cortical Bone; Cortical Bone - diagnostic imaging; Cortical Bone - pathology; diagnostic imaging; Endocrinology and Diabetes; Endokrinologi och diabetes; epidemiology; Female; Fractures; Fractures, Bone - diagnostic imaging; Fractures, Bone - epidemiology; Humans; Incidence; Male; Middle Aged; Osteoporotic Fractures; Osteoporotic Fractures - diagnostic imaging; Osteoporotic Fractures - epidemiology; Osteoporotic Fractures - physiopathology; pathology; Photon; physiopathology; Prospective Studies; Radius; Radius - diagnostic imaging; Radius - pathology; Risk Assessment; Risk Factors
• ISSN: 0884-0431; 1523-4681; 1523-4681
• DOI: 10.1093/jbmr/zjae143

Identifying individuals at risk for short-term fracture is essential to offer prompt beneficial treatment, especially since many fractures occur in those without osteoporosis by DXA-aBMD. We evaluated whether deficits in bone microarchitecture and density predict short-term fracture risk independent of the clinical predictors, DXA-BMD and FRAX. We combined data from eight cohorts to conduct a prospective study of bone microarchitecture at the distal radius and tibia (by HR-pQCT) and 2-year incidence of fracture (non-traumatic and traumatic) in 7327 individuals (4824 women, 2503 men, mean 69 ± 9 years). We estimated sex-specific hazard ratios (HR) for associations between bone measures and 2-year fracture incidence, adjusted for age, cohort, height, and weight, and then additionally adjusted for FN aBMD or FRAX for major osteoporotic fracture. Only 7% of study participants had FN T-score ≤ -2.5, whereas 53% had T-scores between -1.0 and -2.5 and 37% had T-scores ≥-1.0. Two-year cumulative fracture incidence was 4% (296/7327). Each SD decrease in radius cortical bone measures increased fracture risk by 38%-76% for women and men. After additional adjustment for FN-aBMD, risks remained increased by 28%-61%. Radius trabecular measures were also associated with 2-year fracture risk independently of FN-aBMD in women (HRs range: 1.21 per SD for trabecular separation to 1.55 for total vBMD). Decreased failure load (FL) was associated with increased fracture risk in both women and men (FN-aBMD ranges of adjusted HR = 1.47-2.42). Tibia measurement results were similar to radius results. Findings were also similar when models were adjusted for FRAX. In older adults, FL and HR-pQCT measures of cortical and trabecular bone microarchitecture and density with strong associations to short-term fractures improved fracture prediction beyond aBMD and FRAX. Thus, HR-pQCT may be a useful adjunct to traditional assessment of short-term fracture risk in older adults, including those with T-scores above the osteoporosis range.