Compromised Bone Microarchitecture and Estimated Bone Strength in Young Adults With Cystic Fibrosis

Context: Young adults with cystic fibrosis (CF) are at risk for low bone density and fractures, but the underlying alterations in bone microarchitecture that may contribute to their increased fracture risk are currently unknown. Objective: The main goal of this study was to use high-resolution perip...

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Published in:The journal of clinical endocrinology and metabolism 2014-09, Vol.99 (9), p.3399-3407
Main Authors: Putman, Melissa S, Milliren, Carly E, Derrico, Nicholas, Uluer, Ahmet, Sicilian, Leonard, Lapey, Allen, Sawicki, Gregory, Gordon, Catherine M, Bouxsein, Mary L, Finkelstein, Joel S
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Adult
Bone Density - physiology
Cross-Sectional Studies
Cystic Fibrosis - pathology
Endocrine Research
Female
Fractures, Bone - diagnostic imaging
Fractures, Bone - pathology
Humans
Male
Radius - diagnostic imaging
Radius - pathology
Radius - ultrastructure
Risk Assessment
Tibia - diagnostic imaging
Tibia - pathology
Tibia - ultrastructure
Tomography, X-Ray Computed
Young Adult
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Summary:Context: Young adults with cystic fibrosis (CF) are at risk for low bone density and fractures, but the underlying alterations in bone microarchitecture that may contribute to their increased fracture risk are currently unknown. Objective: The main goal of this study was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) to characterize the bone microarchitecture, volumetric bone mineral density (vBMD), and estimated strength of the radius and tibia in young adults with CF compared with healthy volunteers. Design and Setting: This was a cross-sectional study at an outpatient clinical research center within a tertiary academic medical center. Participants: Thirty young adults with CF, 18 to 40 years of age, were evaluated and compared with 60 healthy volunteers matched by age (±2 years), gender, and race. Main Outcome Measures: The primary outcomes were HR-pQCT–derived cortical and trabecular vBMD, bone microarchitecture, and estimates of bone strength. Results: At the radius and tibia, young adults with CF had smaller bone cross-sectional area and lower vBMD. Cortical and trabecular microarchitecture were compromised at both sites, most notably involving the trabecular bone of the tibia. These differences translated into lower estimated bone strength both at the radius and tibia. After accounting for body mass index differences, young adults with CF had lower bone area and estimated bone strength at the radius and had compromised trabecular microarchitecture and lower total and trabecular vBMD and estimated bone strength at the tibia. Alterations in trabecular bone density and microarchitecture and estimated strength measures of the tibia were also greater than expected based on dual-energy x-ray absorptiometry-derived areal BMD differences. Conclusions: Young adults with CF have compromised bone microarchitecture and lower estimated bone strength at both the radius and tibia, even after accounting for their smaller body size. These skeletal deficits likely explain the higher fracture risk observed in young adults with CF.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2014-1982