Relationship between phalangeal bone density and risk of vertebral fracture.

The aims of our study were to determine the relationship between bone mineral density (BMD) measurements of the phalanges obtained with the accuDEXA and recent vertebral fractures. To determine whether osteoarthritis of the hands affects phalangeal BMD measurements, and to illustrate the conversion of phalangeal BMD measurements to absolute fracture risk estimates for clinical application. The prospective Hawaii Osteoporosis Study began in 1981, and incident vertebral fractures were identified from serial radiographs obtained at approx 2-yr intervals. Vertebral fractures occurring between 1993 and 1994 and 1997 and 1998 were compared to phalangeal BMD measurements obtained in 1997-1998. A total of 199 women participated in this case-control study. The association of the phalangeal BMD measurements with vertebral fractures was examined in age-adjusted, logistic regression models. Results are expressed as odds ratios (ORs) per SD difference in the phalangeal BMD measurements. Osteoarthritis of the hands was graded according to the Kellgren-Lawrence scale. There were 34 incident fractures since the eighth examination in 1993-1994. For vertebral fractures, the OR per SD of phalangeal BMD was 1.5 (1.0-2.1). Phalangeal BMD was not influenced significantly by established osteoarthritis (p = 0.68). Phalangeal BMD measurements obtained with the accuDEXA device relate to recent vertebral fractures and can be used to identify women at high risk of fractures. The phalangeal BMD measurements obtained with this device are not significantly influenced by the presence of osteoarthritis of the hands.     

Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk.

Low bone mineral density (BMD) is correlated with increased fracture risk. Whether greater BMD increases induced by osteoporosis drugs are related to greater decreases in fracture risk is controversial. We analyzed the relationship between BMD change and fracture risk in postmenopausal osteoporotic women receiving antiresorptive treatment. The analysis combined data from three pivotal risedronate fracture end-point trials. Women received risedronate (n = 2047) or placebo (n = 1177) daily for up to 3 yr. The BMD and vertebral radiographs were assessed periodically during 3 yr. The estimated risk of new vertebral fracture was compared between patients whose BMD increased and those whose BMD decreased. Risedronate-treated patients whose BMD decreased were at a significantly greater risk (p = 0.003) of sustaining a vertebral fracture than patients whose BMD increased. The fracture risk was similar (about 10%) in risedronate-treated patients whose increases in BMD were < 5% (the median change from baseline) and in those whose increases were >/= 5% (p = 0.453). The changes in lumbar spine BMD explained only 18% (95% confidence interval [CI], 10%, 26%; p < 0.001) of risedronate's vertebral fracture efficacy. Although patients showing an increase in BMD had a lower fracture risk than patients showing a decrease in BMD, greater increases in BMD did not necessarily predict greater decreases in fracture risk.     

The relationship between bone mineral density and fracture risk

Osteoporosis is a disorder characterized by low bone density and impaired bone strength which is an important risk factor for fracture in older adults. The diagnosis of osteoporosis in postmenopausal women is now based on bone density testing by dual energy x-ray absorptiometry but not other methodologies. However, a specific but arbitrary diagnostic threshold must be distinguished from a strategy to assess fracture risk. In untreated postmenopausal women and older men, bone density is an important, but not the only, determinant for fracture risk. Combining bone density measurements with other independent and validated risk factors for fracture provides a much more accurate assessment of an individual patient’s risk for fracture than does bone density alone. The most important of these other risk factors are age and prior fracture history. Clinical guidelines will move away from recommending treatment at specific T scores toward intervention thresholds based on absolute fracture risk. By basing who to treat on fracture probability, therapy can be targeted to those patients who would receive the greatest benefit.     

Comparison of biochemical markers of bone turnover and bone mineral density between hip fracture and vertebral fracture.

