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Sharma AK, Masterson R, Holt SG, Toussaint ND. Emerging role of high-resolution imaging in the detection of renal osteodystrophy. Nephrology (Carlton) 2016; 21:801-11. [PMID: 27042945 DOI: 10.1111/nep.12790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/14/2016] [Accepted: 03/25/2016] [Indexed: 12/17/2022]
Abstract
The term renal osteodystrophy refers to changes in bone morphology induced by chronic kidney disease (CKD) and represents the skeletal component of the entity 'chronic kidney disease - mineral and bone disorder'. Changes in turnover, mineralization, mass and microarchitecture impair bone quality, compromising strength and increasing susceptibility to fractures. Fractures are more common in CKD compared with the general population and result in increased morbidity and mortality. Screening for fracture risk and management of renal osteodystrophy are hindered by the complex, and still only partially understood, pathophysiology and the inadequacy of currently available diagnostic methods. Bone densitometry and bone turnover markers, although potentially helpful, have significant limitations in patients with CKD, and the 'gold standard' test of bone biopsy is infrequently performed in routine clinical practice. However, recent advances in high-resolution bone microarchitecture imaging may offer greater potential for quantification and assessment of bone structure and strength and, when used in conjunction with serum biomarkers, may allow non-invasive testing for a diagnostic virtual bone biopsy.
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Affiliation(s)
- Ashish K Sharma
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Rosemary Masterson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen G Holt
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia
| | - Nigel D Toussaint
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia. .,Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia.
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152
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Abstract
Given the expected rapid growth of the geriatric world population (=individuals aged >65 years) to 1.3 billion by 2050, age-related diseases such as osteoporosis and its sequelae, osteoporotic fractures, are on the rise. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry (DXA) is the current gold standard to diagnose osteoporosis, to assess osteoporotic fracture risk, and to monitor treatment-induced BMD changes. However, most fragility fractures occur in patients with normal or osteopenic aBMD, indicating that factors beyond BMD impact bone strength. Recent developments in DXA technology such as TBS, VFA, and hip geometry analysis are now available to assess some of these non-BMD parameters from the DXA image. This review will discuss the use of DXA and DXA-assisted technologies and their respective advantages and disadvantages. Special attention is given to if and how each method is indicated in the geriatric population, and the latest ISCD 2015 guidelines have been incorporated.
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Affiliation(s)
- Ursula Heilmeier
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94158, USA
| | - Jiwon Youm
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94158, USA
| | - Soheyla Torabi
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94158, USA
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, San Francisco, 185 Berry Street, Lobby 6, Suite 350, San Francisco, CA 94158, USA
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco , 400 Parnassus Avenue, UC Clinics, Room 367, San Francisco, CA 94143, USA
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153
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Lam FMH, Bui M, Yang FZH, Pang MYC. Chronic effects of stroke on hip bone density and tibial morphology: a longitudinal study. Osteoporos Int 2016; 27:591-603. [PMID: 26329101 DOI: 10.1007/s00198-015-3307-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED The study aimed to quantify the long-term effects of stroke on tibial bone morphology and hip bone density. Only the trabecular bone mineral density and bone strength index in the hemiparetic tibial distal epiphysis showed a significant decline among individuals who had sustained a stroke 12-24 months ago. INTRODUCTION This study aims to determine the changes in bone density and morphology in lower limb long bones during a 1-year follow-up period and their relationship to muscle function in chronic stroke patients. METHODS Twenty-eight chronic stroke patients (12-166 months after the acute stroke event at initial assessment) and 27 controls underwent bilateral scanning of the hip and tibia using dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. Each subject was re-assessed 1 year after the initial assessment. RESULTS Twenty stroke cases and 23 controls completed all assessments. At the end of the follow-up, the paretic tibial distal epiphysis suffered significant decline in trabecular bone density (-1.8 ± 0.6 %, p = 0.006) and bone strength index (-2.7 ± 0.6 %, p < 0.001). More severe decline in the former was associated with poorer leg muscle strength (ρ = 0.447, p = 0.048) and motor recovery (ρ = 0.489, p = 0.029) measured at initial assessment. The loss in trabecular bone density remained significant among those whose stroke onset was 12-24 months ago (p < 0.001), but not among those whose stroke onset was beyond 24 months ago (p > 0.05) at the time of initial assessment. The changes of outcomes in the tibial diaphysis, except for cortical bone mineral content on the non-paretic side (-1.3 ± 0.3 %, p = 0.003), and hip bone density were well within the margin of error for precision. CONCLUSIONS There is evidence of continuous trabecular bone loss in the paretic tibial distal epiphysis among chronic stroke patients, but it tends to plateau after 2 years of stroke onset. The steady state may have been reached earlier in the hip and tibial diaphysis.
