Osteoporos Int (2015) 26:2461–2469 DOI 10.1007/s00198-015-3160-8
ORIGINAL ARTICLE
Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture K. Crockett 1 & C. M. Arnold 1 & J. P. Farthing 2 & P. D. Chilibeck 2 & J. D. Johnston 3 & B. Bath 1 & A. D. G. Baxter-Jones 2 & S. A. Kontulainen 2
Received: 22 January 2015 / Accepted: 29 April 2015 / Published online: 23 May 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Summary Distal radius (wrist) fracture (DRF) in women over age 50 years is an early sign of bone fragility. Women with a recent DRF compared to women without DRF demonstrated lower bone strength, muscle density, and strength, but no difference in dual-energy x-ray absorptiometry (DXA) measures, suggesting DXA alone may not be a sufficient predictor for DRF risk. Introduction The objective of this study was to investigate differences in bone and muscle properties between women with and without a recent DRF. Methods One hundred sixty-six postmenopausal women (50– 78 years) were recruited. Participants were excluded if they had taken bone-altering medications in the past 6 months or had medical conditions that severely affected daily living or the upper extremity. Seventy-seven age-matched women with a fracture in the past 6–24 months (Fx, n=32) and without fracture (NFx, n=45) were measured for bone and muscle properties using the nondominant (NFx) or non-fractured limb (Fx). Peripheral quantitative computed tomography (pQCT) was used to estimate bone strength in compression (BSIc) at the distal radius and tibia, bone strength in torsion (SSIp) at
the shaft sites, muscle density, and area at the forearm and lower leg. Areal bone mineral density at the ultradistal forearm, spine, and femoral neck was measured by DXA. Grip strength and the 30-s chair stand test were used as estimates of upper and lower extremity muscle strength. Limb-specific between-group differences were compared using multivariate analysis of variance (MANOVA). Results There was a significant group difference (p0.05) between the Fx and NFx groups for age, height, weight, physical activity
Osteoporos Int (2015) 26:2461–2469
levels, age at onset of menopause, vitamin D and calcium intake, or aBMD at the femoral neck and lumbar spine (Table 1). There were no indications of any cognitive impairment as measured with the mini-cognitive screening test [21]. Primary outcomes One participant’s pQCT forearm scan was excluded from the analysis due to measurement error. Three participants did not have their lower leg scanned due to large leg girth and limited size of the gantry. Two DXA scans were excluded: one from a participant with bilateral hip replacement and another one had a nonremovable bracelet on her wrist. Bone strength indices, muscle area, density, and strength There was a significant multivariate effect indicating a group difference (Pillai’s trace=0.20, F(3.41,69)=5, p=0.008). The Fx group had 16 % lower BSIc at the distal radius (p=0.033), 3 % lower forearm muscle density at the radius shaft site (p= 0.016), and 20 % lower grip strength (p=0.001) than the NFx group (Table 2, Fig. 2). There were no significant differences in SSIp at the radius shaft or forearm muscle area (Table 2, Fig. 2). Similarly, at the lower leg, there was a multivariate group difference (Pillai’s trace=0.28, F(5,68), p
ORIGINAL ARTICLE
Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture K. Crockett 1 & C. M. Arnold 1 & J. P. Farthing 2 & P. D. Chilibeck 2 & J. D. Johnston 3 & B. Bath 1 & A. D. G. Baxter-Jones 2 & S. A. Kontulainen 2
Received: 22 January 2015 / Accepted: 29 April 2015 / Published online: 23 May 2015 # International Osteoporosis Foundation and National Osteoporosis Foundation 2015
Abstract Summary Distal radius (wrist) fracture (DRF) in women over age 50 years is an early sign of bone fragility. Women with a recent DRF compared to women without DRF demonstrated lower bone strength, muscle density, and strength, but no difference in dual-energy x-ray absorptiometry (DXA) measures, suggesting DXA alone may not be a sufficient predictor for DRF risk. Introduction The objective of this study was to investigate differences in bone and muscle properties between women with and without a recent DRF. Methods One hundred sixty-six postmenopausal women (50– 78 years) were recruited. Participants were excluded if they had taken bone-altering medications in the past 6 months or had medical conditions that severely affected daily living or the upper extremity. Seventy-seven age-matched women with a fracture in the past 6–24 months (Fx, n=32) and without fracture (NFx, n=45) were measured for bone and muscle properties using the nondominant (NFx) or non-fractured limb (Fx). Peripheral quantitative computed tomography (pQCT) was used to estimate bone strength in compression (BSIc) at the distal radius and tibia, bone strength in torsion (SSIp) at
the shaft sites, muscle density, and area at the forearm and lower leg. Areal bone mineral density at the ultradistal forearm, spine, and femoral neck was measured by DXA. Grip strength and the 30-s chair stand test were used as estimates of upper and lower extremity muscle strength. Limb-specific between-group differences were compared using multivariate analysis of variance (MANOVA). Results There was a significant group difference (p0.05) between the Fx and NFx groups for age, height, weight, physical activity
Osteoporos Int (2015) 26:2461–2469
levels, age at onset of menopause, vitamin D and calcium intake, or aBMD at the femoral neck and lumbar spine (Table 1). There were no indications of any cognitive impairment as measured with the mini-cognitive screening test [21]. Primary outcomes One participant’s pQCT forearm scan was excluded from the analysis due to measurement error. Three participants did not have their lower leg scanned due to large leg girth and limited size of the gantry. Two DXA scans were excluded: one from a participant with bilateral hip replacement and another one had a nonremovable bracelet on her wrist. Bone strength indices, muscle area, density, and strength There was a significant multivariate effect indicating a group difference (Pillai’s trace=0.20, F(3.41,69)=5, p=0.008). The Fx group had 16 % lower BSIc at the distal radius (p=0.033), 3 % lower forearm muscle density at the radius shaft site (p= 0.016), and 20 % lower grip strength (p=0.001) than the NFx group (Table 2, Fig. 2). There were no significant differences in SSIp at the radius shaft or forearm muscle area (Table 2, Fig. 2). Similarly, at the lower leg, there was a multivariate group difference (Pillai’s trace=0.28, F(5,68), p
