ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2020
Deterioration of Cortical and Trabecular Microstructure Identifies Women With Osteopenia or Normal Bone Mineral Density at Imminent and Long-Term Risk for Fragility Fracture: A Prospective Study.
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 2 of them syntheses that pooled it.
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Who cites it
33 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Pooled it
- Pooled it
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- Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial.BMJ (Clinical research ed.) · 2021Trial
- Distinct Cortical Microstructure in Postmenopausal Women with Distal Radius and Proximal Humerus Fractures.Calcified tissue international · 2026Article
- Therapeutic functions of tanshinone IIA in a zebrafish model of glucocorticoid-induced osteoporosis.Frontiers in pharmacology · 2026Article
- Localized bone deterioration predicts declining failure load and increased fracture risk.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- A novel computed tomography-based algorithm for the quantitative identification of lumbar spine-localized trabecular bone loss in patients with type 2 diabetes mellitus.Quantitative imaging in medicine and surgery · 2026Article
- Prevalence of osteoporosis in postmenopausal Indian women: A cross-sectional study.Bioinformation · 2026Article
- Quantifying localized bone loss in clinical computed tomography using void spaces.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Metformin facilitates osteogenic differentiation of bone marrow stromal cells through AMPK-dependent autophagy: an investigation into the healing of osteoporotic fractures in murine models.Journal of orthopaedic surgery and research · 2025Article
- Thermal profile of the spine for the assessment of bone metabolic disorders.Scientific reports · 2025Article
- 7-Hydroxyflavone Mitigates OsteoporosisCurrent topics in medicinal chemistry · 2025Article
- Short-term risk of fracture is increased by deficits in cortical and trabecular bone microarchitecture independent of DXA BMD and FRAX: Bone Microarchitecture International Consortium (BoMIC) prospective cohorts.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2024Article
- Predictive value of serum inflammatory biomarkers in postmenopausal osteoporosis: A cross-sectional study in northwest Iran.Heliyon · 2024Article
- Treatment effects, adverse outcomes and cardiovascular safety of romosozumab - Existing worldwide data: A systematic review and meta-analysis.Journal of orthopaedic translation · 2024Review
- The MicroRNAs in the Pathophysiology of Osteoporosis.International journal of molecular sciences · 2024Review
- The relationship between bone strain index, bone mass, microarchitecture and mechanical behavior in human vertebrae: an ex vivo study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Article
- The Impact of Gender-Affirming Hormone Therapy on Physical Performance.The Journal of clinical endocrinology and metabolism · 2024Review
- Mechanical impact of regional structural deterioration and tissue-level compensation on proximal femur trabecular bone.Frontiers in bioengineering and biotechnology · 2024Article
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
More than 70% of women sustaining fractures have osteopenia or "normal" bone mineral density (BMD). These women remain undetected using the BMD threshold of -2.5 SD for osteoporosis. As microstructural deterioration increases bone fragility disproportionate to the bone loss producing osteopenia/normal BMD, we hypothesized that the structural fragility score (SFS) of ≥70 units, a measure capturing severe cortical and trabecular deterioration, will identify these women. Distal radial images were acquired using high-resolution peripheral quantitative tomography in postmenopausal French women, mean age 67 years (range 42-96 years); 1539 women were followed for 4 years (QUALYOR) and 561 women followed for 8 years (OFELY). Women with osteopenia or normal BMD accounted for ~80% of fractures. Women ≥70 years, 29.2% of the cohort, accounted for 39.2% to 61.5% of fractures depending on follow-up duration. Women having fractures had a higher SFS, lower BMD, and a higher fracture risk assessment score (FRAX) than women remaining fracture-free. In each BMD category (osteoporosis, osteopenia, normal BMD), fracture incidence was two to three times higher in women with SFS ≥70 than <70. In multivariable analyses, associations with fractures remained for BMD and SFS, not FRAX. BMD was no longer, or weakly, associated with fractures after accounting for SFS, whereas SFS remained associated with fracture after accounting for BMD. SFS detected two-to threefold more women having fractures than BMD or FRAX. SFS in women with osteopenia/normal BMD conferred an odds ratio for fracture of 2.69 to 5.19 for women of any age and 4.98 to 12.2 for women ≥70 years. Receiver-operator curve (ROC) analyses showed a significant area under the curve (AUC) for SFS, but not BMD or FRAX for the women ≥70 years of age. Targeting women aged ≥70 years with osteopenia indicated that treating 25% using SFS to allocate treatment conferred a cost-effectiveness ratio < USD $21,000/QALY saved. Quantifying microstructural deterioration complements BMD by identifying women without osteoporosis at imminent and longer-term fracture risk. © 2019 American Society for Bone and Mineral Research.
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