Bone density and the biochemical markers of bone turnover were compared between 26 hip-fracture patients and 41 vertebral-fracture patients after age adjustment to investigate whether or not type of osteoporosis differs between hip fracture and vertebral fracture. C-Terminal propepides of type I collagen (PIPC) was lower in hip fracture than vertebral fracture. The other bone formation markers (bone-specific alkaline phosphatase [ALP], osteocalcin) tended to be lower, and bone resorption markers (deoxypyridinoline, C-telopeptide crosslinking of type I collagen [CTX] tended to be higher in hip fracture compared to vertebral fracture. Mean of Z-scores of spine bone mineral density (BMD) in hip fracture and vertebral fracture were -0.461 and -0.919, respectively. Mean of Z-scores of femoral neck BMD in hip fracture and vertebral fracture were -0.994 and -0.361, respectively. All Z-scores were negative values, which means reduction of BMD compared to decade-matched controls. Z-scores of bone formation markers, such as bone-specific ALP, osteocalcin, and PIPC, were positive values in vertebral fracture, which means an increase against decade-matched controls, whereas those were negative values in hip fracture. Z-scores of bone resorption markers, such as deoxypyridinoline and CTX, were greater in hip fracture than in vertebral fracture. To express bone balance between formation and resorption in hip fracture and vertebral fracture, we calculated an uncoupling status index (USI) by the values of biochemical markers. USI of hip fracture showed a great negative value (-1.29), which indicates excess of bone resorption over formation, whereas that of vertebral fracture showed a small positive value (0.23). In conclusion, bone formation markers increase in vertebral fractures, but decrease in hip fracture. Bone resorption markers increase in both fracture, but greater increase in hip fracture.     

Clinical risk factor status in patients with vertebral fracture but normal bone mineral density

BACKGROUND CONTEXTNormal bone mineral density (BMD) as measured by dual-energy x-ray absorptiometry (DXA) is present in approximately 10% of older adults with fracture. BMD alone does not evaluate bone quality or clinical risk factors, and therefore, may not adequately capture a patient's fracture risk. Thus, despite a normal DXA-measured BMD, the underlying bone may be abnormal, suggesting that further bone health evaluation, and potentially, pharmacologic treatment may be warranted.PURPOSETo determine the prevalence of normal BMD, clinical fracture risk factors, and quantitative risk of fracture using the Fracture Risk Assessment Tool (FRAX) in vertebral fracture patients with normal BMD enrolled in the Own the Bone registry, thus facilitating identification of those who meet criteria for anti-osteoporosis therapy.STUDY DESIGN/SETTINGRetrospective, national registry-based cohort.PATIENT SAMPLEFrom July 2016 to July 2021, 1,807 patients age ≥50 who sustained a vertebral fracture and had DXA data available from within 2 years prior to enrollment in the American Orthopaedic Association's Own the Bone (AOA OTB) registry were included.OUTCOME MEASURESWorld Health Organization (WHO) DXA T-score based bone classification criteria; FRAX risk scores of major osteoporotic fracture or hip fracture.METHODSDemographic data, prior fracture site, and clinical fracture risk factors were collected. BMD status was classified by the WHO T-score criteria: ≥ -1.0 normal, -1.1 to -2.4 osteopenia, and ≤ -2.5 osteoporosis, with low bone mass including either osteopenia or osteoporosis. In normal BMD patients, FRAX scores were calculated with and without BMD, with the treatment threshold defined as a major osteoporotic fracture risk ≥20% or hip fracture risk ≥3%.RESULTSMean±SD age was 72.0±9.7, 78.1% were female, and 92.4% were Caucasian. Normal BMD was present in 7.9%. Clinical fracture risk factors including alcohol use ≥3 units/day and history of ≥2 falls in the year prior to enrollment were more common in normal BMD (11.2% and 28%, respectively) compared to low bone mass patients (3.4% and 25.2%, respectively). A prior vertebral fracture had occurred in 49.5% with normal BMD compared to 45.8% with low bone mass, while a prior non-major osteoporotic fracture occurred in 28.9% and 29.3% of normal BMD and low bone mass patients, respectively. In normal BMD patients, either a prior fracture or FRAX risk with BMD meeting treatment thresholds was present in 85%.CONCLUSIONSClear indications for receipt of pharmacologic therapy, ie, prior fracture or elevated fracture risk, were present in most patients with vertebral fracture and normal BMD enrolled in the AOA OTB. Prior non-major osteoporotic fractures were common and may be useful indicators of underlying bone disease. Surgeons must recognize that other important risk factors apart from BMD may indicate poor bone health, and thus, help guide further bone health evaluation.     

