The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture

Abstract

Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.

Fracture: Imaging advances explain Chinese fracture risk

Advances in imaging technology have shed light on the reasons why the Chinese have different fracture risks compared to other populations. Marcella Walker and Elaine Cong from the New York Presbyterian Hospital reviewed the role new techniques for assessing bone quality have played in advancing our understanding of the epidemiology of fracture in the Chinese population. In particular, new imaging techniques have revealed that the Chinese skeleton has microstructural and mechanical advantages, explaining the lower risk of hip and non-vertebral fractures compared to other populations. The authors conclude that understanding structural and mechanical differences in skeletons between races is vital to understanding differences in bone strength and fracture risk between populations. Ongoing study of the Chinese skeleton will help to identify individuals at high risk of fracture across all populations.

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