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Localized bone deterioration predicts declining failure load and increased fracture risk.

Annabel R Bugbird1,2, Lauren A Burt1,3, Danielle E Whittier1,4

  • 1McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

Osteoporosis International : a Journal Established As Result of Cooperation Between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Summary

Bone void spaces increase with age and progress faster in women, impacting fracture risk and bone strength. These findings suggest void spaces may indicate early skeletal deterioration and aid in osteoporosis monitoring.

Keywords:
Bone lossHR-pQCTHigh resolution peripheral quantitative computed tomographyMicroarchitectureOsteoporosisVoid space

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Area of Science:

  • Orthopedics
  • Gerontology
  • Bone Biology

Background:

  • Localized bone loss, termed void spaces, represents areas of trabecular deterioration compromising bone strength.
  • Previous research on void spaces relied on cross-sectional data, limiting insights into temporal changes due to secular effects.
  • This study addresses these limitations by analyzing longitudinal data to understand void space progression over time.

Purpose of the Study:

  • To longitudinally assess age- and sex-related changes in bone void spaces.
  • To investigate the relationship between void spaces and fracture risk.
  • To explore the association between void spaces and bone strength.

Main Methods:

  • Analysis of 603 participants from a longitudinal population study with HR-pQCT scans of the distal radius and tibia at two time points (3-10 years apart).
  • Quantification of void space as the ratio of void space to total volume (VS/TV [%]) after scan registration.
  • Linear mixed-effects models and linear regression were used to evaluate void space progression and its association with fracture risk and bone strength.

Main Results:

  • Void space increased by 0.02% annually with age (p<0.001), showing slower progression in males (p<0.001).
  • A 1% increase in VS/TV correlated with a 0.5% increase in fracture risk (p<0.01).
  • Increased VS/TV was associated with reduced bone strength, particularly at the tibia (111.3 N reduction, p=0.006).

Conclusions:

  • Bone void spaces increase with age and progress more slowly in males, significantly impacting bone strength, especially in the tibia.
  • While the effect on fracture risk was modest, void space may serve as an early indicator of skeletal deterioration.
  • Void space assessment holds potential for monitoring osteoporosis and guiding skeletal health interventions.