Usefulness of regional bone measurements in patients with osteoporotic fractures of the spine and distal forearm

Abstract

Bone mineral mass was measured in normal subjects and osteoporotic patients at two forearm sites (proximal and distal of the 8 mm site between the two forearm bones) by single photon absorptiometry and in the spine and whole body by dual photon absorptiometry. There were no signs of preferential low spinal bone mass in 28 patients with vertebral fractures. Their bone mass was at all sites 26% to 37% lower than the premenopausal mean value and 7% to 13% lower than in age-matched normal women. In 45 patients with forearm fractures bone reduction was also universal but only 3% to 6% lower than in healthy women of comparable age. The spinal bone mass in all the patients was significantly related to both forearm measurements with coefficients of correlation of 0.58-0.61 and s.e.e. of 18%. Compared to the premenopausal normal range the distal forearm site had a greater sensitivity in identifying patients with vertebral fractures than had the spinal measurement (chi-square test, p < 0.01). We thus conclude that patients with vertebral fractures have universal osteoporosis and that measurement of spinal BMC had no predictive advantages over that of the forearm bone mass for population studies. J NucÃ-Med 28:960-965,1987"one mass in young, healthy women in different regions is interrelated while the representati vity of local bone measurements has been questioned in elderly and osteoporotic women (1,2). Although studies indicate that the rate of trabecular bone loss exceeds the cortical loss in the first postmenopausal years (3,4), bone is lost from all parts of the skeleton (5). In elderly women, the reduction in bone mass is the same at central and peripheral measuring sites (6) and in osteoporotic pa tients with hip fracture it is uniformly low (6-8). Many factors influence the rate of bone loss. Some individuals will lose more than others at individual sites, and frac tures are likely to occur at sites with the lowest bone mass.The prevalence of fractures of the distal forearm and the spine increases rapidly a few years after the meno pause. It has been claimed that vertebral fractures are the result of a predominant loss of trabecular bone (8), and a preferential low spinal bone mass, estimated by

Journal of Bone and Mineral Research

“…Similar results were found in comparisons of QCT with SPA in 225 postmenopausal women (108 with vertebral fractures) (Nordin 1987) and in comparisons of DPA with SPA in 90 postmenopausal women (18 with vertebral fractures) (Mazess 1984). Other studies with small numbers of vertebral fracture patients have found no significant advantage of DPA over SPA (Nilas 1987, Grubb 1984. In a population-based study of 1,018 Japanese-American women, however, found better agreement between DPA and 0s calcis measurements and concluded that 0s calcis measurements performed as well as DPA of the lumbar spine in determining bone mass and predicting vertebral fracture risk.…”

Relationships between Bone and Skin Atrophies during Aging

“…Regional specificity may account for the variable magnitudes found in the age-related bone loss [Seeman and Martin. 1989] of vertebrae and upper femoral extremity although other studies seem to indicate that bone loss form all parts of the skeleton develops in a similar way [Nilas et al, 1987]. Our explanations for the moderate correlation between skin fold thickness and lumbar BMD include the presence of osteophytes, spondylo-osteoarthritic changes and/or cal cified aorta in the region of interest automatically defined by the software and taken into account for lumbar BMD measurement.…”

Cross Sectional and Longitudinal Study of Bone Mineral Content of the Distal Forearm in Adult Premenopausal Women

“…It has since become apparent that variations in the fat content of the forearm may be a significant source of error, particularly in longitudinal studies (Need, Horowitz, Walker, Chatterton, Chapman and Nordin 1989;Nilas, Podenphant, Riis, Gotfiedsen and Christiansen 1987). We have therefore established normal ranges for fat-corrected forearm bone mineral content and density in premenopausal women.…”