Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

T T Borgen; Å Bjørnerem; L B Solberg; C Andreasen; C Brunborg; M-B Stenbro; L M Hübschle; W Figved; E M Apalset; J-E Gjertsen; T Basso; I Lund; A K Hansen; J-M Stutzer; C Dahl; L Nordsletten; F Frihagen; E F Eriksen

doi:10.1007/s00198-019-05215-z

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

Osteoporos Int. 2020 Mar;31(3):505-514. doi: 10.1007/s00198-019-05215-z. Epub 2019 Nov 21.

Authors

T T Borgen^{1

2}, Å Bjørnerem^{3

4}, L B Solberg⁵, C Andreasen^{3

6}, C Brunborg⁷, M-B Stenbro⁸, L M Hübschle⁹, W Figved¹⁰, E M Apalset^{11

12}, J-E Gjertsen^{13

14}, T Basso¹⁵, I Lund⁵, A K Hansen^{3

6}, J-M Stutzer¹⁶, C Dahl¹⁷, L Nordsletten^{18

5}, F Frihagen⁵, E F Eriksen^{18

19}

Affiliations

¹ Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway. tove.tveitan.borgen@vestreviken.no.
² Department of Clinical Medicine, University of Oslo, Oslo, Norway. tove.tveitan.borgen@vestreviken.no.
³ Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
⁴ Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.
⁵ Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway.
⁶ Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway.
⁷ Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
⁸ Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway.
⁹ Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway.
¹⁰ Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway.
¹¹ Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
¹² Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹³ Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
¹⁴ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
¹⁵ Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway.
¹⁶ Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway.
¹⁷ Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway.
¹⁸ Department of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁹ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.

Abstract

Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS.

Introduction: Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures.

Methods: This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed.

Results: Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (β_{per SD} = - 0.26, 95% CI: - 0.36,- 0.15), parental hip fracture (β = - 0.29, 95% CI: - 0.54,- 0.05), and daily alcohol intake (β = - 0.43, 95% CI - 0.79, - 0.08) were associated with lower TBS. Higher BMD of femoral neck (β_{per SD} = 0.34, 95% CI 0.25-0.43) and lumbar spine (β_{per SD} = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (OR_{per SD} = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (OR_{per SD} = 0.75 95% CI 0.60-0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found.

Conclusion: Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

Keywords: Bone mineral density; Fracture risk; Osteoporosis; Trabecular bone score; Vertebral fracture assessment; Vertebral fractures.

MeSH terms

Absorptiometry, Photon
Aged
Bone Density
Cancellous Bone / diagnostic imaging
Child
Cross-Sectional Studies
Diabetes Mellitus, Type 2*
Female
Humans
Lumbar Vertebrae / diagnostic imaging
Norway / epidemiology
Osteoporotic Fractures* / epidemiology
Osteoporotic Fractures* / etiology
Spinal Fractures* / diagnostic imaging
Spinal Fractures* / epidemiology
Spinal Fractures* / etiology

Abstract

MeSH terms

Grants and funding