Cross-sectional Versus Longitudinal Change in a Prospective HR-pQCT Study

Burt, Lauren A; Hanley, David A.; Boyd, Steven K.

doi:10.1002/jbmr.3129

Cited by 42 publications

(68 citation statements)

References 37 publications

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“…This mechanism produces cortical remnants on the endocortical surface resembling trabecular bone which the HR‐pQCT software includes in trabecular bone . Trabecularization of the inner cortical layer results in an increase in Tb.Ar associated with the spurious stability of Tb.vBMD, which was found previously . The inclusion of thick cortical remnants results in a spurious stability of Tb.N and Tb.Th.…”

Section: Discussionsupporting

confidence: 72%

“…(46) Trabecularization of the inner cortical layer results in an increase in Tb.Ar associated with the spurious stability of Tb.vBMD, which was found previously. (36,47) The inclusion of thick cortical remnants results in a spurious stability of Tb.N and Tb.Th. Because they are few and chaotically distributed, their inclusion has no impact on Tb.…”

Section: Discussionmentioning

confidence: 99%

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Low Muscle Strength and Mass Is Associated With the Accelerated Decline of Bone Microarchitecture at the Distal Radius in Older Men: the Prospective STRAMBO Study

Wagner

Chapurlat

Écochard

et al. 2018

Journal of Bone and Mineral Research

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Low muscle mass and strength are associated with poor bone microarchitecture. We studied the association of muscle mass and strength with changes in bone microarchitecture of distal radius in 821 older men during an 8-year prospective follow-up. Bone microarchitecture was assessed by high resolution peripheral quantitative computed tomography (XtremeCT-1, Scanco) at baseline, then after 4 and 8 years. Relative appendicular lean mass of the upper limbs (RALM-u.l.) was calculated as DXA-measured lean mass of upper limbs divided by (height) . Relative grip strength was calculated as grip strength divided by height. Decrease in bone mineral content (BMC), total volumetric bone mineral density (Tt.vBMD), cortical thickness (Ct.Th), cortical area (Ct.Ar) and cortical vBMD (Ct.vBMD) accelerated with age. Trabecular area (Tb.Ar) expansion and trabecular bone deterioration accelerated with age. Men in the first RALM-u.l. quartile had more rapid loss of BMC, Tt.vBMD, Ct.Th, Ct.vBMD and Ct.Ar vs. the highest quartile. They had more rapid increase in Tb.Ar. Men in the lowest quartile of grip strength had greater decrease in BMC, Tt.vBMD, Ct.Th, Ct.vBMD, Ct.Ar, and greater increase in Tb.Ar vs. the highest quartile. In the models including ALM-u.l. and grip strength (not corrected for height), both muscle-related variables were associated with more rapid bone microarchitectural deterioration (slightly more so for grip strength). Trabecular vBMD (Tb.vBMD) and Central.Tb.vBMD increased in men having higher muscle mass and strength. Trends in trabecular number and thickness did not differ across the groups in all the analyses. Thus, in men, aging-related deterioration of bone microarchitecture was most rapid after the age of 80. Low grip strength (and slightly more weakly low RALM-u.l.) is associated with the more rapid decrease in Tt.vBMD and cortical variables, and with greater Tb.Ar expansion. In conclusion, dynapenia and sarcopenia contribute to the deterioration of bone microarchitecture in older men. © 2018 American Society for Bone and Mineral Research.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Low Muscle Strength and Mass Is Associated With the Accelerated Decline of Bone Microarchitecture at the Distal Radius in Older Men: the Prospective STRAMBO Study

Wagner

Chapurlat

Écochard

et al. 2018

Journal of Bone and Mineral Research

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“…We found that both cortical and trabecular parameters of the distal radius were associated with incident fracture, but that cortical HR‐pQCT parameters of the distal tibia were more consistent predictors of clinical fracture than trabecular parameters at this site. Studies of longitudinal change in older men have shown that both total and cortical volumetric BMD of the distal radius and tibia decrease over time, whereas there was no concurrent change in trabecular BMD . A subsequent longitudinal study in the same cohort compared fracture cases versus non‐cases (albeit limited to women only) and reported modest changes in total and cortical BMD among cases and non‐cases, but only marginal change in trabecular BMD at the distal tibia, but this study had to few fracture cases to assess whether there were differences by fracture status .…”

Section: Discussionmentioning

confidence: 73%

“…The discrepancy between our findings and finding based on younger postmenopausal women may be related to patterns of age‐related bone loss. Using cross‐sectional data, the estimated mean total decrement comparing old versus young men between the ages 20 and 90 years is 32% at the distal radius versus 22% at the tibia, thus suggesting that there may be preferential bone loss at the distal radius and this loss would be more prominent in older men.…”

Section: Discussionmentioning

confidence: 99%

“…Patterns of bone strength and bone loss are also known to be different between men and women. (27)(28)(29) A longitudinal study using pQCT in older men showed that there are concurrent changes in bone area and volumetric density at the distal radius whereby increasing bone area is associated with decreasing BMD. (30) In our study, larger bones did have lower volumetric BMD and thinner cortices, both of which were risk factors for fracture.…”

Section: Discussionmentioning

confidence: 99%

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Volumetric Bone Mineral Density and Failure Load of Distal Limbs Predict Incident Clinical Fracture Independent of FRAX and Clinical Risk Factors Among Older Men

