Jenkins, T., Coutts, L.V., D'Angelo, S., Dunlop, D.G., Oreffo, R.O., Cooper, C., Harvey, N.C., Thurner, P.J., Arden, N.K., Latham, J.M., Taylor, P., Baxter, M., Moss, N., Ball, C. and Chan, K. (2016) Site dependent reference point microindentation complements clinical measures for improved fracture risk assessment at the human femoral neck. Journal of Bone and Mineral Research, 31 (1), 196-203. (doi:10.1002/jbmr.2605). (PMID:26235931)
Abstract
In contrast to traditional approaches to fracture risk assessment using clinical risk factors and Bone Mineral Density (BMD), a new technique, Reference Point micro-Indentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments.
Femoral neck samples were collected at surgery following low trauma hip fracture (n?=?46; 17 male, 83 (IQR 77-87) years), and compared, using RPI (Biodent HfcTM), with 16 cadaveric control samples, free from bone disease (7 male; 65 (IQR 61-74) years). A subset of fracture patients returned for Dual-energy X-ray Absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans.
The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p?<?0.001), which persisted with adjustment for age, sex, BMI and height (p?<?0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using ROC analysis (AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99).
In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment, and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck.
This record has no associated files available for download.
More information
Identifiers
Catalogue record
Export record
Altmetrics
Contributors
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.