Age dependence of the normal/abnormal difference of bone mineral density in osteoporotic women

The development, incidence and treatment trends of trochanteric fractures in Germany: a cohort study

BACKGROUND

Hip fractures are a major public health problem worldwide and can lead to disability, increased mortality, and reduced quality of life. We aim to provide a nationwide epidemiological analysis of trochanteric and subtrochanteric fractures and their respective surgical treatments.

METHODS

Data were retrieved from the national database of the German Department of the Interior. ICD-10-GM and OPS data from the period of 2006 to 2020 were analysed and all patients with trochanteric and subtrochanteric fractures as their main diagnosis, who were treated in a German hospital, were included. Patients were grouped by age and gender and linear regression was performed where suitable to calculate statistically significant correlations between variables and incidences.

RESULTS

985,104 pertrochanteric fractures and 178,810 subtrochanteric fractures were reported during the analysed period. We calculated a mean incidence of 80.08 ± 6.34 for pertrochanteric and 14.53 ± 1.50 for subtrochanteric fractures per million inhabitants. In both fracture types, a distinct dependence of incidence on age can be determined. Incidence rates equally rise in both sexes through the age groups with an increase of about 288-fold from those under the age of 60 to those over the age of 90 in pertrochanteric fractures, and about 123-fold in subtrochanteric fractures. Intramedullary nailing was the most common kind of treatment for both fracture types with augmentative cerclages on the rise throughout the whole period. Plate and dynamic compression screws were decreasing in frequency over the analysed period in both fractures.

CONCLUSIONS

We provided incidence data on per- and subtrochanteric fractures and their treatment. We calculated an economic impact of approximately 1.563 billion € per year in Germany. With regards to recent literature on costs of treatment and our findings regarding the implementation and utilization of different treatment methods, we conclude that the reinforcement of nationwide prevention programs is a relevant step in lessening the economic burden. We welcome the increased utilisation of intramedullary nailing as many studies show beneficiary outcomes and cost effectiveness in most of the included fracture types.

Quantitative US of the calcaneus: cutoff levels for the distinction of healthy and osteoporotic individuals

PURPOSE

To calculate cutoff levels for quantitative ultrasonography (US) performed to distinguish healthy individuals and those with osteoporosis identified with dual x-ray absorptiometry.

MATERIALS AND METHODS

In 1,357 patients (856 females, aged 55.1 years +/- 15.4 [mean +/- SD]; 501 males, aged 50.4 years +/- 15), bone mineral density measurements of the lumbar spine (posteroanterior, L1 through L4) and femoral neck were obtained, and quantitative US was performed to determine the stiffness of the calcaneus. Individuals with a T score less than -2.5 (osteoporotic) at the spine and femur were identified, and upper T-score cutoff values (3 SDs from the mean) in the groups of male and female patients with osteoporosis were identified.

RESULTS

Females with dual x-ray absorptiometric values that were indicative of osteoporosis of the spine had an upper T-score cutoff value of -1.0 (males, -0.2). Females who had femoral osteoporosis showed an upper quantitative US T-score cutoff value of -0.6 (males, 0).

CONCLUSION

Cutoff values may permit the use of quantitative US to screen for the presence of osteoporosis in the spine and femur. Quantitative US will help to prevent unnecessary dual x-ray absorptiometric and conventional radiographic examinations.

The relationship between dynamic, isokinetic and isometric strength and bone mineral density in a population of 45 to 65 year old women

This study investigated the relationship between age, lumbar spine bone mineral density (LS BMD) and muscular strength of peri and postmenopausal women between 45 and 65 years either taking or not taking hormone replacement therapy (HRT). Ninety six women were tested for LS BMD (L2-L4), one repetition maximum (1RM) bench press and squat, maximal voluntary isometric contraction (MVC) of the knee extensors and peak torque of back extensor muscles at a speed of 30 degrees s(-1). Bone and strength data were analysed to evaluate the relationships in incrementing five year age groups and based on groups either taking or not taking HRT. ANOVA revealed significant differences in LS BMD between the 45-49 and 55-59 (F[3,92]=2.6411, p<0.05; -8%) age groups amounting to an annual bone loss of 0.8% for this Australian based population. Non significant LS BMD results were evident after controlling for the influence of age and menopausal status on the groups either taking or not taking HRT. Significant differences between the 45-49 and 60-64 (F[3,92]=2.7463, p<0.05) age groups for 1RM bench press and the 45-49 and 60-64, 50-54 and 60-64, and, 55-59 and 60-64 (F[3,92]=4.2816, p<0.05) age groups for 1RM squat amounting to an 18.8% and 37.5% loss of dynamic upper and lower body strength, respectively. Group correlation coefficients ranged between (r=-0.20 and -0.34, p<0.05) for LS BMD, strength and age. The conclusions demonstrate a concomitant decline in maximal muscle strength and bone density between women 45 and 65 years irrespective of HRT. These results also demonstrate a 50% greater decline in lower body strength compared to upper body strength between women 45 and 65 years.

