Calcified Tissue International

, Volume 104, Issue 1, pp 14–25 | Cite as

Metacarpal Indices and Their Association with Fracture in South African Children and Adolescents

  • A. MaganEmail author
  • L. K. Micklesfield
  • S. A. Norris
  • K. Thandrayen
  • R. J. Munthali
  • J. M. Pettifor
Original Research


This prospective study assessed whether metacarpal indices predict fracture risk in children and adolescents. Radiogrammetry was performed at the second metacarpal midshaft on annual hand–wrist radiographs of 359 South African (SA) children aged 10–17 years. Bone length, bone width, and medullary width were measured, and the following proxies for bone strength calculated: metacarpal index (MCI), bone mineral density (BMD), section modulus (SM), stress–strain index (SSI), and slenderness index (SLI). Height and weight were measured annually. Self-reported physical activity (PA) and fracture history were obtained at ages 15 years (for the preceding 12 months) and 17 years, respectively. At 17 years, 82 (23%) participants (black, 16%; white, 42%; p < 0.001) reported a previous fracture. None of the bone measures or indices were associated with fracture in black participants. In white females, after adjusting for PA, a 1 standard deviation (SD) greater SLI doubled the fracture risk [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.08, 3.98]. In white males, a 1 SD greater BMD was associated with a 2.62-fold increase in fracture risk (OR 3.62; 95% CI 1.22, 10.75), whilst a 1 SD greater SM (OR 2.29; 95% CI 1.07, 4.89) and SSI (OR 2.23; 95% CI 1.11, 4.47) were associated with a more than twofold increase in fracture risk, after height, and PA adjustment. No single index consistently predicted fracture across the four groups possibly due to ethnic and sex differences in bone geometry, muscle mass, and skeletal loading. Metacarpal radiogrammetry did not reliably predict fracture in SA children.


Radiogrammetry Metacarpal indices Bone strength Fracture Adolescents 



The Bone Health Cohort (BHC) was supported financially by the Wellcome Trust (UK) and the South African MRC. JMP received funding from the National Research Foundation. SAN was supported by the DST-NRF Centre of Excellence in Human Development at the University of the Witwatersrand. The contribution of the BHC staff, participants and caregivers is gratefully acknowledged.

Author Contributions

Study design JMP, SAN, LKM, Analysis of Radiographs AM, Fracture data collection KT, Integrity of data AM and RJM, Data interpretation AM, LKM, JMP, RJM, Drafting and revising manuscript- AM, LKM, SAN, KT, RJM, JMP.

Compliance with Ethical Standards

Conflict of interest

Ansuyah Magan, L.K. Micklesfield, S.A. Norris, K. Thandrayen, R.J. Munthali, and J.M. Pettifor declare no conflict of interest.

Human and Animal Rights and Informed Consent

This study was approved by the University of the Witwatersrand Committee for Research on Human Subjects and was performed in accordance with the Ethical Standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Informed assent from adolescent participants and consent from parents were obtained for inclusion in this study.

Supplementary material

223_2018_467_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health SciencesUniversity of the WitwatersrandParktownSouth Africa

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