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Affiliation(s)
- F M H Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - M Bui
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - F Z H Yang
- Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - M Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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154
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Link TM. Radiology of Osteoporosis. Can Assoc Radiol J 2016; 67:28-40. [DOI: 10.1016/j.carj.2015.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/04/2015] [Accepted: 02/17/2015] [Indexed: 12/18/2022] Open
Abstract
The radiologist has a number of roles not only in diagnosing but also in treating osteoporosis. Radiologists diagnose fragility fractures with all imaging modalities, which includes magnetic resonance imaging (MRI) demonstrating radiologically occult insufficiency fractures, but also lateral chest radiographs showing asymptomatic vertebral fractures. In particular MRI fragility fractures may have a nonspecific appearance and the radiologists needs to be familiar with the typical locations and findings, to differentiate these fractures from neoplastic lesions. It should be noted that radiologists do not simply need to diagnose fractures related to osteoporosis but also to diagnose those fractures which are complications of osteoporosis related pharmacotherapy. In addition to using standard radiological techniques radiologists also use dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantitatively assess bone mineral density for diagnosing osteoporosis or osteopenia as well as to monitor therapy. DXA measurements of the femoral neck are also used to calculate osteoporotic fracture risk based on the Fracture Risk Assessment Tool (FRAX) score, which is universally available. Some of the new technologies such as high-resolution peripheral computed tomography (HR-pQCT) and MR spectroscopy allow assessment of bone architecture and bone marrow composition to characterize fracture risk. Finally radiologists are also involved in the therapy of osteoporotic fractures by using vertebroplasty, kyphoplasty, and sacroplasty. This review article will focus on standard techniques and new concepts in diagnosing and managing osteoporosis.
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Affiliation(s)
- Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
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155
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Lam FMH, Pang MYC. Correlation between tibial measurements using peripheral quantitative computed tomography and hip areal bone density measurements in ambulatory chronic stroke patients. Brain Inj 2015; 30:199-207. [DOI: 10.3109/02699052.2015.1090625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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156
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Kyriakou A, Shepherd S, Mason A, Faisal Ahmed S. A critical appraisal of vertebral fracture assessment in paediatrics. Bone 2015; 81:255-259. [PMID: 26226331 DOI: 10.1016/j.bone.2015.07.032] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/12/2015] [Accepted: 07/24/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE There is a need to improve our understanding of the clinical utility of vertebral fracture assessment (VFA) in paediatrics and this requires a thorough evaluation of its readability, reproducibility, and accuracy for identifying VF. METHODS VFA was performed independently by two observers, in 165 children and adolescents with a median age of 13.4 years (range, 3.6, 18). In 20 of these subjects, VFA was compared to lateral vertebral morphometry assessment on lateral spine X-ray (LVM). RESULTS 1528 (84%) of the vertebrae were adequately visualised by both observers for VFA. Interobserver agreement in vertebral readability was 94% (kappa, 0.73 [95% CI, 0.68, 0.73]). 93% of the non-readable vertebrae were located between T6 and T9. Interobserver agreement per-vertebra for the presence of VF was 99% (kappa, 0.85 [95% CI, 0.79, 0.91]). Interobserver agreement per-subject was 91% (kappa, 0.78 [95% CI, 0.66, 0.87]). Per-vertebra agreement between LVM and VFA was 95% (kappa 0.79 [95% CI, 0.62, 0.92]) and per-subject agreement was 95% (kappa, 0.88 [95% CI, 0.58, 1.0]). Accepting LVM as the gold standard, VFA had a positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95% in per-vertebra analysis and a PPV of 100% and NPV of 93% in per-subject analysis. CONCLUSION VFA reaches an excellent level of agreement between observers and a high level of accuracy in identifying VF in a paediatric population. The readability of vertebrae at the mid thoracic region is suboptimal and interpretation at this level should be exercised with caution.
