Bone microarchitecture of the talus changes with aging

TY - JOUR

T1 - Bone microarchitecture of the talus changes with aging

AU - Krause, Matthias

AU - Rupprecht, Martin

AU - Mumme, Marcus

AU - Püschel, Klaus

AU - Amling, Michael

AU - Barvencik, Florian

PY - 2013/11/1

Y1 - 2013/11/1

N2 - BACKGROUND: Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.QUESTIONS/PURPOSES: The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex.METHODS: Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30).RESULTS: The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex.CONCLUSIONS: Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age.CLINICAL RELEVANCE: Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.

AB - BACKGROUND: Fractures of the talus in the elderly are rare and usually result from high-impact injuries, suggesting only minor age-related bone structure changes. However, total ankle replacement failures with age often result from talar subsidence, suggesting age-related bone loss in the talus. Despite a number of histological analyses of talar microarchitecture, the effects of age and sex on talar microarchitecture changes remain poorly defined.QUESTIONS/PURPOSES: The aim of this study was to analyze changes or differences in the trabecular microarchitecture of the talus with regard to (1) age and (2) sex.METHODS: Sixty human tali were harvested from 30 patients at autopsy of three different age groups (20-40, 41-60, 61-80 years). The specimens were analyzed by radiography, micro-CT, and histological analysis. Given that there was no difference between the left and right talus, static histomorphometric parameters were assessed in three regions of interest of the right talus only (body, neck, head; n = 30).RESULTS: The talar body, neck, and head were affected differently by age-related changes. The greatest loss of bone volume with age was seen in the talar body (estimate: -0.239; 95% confidence interval [CI], -0.365 to -0.114; p < 0.001). In the talar neck (estimate: -0.165; 95% CI, -0.307 to -0.023; p = 0.025), bone loss was only moderate and primarily was the result of reduction in trabecular thickness (estimate: -1.288; 95% CI, -2.449 to -0.127; p = 0.031) instead of number (estimate: -0.001; 95% CI, -0.005 to -0.003; p = 0.593). Bone structure changes were independent of sex.CONCLUSIONS: Age-related bone structure changes predominantly occur in the talar body, which poses a potential risk factor for total ankle replacement loosening. The moderate changes in the talar neck might explain the persistent low incidence of talar neck fractures with age.CLINICAL RELEVANCE: Our findings suggest that before total ankle replacement implantation, careful patient selection with dual-energy xray absorptiometry evaluation may be necessary to reduce the risk of talar implant subsidence.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Aging

KW - Autopsy

KW - Bone Remodeling

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Osteoporosis

KW - Sex Factors

KW - Talus

KW - X-Ray Microtomography

KW - Young Adult

U2 - 10.1007/s11999-013-3195-0

DO - 10.1007/s11999-013-3195-0

M3 - SCORING: Journal article

C2 - 23893363

VL - 471

SP - 3663

EP - 3671

JO - CLIN ORTHOP RELAT R

JF - CLIN ORTHOP RELAT R

SN - 0009-921X

IS - 11

ER -