Early Changes in Bone Density, Micro Architecture, Bone Resorption and Inflammation Predict the Clinical Outcome 12 weeks after Conservatively Treated Distal Radius Fractures: An Exploratory Study

U. Meyer, J.J. de Jong, S.G.P. Bours, A.P. Keszei, J.J. Arts, P.R.G. Brink, P. Menheere, T.A.C.M. van Geel, B. van Rietbergen, J.P.W. van den Bergh, P. Geusens, P.C. Willems

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Abstract

Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 +/- 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (beta -0.96 [95% CI -1.75 to - 0.16], R-2 = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R-2 = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R-2 = 0.33) and in ICTP (12.1 [0.0 to 24.1], R-2 = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R-2 = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12-week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. (C) 2014 American Society for Bone and Mineral Research.

Original languageEnglish
Pages (from-to)2065-2073
Number of pages9
JournalJournal of Bone and Mineral Research
Volume29
Issue number9
DOIs
Publication statusPublished - Sep 2014

Keywords

  • BONE QCT/MICRO-CT
  • INJURY/FRACTURE HEALING
  • BIOCHEMICAL MARKERS OF BONE TURNOVER
  • OSTEOPOROSIS
  • BIOMECHANICS
  • FINITE-ELEMENT-ANALYSIS
  • QUALITY-OF-LIFE
  • OSTEOPOROTIC FRACTURES
  • COLLES FRACTURE
  • ALGODYSTROPHY
  • DISABILITY
  • PATIENT
  • TURNOVER
  • COMPLICATION
  • ASSOCIATION

Cite this

@article{1427f65600de4745989038a601c96dd4,
title = "Early Changes in Bone Density, Micro Architecture, Bone Resorption and Inflammation Predict the Clinical Outcome 12 weeks after Conservatively Treated Distal Radius Fractures: An Exploratory Study",
abstract = "Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 +/- 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (beta -0.96 [95{\%} CI -1.75 to - 0.16], R-2 = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R-2 = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R-2 = 0.33) and in ICTP (12.1 [0.0 to 24.1], R-2 = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R-2 = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12-week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. (C) 2014 American Society for Bone and Mineral Research.",
keywords = "BONE QCT/MICRO-CT, INJURY/FRACTURE HEALING, BIOCHEMICAL MARKERS OF BONE TURNOVER, OSTEOPOROSIS, BIOMECHANICS, FINITE-ELEMENT-ANALYSIS, QUALITY-OF-LIFE, OSTEOPOROTIC FRACTURES, COLLES FRACTURE, ALGODYSTROPHY, DISABILITY, PATIENT, TURNOVER, COMPLICATION, ASSOCIATION",
author = "U. Meyer and {de Jong}, J.J. and S.G.P. Bours and A.P. Keszei and J.J. Arts and P.R.G. Brink and P. Menheere and {van Geel}, T.A.C.M. and {van Rietbergen}, B. and {van den Bergh}, J.P.W. and P. Geusens and P.C. Willems",
year = "2014",
month = "9",
doi = "10.1002/jbmr.2225",
language = "English",
volume = "29",
pages = "2065--2073",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley",
number = "9",

}

Early Changes in Bone Density, Micro Architecture, Bone Resorption and Inflammation Predict the Clinical Outcome 12 weeks after Conservatively Treated Distal Radius Fractures: An Exploratory Study. / Meyer, U.; de Jong, J.J.; Bours, S.G.P.; Keszei, A.P.; Arts, J.J.; Brink, P.R.G.; Menheere, P.; van Geel, T.A.C.M.; van Rietbergen, B.; van den Bergh, J.P.W.; Geusens, P.; Willems, P.C.

In: Journal of Bone and Mineral Research, Vol. 29, No. 9, 09.2014, p. 2065-2073.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Early Changes in Bone Density, Micro Architecture, Bone Resorption and Inflammation Predict the Clinical Outcome 12 weeks after Conservatively Treated Distal Radius Fractures: An Exploratory Study

AU - Meyer, U.

AU - de Jong, J.J.

AU - Bours, S.G.P.

AU - Keszei, A.P.

AU - Arts, J.J.

AU - Brink, P.R.G.

AU - Menheere, P.

AU - van Geel, T.A.C.M.

AU - van Rietbergen, B.

AU - van den Bergh, J.P.W.

AU - Geusens, P.

AU - Willems, P.C.

PY - 2014/9

Y1 - 2014/9

N2 - Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 +/- 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (beta -0.96 [95% CI -1.75 to - 0.16], R-2 = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R-2 = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R-2 = 0.33) and in ICTP (12.1 [0.0 to 24.1], R-2 = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R-2 = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12-week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. (C) 2014 American Society for Bone and Mineral Research.

AB - Fracture healing is an active process with early changes in bone and inflammation. We performed an exploratory study evaluating the association between early changes in densitometric, structural, biomechanical, and biochemical bone parameters during the first weeks of fracture healing and wrist-specific pain and disability at 12 weeks in postmenopausal women with a conservatively treated distal radius fracture. Eighteen patients (aged 64 +/- 8 years) were evaluated at 1 to 2 and 3 to 4 weeks postfracture, using high-resolution peripheral quantitative computed tomography (HR-pQCT), micro-finite element analysis, serum procollagen type-I N-terminal propeptide (P1NP), carboxy-terminal telopeptide of type I collagen (ICTP), and high-sensitive C-reactive protein (hsCRP). After 12 weeks, patients rated their pain and disability using Patient Rated Wrist Evaluation (PRWE) questionnaire. Additionally, Quick Disability of the Arm Shoulder and Hand (QuickDASH) questionnaire and active wrist range of motion was evaluated. Linear regression models were used to study the relationship between changes in bone parameters and in hsCRP from visit 1 to 2 and PRWE score after 12 weeks. A lower PRWE outcome, indicating better outcome, was significantly related to an early increase in trabecular bone mineral density (BMD) (beta -0.96 [95% CI -1.75 to - 0.16], R-2 = 0.37), in torsional stiffness (-0.14 [-0.28 to -0.004], R-2 = 0.31), and to an early decrease in trabecular separation (209 [15 to 402], R-2 = 0.33) and in ICTP (12.1 [0.0 to 24.1], R-2 = 0.34). Similar results were found for QuickDASH. Higher total dorsal and palmar flexion range of motion was significantly related to early increase in hsCRP (9.62 [3.90 to 15.34], R-2 = 0.52). This exploratory study indicates that the assessment of early changes in trabecular BMD, trabecular separation, calculated torsional stiffness, bone resorption marker ICTP, and hsCRP after a distal radius fracture provides valuable information regarding the 12-week clinical outcome in terms of pain, disability, and range of motion and validates its use in studies on the process of early fracture healing. (C) 2014 American Society for Bone and Mineral Research.

KW - BONE QCT/MICRO-CT

KW - INJURY/FRACTURE HEALING

KW - BIOCHEMICAL MARKERS OF BONE TURNOVER

KW - OSTEOPOROSIS

KW - BIOMECHANICS

KW - FINITE-ELEMENT-ANALYSIS

KW - QUALITY-OF-LIFE

KW - OSTEOPOROTIC FRACTURES

KW - COLLES FRACTURE

KW - ALGODYSTROPHY

KW - DISABILITY

KW - PATIENT

KW - TURNOVER

KW - COMPLICATION

KW - ASSOCIATION

U2 - 10.1002/jbmr.2225

DO - 10.1002/jbmr.2225

M3 - Article

VL - 29

SP - 2065

EP - 2073

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

SN - 0884-0431

IS - 9

ER -