Langsetmo

Peters

Burghardt

et al. 2018

Journal of Bone and Mineral Research

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Our objective was to determine the associations of peripheral bone strength and microarchitecture with incident clinical and major osteoporotic fracture among older men after adjusting for major clinical risk factors. We used a prospective cohort study design with data from 1794 men (mean age 84.4 years) in the Osteoporotic Fractures in Men (MrOS) study. Eligible men attended the year 14 visit, had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans of the distal radius and distal or diaphyseal tibia, DXA measured BMD, and were followed for mean 1.7 years for incident fracture. Failure load was estimated using finite element analysis. We used Cox proportional hazards models with standardized HR-pQCT parameters as exposure variables. Primary outcome was clinical fracture (n = 108). Covariates included either Fracture Risk Assessment Tool (FRAX) major osteoporotic fracture probability calculated with BMD (FRAX-BMD), or individual clinical risk factors (CRF) including age, total hip BMD, race, falls, and prevalent fracture after age 50 years. Lower failure load was associated with higher risk of incident clinical fracture and incident major osteoporotic fracture. For clinical fracture with FRAX-BMD adjustment, the associations ranged from hazard ratio (HR) 1.58 (95% CI, 1.25 to 2.01) to 2.06 (95% CI, 1.60 to 2.66) per SD lower failure load at the diaphyseal tibia and distal radius. These associations were attenuated after adjustment for individual CRFs, but remained significant at the distal sites. Associations of volumetric BMD with these outcomes were similar to those for failure load. At the distal radius, lower trabecular BMD, number, and thickness, and lower cortical BMD, thickness, and area were all associated with higher risk of clinical fracture, but cortical porosity was not. Among community-dwelling older men, HR-pQCT measures including failure load, volumetric BMD, and microstructure parameters at peripheral sites (particularly distal radius) are robust independent predictors of clinical and major osteoporotic fracture. © 2018 American Society for Bone and Mineral Research.

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Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength

Burt

Billington

Rose

et al. 2019

JAMA

254

291

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IMPORTANCE Few studies have assessed the effects of daily vitamin D doses at or above the tolerable upper intake level for 12 months or greater, yet 3% of US adults report vitamin D intakes of at least 4000 IU per day.OBJECTIVE To assess the dose-dependent effect of vitamin D supplementation on volumetric bone mineral density (BMD) and strength.DESIGN, SETTING, AND PARTICIPANTS Three-year, double-blind, randomized clinical trial conducted in a single center in Calgary, Canada, from August 2013 to December 2017, including 311 community-dwelling healthy adults without osteoporosis, aged 55 to 70 years, with baseline levels of 25-hydroxyvitamin D (25[OH]D) of 30 to 125 nmol/L. INTERVENTIONS Daily doses of vitamin D 3 for 3 years at 400 IU (n = 109), 4000 IU (n = 100), or 10 000 IU (n = 102). Calcium supplementation was provided to participants with dietary intake of less than 1200 mg per day. MAIN OUTCOMES AND MEASURESCo-primary outcomes were total volumetric BMD at radius and tibia, assessed with high resolution peripheral quantitative computed tomography, and bone strength (failure load) at radius and tibia estimated by finite element analysis. RESULTSOf 311 participants who were randomized (53% men; mean [SD] age, 62.2 [4.2] years), 287 (92%) completed the study. Baseline, 3-month, and 3-year levels of 25(OH)D were 76.3, 76.7, and 77.4 nmol/L for the 400-IU group; 81.3, 115.3, and 132.2 for the 4000-IU group; and 78.4, 188.0, and 144.4 for the 10 000-IU group. There were significant group × time interactions for volumetric BMD. At trial end, radial volumetric BMD was lower for the 4000 IU group (−3.9 mg HA/cm 3 [95% CI, −6.5 to −1.3]) and 10 000 IU group (−7.5 mg HA/cm 3 [95% CI, −10.1 to −5.0]) compared with the 400 IU group with mean percent change in volumetric BMD of −1.2% (400 IU group), −2.4% (4000 IU group), and −3.5% (10 000 IU group). Tibial volumetric BMD differences from the 400 IU group were −1.8 mg HA/cm 3 (95% CI, −3.7 to 0.1) in the 4000 IU group and −4.1 mg HA/cm 3 in the 10 000 IU group (95% CI, −6.0 to −2.2), with mean percent change values of −0.4% (400 IU), −1.0% (4000 IU), and −1.7% (10 000 IU). There were no significant differences for changes in failure load (radius, P = .06; tibia, P = .12).CONCLUSIONS AND RELEVANCE Among healthy adults, treatment with vitamin D for 3 years at a dose of 4000 IU per day or 10 000 IU per day, compared with 400 IU per day, resulted in statistically significant lower radial BMD; tibial BMD was significantly lower only with the 10 000 IU per day dose. There were no significant differences in bone strength at either the radius or tibia. These findings do not support a benefit of high-dose vitamin D supplementation for bone health; further research would be needed to determine whether it is harmful.

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Cross-sectional Versus Longitudinal Change in a Prospective HR-pQCT Study

Cited by 42 publications

References 37 publications

Low Muscle Strength and Mass Is Associated With the Accelerated Decline of Bone Microarchitecture at the Distal Radius in Older Men: the Prospective STRAMBO Study

Low Muscle Strength and Mass Is Associated With the Accelerated Decline of Bone Microarchitecture at the Distal Radius in Older Men: the Prospective STRAMBO Study

Volumetric Bone Mineral Density and Failure Load of Distal Limbs Predict Incident Clinical Fracture Independent of FRAX and Clinical Risk Factors Among Older Men

Effect of High-Dose Vitamin D Supplementation on Volumetric Bone Density and Bone Strength

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