Fracture Risk Assessment in Older Adults Using a Combination of Selected Quantitative Computed Tomography Bone Measures: A Subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study

Abstract

Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry–like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status.

Milk consumption throughout life and bone mineral content and density in elderly men and women

“…Additionally, Black et al [34] found that for femoral neck integral volumetric density, the 5-year risk of hip fracture in the lowest quartile was >15 times that in the highest quartile (3.6 versus 0.2 %). Similarly, we have also found in our own material from the AGES-Reykjavik Study that vBMD predicts hip fractures in elderly men and women [36, 37]. The difference of 0.2 Z-scores (equal to 0.2 SD in vBMD) seen in the present study between individuals with high versus low frequency of milk intake in midlife is therefore likely to be of clinical relevance.…”

Bone disease in monoclonal gammopathy of undetermined significance: results from a screened population-based study

“…33 Another strength of our study is the use of QCT measurements that have previously been shown to correlate well with DXA measurements as well as subsequent risk of fracture. 15,34 Furthermore, QCT measurements as opposed to DXA are not confounded by skeletal size and provide measurements from trabecular and cortical bone separately.…”

“…Low scores for the QCT measures vertebral trabecular BMD, femoral neck cortical thickness, and femoral neck trabecular BMD have been associated with increased risk of fractures in both men and women. 15 Two studies have used skeletal imaging techniques to compare bone disease in MGUS patients to matched controls. 16,17 In a study on 50 MGUS patients, compared with 100 controls, MGUS patients were found to have decreased BMD at the total femur, but no differences were found at other sites.…”

Hip Fractures and Bone Mineral Density in the Elderly—Importance of Serum 25-Hydroxyvitamin D

“…We measured volumetric QCT-BMD rather than areal BMD, but similar associations have been shown between fractures and BMD using these two measures [35] , [36] . Similar to many previous studies [3] , [12] we found a slight but significant positive trend between BMD in femoral neck and serum concentrations of 25(OH)D in both sexes.…”