Abnormal microarchitecture and stiffness in postmenopausal women with ankle fractures

Ankle fractures are not typically considered osteoporotic fractures. However, bone quality in patients with low trauma ankle fractures has not been explored.

Women with (n = 17) and without (n = 112) a history of low trauma ankle fracture after menopause had areal bone mineral density measured by dual-energy x-ray absorptiometry, trabecular (Tb) and cortical volumetric bone mineral density, and Tb microarchitecture measured by high-resolution peripheral computed tomography of the radius and tibia. Finite element analysis was performed to estimate bone stiffness.

Women with fractures were older (72 ± 2 vs. 68 ± 1 yr; P < 0.02) but similar with respect to race and body mass index. Mean T-scores by dual-energy x-ray absorptiometry of fracture subjects were above the osteoporotic range and did not differ from controls. By high-resolution peripheral computed tomography at the radius, fracture subjects had preferentially lower central trabecular bone density, lower Tb number, and increased separation compared with controls (P < 0.0001-0.04). At the tibia, fracture subjects had lower total and Tb density, lower Tb number, and increased Tb separation and network heterogeneity (P < 0.02). Whole-bone stiffness was 13-17% lower at the radius and tibia in fracture subjects (P < 0.003-0.01).

Postmenopausal women with ankle fractures have disrupted microarchitecture and decreased stiffness compared with women with no fracture history, suggesting that low trauma ankle fractures should be considered similarly to other classical osteoporotic fractures.