Age-Related Differences of Bone Mass, Geometry, and Strength in Treatment-Naïve Postmenopausal Women. A Tibia pQCT Study

Most studies addressing the effects of aging on bone strength have focused mainly on (areal) bone mineral densities and bone mineral content (BMC) and less on bone geometry. We assessed age-related differences of bone mass (grams of bone mineral), geometry, and derived strength in 219 treatment-naïve postmenopausal women using peripheral quantitative computed tomography of the load-bearing tibia. Subjects were separated in 3 age groups: A = 48-59 yr (N = 80), B = 60-69 yr (N = 84), C = 70-80 yr (N = 55). Three slices were obtained for each individual, at the 4% (trabecular), 14% (subcortical and cortical), and 38% (cortical bone) of tibia length sites. Trabecular, subcortical, and cortical BMC (mg per 1-mm slice), volumetric bone mineral densities (mg/cm3), bone cross-sectional areas (mm2), periosteal (PERI_C, mm) and endosteal circumference (ENDO_C, mm), mean cortical thickness (CRT_THK, mm), and Stress Strain Indexes (SSIs, mm3) were studied. Trabecular and cortical BMC and volumetric densities were significantly lower in the elder subjects (group C) compared with younger subjects (groups A and B), p < 0.0005. Cortical area and CRT_THK were significantly lower in group C (vs A and B, p < 0.0005), whereas total cross-sectional area was higher in group C compared with A and B. ENDO_C was significantly higher in older subjects (group C vs A and B, p < 0.0005), whereas PERI_C did not differ significantly between the age groups. SSIs were significantly lower in older subjects at the 14% site (group C vs A, p < 0.0005 and C vs B, p < 0.005), and at the 38% site (group C vs group A, p < 0.01). Our results indicate that age-induced differences on bone strength entail significant alterations not only of bone mass, but also of bone geometry.