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Distal Forearm Fractures and Inheritance of Bone Mass
Journal of Clinical Densitometry: Assessment of Skeletal Health, vol. 16, no. 1, 79e80, 2013 Ó Copyright 2013 by The International Society for Clinical Densitometry 1094-6950/16:79e80/$36.00 http://dx.doi.org/10.1016/j.jocd.2012.09.001
Original Article
Distal Forearm Fractures and Inheritance of Bone Mass Stephen Paul Tuck* Department of Rheumatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
hip sites. Daughters of women with distal forearm fractures whose mothers were osteoporotic on DXA scanning also had lower peak lumbar spine BMD. These differences persisted after adjusting for age, height, and body mass index. This is not surprising as there is extensive literature to show that women with a maternal history of fracture or osteoporosis have lower BMD than age-matched control subjects (7). As far back as 1994, Seeman et al (8) showed that daughters of women with hip fractures have lower BMD compared with a control population. The reasons for this could be both genetic and shared environment. Peak bone mass is largely genetically determined with genetic epidemiological studies suggesting that the heritable component may range between 65% and 92% (9). Recently, quantitative trait locus studies in mice and humans have identified multiple chromosomal regions that influence bone mass (10e12). Indeed, there are now many studies implicating a growing number of genes in the determination of bone density and fracture risk, with the results seeming to vary with both race and gender. Environmental factors are also of considerable importance, and these may well be shared between offspring and their parents. Birth weight and in utero nutrition have been demonstrated to be important in determining bone mass in both childhood and adulthood (13,14). There are also good data on the importance of maternal nutrition, lifestyle, and 25-hydroxyvitamin D status (15) as well as on physical activity, calcium intake, and childhood bone mineral content (16). Data from long-term follow-up studies from birth to adulthood such as the Newcastle 1000 Families Study (17) at 50 yr have demonstrated the importance of adult life factors on later BMD.
Low-trauma distal forearm fractures in postmenopausal women have long been recognized as an indicator of osteoporosis. Indeed, up to 50% of such women have bone density measurements on dual-energy X-ray absorptiometry (DXA) in the osteoporotic range as defined by the World Health Organization (1). Similar results are seen in men with distal forearm fractures, with up to 42% having T-scores 2.5 using gender-specific normative data (2). Furthermore, after a first distal forearm fracture, there is an increased risk of subsequent fractures with hip fractures being increased by 1.4fold in women and 2.7-fold in men and vertebral fractures by 5.2-fold and 10.7-fold, respectively (3). As reported by Center et al (4) in 1999, there is also an increase in standardized mortality ratio after distal forearm fractures, which is particularly high for men and still persists according to more recent data from both Danish and Canadian cohorts (4,5,6). They are so of considerable importance both in their own right and as indicators of osteoporosis and increased fracture risk. Therefore, any data that help us to understand their pathogenesis are to be welcomed. In clinic, I am often asked by my patients if their children are at risk? In this journal, FernandezOjeda et al present data that may help to answer this question. They have demonstrated that the daughters of women with distal forearm fractures have lower peak bone mineral density (BMD) than age- and gender-matched control subjects at the Received 8/22/2012; Accepted 9/4/2012. *Address correspondence to: Stephen Paul Tuck, BSc, MBChB, MRCP (Ireland), MD, Department of Rheumatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom. E-mail: stephen.tuck@ stees.nhs.uk
79
80 So the next time that I am asked the question ‘‘Are my children at risk?’’ I shall be able to say that the answer would appear to be yes, and this includes daughters of postmenopausal women with low-trauma distal forearm fractures. The reasons for this include genetics and shared environment. All medical and paramedical professionals involved with direct patient care need to bear this in mind, and perhaps lifestyle advice and risk assessment should be applied to children of patients who sustain osteoporotic fractures.
References 1. Earnshaw SA, Caute SA, Worley A, Hosking DJ. 1998 Colles’ fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int 8:53e60. 2. Tuck SP, Raj N, Summers GD. 2002 Is distal forearm fracture in men due to osteoporosis? Osteoporos Int 13: 630e636. 3. Cuddihy MT, Gabriel SE, Crowson CS, et al. 1999 Forearm fractures as predictors of subsequent osteoporotic fracture. Osteoporos Int 9:469e475. 4. Center JR, Nguyen TV, Schnieder D, et al. 1999 Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878e882. 5. Morin S, Lix LM, Azimaee M, et al. 2011 Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22(9):2439e2448. 6. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. 2010 Excess mortality in men compared with women following hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39(2):203e209.
