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Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, Atkinson EJ, Therneau TM, Siggeirsdottir K, Cheng X, Melton LJ, Keyak J, Gudnason V, Khosla S, Harris TB, Lang TF. Proximal femoral density distribution and structure in relation to age and hip fracture risk in women. J Bone Miner Res 2013; 28:537-46. [PMID: 23109068 PMCID: PMC3578081 DOI: 10.1002/jbmr.1802] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/02/2012] [Accepted: 10/10/2012] [Indexed: 01/23/2023]
Abstract
Hip fracture risk rises exponentially with age, but there is little knowledge about how fracture-related alterations in hip structure differ from those of aging. We employed computed tomography (CT) imaging to visualize the three-dimensional (3D) spatial distribution of bone mineral density (BMD) in the hip in relation to age and incident hip fracture. We used intersubject image registration to integrate 3D hip CT images into a statistical atlas comprising women aged 21 to 97 years (n = 349) and a group of women with (n = 74) and without (n = 148) incident hip fracture 4 to 7 years after their imaging session. Voxel-based morphometry was used to generate Student's t test statistical maps from the atlas, which indicated regions that were significantly associated with age or with incident hip fracture. Scaling factors derived from intersubject image registration were employed as measures of bone size. BMD comparisons of young, middle-aged, and older American women showed preservation of load-bearing cortical and trabecular structures with aging, whereas extensive bone loss was observed in other trabecular and cortical regions. In contrast, comparisons of older Icelandic fracture women with age-matched controls showed that hip fracture was associated with a global cortical bone deficit, including both the superior cortical margin and the load-bearing inferior cortex. Bone size comparisons showed larger dimensions in older compared to younger American women and in older Icelandic fracture women compared to controls. The results indicate that older Icelandic women who sustain incident hip fracture have a structural phenotype that cannot be described as an accelerated pattern of normal age-related loss. The fracture-related cortical deficit noted in this study may provide a biomarker of increased hip fracture risk that may be translatable to dual-energy X-ray absorptiometry (DXA) and other clinical images.
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Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Roy Harnish
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Isra Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Timothy Streeper
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Shreyasee Amin
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Terry M. Therneau
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoguang Cheng
- Department of Radiology, Beijing Ji Shui Tan Hospital, Beijing, China
| | - L. Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joyce Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamara B. Harris
- Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Pewsey E. Science writing competition: Hip, hip, hooray! eLife 2013; 2:e00646. [PMID: 23538735 PMCID: PMC3594797 DOI: 10.7554/elife.00646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
X-rays are best known for showing where bones have fractured, but researchers can also use X-rays to investigate why bones break, which could lead to treatments that reduce the number of elderly people who suffer broken hips.
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Affiliation(s)
- Emma Pewsey
- is a PhD student in the Department of Materials Science and Metallurgy , University of Cambridge , Cambridge , United Kingdom
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