Associations between ultra-distal forearm bone mineral density and incident fracture in women

Kara L Holloway-Kew; Amelia G Betson; Kara B Anderson; Mark A Kotowicz; Julie A Pasco

doi:10.1007/s00198-024-07041-4

Associations between ultra-distal forearm bone mineral density and incident fracture in women

Osteoporos Int. 2024 Mar 6. doi: 10.1007/s00198-024-07041-4. Online ahead of print.

Authors

Kara L Holloway-Kew¹, Amelia G Betson², Kara B Anderson², Mark A Kotowicz^{2

3

4}, Julie A Pasco^{2

3

4

5}

Affiliations

¹ Deakin University, Institute for Mental and Physical Health and Clinical Translation - IMPACT, Geelong, Australia. k.holloway@deakin.edu.au.
² Deakin University, Institute for Mental and Physical Health and Clinical Translation - IMPACT, Geelong, Australia.
³ Department of Medicine - Western Health, The University of Melbourne, St Albans, Australia.
⁴ University Hospital Geelong, Barwon Health, Geelong, Australia.
⁵ Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia.

PMID: 38448781
DOI: 10.1007/s00198-024-07041-4

Abstract

Bone mineral density measured at the ultra-distal forearm site was associated with any fracture, as well as distal radius fracture in women from a longitudinal cohort study.

Purpose: Femoral neck (BMD_hip) and lumbar spine (BMD_spine) bone mineral density (BMD) are routinely used to assess fracture risk. More data are needed to understand how ultra-distal forearm BMD (BMD_UDforearm) may assist fracture prediction.

Methods: Using a Lunar DPX-L, Geelong Osteoporosis Study women (n = 1026), aged 40-90 years, had BMD measured. Incident low-trauma fractures were radiologically verified. Using Cox proportional hazard models, hazard ratios (HR) were calculated for BMD_UDforearm as a continuous variable (expressed as a one-unit decrease in T-score) and a categorical variable (normal/osteopenia/osteoporosis). Areas under receiver operating characteristics (AUROC) curves were calculated. Analyses were conducted for any fracture and distal radius fractures.

Results: During 14,270 person-years of follow-up, there were 318 fractures (85 distal radius). In adjusted models, continuous BMD_UDforearm was associated with any (HR 1.26;95%CI 1.15-1.39) and distal radius fractures (HR 1.59;95%CI 1.38-1.83). AUROCs for continuous BMD_UDforearm, 33% forearm(BMD_33%forearm), BMD_hip, BMD_spine, and FRAX without BMD were similar for any fracture (p > 0.05). For distal radius fracture, the AUROC for BMD_UDforearm was higher than other sites and FRAX (p < 0.05). In adjusted models, those with osteoporosis had a higher likelihood of any fracture (HR 2.12; 95%CI 1.50-2.98). For distal radius fractures, both osteopenia and osteoporosis had a higher risk (HR 4.31; 95%CI 2.59-7.15 and 4.81; 95%CI 2.70-8.58). AUROCs for any fracture were similar for categorical BMD at all sites but lower for FRAX (p < 0.05). For distal radius fractures, the AUROC for BMD_UDforearm, was higher than other sites and FRAX (p < 0.05).

Conclusion: Ultra-distal forearm BMD may aid risk assessments for any distal radius fractures.

Keywords: Forearm fracture; Fractures; Ultra-distal forearm bone mineral density; Women.