Bone microstructure and self-perception of fracture risk among women participating in the UK arm of the GLOW study.

Abstract

Osteoporotic fractures are associated with considerable morbidity, mortality and
socioeconomic cost. A significant contribution to fracture risk is bone fragility which can be assessed using a novel imaging technique, high-resolution peripheral quantitative computed tomography (HR-pQCT), that provides data on bone geometry, density and microarchitecture, and has previously been used in a study of women aged 55-80 recruited through primary care to the Southampton, UK based arm of the Global Longitudinal Study of Osteoporosis in Women (GLOW) Study.
Self-perception of risk of a condition requires an individual to compare their own health status to others, and has been considered in the osteoporosis literature. Self-perception of fracture risk (SPR) has been previously reported to be underestimated in postmenopausal women worldwide, suggesting that there might be a disconnect between SPR and actual fracture risk, and has also been previously captured in the GLOW Study.
The aims of this thesis are to use the GLOW study to: (a) examine relationships between HR-pQCT parameters and fracture (b) determine associations between HR-pQCT parameters and adiposity (c) consider associations between SPR and bone health; and (d) consider the determinants of SPR.
492 participants from the UK arm of GLOW underwent HR-pQCT of the non-dominant distal radius and tibia and dual energy x-ray absorptiometry (DXA) to estimate body composition and femoral neck areal bone mineral density (aBMD). Information on demographics, lifestyle, fracture, SPR and comorbidities was obtained from study questionnaires.
Microstructural parameters of the bone evaluated by HR-pQCT appear to be different at skeletal regions containing predominantly trabecular bone between healthy postmenopausal women and those who had fractured. There was a trend suggesting favourable cortical and trabecular microarchitecture with increased BMI category at both radius and tibia, although women with the highest BMI appeared to have less favourable bone microarchitecture taking into account their body size. Higher SPR bands were related to a decrease in areal BMD at the femoral neck and lower tibial trabecular
volumetric density. Finally, we demonstrated that SPR in this group captured an aspect 4 of fracture risk not currently measured using FRAX, and translated to improved
antiosteoporosis medication (AOM) uptake.
This study highlights novel associations between SPR, body composition and bone microarchitecture. It has demonstrated that patterns of bone microarchitecture differ in postmenopausal women by fracture status, and that SPR may contribute to fracture prediction, beyond conventional fracture algorithm variables.

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Identifiers

ORCID for Elaine Dennison: orcid.org/0000-0002-3048-4961

ORCID for Cyrus Cooper: orcid.org/0000-0003-3510-0709

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