The fracture risk index and bone mineral density as predictors of vertebral structural failure

Structural failure becomes increasingly likely as the load on bone approximates or exceeds the bones ability to withstand it. The vertebral fracture risk index (FRI) expresses the risk for structural failure as a ratio of compressive stress (load per unit area) to estimated failure stress, and so should be a more sensitive and specific predictor of vertebral fracture than spine areal BMD (aBMD) or volumetric BMD (vBMD), surrogates of bone strength alone. To address this issue, we analyzed the results of a case-control study of 89 postmenopausal women with vertebral fractures and 306 controls in Melbourne, Australia, and a 10-year community-based prospective study in which 30 postmenopausal women who had incident vertebral fractures were compared with 150 controls in Lyon, France. The FRI and vBMD of the third lumbar vertebral body and spine aBMD were derived using dual X-ray absorptiometry. In the cross-sectional analysis, each SD increase in FRI was associated with 2.1-fold (95% confidence interval [CI], 1.55–2.73) increased vertebral fracture risk, while each SD decrease in aBMD or vBMD was associated with 4.0-fold (95% CI, 2.69–6.18 and 2.65–6.94, respectively) increase in risk. Using receiver operating characteristic (ROC) analysis, the FRI was less sensitive and specific than aBMD in discriminating cases and controls (area under ROC, 0.76 vs 0.84, p <0.01). The area under ROC curve did not differ between FRI and vBMD (0.76 vs 0.79, NS). In the prospective data set, the FRI was not predictive [hazard ratio, HR, 1.20 (95% CI, 0.9–1.7)] and was in contrast to aBMD [HR, 2.4 (95% CI, 1.5–3.8)] and vBMD [HR, 2.1 (95% CI, 1.39–3.17)]. There was also lower sensitivity using a cutoff value of FRI 1 compared with aBMD T -score of –2.5 SD in both studies. There was poor agreement (kappa=0.13–0.18) between FRI and aBMD T -scores in detecting fractures; each method only identified around 50% of fractured cases. Within the constraints of the sample size, we concluded that applying a biomechanical index such as FRI at the spine is no better in discriminating fracture cases and controls than conventional aBMD or vBMD. The FRI may not predict incident vertebral fractures.     

Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy

The structural basis for the reduction in vertebral and nonvertebral fracture risk in patients using anti-resorptive therapy is not well understood. As reduced bone mineral density (BMD) increases the risk for fracture and anti-resorptive agents increase BMD, it was commonly held that the increase in BMD explained the fracture risk reduction until several meta-analyses either failed to detect a significant association between vertebral fracture risk reduction and the incremental increase in BMD or reported that only a small proportion of the vertebral fracture risk reduction was explained by changes in BMD. Recently, it was reported that the risk of nonvertebral fractures decreased when an increase in BMD accompanied anti-resorptive treatment [J. Clin. Endrocrinol. Metab. 87 (2002) 1586]. However, a reanalysis of the data, using the same statistical methods after correcting for discrepancies in the reported BMD and person-year data, suggested that the magnitude of reductions in nonvertebral fracture risk was not associated with the magnitude of increases in BMD at the end of the first year or at completion of the studies. We infer that only a small proportion of risk reduction in vertebral and nonvertebral fractures observed with anti-resorptive drug therapy is explained by the increase in BMD. Further studies are needed to define the structural basis of the fracture risk reduction.     

Correlations between vertebral regional bone mineral density (rBMD) and whole bone fracture load

To assess the significance of regional quantitative computed tomography measurements of bone density with respect to mechanical strength in the human lumbar spine, 58 vertebrae (from 12 males, 10 females) were scanned in vitro with multiple-thin-slice quantitative computed tomography and then compressed to fracture. With computer graphics, 18 specific regions of physical density and 10 combination averages of density were identified within each vertebral body. To ensure the statistical independence of data, the individual vertebral specimens were assigned to one of three groups (T11-L1, L2-L3, or L4-L5). Use of best-subsets procedures resulted in regression models to predict fracture strength. These models used specific regional density values and often the age and sex of the donors. The correlation coefficients that resulted from the multiple regression models ranged from r = 0.88 to r = 0.95. When the density values were multiplied by the minimum cross-sectional area of the vertebral body, similar regional density averages were selected, and the predictive values were slightly improved (r = 0.94-0.97). The heterogeneity of the density samples (measured as standard deviation) in multiple regression fashion also produced strong correlation coefficients (r = 0.88-0.94). The bone density in an anterior cylinder of the midplane region, the location measured most often in quantitative computed tomography densitometry, was strongly correlated (r = 0.85) to fracture load for the T12-L1 group (N = 20), but was not significant for the other two groups of vertebrae. The cancellous bone density from the female data was not found to be significantly different from the male data set.(ABSTRACT TRUNCATED AT 250 WORDS)     

