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Site dependent reference point microindentation complements clinical measures for improved fracture risk assessment at the human femoral neck

Site dependent reference point microindentation complements clinical measures for improved fracture risk assessment at the human femoral neck
Site dependent reference point microindentation complements clinical measures for improved fracture risk assessment at the human femoral neck
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 article is protected by copyright. All rights reserved
indentation (micro), fracture risk assessment, osteoporosis, DXA, aging
0884-0431
196-203
Jenkins, T.
e079f477-2bcf-41ea-bb7f-bcbbb5f5c945
Coutts, L.V.
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D'Angelo, S.
13375ecd-1117-4b6e-99c0-32239f52eed6
Dunlop, D.G.
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Oreffo, R.O.
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Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Thurner, P.J.
ab711ddd-784e-48de-aaad-f56aec40f84f
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Latham, J.M.
c16a0f2e-dd8f-470d-b0e5-8914e46ac00e
Taylor, P.
28b91e71-fad2-4375-8a1e-535f861901c3
Baxter, M.
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Moss, N.
158d59ed-43e7-4ab8-9034-726e9bacb0b4
Ball, C.
e3c95e80-c831-4f74-945b-be79abe093c7
Chan, K.
2fad0805-393b-4c6c-90a2-fd6fd9dfa29c
Jenkins, T.
e079f477-2bcf-41ea-bb7f-bcbbb5f5c945
Coutts, L.V.
90c9e532-5400-4ef8-853f-0e3c311b4f27
D'Angelo, S.
13375ecd-1117-4b6e-99c0-32239f52eed6
Dunlop, D.G.
5f8d8b5c-e516-48b8-831f-c6e5529a52cc
Oreffo, R.O.
ff9fff72-6855-4d0f-bfb2-311d0e8f3778
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Thurner, P.J.
ab711ddd-784e-48de-aaad-f56aec40f84f
Arden, N.K.
23af958d-835c-4d79-be54-4bbe4c68077f
Latham, J.M.
c16a0f2e-dd8f-470d-b0e5-8914e46ac00e
Taylor, P.
28b91e71-fad2-4375-8a1e-535f861901c3
Baxter, M.
524b69f2-f142-4af0-ad71-2e82a2988509
Moss, N.
158d59ed-43e7-4ab8-9034-726e9bacb0b4
Ball, C.
e3c95e80-c831-4f74-945b-be79abe093c7
Chan, K.
2fad0805-393b-4c6c-90a2-fd6fd9dfa29c

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)

Record type: Article

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 article is protected by copyright. All rights reserved

Full text not available from this repository.

More information

Accepted/In Press date: 28 July 2015
e-pub ahead of print date: 1 August 2015
Published date: January 2016
Keywords: indentation (micro), fracture risk assessment, osteoporosis, DXA, aging
Organisations: Faculty of Medicine, Bioengineering Group, MRC Life-Course Epidemiology Unit

Identifiers

Local EPrints ID: 380419
URI: http://eprints.soton.ac.uk/id/eprint/380419
ISSN: 0884-0431
PURE UUID: 75c21d8c-d78e-47dc-9a44-fbe04746a31d
ORCID for S. D'Angelo: ORCID iD orcid.org/0000-0002-7267-1837
ORCID for R.O. Oreffo: ORCID iD orcid.org/0000-0001-5995-6726
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for P.J. Thurner: ORCID iD orcid.org/0000-0001-7588-9041

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Date deposited: 10 Sep 2015 14:14
Last modified: 17 Dec 2019 01:56

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