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Affiliation(s)
- Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
| | - Sheila Shepherd
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
| | - Avril Mason
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Royal Hospital for Sick Children (RHSC), 1345 Govan Road, Glasgow G51 4TF, United Kingdom.
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157
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Lewis JR, Schousboe JT, Lim WH, Wong G, Zhu K, Lim EM, Wilson KE, Thompson PL, Kiel DP, Prince RL. Abdominal Aortic Calcification Identified on Lateral Spine Images From Bone Densitometers Are a Marker of Generalized Atherosclerosis in Elderly Women. Arterioscler Thromb Vasc Biol 2015; 36:166-173. [PMID: 26603153 DOI: 10.1161/atvbaha.115.306383] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 11/15/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dual-energy x-ray absorptiometry is a low-cost, minimal radiation technique used to improve fracture prediction. Dual-energy x-ray absorptiometry machines can also capture single-energy lateral spine images, and abdominal aortic calcification (AAC) is commonly seen on these images. APPROACH AND RESULTS We investigated whether dual-energy x-ray absorptiometry-derived measures of AAC were related to an established test of generalized atherosclerosis in 892 elderly white women aged >70 years with images captured during bone density testing in 1998/1999 and B-mode carotid ultrasound in 2001. AAC scores were calculated using a validated 24-point scale into low (AAC24 score, 0 or 1), moderate (AAC24 scores, 2-5), and severe AAC (AAC24 scores, >5) seen in 45%, 36%, and 19%, respectively. AAC24 scores were correlated with mean and maximum common carotid artery intimal medial thickness (rs=0.12, P<0.001 and rs=0.14, P<0.001). Compared with individuals with low AAC, those with moderate or severe calcification were more likely to have carotid atherosclerotic plaque (adjusted prevalence ratio (PR), 1.35; 95% confidence interval, 1.14-1.61; P<0.001 and prevalence ratio, 1.94; 95% confidence interval, 1.65-2.32; P<0.001, respectively) and moderate carotid stenosis (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.39-3.54; P=0.001 and adjusted prevalence ratio, 4.82; 95% confidence interval, 3.09-7.050; P<0.001, respectively). The addition of AAC24 scores to traditional risk factors improved identification of women with carotid atherosclerosis as quantified by C-statistic (+0.075, P<0.001), net reclassification (0.249, P<0.001), and integrated discrimination (0.065, P<0.001). CONCLUSIONS AAC identified on images from a dual-energy x-ray absorptiometry machine were strongly related to carotid ultrasound measures of atherosclerosis. This low-cost, minimal radiation technique used widely for osteoporosis screening is a promising marker of generalized extracoronary atherosclerosis.
