Background Bone loss increases after menopause. However, bonestrength also depends on structural characteristics such asbone size. Whether bone size increases as a result of periostealapposition and whether a strength index accounting for bothbone density and bone size might predict the risk of fracturebetter than bone density alone are unclear.
Methods Bone mass and the skeletal structure of the distal radiuswere evaluated by single-photon absorptiometry every other yearin 108 women, all of whom were followed from the time of menopausefor a mean period of 15 years. Postmenopausal serum estradiollevels and fractures of the distal radius were noted.
Results The mean (±SD) annual decrease in bone mineraldensity was 1.9±0.7 percent. The medullary bone diameterincreased annually by 1.1±0.9 percent, and the periostealdiameter by 0.7±0.3 percent; the strength index decreasedby 0.7±0.7 percent. The expansion of the medullary diameterand the expansion of the periosteal diameter were correlatedwith one another (r = 0.54, P<0.001), and women in the highestquartile of medullary expansion had more loss of bone mineraldensity and greater periosteal apposition than women in thelowest quartile (P<0.001 for both comparisons). The postmenopausalserum estradiol level was correlated with changes in the periostealdiameter (r = –0.25, P=0.009) and with changes in bonemineral density (r = 0.34, P<0.001). A 1-SD decrement inthe strength index at base line was associated with a risk ratiofor fracture of the distal radius of 3.8 (95 percent confidenceinterval, 1.8 to 8.0).
Conclusions Increased bone loss after menopause is associatedwith increased periosteal apposition, which partially preservesbone strength. A strength index may be a helpful predictor ofthe risk of fracture.
Source Information
From the Departments of Orthopedics (H.G.A., O.J., M.K.K.) and Obstetrics and Gynecology (G.R.), Malmö University Hospital, Malmö, Sweden; and the Department of Orthopedic Surgery and the Biomechanics and Biomaterials Research Center, Indiana University, Indianapolis (C.H.T.).
Address reprint requests to Dr. Ahlborg at the Department of Orthopedics, Malmö University Hospital, SE-205 02 Malmö, Sweden, or at henrik.ahlborg{at}skane.se.
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