The ability of structural deterioration to predict fracture is independent of bone mineral density status: the OFELY study — ASN Events
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The ability of structural deterioration to predict fracture is independent of bone mineral density status: the OFELY study (#31)

Ego Seeman 1 2 , Elisabeth Sornay-Rendu 3 , Yu Peng 4 , Lucy Busija 2 , Roger Zebaze 1 , Roland Chapurlat 3
  1. Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, West Heidelberg, VIC, Australia
  2. Institute for Health and Ageing, Australian Catholic University, Melbourne, VIC, Australia
  3. INSERM UMR1033 and Université de Lyon, Lyon, France
  4. Straxcorp, Melbourne, VIC, Australia

Introduction       Most of the health burden of fractures arises from women with osteopenia or normal BMD.  These women are at low risk for fracture as a group, but among them are women with bone fragility not captured by the diagnostic threshold of ‘osteoporosis’. The challenge is to identify this small percentage of women among the great many at low risk so that treatment can be targeted to them and avoided in the majority not needing it.

Methods              In a 10-year prospective study, 562 French postmenopausal women had measurements of distal radial cortical and trabecular microstructure using high resolution peripheral quantitative computed tomography, femoral neck BMD and FRAX. Cortical and trabecular deterioration were expressed as a Structural Fragility Score (SFS) using StrAx1.0.  Results are presented as relative risks (RR) with 95% confidence intervals (CI).

Results               By 2 years of follow up, 31 women had had a fracture; 7 (22.5%) had osteoporosis and 24 (77.41%) had osteopenia or normal BMD.  The SFS identified women with osteoporosis (BMD threshold of -2.5 SD) who sustained fractures- RR = 4.93 (95%CI 2.30 – 10.52, p = 0.0008), and the remainder women with osteopenia or normal BMD -RR= (45.8%) (RR 2.12, 95% CI 1.33- 3.39; p = 0.008).

By 10 years of follow-up, 130 women had had a fracture; The SFS identified the subset of these women with osteoporosis who sustained fracture – RR= 2.26 (RR 95% CI 1.22- 4.89; p = 0.01; and the remainder who were classified as having osteopenia or normal BMD 43 of 115 (37%) women having fractures - RR = 1.99 (95% CI 1.46-2.73; p <0.0001).  

Conclusion         Finding osteopenia or normal BMD does not exclude bone fragility.  Measuring bone microstructure detects women at risk in these BMD categories with similar ability as in those with osteoporosis.