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Affiliation(s)
- Joshua R Lewis
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Institute for Research and Education, Minneapolis, MN, USA and Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Wai H Lim
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kun Zhu
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ee M Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia.,PathWest, Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Peter L Thompson
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Douglas P Kiel
- Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Richard L Prince
- University of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, Perth, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, Australia
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158
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Abstract
Osteoporosis per se is not a harmful disease. It is the sequela of osteoporosis and most particularly the occurrence of osteoporotic fracture that makes osteoporosis a serious medical condition. All of the preventative measures, investigations, treatment and research into osteoporosis have one primary goal and that is to prevent the occurrence of osteoporotic fracture. Vertebral fracture is by far and away the most prevalent osteoporotic fracture. The significance and diagnosis of vertebral fracture are discussed in this article.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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159
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Brett AD, Brown JK. Quantitative computed tomography and opportunistic bone density screening by dual use of computed tomography scans. J Orthop Translat 2015; 3:178-184. [PMID: 30035056 PMCID: PMC5986997 DOI: 10.1016/j.jot.2015.08.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/25/2015] [Accepted: 08/26/2015] [Indexed: 01/08/2023] Open
Abstract
Central dual-energy X-ray absorptiometry (DXA) of the lumbar spine and proximal femur is the preferred method for bone mineral density (BMD) testing. Despite the fracture risk statistics, osteoporosis testing with DXA remains underused. However, BMD can also be assessed with quantitative computed tomography (QCT) that may be available when access to DXA is restricted. For patients undergoing a primary CT study of the abdomen or pelvis, a potential opportunity exists for concurrent BMD screening by QCT without the need for any additional imaging, radiation exposure, or patient time.
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Affiliation(s)
| | - J. Keenan Brown
- Corresponding author. Mindways Software Inc., 3001 S Lamar Blvd, Suite 302, Austin, TX 78704, USA.
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160
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Bredella MA, Daley SM, Kalra MK, Brown JK, Miller KK, Torriani M. Marrow Adipose Tissue Quantification of the Lumbar Spine by Using Dual-Energy CT and Single-Voxel (1)H MR Spectroscopy: A Feasibility Study. Radiology 2015; 277:230-5. [PMID: 25988401 DOI: 10.1148/radiol.2015142876] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To test the performance of dual-energy computed tomography (CT) in the assessment of marrow adipose tissue (MAT) content of the lumbar spine by using proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy as a reference standard and to determine the influence of MAT on the assessment of bone mineral density (BMD). MATERIALS AND METHODS This study was institutional review board approved and complied with HIPAA guidelines. Written informed consent was obtained. Twelve obese osteopenic but otherwise healthy subjects (mean age ± standard deviation, 43 years ± 13) underwent 3-T (1)H MR spectroscopy of the L2 vertebra by using a point-resolved spatially localized spectroscopy sequence without water suppression. The L2 vertebra was scanned with dual-energy CT (80 and 140 kV) by using a dual-source multi-detector row CT scanner with a calibration phantom. Mean basis material composition relative to the phantom was estimated in the L2 vertebra. Volumetric BMD was measured with and without correction for MAT. Bland-Altman 95% limits of agreement and Pearson correlation coefficients were calculated. RESULTS There was excellent agreement between (1)H MR spectroscopy and dual-energy CT, with a mean difference in fat fraction of -0.02 between the techniques, with a 95% confidence interval of -0.24, 0.20. There was a strong correlation between marrow fat fraction obtained with (1)H MR spectroscopy and that obtained with dual-energy CT (r = 0.91, P < .001). The presence of MAT led to underestimation of BMD, and this bias increased with increasing MAT content (P < .001). CONCLUSION Dual-energy CT can be used to assess MAT content and BMD of the lumbar spine in a single examination and provides data that closely agree and correlate with (1)H MR spectroscopy data.
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Affiliation(s)
- Miriam A Bredella
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
| | - Scott M Daley
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
| | - Mannudeep K Kalra
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
| | - J Keenan Brown
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
| | - Karen K Miller
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
| | - Martin Torriani
- From the Department of Radiology (M.A.B., S.M.D., M.K.K., M.T.) and Neuroendocrine Unit (K.K.M.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Mindways Software, Austin, Tex (J.K.B.)