Journal of Clinical Densitometry: Assessment of Skeletal Health
Tuck 7. Keen RW, Hart DJ, Arden NK, et al. 1999 Family history of appendicular fracture and risk of osteoporosis: a populationbased study. Osteoporos Int 10:161e166. 8. Seeman E, Tsalamandris C, Formica C, et al. 1994 Reduced femoral neck bone density in the daughters of women with hip fractures: the role of low peak density in the pathogenesis of osteoporosis. J Bone Miner Res 9:739e743. 9. Ngyuen TV, Blangero J, Eisman JA. 2000 Genetic epidemiological approaches to the search for osteoporosis genes. J Bone Miner Res 15:392e401. 10. Deng HW, Xu FH, Huang QY, et al. 2002 A whole-genome linkage scan suggests several genomic regions potentially containing quantitative trait loci for osteoporosis. J Clin Endocrinol Metab 87:5151e5159. 11. Koller DL, Liu G, Econs MJ, et al. 2001 Genome screen for quantitative trait loci underlying normal variation in femoral structure. J Bone Miner Res 16:985e991. 12. Orwoll ES, Belknap JK, Klein RF. 2001 Gender specificity in the genetic determinant of bone mass. J Bone Miner Res 16:1962e1971. 13. Baird J, Kurshid MA, Kim M, et al. 2011 Does birthweight predict bone mass in adulthood? A systematic review and meta-analysis. Osteoporos Int 22:1323e1334. 14. Harvey NC, Mahon PA, Kim M, et al. 2012 Intrauterine growth and postnatal skeletal development: findings from the Southampton Women’s Survey. Paediatr Perinat Epidemiol 26:34e44. 15. Goodfellow LR, Earl S, Cooper C, Harvey NC. 2010 Maternal diet, behaviour and offspring skeletal health. Int J Environ Res Public Health 7:1760e1772. 16. Harvey NC, Cole ZA, Crozier SR, et al. 2012 Physical activity, calcium intake and childhood bone mineral: a population-based cross-sectional study. Osteoporos Int 23:121e130. 17. Pearce MS, Birrell FN, Francis RM, et al. 2005 Lifecourse study of bone health at age 49-51 years: the Newcastle Thousand Families Cohort Study. J Epidemiol Community Health 59:475e480.
Volume 16, 2013
Original Article
Distal Forearm Fractures and Inheritance of Bone Mass Stephen Paul Tuck* Department of Rheumatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom
hip sites. Daughters of women with distal forearm fractures whose mothers were osteoporotic on DXA scanning also had lower peak lumbar spine BMD. These differences persisted after adjusting for age, height, and body mass index. This is not surprising as there is extensive literature to show that women with a maternal history of fracture or osteoporosis have lower BMD than age-matched control subjects (7). As far back as 1994, Seeman et al (8) showed that daughters of women with hip fractures have lower BMD compared with a control population. The reasons for this could be both genetic and shared environment. Peak bone mass is largely genetically determined with genetic epidemiological studies suggesting that the heritable component may range between 65% and 92% (9). Recently, quantitative trait locus studies in mice and humans have identified multiple chromosomal regions that influence bone mass (10e12). Indeed, there are now many studies implicating a growing number of genes in the determination of bone density and fracture risk, with the results seeming to vary with both race and gender. Environmental factors are also of considerable importance, and these may well be shared between offspring and their parents. Birth weight and in utero nutrition have been demonstrated to be important in determining bone mass in both childhood and adulthood (13,14). There are also good data on the importance of maternal nutrition, lifestyle, and 25-hydroxyvitamin D status (15) as well as on physical activity, calcium intake, and childhood bone mineral content (16). Data from long-term follow-up studies from birth to adulthood such as the Newcastle 1000 Families Study (17) at 50 yr have demonstrated the importance of adult life factors on later BMD.
