Association of moderate/severe vertebral fractures with reduced trabecular volumetric bone density in older women and reduced areal femoral neck bone density in older men from the community: A cross-sectional study (SPAH)

Abstract Background Many vertebral fractures (VF) occur in individuals classified by DXA as being at low risk of fragility fractures. The aim of this study was to verify the association between VF and peripheral bone microarchitecture and strength parameters (SP) using, in addition to DXA, high-resolution peripheral quantitative computed tomography (HR-pQCT) and axial bone microarchitecture using the trabecular bone score (TBS). Study design Cross-sectional study of 276 community-dwelling subjects aged ≥65 years from the SPAH study cohort. Methods Lateral DXA scans of the spine were analyzed to assess VF. HR-pQCT was performed at the radius and tibia. TBS was determined using DXA. Results VF was observed in 42.6% of women and 28% of men. At the tibia, women with moderate/severe VF had lower volumetric bone density (vBMD), trabecular number (Tb.N), and SP, and higher trabecular separation (Tb.Sp); and men with VF had lower Tb.N and SP, and higher Tb.Sp. At the radius, women with moderate/severe VF had lower vBMD, trabecular and cortical thickness and SP; and men with VF had lower trabecular vBMD and SP. No associations between TBS and VF were observed in either gender. Logistic regression analysis revealed that trabecular vBMD at the tibia in women (OR:0.980, 95%CI:0.963–0.997, p = 0.022) and femoral neck aBMD in men (OR:0.445, 95%CI:0.212–0.935, p = 0.033) were independently associated with VF. Conclusion HR-pQCT images detected differences in bone microstructure in older women with VF independent of aBMD and TBS by DXA, and HR-pQCT could be a useful tool to assess fracture risk. In men, femoral neck aBMD was associated with VF, and DXA continues to be an important tool for predicting VF.