Body composition and bone mineral density of Chinese women with vertebral fracture

This study was designed to compare the body composition and bone mineral density measurements (BMD) in Chinese women with vertebral fracture and normal controls. A total of 400 community dwelling Chinese women aged 70–79 years old were studied. Vertebral height ratios were calculated from lateral thoracic and lumbar spine X-rays and subjects were classified into definite cases (n = 122), doubtful cases (n = 138) and normal controls (n = 140). Bone mineral density and body composition measurements were made by dual X-ray densitometry. The height, fat mass, lean mass, and BMD at all sites were significantly lower in patients with definite fracture than normal controls. Nevertheless, BMD at the hip was more predictive of vertebral fracture than BMD at the spine, the odds ratio in the lowest quartile of hip BMD being 3.8 (95% C.I. = 1.3 to 10.9). Finally, the extent of spinal deformity was poorly predicted by a combination of the anthropometric and BMD measurements, as only 12% of the total variance in TD1 was accounted for.     

Association of PLXNA2 polymorphisms with vertebral fracture risk and bone mineral density in postmenopausal Korean population

Introduction Plexin A2 (PLXNA2) is a receptor that recognizes secreted or membrane-bound semaphorin 3A, which is implicated in neural regulation of bone metabolism.Materials and Methods In the present study, we identified 48 genetic polymorphisms in PLXNA2 by resequencing, and 10 single nucleotide polymorphisms (SNPs) were selected for further investigation into their potential involvement in osteoporosis in a postmenopausal population (n=560).Results Two SNPs, +14G>A (Gln5Arg) and +183429C>T (Tyr1621Tyr), and Block1-ht2 were associated with risk of vertebral fracture (p=0.01–0.05), and three SNPs, +799G>A (Ala267Thr), +135391G>A, and +190531G>C, were associated with bone mineral density at various femur sites (p=0.003–0.03). Particularly, the minor allele of +14G>A was associated with a protective effect on vertebral fracture and higher lumbar bone mineral density, suggesting that +14G>A may be a useful marker for osteoporosis and its related fracture.Conclusion These results provide, for the first time, evidence supporting the association of PLXNA2 with osteoporosis in postmenopausal women. Electronic Supplementary Material Supplementary material is available for this article at     

绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系

目的探讨绝经后妇女骨质疏松性椎体骨折与腰椎骨密度的关系。方法选择骨质疏松性椎体骨折的绝经后妇女23例为骨折组,无椎体骨折的25例绝经后骨质疏松妇女为对照组。两组的年龄、绝经年限、身高、体重、体重指数差异无显著性,均行胸腰椎正侧位X线摄片。用双能X线吸收仪（DXA）测量的腰椎（L2-4）前后位骨密度（BMD）、骨矿含量（BMC）和T值。结果骨折组BMD、BMC和T值均低于对照组（P〈0.01）。结论腰椎BMD降低与绝经后妇女的骨质疏松性椎体骨折相关。绝经后骨质疏松妇女应重视BMD变化,预防椎体骨折的发生。     

Relationship between bone mineral density changes with denosumab treatment and risk reduction for vertebral and nonvertebral fractures