Comparisons of noninvasive bone mineral measurements in assessing age-related loss, fracture discrimination, and diagnostic classification

The purpose of this study was to examine the commonly available methods of noninvasively assessing bone mineral status across three defined female populations to examine their interrelationships, compare their respective abilities to reflect age- and menopause-related bone loss, discriminate osteoporotic fractures, and classify patients diagnostically. A total of 47 healthy premenopausal (age 33 +/- 7 years), 41 healthy postmenopausal (age 64 +/- 9 years), and 36 osteoporotic postmenopausal (age 70 +/- 6 years) women were examined with the following techniques: (1) quantitative computed tomography of the L1-L4 lumbar spine for trabecular (QCT TRAB BMD) and integral (QCT INTG BMD) bone mineral density (BMD); (2) dual X-ray absorptiometry of the L1-L4 posterior-anterior (DXA PA BMD) and L2-L4 lateral (DXA LAT BMD) lumbar spine, of the femoral neck (DXA NECK BMD) and trochanter (DXA TROC BMD), and of the ultradistal radius (DXA UD BMD) for integral BMD; (3) peripheral QCT of the distal radius for trabecular BMD (pQCT TRAB BMD) and cortical bone mineral content (BMC) (pQCT CORT BMC); (4) two radiographic absorptiometric techniques of the metacarpal (RA METC BMD) and phalanges (RA PHAL BMD) for integral BMD; and (5) two quantitative ultrasound devices (QUS) of the calcaneus for speed of sound (SOS CALC) and broadband ultrasound attenuation (BUA CALC). In general, correlations ranged from (r = 0.10-0.93) among different sites and techniques. We found that pQCT TRAB BMD correlated poorly (r < or = 0.46) with all other measurements except DXA UD BMD (r = 0.62,p < or = 0.0001) and RA PHAL BMD (r = 0.52, p < or = 0.0001). The strongest correlation across techniques was between QCT INT BMD and DXA LAT BMD (r = 0.87, p < or = 0.0001), and the weakest correlation within a technique was between pQCT TRAB BMD and pQCT CORT BMC (r = 0.25,p < or = 0.05). Techniques showing the highest correlations with age in the healthy groups also showed the greatest differences among groups. They also showed the best discrimination (as measured by the odds ratios) for the distinction between healthy postmenopausal and osteoporotic postmenopausal groups based on age-adjusted logistic regression analysis. For each anatomic site, the techniques providing the best results were: (1) spine, QCT TRAB BMD (annual loss, -1.2% [healthy premenopausal and healthy postmenopausal]); Student's t-value [not the T score], 5.4 [healthy postmenopausal vs. osteoporotic postmenopausal]; odds ratio, 43 [age-adjusted logistic regression for healthy postmenopausal vs. osteoporotic postmenopausal]); (2) hip, DXA TROC BMD (-0.46; 3.5; 2.2); (3) radius, DXA UD BMD (-0.44; 3.3; 1.9) and pQCT, CORT BMC (-0.72; 2.9; 1.7); (4) hand, RA PHAL (-0.51; 3.6; 2.0); and (5) calcaneus, SOS (-0.09; 3.4; 2.1) and BUA (-0.52; 2.6; 1.7). Despite these performance trends, the differences among sites and techniques were statistically insignificant (p > 0.05) using age-adjusted receiver operating characteristic (ROC) curve analysis. Nevertheless, kappa score analysis (using -2.0 T score as the cut-off value for osteopenia and -2.5 T score for osteoporosis) showed that in general the diagnostic agreement among these measurements in classifying women as osteopenic or osteoporotic was poor, with kappa scores averaging about 0.4 (exceptions were QCT TRAB/INTG BMD, DXA LAT BMD, and RA PHAL BMD, with kappa scores ranging from 0.63 to 0.89). Often different patients were estimated at risk by using different measurement sites or techniques.

Correlation of total-body bone mineral content determined by dual-energy X-ray absorptiometry with bone mineral density determined by peripheral quantitative computed tomography

RATIONALE AND OBJECTIVES

We sought to determine the value of peripheral quantitative computed tomography (pQCT) in measuring bone mineral density.

METHODS

In 50 healthy, eugonodal premenopausal women, we correlated measurements of total bone mineral content (BMCTB), made with dual-energy X-ray absorptiometry (DXA), and bone mineral density, determined by pQCT.

RESULTS

The partial correlations, adjusted for weight and age, between BMCTB and cortical bone density, total bone density, and trabecular bone density were .71 (p < .0001), .63 (p < .0001), and .32 (p < .05), respectively.

CONCLUSION

These results and the advantages of pQCT--providing precise bone density determinations for trabecular and compact bone separately, having a high spatial resolution that allows a "compartmental" analysis of bone structure, having a low coefficient of variation, and having a minimal radiation dose (< 5 mrem)--confirm the adequacy of using this method for bone mass studies.