Jornal de Osteoporose e Atividade Física
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Bone Strength, Skeletal Muscle Area, and Biochemical Markers Associated with Bone Metabolism in Patients with Fragility Distal Radius Fracture

Shigeharu Uchiyama* , Shota Ikegami, Mikio Kamimura, Hideki Moriya, Tsutomu Akahane, Kiichi Nonaka, Toshihiko Imaeda and Hiroyuki Kato

Distal radius fracture (DRF) is often the first fragility fracture that occurs in postmenopausal women and exhibits the high risk of future fragility fractures at the other skeletal sites. So far, the other factors rather than bone mineral density have not been well investigated. Our aim was to determine the characteristics of the patients with previous fragility DRFs.

We enrolled 48 postmenopausal women with a history of fragility DRF (fracture group) and age-matched 96 healthy postmenopausal women volunteers (control group). Hip BMD of all the participants was obtained using DXA. Geometrical parameters and biomechanical indices of the femoral neck were obtained using quantitative CT. Using CT images, the cross-sectional area of the skeletal muscle and fat inside the fascia was calculated at the proximal thigh. Twelve biochemical markers and hormones associated with bone metabolism were also measured. Each parameter was compared between the patients and controls by analysis of variance (ANOVA), followed by ANCOVA adjusting for femoral neck areal BMD. BMD of the femoral neck was significantly lower in the fracture group than the control, while skeletal muscle area was not. Femoral neck cortical thickness was significantly smaller and buckling ratio was significantly greater in the fracture group; however, after adjusting for BMD, the differences were no longer significant. Further, 25(OH)D, Urinary deoxypyridinoline (DPD), and serum and urinary pentosidine levels were significantly higher in the fracture group than in the control group; those differences remained significant after adjusting for BMD. The patients with previous DRFs exhibited lower BMD, which was not accompanied by lower skeletal muscle area or muscle strength. Further, bone metabolism alterations such as low 25(OH)D, high DPD, and high serum and urinary pentosidine levels were also observed in such patients, independent of the areal BMD determined by DXA. Level of Evidence: Prognotic Study.