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Bone scanning for osteoporosis 'could be used to predict hip fractures'

Published on 29 November 2016
Bone scanning for osteoporosis 'could be used to predict hip fractures'

A new study has shed light on the way in which people with a specific type of osteoporosis are likely to experience weakness in their bones that increases their chances of suffering a fracture.

The research from the University of Cambridge, which was funded by Arthritis Research UK, has shown how further examination of bone quality might in future help to identify which patients may be at greatest risk of a hip fracture.

Bone mapping to identify weak spots

Focal osteoporosis is a form of the disease that affects specific parts of the bone. It is recognised that focal osteoporosis present in certain areas of the hips can greatly increase a person's chance of a fracture, as these parts of the hip are particularly vulnerable to rapid bone loss with ageing due to limited stress during walking and sitting.

For this research, published in the scientific journal Bone, a technique known as cortical bone mapping (CBM) was applied to CT scans in order to find areas of bone weakness in patients with acute hip fractures.

A total of 313 female and 40 male volunteers took part in this research, which revealed that hip fracture patients tended to have specific patterns of focal osteoporosis. These patterns were shown to correspond to the type of fracture the patient had, which shows that focal osteoporosis could allow us to determine the location of hip fractures.

Potential diagnostic insights from bone scans

CBM analysis was shown to be better at identifying fracture types than traditional techniques of measuring the bone mineral density. However, only a minimal improvement was seen in terms of predicting hip fractures. The researchers then included measurements of the spongy trabecular tissue inside the bones, which helped to improve this performance. In doing so, focal osteoporosis was confirmed to be associated with reduced levels of spongy trabecular bone tissue below the hard cortical shell.

Overall, the research demonstrated the potential application of the CBM technique in showing the benefits of osteoporosis drug treatments and exercises. This could be useful, as it suggests that the two main categories of hip fracture will need different preventative strategies.

Researcher Ken Poole, of the department of medicine at the University of Cambridge and Addenbrooke's Hospital, said: "We confirmed Jonathan Reeve's landmark observation that the osteoporosis of hip fracture patients targets a few key areas, not the whole bone.

"We can now identify these key areas with ordinary CT scans of patients, and the areas of focal osteoporosis we found link very well to the place the fracture happens. Focal osteoporosis is a new target for exercise and drug therapies aimed at preventing fracture."

The Arthritis Research UK view

Natalie Carter, head of research liaison and evaluation at Arthritis Research UK, said: "Approximately 3 million people in the UK are thought to have osteoporosis, which is characterised by low bone density. The condition causes more than 250,000 fractures every year, which in some cases can be life-threatening - around 20 per cent of those who get a hip fracture die within a year.

"This research is interesting as it shows that focal osteoporosis determines the location of a hip fracture, meaning that it could be possible to predict a hip fracture before it happens. Focal osteoporosis is typically asymptomatic until after a fracture occurs, so this study is important, as it could help provide the knowledge needed to intervene beforehand."

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