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dc.contributor.authorKral, Rita
dc.contributor.authorOsima, Marit
dc.contributor.authorBorgen, Tove Tveitan
dc.contributor.authorVestgaard, Roald
dc.contributor.authorRichardsen, Elin
dc.contributor.authorBjørnerem, Åshild
dc.date.accessioned2018-01-04T08:55:25Z
dc.date.available2018-01-04T08:55:25Z
dc.date.issued2017-09-25
dc.description.abstractThe Fracture Risk Assessment Tool (FRAX) and Garvan Calculator have improved the individual prediction of fracture risk. However, additional bone measurements that might enhance the predictive ability of these tools are the subject of research. There is increasing interest in cortical parameters, especially cortical porosity. Neither FRAX nor Garvan include measurements of cortical architecture, important for bone strength, and providing independent information beyond the conventional approaches. We tested the hypothesis that cortical parameters are associated with fracture risk, independent of FRAX and Garvan estimates. This nested case-control study included 211 postmenopausal women aged 54–94 years with nonvertebral fractures, and 232 controls from the Tromsø Study in Norway. We assessed FRAX and Garvan 10-year risk estimates for fragility fracture, and quantified femoral subtrochanteric cortical porosity, thickness, and area from computed tomography images using StrAx1.0 software. Per standard deviation higher cortical porosity, thinner cortices, and smaller cortical area, the odds ratio (95% confidence interval) for fracture was 1.71 (1.38–2.11), 1.79 (1.44–2.23), and 1.52 (1.19–1.95), respectively. Cortical porosity and thickness, but not area, remained associated with fracture when adjusted for FRAX and Garvan estimates. Adding cortical porosity and thickness to FRAX or Garvan resulted in greater area under the receiver operating characteristic curves. When using cortical porosity (>80th percentile) or cortical thickness (<20th percentile) combined with FRAX (threshold >20%), 45.5% and 42.7% of fracture cases were identified, respectively. Using the same cutoffs for cortical porosity or thickness combined with Garvan (threshold >25%), 51.2% and 48.3% were identified, respectively. Specificity for all combinations ranged from 81.0–83.6%. Measurement of cortical porosity or thickness identified 20.4% and 17.5% additional fracture cases that, were unidentified using FRAX alone, and 16.6% and 13.7% fracture cases unidentified using Garvan alone. In conclusion, cortical parameters may help to improve identification of women at risk for fracture.en_US
dc.descriptionSource at <a href=https://doi.org/10.1371/journal.pone.0185363> https://doi.org/10.1371/journal.pone.0185363 </a>en_US
dc.identifier.citationKral, R., Osima, M., Borgen, T.T., Vestgaard, R., Richardsen, E. & Bjørnerem, Å. (2017). Increased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal women . <i>PLoS ONE, 12</i>(9), e0185363. https://doi.org/10.1371/journal.pone.0185363en_US
dc.identifier.cristinIDFRIDAID 1506175
dc.identifier.doi10.1371/journal.pone.0185363
dc.identifier.issn1932-6203
dc.identifier.urihttps://hdl.handle.net/10037/11902
dc.language.isoengen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.ispartofKral, R. (2018). Cortical bone and fracture risk: The Tromsø Study. Doctoral thesis. <a href=http://hdl.handle.net/10037/13979>http://hdl.handle.net/10037/13979.</a>
dc.relation.journalPLoS ONE
dc.rights.accessRightsopenAccessen_US
dc.subjectVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Geriatri: 778en_US
dc.subjectVDP::Medical disciplines: 700::Clinical medical disciplines: 750::Geriatrics: 778en_US
dc.titleIncreased cortical porosity and reduced cortical thickness of the proximal femur are associated with nonvertebral fracture independent of Fracture Risk Assessment Tool and Garvan estimates in postmenopausal womenen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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