Distal Radius Morphology and Bone Mineral Density Show Significant Sex- and Age-Based Differences With Implications for Allograft Glenoid Reconstruction

To assess variations in distal radius morphology to identify factors that may influence optimal graft selection in glenoid reconstruction.

A single-institution, retrospective database of wrist computed tomography scans was reviewed to identify patients with intact, uninjured distal radii. Exclusion criteria included fractures, hardware, or cysts in the distal radius and inadequate computed tomography views or quality. Patient age at the time of computed tomography scan was categorized into <30, 30 to 50, and >50 years, and sex was recorded. Measurements included coronal and sagittal radius of curvature (ROC) and axial area, perimeter, and bone mineral density (BMD). These parameters were compared across different age groups and between sexes, with subgroup analyses and multivariable linear regression performed.

A total of 100 patients were included, with a mean age of 42.6 ± 18.3 years (range: 18-88), and 54% were men. Men had a significantly greater mean ROC than women in both coronal (26.5 ± 5.0 vs 23.5 ± 4.2 mm, P = .002) and sagittal (12.6 ± 2.1 vs 11.1 ± 1.4 mm, P < .001) planes. Mean area, perimeter, and BMD were also significantly higher in men compared with women across the total cohort and within all age groups (P < .05). BMD varied across age groups, with patients <30 years having significantly greater BMD than age groups 30 to 50 (P = .011) and >50 years (P = .032). On multivariable analysis, male sex was independently associated with greater BMD, coronal and sagittal ROC, area, and perimeter, whereas age <30 years was associated with greater BMD and age >50 years with larger area and perimeter.

Distal radius morphology and BMD vary by sex and age, with men showing greater mean ROC, graft size parameters, and BMD, whereas younger age is associated with higher BMD. For glenoid reconstruction, distal radius allografts derived from younger male donors may provide larger grafts with higher BMD and favorable curvature characteristics to the native glenoid.

Distal radius allograft reconstruction has emerged as a viable option for glenoid bone loss in anterior shoulder instability. This study defines age- and sex-based variations in distal radius morphology and bone density to help guide surgeons in selecting grafts with appropriate size, curvature, and bone quality for glenoid augmentation.