Low-trauma distal forearm fractures in postmenopausal women have long been recognized as an indicator of osteoporosis. Indeed, up to 50% of such women have bone density measurements on dual-energy X-ray absorptiometry (DXA) in the osteoporotic range as defined by the World Health Organization (1). Similar results are seen in men with distal forearm fractures, with up to 42% having T-scores 2.5 using gender-specific normative data (2). Furthermore, after a first distal forearm fracture, there is an increased risk of subsequent fractures with hip fractures being increased by 1.4fold in women and 2.7-fold in men and vertebral fractures by 5.2-fold and 10.7-fold, respectively (3). As reported by Center et al (4) in 1999, there is also an increase in standardized mortality ratio after distal forearm fractures, which is particularly high for men and still persists according to more recent data from both Danish and Canadian cohorts (4,5,6). They are so of considerable importance both in their own right and as indicators of osteoporosis and increased fracture risk. Therefore, any data that help us to understand their pathogenesis are to be welcomed. In clinic, I am often asked by my patients if their children are at risk? In this journal, FernandezOjeda et al present data that may help to answer this question. They have demonstrated that the daughters of women with distal forearm fractures have lower peak bone mineral density (BMD) than age- and gender-matched control subjects at the Received 8/22/2012; Accepted 9/4/2012. *Address correspondence to: Stephen Paul Tuck, BSc, MBChB, MRCP (Ireland), MD, Department of Rheumatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, United Kingdom. E-mail: stephen.tuck@ stees.nhs.uk
79
80 So the next time that I am asked the question ‘‘Are my children at risk?’’ I shall be able to say that the answer would appear to be yes, and this includes daughters of postmenopausal women with low-trauma distal forearm fractures. The reasons for this include genetics and shared environment. All medical and paramedical professionals involved with direct patient care need to bear this in mind, and perhaps lifestyle advice and risk assessment should be applied to children of patients who sustain osteoporotic fractures.
References 1. Earnshaw SA, Caute SA, Worley A, Hosking DJ. 1998 Colles’ fracture of the wrist as an indicator of underlying osteoporosis in postmenopausal women: a prospective study of bone mineral density and bone turnover rate. Osteoporos Int 8:53e60. 2. Tuck SP, Raj N, Summers GD. 2002 Is distal forearm fracture in men due to osteoporosis? Osteoporos Int 13: 630e636. 3. Cuddihy MT, Gabriel SE, Crowson CS, et al. 1999 Forearm fractures as predictors of subsequent osteoporotic fracture. Osteoporos Int 9:469e475. 4. Center JR, Nguyen TV, Schnieder D, et al. 1999 Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878e882. 5. Morin S, Lix LM, Azimaee M, et al. 2011 Mortality rates after incident non-traumatic fractures in older men and women. Osteoporos Int 22(9):2439e2448. 6. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. 2010 Excess mortality in men compared with women following hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39(2):203e209.
Journal of Clinical Densitometry: Assessment of Skeletal Health
Tuck 7. Keen RW, Hart DJ, Arden NK, et al. 1999 Family history of appendicular fracture and risk of osteoporosis: a populationbased study. Osteoporos Int 10:161e166. 8. Seeman E, Tsalamandris C, Formica C, et al. 1994 Reduced femoral neck bone density in the daughters of women with hip fractures: the role of low peak density in the pathogenesis of osteoporosis. J Bone Miner Res 9:739e743. 9. Ngyuen TV, Blangero J, Eisman JA. 2000 Genetic epidemiological approaches to the search for osteoporosis genes. J Bone Miner Res 15:392e401. 10. Deng HW, Xu FH, Huang QY, et al. 2002 A whole-genome linkage scan suggests several genomic regions potentially containing quantitative trait loci for osteoporosis. J Clin Endocrinol Metab 87:5151e5159. 11. Koller DL, Liu G, Econs MJ, et al. 2001 Genome screen for quantitative trait loci underlying normal variation in femoral structure. J Bone Miner Res 16:985e991. 12. Orwoll ES, Belknap JK, Klein RF. 2001 Gender specificity in the genetic determinant of bone mass. J Bone Miner Res 16:1962e1971. 13. Baird J, Kurshid MA, Kim M, et al. 2011 Does birthweight predict bone mass in adulthood? A systematic review and meta-analysis. Osteoporos Int 22:1323e1334. 14. Harvey NC, Mahon PA, Kim M, et al. 2012 Intrauterine growth and postnatal skeletal development: findings from the Southampton Women’s Survey. Paediatr Perinat Epidemiol 26:34e44. 15. Goodfellow LR, Earl S, Cooper C, Harvey NC. 2010 Maternal diet, behaviour and offspring skeletal health. Int J Environ Res Public Health 7:1760e1772. 16. Harvey NC, Cole ZA, Crozier SR, et al. 2012 Physical activity, calcium intake and childhood bone mineral: a population-based cross-sectional study. Osteoporos Int 23:121e130. 17. Pearce MS, Birrell FN, Francis RM, et al. 2005 Lifecourse study of bone health at age 49-51 years: the Newcastle Thousand Families Cohort Study. J Epidemiol Community Health 59:475e480.
Volume 16, 2013