Alexander S Dash1, Sanchita Agarwal2, Donald J McMahon3, Felicia Cosman2, Jeri Nieves4, Mariana Bucovsky2, X Edward Guo5, Elizabeth Shane2, Emily M Stein6. 1. Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America. 2. Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America. 3. Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America. 4. Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America. 5. Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States of America. 6. Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America. Electronic address: steine@hss.edu.
Abstract
BACKGROUND: Postmenopausal women with isolated osteoporosis at the 1/3 radius (1/3RO) present a therapeutic dilemma. Little is known about whether these patients have generalized skeletal fragility, and whether this finding warrants treatment. The aim of this study was to investigate the biochemical and microarchitectural phenotype of women with 1/3RO compared to women with classic postmenopausal osteoporosis by DXA at the spine and hip (PMO), and controls without osteoporosis at any site. METHODS: This cross-sectional study enrolled 266 postmenopausal women, who were grouped according to densitometric pattern. Subjects had serum biochemistries, areal BMD (aBMD) measured by DXA, trabecular and cortical vBMD, microarchitecture, and stiffness by high resolution peripheral QCT (HR-pQCT, voxel size ~82 μm) of the distal radius and tibia. RESULTS: Mean age was 68 ± 7 years. DXA T-Scores reflected study design. By HR-pQCT, 1/3RO had abnormalities at both radius and tibia compared to controls: lower total, cortical and trabecular vBMD, cortical thickness and trabecular number, higher trabecular separation and heterogeneity, and lower whole bone stiffness. In contrast, the magnitude and pattern of abnormalities in vBMD, microarchitecture and stiffness in 1/3RO were similar to those in PMO; the difference compared to controls was similar among the two groups. Serum calcium, creatinine, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urine calcium did not differ. CONCLUSIONS: Although aBMD appeared relatively preserved at the spine and hip by DXA, women with 1/3RO had significant microarchitectural and biomechanical deficits comparable to those in women with typical PMO. Further study is required to guide treatment decisions in this population.
BACKGROUND: Postmenopausal women with isolated osteoporosis at the 1/3 radius (1/3RO) present a therapeutic dilemma. Little is known about whether these patients have generalized skeletal fragility, and whether this finding warrants treatment. The aim of this study was to investigate the biochemical and microarchitectural phenotype of women with 1/3RO compared to women with classic postmenopausal osteoporosis by DXA at the spine and hip (PMO), and controls without osteoporosis at any site. METHODS: This cross-sectional study enrolled 266 postmenopausal women, who were grouped according to densitometric pattern. Subjects had serum biochemistries, areal BMD (aBMD) measured by DXA, trabecular and cortical vBMD, microarchitecture, and stiffness by high resolution peripheral QCT (HR-pQCT, voxel size ~82 μm) of the distal radius and tibia. RESULTS: Mean age was 68 ± 7 years. DXA T-Scores reflected study design. By HR-pQCT, 1/3RO had abnormalities at both radius and tibia compared to controls: lower total, cortical and trabecular vBMD, cortical thickness and trabecular number, higher trabecular separation and heterogeneity, and lower whole bone stiffness. In contrast, the magnitude and pattern of abnormalities in vBMD, microarchitecture and stiffness in 1/3RO were similar to those in PMO; the difference compared to controls was similar among the two groups. Serum calcium, creatinine, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urine calcium did not differ. CONCLUSIONS: Although aBMD appeared relatively preserved at the spine and hip by DXA, women with 1/3RO had significant microarchitectural and biomechanical deficits comparable to those in women with typical PMO. Further study is required to guide treatment decisions in this population.
Authors: Stephanie Boutroy; Bert Van Rietbergen; Elisabeth Sornay-Rendu; Francoise Munoz; Mary L Bouxsein; Pierre D Delmas Journal: J Bone Miner Res Date: 2008-03 Impact factor: 6.741
Authors: A Cohen; D W Dempster; R Müller; X E Guo; T L Nickolas; X S Liu; X H Zhang; A J Wirth; G H van Lenthe; T Kohler; D J McMahon; H Zhou; M R Rubin; J P Bilezikian; J M Lappe; R R Recker; E Shane Journal: Osteoporos Int Date: 2009-05-20 Impact factor: 4.507
Authors: Elisabeth Sornay-Rendu; Jose-Luis Cabrera-Bravo; Stéphanie Boutroy; Françoise Munoz; Pierre D Delmas Journal: J Bone Miner Res Date: 2009-04 Impact factor: 6.741
Authors: B Lawrence Riggs; L Joseph Melton; Richard A Robb; Jon J Camp; Elizabeth J Atkinson; Lisa McDaniel; Shreyasee Amin; Peggy A Rouleau; Sundeep Khosla Journal: J Bone Miner Res Date: 2008-02 Impact factor: 6.741