Non-invasive Assessment of Lower Limb Geometry and Strength Using Hip Structural Analysis and Peripheral Quantitative Computed Tomography: A Population-Based Comparison

Abstract

Hip fracture is the most significant complication of osteoporosis in terms of mortality, long-term disability and decreased quality of life. In the recent years, different techniques have been developed to assess lower limb strength and ultimately fracture risk. Here we examine relationships between two measures of lower limb bone geometry and strength; proximal femoral geometry and tibial peripheral quantitative computed tomography. We studied a sample of 431 women and 488 men aged in the range 59–71 years. The hip structural analysis (HSA) programme was employed to measure the structural geometry of the left hip for each DXA scan obtained using a Hologic QDR 4500 instrument while pQCT measurements of the tibia were obtained using a Stratec 2000 instrument in the same population. We observed strong sex differences in proximal femoral geometry at the narrow neck, intertrochanteric and femoral shaft regions. There were significant (p < 0.001) associations between pQCT-derived measures of bone geometry (tibial width; endocortical diameter and cortical thickness) and bone strength (strength strain index) with each corresponding HSA variable (all p < 0.001) in both men and women. These results demonstrate strong correlations between two different methods of assessment of lower limb bone strength: HSA and pQCT. Validation in prospective cohorts to study associations of each with incident fracture is now indicated.

Triglyceride Glucose–Body Mass Index Is a Reliable Indicator of Bone Mineral Density and Risk of Osteoporotic Fracture in Middle-Aged and Elderly Nondiabetic Chinese Individuals

“…Independent of BMD, bone geometry contributes to fracture risk [ 6 , 7 , 8 ]. Geometric parameters of the femoral neck, such as cross-sectional area (CSA), buckling ratio (BR), and section modulus (SM) [ 9 ] also describe bone strength and are independently predictive of hip fragility fracture [ 10 , 11 , 12 ].…”

Difference in the trajectory of change in bone geometry as measured by hip structural analysis in the narrow neck, intertrochanteric region, and femoral shaft between men and women following hip fracture

“…Studies of sex differences in bone geometry across adult lifespan have consistently demonstrated that compared to women, men have greater aerial BMD, cross-sectional bone areas (CSA), bone diameters, section moduli (bending strength; SM), and lower buckling ratio (cortical instability; BR) at the narrow neck (NN), intertrochanteric region (IT), and femoral shaft (FS) [1,5,11–16]. Cross-sectional investigations indicate that BMD decreases with age in both men and women but expansions in outer diameter serve to preserve bending strength and compensate for net BMD decline [1,12,15,17].…”