Oral Presentation ANZBMS-MEPSA-ANZORS 2022

Poor alignment of a smaller femur with the upper body may contribute to increased fracture risk in women with POI (#250)

Navira Samad 1 2 , Hanh Nguyen 2 , Roger Zebaze 2 , Jasna Aleskova 1 3 , Julie Pasco 4 5 6 7 , Mark Kotowicz 4 5 8 , Frances Milat 1 3 9 , Peter Ebeling 1 9 , Amanda Vincent 1 6
  1. Department of Endocrinology, Monash Health, Melbourne, Victoria, Australia
  2. Department of Medicine Western Health, Monash University, Melbourne, Victoria, Australia
  3. Hudson Institute of Clinical Research, Clayton, Melbourne, Victoria, Australia
  4. IMPACT - Institute for Physical and Mental Health and Clinical Translation, Geelong, VIC, Australia, Deakin University, Geelong, Victoria, Australia
  5. Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
  6. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  7. University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
  8. Department of Endocrinology & Diabetes, University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
  9. Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia

Background and objective: Resistance to hip fractures relies on adequate compressive strength, determined by femur alignment and geometry. Oestrogen is a crucial determinant of bone accrual, peak bone mass 1 and geometry 2; however, premature ovarian insufficiency (POI) is characterised by hypoestrogenism. We hypothesised that hypoestrogenism as seen in women with POI is associated with an impaired femur alignment and/or smaller femoral size. 

 

Methods: We conducted a cross-sectional, case-control study including 89 women with spontaneous normal karyotype (s-POI) or iatrogenic (i-POI) POI, aged 20-40 years (cases) compared with 89 age and BMI-matched population-based controls, from 2005-2021. Hip geometrical features using Lunar Advanced Hip Analysis (AHA) software were measured and the axis of the femoral shaft with the vertical (α)- an indicator of its alignment with the upper body was also calculated (Figure 1). 

 

Results:

Median age (range) of POI diagnosis occurred at 35 (18-40) years; mean POI duration at time of DXA was 2.07 (range 0-13) years. Oestrogen therapy was recorded in 82% of POI women. Cross-sectional area at the femoral neck (CSA mm2) was lower in POI women compared with controls (139.30 ± 29.08 vs 157.29 ± 22.26; p<0.001) (Table 1). The angle between the femur shaft axis and the upper body (α) was lower in POI women compared with controls (-2.34 ± 4.30 vs 1.24 ± 3.72; p<0.001). After adjustment for the differences in height and ethnicity among the controls and POI participants, cortical thicknesses and ratios, hip axis length, and buckling ratio were not significantly different between groups.

 

Conclusion and Inferences:

Women with POI exhibit a smaller femur that was poorly aligned with the upper body. Further research is needed to establish the role of this newly identified feature in fracture risk prediction in these patients and influence on therapeutic decisions.

 

 

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  1. Almeida, M., et al., Estrogens and Androgens in Skeletal Physiology and Pathophysiology. Physiol Rev, 2017. 97(1): p. 135-187.
  2. Petit, M.A., et al., Femoral bone structural geometry adapts to mechanical loading and is influenced by sex steroids: the Penn State Young Women's Health Study. Bone, 2004. 35(3): p. 750-9.