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Simon A, Schäfer HS, Schmidt FN, Stürznickel J, Amling M, Rolvien T. Compartment-specific effects of muscle strength on bone microarchitecture in women at high risk of osteoporosis. J Cachexia Sarcopenia Muscle 2022; 13:2310-2321. [PMID: 35852049 PMCID: PMC9530535 DOI: 10.1002/jcsm.13044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/27/2022] [Accepted: 06/25/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND It is well known that skeletal integrity is influenced by the musculature. Poor muscle strength (i.e. sarcopenia) is considered a major predictor of fragility fractures. While this observation appears particularly relevant for older women with increased risk of osteoporosis, there has been no comprehensive investigation to determine the influence of muscle performance on compartment-specific bone microarchitecture in multiple body regions. METHODS We retrospectively analysed data from different muscle performance and bone microarchitecture assessments in 230 women (aged 21 to 87 years) at high risk of osteoporosis. Muscle performance tests included grip strength and chair rising test (CRT) combined with mechanography. Balance was determined by Romberg posturography. Areal bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) at the hip and lumbar spine. Compartment-specific volumetric BMD, microarchitecture, and geometry were assessed by second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) at multiple skeletal sites (distal radius, tibia, and fibula). Regression models were applied to test for interactions between muscle and bone parameters. Subgroups were defined to compare women with osteoporosis and osteosarcopenia regarding BMD and microarchitecture. RESULTS While osteoporosis was diagnosed in 115/230 (50.0%) women, sarcopenia was detected in 38/230 (16.5%). Positive associations of both grip strength and CRT maximum force with cortical geometric and microarchitectural parameters were detected at all measured sites, with the strongest effect applying to CRT maximum force and tibial parameters (e.g. tibial cortical area R2 = 0.36, P < 0.0001, and tibial cortical thickness R2 = 0.26, P < 0.0001). Balance parameters showed much weaker or no associations with HR-pQCT parameters. Major associations between muscle strength and trabecular parameters could not be confirmed. Age and body mass index were confirmed as negative and positive predictors for several microarchitectural parameters, respectively. An independent predictive value of grip strength on radial, tibial, and fibular (all P < 0.01) cortical area and of CRT maximum relative force on cortical thickness (all P < 0.05) was revealed. Women with osteosarcopenia showed significantly reduced cortical HR-pQCT parameters but no differences in DXA values compared with women with osteoporosis but no sarcopenia. Stratification by fracture and treatment status revealed that vertebral fractures and denosumab treatment altered the muscle-bone interaction. CONCLUSIONS A systemic interaction between muscle strength and bone microarchitecture was demonstrated, and this interaction appears to be primarily with the cortical bone compartment. The value of muscle assessments in fracture risk evaluation may be partly mediated by their effects on bone microarchitecture.
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Affiliation(s)
- Alexander Simon
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah S Schäfer
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Stürznickel J, Schmidt FN, Schäfer HS, Beil FT, Frosch KH, Schlickewei C, Amling M, Barg A, Rolvien T. Bone microarchitecture of the distal fibula assessed by HR-pQCT. Bone 2021; 151:116057. [PMID: 34139389 DOI: 10.1016/j.bone.2021.116057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
The distal fibula represents one of the most common fracture sites, and its epidemiology is characterized by a high incidence in both adolescence and the elderly. While fracture occurrence is influenced by trauma mechanism, a possible underlying skeletal microarchitectural deterioration in certain patient groups remains elusive. The purpose of this study was to determine the influence of age, sex, and overall skeletal status on fibular microarchitecture. We analyzed the microarchitecture of the distal fibula in 300 people by high-resolution peripheral quantitative computed tomography (HR-pQCT). Three areal bone mineral density (aBMD) groups (normal, osteopenia, osteoporosis; n = 100 per group) based on the concurrent assessment of aBMD by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and total hip were established. Next to group comparisons, linear and non-linear regression analyses were carried out to assess the association between age, sex, BMI, tibial and fibular microarchitecture. While women had lower values for both trabecular bone volume fraction (BV/TVd, p < 0.001) and cortical thickness (Ct.Thd, p < 0.001) than men, osteoporosis by DXA negatively affected these parameters in both sexes. Remarkably, cortical but not trabecular microarchitecture declined with age, with a stronger decrease in females compared to males (Ct.Thd female -10.0 μm/year (95% CI: -12.2 to -7.7 μm/year), male -4.0 μm/year (95% CI: -6.3 to -1.7 μm/year)). Moderate positive associations between distal tibial and fibular microarchitecture were noted (e.g., BV/TVd R2 = 0.54, Ct.Thd R2 = 0.58). In summary, we here demonstrate the severe negative effects of age, female sex and osteoporosis on distal fibula bone mineralization and microarchitecture. The presented findings are likely to explain the higher susceptibility to distal fibula fractures in elderly women (independent of trauma mechanism). These alterations in fibular bone quality must be taken into account in the context of fracture prevention and treatment (e.g., osteosynthesis planning).
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Affiliation(s)
- Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Hannah S Schäfer
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Timo Beil
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
| | - Carsten Schlickewei
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Alexej Barg
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany; Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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