Trabecular Volumetric Bone Mineral Density Is Associated With Previous Fracture During Childhood and Adolescence in Males: The GOOD Study

Areal bone mineral density (aBMD) measured with dual-energy X-ray absorptiometry (DXA) has been associated with fracture risk in children and adolescents, but it remains unclear whether this association is due to volumetric BMD (vBMD) of the cortical and/or trabecular bone compartments or bone size. The aim of this study was to determine whether vBMD or bone size was associated with Xray-verified fractures in men during growth. In total, 1068 men (aged 18.9 +/- 0.6 years) were included in the population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) Study. Areal BMD was measured by DXA, whereas cortical and trabecular vBMD and bone size were measured by peripheral quantitative computerized tomography (pQCT). X-ray records were searched for fractures. Self-reported fractures in 77 men could not be confirmed in these records. These men were excluded, resulting in 991 included men, of which 304 men had an X-ray-verified fracture and 687 were nonfracture subjects. Growth charts were used to establish the age of peak height velocity (PHV, n = 600). Men with prevalent fractures had lower aBMD (lumbar spine 2.3%, p = 0 0 5; total femur 2.6%, p=.004, radius 2.1%, p<.001) at all measured sites than men without fracture. Using pQCT measurements, we found that men with a prevalent fracture had markedly lower trabecular vBMD (radius 6.6%, p=7.5 x 10(-8); tibia 4.5%, p=1.7 x 10(-7)) as well as a slightly lower cortical vBMD (radius 0.4%, p=.0012; tibia 0.3%, p=.015) but not reduced cortical cross-sectional area than men without fracture. Every SD decrease in trabecular vBMD of the radius and tibia was associated with 1.46 [radius 95% confidence interval (Cl) 1.26-1.69; tibia 95% CI 1.26-1.68] times increased fracture prevalence. The peak fracture incidence coincided with the timing of PHV (+/-1 year). In conclusion, trabecular vBMD but not aBMD was independently associated with prevalent X-ray-verified fractures in young men. Further studies are needed to determine if assessment of trabecular vBMD could enhance prediction of fractures during growth in males. (C) 2010 American Society for Bone and Mineral Research.