JBMR: HR-pQCT is the best performance parameter for predicting fragility fractures

Background and purpose: Osteoporosis is a systemic bone disease characterized by bone loss and deterioration of bone structure, which can lead to fragility fractures
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The use of bone imaging to accurately predict fragility fractures has always been an important issue, but the current dual-energy X-ray bone densitometer (DXA) gold standard for diagnosing osteoporosis cannot fully meet this goal

Osteoporosis is a systemic bone disease characterized by bone loss and deterioration of bone structure, which can lead to fragility fractures

Search method: Document search in Embase, PubMed and Web of Science databases
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The keywords "HR-pQCT OR high resolution peripheral quantitative computed tomography OR XtremeCT" and "fracture*" search in all fields

Search method:

Search criteria: The inclusion criteria are as follows: (i) clinical research, (ii) subjects aged ≥50 years or postmenopausal, (iii) fragility fractures, that is, falling from standing height
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(15) The exclusion criteria are as follows: (i) non-English articles, (ii) reviews, meeting abstracts, case reports, protocol terms, (iii) diseases that affect bone metabolism, (iv) non-standard HR-pQCT parameters or Evaluation, (v) accuracy or validation or machine learning research, (vi) skull, face, finger and toe fractures

search condition:

Selected research: The research selection was conducted by two independent reviewers
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The copy is removed

Selected research:

Data extraction : The reviewers extracted the following information: study design, race, gender, age, sample size, degree of trauma, fragility fracture location, fracture prediction results (odds ratio [OR], hazard ratio [HR]), HR-pqct model , Measurement location and HR-pqct related parameter data
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Data extraction :

Quality assessment of included studies : Two authors independently assessed the quality of the selected studies
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The disagreement was resolved through discussion

Quality assessment of included studies :

Results: A total of 25 articles for systematic reviews and 16 articles for meta-analysis were included
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HR-pQCT can significantly predict sudden fractures and/or major osteoporotic fractures (MOFs)

Figure 1 Flow chart of the selection process of literature search
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Figure 1 Flow chart of the selection process of literature search
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Table 1 Quality evaluation of Newcastle-Ottawa scale in case-control study

Table 1 Quality evaluation of Newcastle-Ottawa scale in case-control study

Table 2 The Newcastle-Ottawa scale assesses the quality of cohort studies

Table 2 The Newcastle-Ottawa scale assesses the quality of cohort studies

Figure 2 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; (D) distal tibia; MOF
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Ct.

Figure 2 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; (D) distal tibia; MOF
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Ct.
vBMD = cortical volume bone mineral density; MOF = major osteoporotic fractures
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Figure 3 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; (D) distal tibia; MOF
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MOF = major osteoporotic fracture; Tb.
Th = trabecular bone thickness
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Figure 3 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; (D) distal tibia; MOF
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MOF = major osteoporotic fracture; Tb.
Th = trabecular bone thickness
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Figure 4 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; MOF
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MOF = severe osteoporotic fracture
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Figure 4 (A) distal radius; (B) distal tibia; (B) distal tibia; (C) distal radius; (D) distal tibia; MOF
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MOF = severe osteoporotic fracture
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Conclusion: HR-pQCT can be widely used in the diagnosis of osteoporosis and the prediction of fragility fractures in the future
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HR-pQCT can be widely used in the diagnosis of osteoporosis and the prediction of fragility fractures in the future
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Original source:

Cheung WH, Hung VW, Cheuk KY,et al.
Best Performance Parameters of HR-pQCT to Predict Fragility Fracture-Systematic Review and Meta-analysis .
J Bone Miner Res 2021 Sep 29

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