Dual-energy X-ray absorptiometric bone mineral density (DXA BMD) is a strong predictor of fracture risk in untreated patients. However, previous patient-level studies suggest that BMD changes explain little of the fracture risk reduction observed with osteoporosis treatment. We investigated the relevance of DXA BMD changes as a predictor for fracture risk reduction using data from the FREEDOM trial, which randomly assigned placebo or denosumab 60 mg every 6 months to 7808 women aged 60 to 90 years with a spine or total hip BMD T-score < -2.5 and not < -4.0. We took a standard approach to estimate the percent of treatment effect explained using percent changes in BMD at a single visit (months 12, 24, or 36). We also applied a novel approach using estimated percent changes in BMD from baseline at the time of fracture occurrence (time-dependent models). Denosumab significantly increased total hip BMD by 3.2%, 4.4%, and 5.0% at 12, 24, and 36 months, respectively. Denosumab decreased the risk of new vertebral fractures by 68% (p < 0.0001) and nonvertebral fracture by 20% (p = 0.01) over 36 months. Regardless of the method used, the change in total hip BMD explained a considerable proportion of the effect of denosumab in reducing new or worsening vertebral fracture risk (35% [95% confidence interval (CI): 20%-61%] and 51% [95% CI: 39%-66%] accounted for by percent change at month 36 and change in time-dependent BMD, respectively) and explained a considerable amount of the reduction in nonvertebral fracture risk (87% [95% CI: 35% - >100%] and 72% [95% CI: 24% - >100%], respectively). Previous patient-level studies may have underestimated the strength of the relationship between BMD change and the effect of treatment on fracture risk or this relationship may be unique to denosumab.     

Clinical risk factor assessment had better discriminative ability than bone mineral density in identifying subjects with vertebral fracture

Summary

This study evaluated the characteristics of patients with vertebral fractures and examined the discriminative ability of clinical risk factors. The findings provide further insights into possible development of a simple, cost-effective scheme for fracture risk assessment using clinical risk factors to identify high-risk patients for further evaluation.

Introduction

Vertebral fractures are the most common complication of osteoporosis. The aim of this study was to evaluate the characteristics of patients with vertebral fractures and to determine the discriminative ability of bone mineral density (BMD) and other clinical risk factors.

Methods

Postmenopausal Southern Chinese women (2,178) enrolled in the Hong Kong Osteoporosis Study since 1995 were prospectively followed up for fracture outcome. Subjects (1,372) with lateral spine radiographs were included in this study. Baseline demographic, BMD, and clinical risk factor information were obtained from a structured questionnaire.

Results

Subjects (299; 22%) had prevalent vertebral fractures. The prevalence of vertebral fractures increased with increasing age, number of clinical risk factors, and decreasing BMD. The odds of having a prevalent vertebral fracture per SD reduction in BMD after adjustment for age in Hong Kong Southern Chinese postmenopausal women was 1.5 for the lumbar spine and femoral neck. Analysis of the receiver operating characteristic curve revealed that bone mineral apparent density did not enhance fracture risk prediction. Subjects with ≥4 clinical risk factors had 2.3-fold higher odds of having a prevalent vertebral fracture while subjects with ≥4 clinical risk factors plus a low BMD (i.e., femoral neck T-score <?2.5) had 2.6-fold. Addition of BMD to clinical risk factors did not enhance the discriminative ability to identify subjects with vertebral fracture.

Conclusions

Based on these findings, we recommend that screening efforts should focus on older postmenopausal women with multiple risk factors to identify women who are likely to have a prevalent vertebral fracture.     

Vertebral deformities identified by vertebral fracture assessment: associations with clinical characteristics and bone mineral density.

Whether vertebral fractures identified on radiographs are painful or not, they are associated with increased morbidity and mortality. Vertebral fractures on X-rays correlate with low bone mineral density (BMD) at the spine and hip in addition to several clinical characteristics. Evidence suggests that vertebral deformities detected by X-ray and by vertebral fracture assessment (VFA) show good agreement. We examined the relationship between VFA-detected vertebral deformities and patient characteristics as well as BMD by analyzing the records of 432 patients who had undergone dual-energy X-ray absorptiometry (DXA) scans with VFA. Patients' demographic data and T-scores were obtained from patient questionnaires and DXA scans. We categorized vertebral deformities by type and severity. Patients with vertebral deformities were significantly older and more likely to report a history of fracture after childhood. Significantly more estrogen use was reported in patients without deformity. Those with deformities had significantly lower T-scores at the femoral neck and total hip but not at the spine. Increased severity and number of deformities correlated with lower T-scores at the total hip and femoral neck but not the spine. In conclusion, vertebral deformities detected by VFA, like those on X-ray, correlate with both clinical characteristics and reduced bone mass at the hip. These relationships, in addition to rapid performance, convenience, and minimal radiation exposure, indicate VFA-detected vertebral deformities are a valuable adjunct in identifying patients in need of additional evaluation and treatment.     

