Relationships Between Stiffness of Human Distal Tibia, Distal Radius, Proximal Femur, and Vertebral Body Assessed by HR-pQCT and cQCT Based Finite Element Analyses

High-resolution peripheral quantitative computed tomography (HR-pQCT) is a promising clinical tool that permits separate measurements of trabecular and cortical bone compartments at the distal radius and tibia. It has an isotropic voxel size of 82 μm, which is high enough to assess the fine microstructural details of trabecular architecture. HR-pQCT images can also be used for building microstructural finite element (μFE) models to estimate the mechanical competence of whole bone segments. Melton et al. showed that derived bone strength parameters (axial rigidity and fall load to failure load ratio) are additional to BMD and bone geometry and microstructure as determinants of forearm fracture risk prediction [1]. Boutroy et al. found that the proportion of the load carried by trabecular bone versus cortical bone is associated with wrist fracture independently of BMD and microarchitecture [2]. These clinical studies demonstrate that HR-pQCT based μFE analyses can provide measurements of mechanical properties that independently associate with fracture risk. However, microstructure of one skeletal site may be different from that of another site. It is unclear whether and to what extent these peripheral measurements reflect the bone strength of the proximal femur and vertebral bodies, the sites of frequent osteoporotic fractures. Currently, central quantitative computed tomography (cQCT) is the most commonly used clinical imaging modality to quantify the structural and mechanical properties of the proximal femur and lumbar spine. We therefore evaluated relationships between the stiffness of the distal radius and tibia estimated by HR-pQCT-based FEA with that of the proximal femur and lumbar spine which was estimated from cQCT-based FEA in the same human subjects.