Greater pQCT calf muscle density is associated with lower fracture risk, independent of FRAX, falls and BMD: a meta-analysis in the Osteoporotic Fractures in Men (MrOS) Study
Greater pQCT calf muscle density is associated with lower fracture risk, independent of FRAX, falls and BMD: a meta-analysis in the Osteoporotic Fractures in Men (MrOS) Study
We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72–1.0 and 0.78; 95% CI, 0.66–0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88–1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59–0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk.
EPIDEMIOLOGY, FRACTURE, FRAX, OSTEOPOROSIS, PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY, PQCT, SARCOPENIA
Harvey, Nicholas C.
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Orwoll, Eric
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Cauley, Jane A.
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Kwok, Timothy
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Karlsson, Magnus K.
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Rosengren, Björn E.
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Ribom, Eva
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Cawthon, Peggy M.
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Ensrud, Kristine
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Liu, Enwu
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Laskou, Faidra
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Ward, Kate A.
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Dennison, Elaine M.
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Cooper, Cyrus
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Kanis, John A.
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Vandenput, Liesbeth
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Lorentzon, Mattias
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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McCloskey, Eugene
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December 2022
Harvey, Nicholas C.
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Orwoll, Eric
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Cauley, Jane A.
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Kwok, Timothy
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Karlsson, Magnus K.
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Rosengren, Björn E.
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Ribom, Eva
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Cawthon, Peggy M.
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Ensrud, Kristine
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Liu, Enwu
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Laskou, Faidra
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Ward, Kate A.
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Dennison, Elaine M.
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Cooper, Cyrus
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Kanis, John A.
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Vandenput, Liesbeth
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Lorentzon, Mattias
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Ohlsson, Claes
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Mellström, Dan
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Johansson, Helena
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McCloskey, Eugene
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Harvey, Nicholas C., Orwoll, Eric, Cauley, Jane A., Kwok, Timothy, Karlsson, Magnus K., Rosengren, Björn E., Ribom, Eva, Cawthon, Peggy M., Ensrud, Kristine, Liu, Enwu, Laskou, Faidra, Ward, Kate A., Dennison, Elaine M., Cooper, Cyrus, Kanis, John A., Vandenput, Liesbeth, Lorentzon, Mattias, Ohlsson, Claes, Mellström, Dan, Johansson, Helena and McCloskey, Eugene
(2022)
Greater pQCT calf muscle density is associated with lower fracture risk, independent of FRAX, falls and BMD: a meta-analysis in the Osteoporotic Fractures in Men (MrOS) Study.
JBMR Plus, 6 (12), [e10696].
(doi:10.1002/jbm4.10696).
Abstract
We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72–1.0 and 0.78; 95% CI, 0.66–0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88–1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59–0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk.
Text
JBMR Plus - 2022 - Harvey - Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk Independent of FRAX
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Accepted/In Press date: 26 October 2022
e-pub ahead of print date: 8 November 2022
Published date: December 2022
Additional Information:
Funding Information:
We thank the participants of MrOS US, Sweden, and Hong Kong. The Osteoporotic Fractures in Men (MrOS) Study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute on Aging (NIA), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Center for Advancing Translational Sciences (NCATS), and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, R01 AG066671, and UL1 TR000128. MrOS Sweden is supported by the Swedish Research Council, ALF/LUA research grants in Gothenburg, and the King Gustav V, Queen Victoria Frimurarestiftelse Research Foundation and ALF and Region Skane research grants in Malmö. The authors also acknowledge support from UK Medical Research Council (MC_PC_21003; MC_PC_21001; MC_PC_21022), UK Medical Research Foundation (MRF‐145‐0011‐DG‐HARV‐C0913) and NIHR Southampton Biomedical Research Centre.
Publisher Copyright:
© 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Keywords:
EPIDEMIOLOGY, FRACTURE, FRAX, OSTEOPOROSIS, PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY, PQCT, SARCOPENIA
Identifiers
Local EPrints ID: 473224
URI: http://eprints.soton.ac.uk/id/eprint/473224
ISSN: 2473-4039
PURE UUID: ff69e43b-c5ce-4277-b997-0b1b2d1620a3
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Date deposited: 12 Jan 2023 18:05
Last modified: 30 Nov 2024 02:51
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Contributors
Author:
Eric Orwoll
Author:
Jane A. Cauley
Author:
Timothy Kwok
Author:
Magnus K. Karlsson
Author:
Björn E. Rosengren
Author:
Eva Ribom
Author:
Peggy M. Cawthon
Author:
Kristine Ensrud
Author:
Enwu Liu
Author:
Faidra Laskou
Author:
John A. Kanis
Author:
Liesbeth Vandenput
Author:
Mattias Lorentzon
Author:
Claes Ohlsson
Author:
Dan Mellström
Author:
Helena Johansson
Author:
Eugene McCloskey
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