PKP治疗不同骨密度椎体压缩骨折的手术疗效分析

目的:观察经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗不同骨密度椎体压缩骨折的临床疗效。方法:回顾性分析2008年3月～2009年11月在我院行PKP治疗的76例单节段中老年椎体压缩骨折患者的临床资料,其中男32例,女44例,年龄50～81岁。应用双能X线吸收法(DEXA)测定腰椎(L2～L4)骨密度值,根据骨密度T值大小将其分为骨质疏松组(A组,33例)、骨量减少组(B组,26例)和骨质正常组(C组,17例),每组均采用标准的PKP手术治疗,术后对患者进行VAS评分、Oswesty功能障碍指数(ODI)评定,并观察各组患者伤椎椎体高度恢复和并发症发生情况。结果:患者疼痛均得到迅速缓解,未发生脊髓神经损伤及球囊破裂。术后随访1.5～2.7年,平均2.1年。三组术后3d及末次随访时VAS、ODI评分均较术前明显降低(P<0.05),组间比较差异无显著性(P>0.05)。伤椎椎体平均高度A组术前为15.7±3.2mm,术后为23.1±5.7mm;B组术前为16.3±3.9mm,术后为22.5±4.8mm;C组术前为15.9±3.0mm,术后为21.8±5.2mm,差异均有统计学意义(P<0.05)。局部后凸角A组术前为24.7°±7.1°,术后为17.8°±5.9°;B组术前为23.5°±6.2°,术后为18.2°±6.5°;C组术前为24.1°±5.6°,术后为18.0°±5.8°,与术前比较均有显著性差异(P<0.05)。A组椎体高度恢复率为65.3%,B组为57.9%,C组为54.2%,组间比较差异具有显著性(P<0.05)。A组1例患者发生骨水泥肺栓塞,经及时抗凝治疗后症状缓解。A组骨水泥渗漏率为6.06%,B组为11.54%,C组为17.65%,组间比较差异无统计学意义(P>0.05)。随访中有2例患者发生邻近椎体骨折,均发生于骨密度最低的A组。结论:PKP对不同骨密度的椎体压缩骨折患者均有良好的疼痛缓解作用,骨密度较低者椎体高度及后凸角度恢复更理想,但合并有骨质疏松症者需注意邻近椎体骨折的发生。     

不同骨密度骨质疏松性椎体压缩骨折骨组织形态与骨代谢标志物分析

目的 观察不同骨密度骨质疏松椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)骨组织形态学特征及骨代谢标志物变化规律.方法 将136例OVCF患者按不同骨密度(T值)分为3组:I组,-3.5相似文献   

Treatment with raloxifene for 2 years increases vertebral bone mineral density as measured by volumetric quantitative computed tomography

Volumetric quantitative computed tomography (vQCT), using multiple thin-slice acquisition, measures three-dimensional volumetric bone mineral density (BMD, mg/cm3). vQCT is often used to measure BMD of lumbar vertebrae and may detect early changes in trabecular, cortical, or integral BMD that extend beyond the technical limits of areal dual X-ray absorptiometry (DXA) BMD measurements. The objective of this study was to determine the effect of 2 years of raloxifene (RLX) treatment on several volumetric BMD measures in a subset of postmenopausal women (n=58) enrolled in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial. Patients in this study were randomized to one of three treatment groups: placebo (n=21), RLX 60 mg/day (n=17), or RLX 120 mg/day (n=20), and all patients received daily calcium (500 mg) and vitamin D (400-600 IU) supplementation. Data from the raloxifene treatment groups were pooled for each analysis. Following 2 years of raloxifene treatment, there was a significant percent change from baseline in the vQCT regions of interest (ROIs) of midintegral BMD, total trabecular BMD, and total integral BMD (P<0.05) compared to placebo, while there was no significant change in the spinal DXA BMD measurement. These data provide the first longitudinal assessment by vQCT of changes in vertebral bone density after 2 years of treatment with raloxifene. vQCT appears to be a valuable technique for measuring the effects of raloxifene treatment in this population of postmenopausal women with osteoporosis.