Association of Moderate/Severe Vertebral Fractures with Reduced Trabecular Volumetric Bone Density in Older Women and Reduced Areal Femoral Neck Bone Density in Older Men from Community: A Cross-Sectional Study (SPAH)

Geórgea H. F. Torres¹, Luis F S Guzman², Jackeline C Alvarenga³, Levi Neto Sr.⁴, Valéria F. Caparbo⁵, Liliam Takayama⁵, Diogo S Domiciano⁶, Neusa Lopes Sr.⁷ and Rosa M R Pereira⁸, ¹Reumatologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ²Cardiologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ³Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil, ⁴Reumatologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil, ⁵Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil, ⁶Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil, ⁷Cardiologia, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil, ⁸Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: DXA, HR-pQCT and fractures

Session Information

Date: Tuesday, October 23, 2018

Title: Osteoporosis and Metabolic Bone Disease – Basic and Clinical Science Poster

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Many vertebral fractures occur in individuals classified by dual X-ray absorptiometry (DXA) as low risk for fragility fractures. No studies have performed a concomitant evaluation of moderate/severe vertebral fractures, high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular bone score (TBS) and areal BMD in general elderly population. Thus, we sought to verify the association between moderate/severe vertebral fractures and bone microarchitecture and strength using HR-pQCT, TBS and DXA in older adults.

Methods: 276 older adults from community(176 women and 100 men) were assessed by questionnaire. Lateral scans of spine obtained from Vertebral Fracture Assessment (VFA) by DXA were done to assess vertebral fractures (semiquantitative method). HR-pQCT was performed at the distal radius and tibia and the following parameters were analyzed: volumetric bone mineral density(vBMD) – total(Tt), trabecular(Tb) and cortical(Ct), structural parameters – trabecular number(Tb.N), trabecular thickness(Tb.Th.), trabecular separation(Tb.Sp), cortical thickness(Ct.Th) and strength variables – Stiffness(S), Estimated ultimate failure load(Fult). TBS was performed using DXA iNsight software. Logistic regression was used to identify independent risk factors for fractures.

Results: At least one vertebral fracture was observed in 42.6% of women and 28% of men. At distal tibia, women with moderate/severe vertebral fractures had lower vBMD (Tt.vBMD, p=0.001; Tb.vBMD, p<0.001; Ct.vBMD, p=0.017), lower Tb.N, p=0.002, higher Tb.Sp, p=0.003 and lower strength parameters(S, p<0.001; F.ult, p<0.001) and men with moderate/severe vertebral fractures had lower Tb.N, p=0.028, higher Tb.Sp, p=0.026 and lower strength parameter (F.ult, p=0.046). At distal radius, women with moderate/severe vertebral fractures had lower vBMD (Tt.vBMD, p=0.003; Tb.vBMD, p=0.031; Ct.vBMD, p=0.003), lower structural parameters (Tb.Th, p=0.026; Ct.Th, p=0.003) and lower bone strength (S, p=0.005; F.ult, p=0.003) and men with moderate/severe vertebral fractures had lower Tb.vBMD, p=0.031 and lower strength parameter (S, p=0.044; F.ult, p=0.041). No differences were observed in TBS in female group (p=0.584) and male group (p=0.667). After adjusting for potential confounding variables, logistic regression model revealed that Tb.vBMD at distal tibia in women (OR 0.980, 95%CI 0.963–0.997, p=0.022) and areal femoral neck BMD in men (OR 0.002, 95%CI 0–0.607, p=0.033) were independently associated with moderate/severe vertebral fractures.

Conclusion: HR-pQCT images detected marked differences on bone microstructure between older women with moderate/severe vertebral fractures independent of areal BMD and TBS by DXA and could be useful tool to assess fracture risk. Differently,in men, areal BMD at femoral neck was associated with moderate/severe vertebral fractures and DXA continue an important clinical tool for predicting vertebral fracture in male gender.

Disclosure: G. H. F. Torres, None; L. F S Guzman, None; J. C. Alvarenga, None; L. Neto Sr., None; V. F. Caparbo, None; L. Takayama, None; D. S. Domiciano, None; N. Lopes Sr., None; R. M. R. Pereira, None, 2.

To cite this abstract in AMA style:

Torres GHF, F S Guzman L, Alvarenga JC, Neto L Sr., Caparbo VF, Takayama L, Domiciano DS, Lopes N Sr., Pereira RMR. Association of Moderate/Severe Vertebral Fractures with Reduced Trabecular Volumetric Bone Density in Older Women and Reduced Areal Femoral Neck Bone Density in Older Men from Community: A Cross-Sectional Study (SPAH) [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/association-of-moderate-severe-vertebral-fractures-with-reduced-trabecular-volumetric-bone-density-in-older-women-and-reduced-areal-femoral-neck-bone-density-in-older-men-from-community-a-cross-secti/. Accessed .

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