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161
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Wilkinson JM, Morris RM, Martin-Fernandez MA, Pozo JM, Frangi AF, Maheson M, Yang L. Use of high resolution dual-energy x-ray absorptiometry-region free analysis (DXA-RFA) to detect local periprosthetic bone remodeling events. J Orthop Res 2015; 33:712-6. [PMID: 25640686 DOI: 10.1002/jor.22823] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/06/2015] [Indexed: 02/04/2023]
Abstract
Dual-energy x-ray absorptiometry (DXA) is the gold standard method for measuring periprosthetic bone remodeling, but relies on a region of interest (ROI) analysis approach. While this addresses issues of anatomic variability, it is insensitive to bone remodeling events at the sub-ROI level. We have validated a high-spatial resolution tool, termed DXA-region free analysis (DXA-RFA) that uses advanced image processing approaches to allow quantitation of bone mineral density (BMD) at the individual pixel (data-point) level. Here we compared the resolution of bone remodeling measurements made around a stemless femoral prosthesis in 18 subjects over 24 months using ROI-based analysis versus that made using DXA-RFA. Using the ROI approach the regional pattern of BMD change varied by region, with greatest loss in ROI5 (20%, p < 0.001), and largest gain in ROI4 (6%, p < 0.05). Analysis using DXA-RFA showed a focal zone of increased BMD localized to the prosthesis-bone interface (30-40%, p < 0.001) that was not resolved using conventional DXA analysis. The 20% bone loss observed in ROI5 with conventional DXA was resolved to a focal area adjacent to the cut surface of the infero-medial femoral neck (up to 40%, p < 0.0001). DXA-RFA enables high resolution analysis of DXA datasets without the limitations incurred using ROI-based approaches.
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Affiliation(s)
- J Mark Wilkinson
- Academic Unit of Bone Metabolism, Northern General Hospital, University of Sheffield, Sheffield, United Kingdom
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162
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Diacinti D, Pisani D, D'Avanzo M, Celli M, Zambrano A, Stoppo M, Diacinti D, Roggini M, Todde F, D'Eufemia P, Pepe J, Minisola S. Reliability of vertebral fractures assessment (VFA) in children with osteogenesis imperfecta. Calcif Tissue Int 2015; 96:307-12. [PMID: 25694358 DOI: 10.1007/s00223-015-9960-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
The aim of this study is to evaluate the diagnostic accuracy of vertebral fractures assessment (VFA) in comparison with conventional radiography in identifying vertebral fractures in children and adolescents affected by OI. On 58 patients (33 males, 25 females; age range 1-18 years; 41 children and 17 adolescents) with osteogenesis imperfecta (OI type I, n = 44, OI type III, n = 4; OI type IV, n = 10), lateral spine images by radiographs and by dual-energy X-ray absorptiometry (DXA) were acquired. For vertebral fracture diagnosis, plain radiographs were used as "gold standard" and VFA and morphometric X-ray absorptiometry (MXA) were performed. The visualized vertebrae were 738 (97.9%) by radiographs and 685 (90.9%) by DXA of a total of 754 vertebrae from T4 to L4. VFA and MXA identified, respectively, 129 (74%) and 116 (66%) of the 175 vertebral fractures detected by radiographs. Radiographs identified 36 patients with vertebral fractures, VFA 35 and MXA 41 (6 false positives). On a per vertebra basis, radiographs and VFA had elevated agreement (93.9%; k score 0.81, 95% CI 0.76-0.86), that resulted slightly lower for MXA (90.6%; k score 0.72, 95% CI 0.65-0.78). VFA and MXA demonstrated high sensitivity (95.6 and 94.1 %, respectively) while specificity was 100% for VFA and 90.6% for MXA on a per patient basis; the agreement was excellent for VFA (98.3%; k score 0.96, 95% CI 0.89-1.03) and good for MXA (87.9%; k score 0.73, 95% CI 0.55-0.91). The diagnostic performance parameters resulted better for VFA (sensitivity 95.6%; specificity 100%; PPV 100%; NPV 97.2%), than for MXA (sensitivity 94.1%; specificity 85.4%; PPV 72.7%; NPV 97.2%). The results of our study demonstrate the reliability of VFA for diagnosis of vertebral fractures in children with OI suggesting its use as a more safe and practical alternative to conventional radiography.
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Affiliation(s)
- D Diacinti
- Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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163
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Aubry-Rozier B, Chapurlat R, Duboeuf F, Iglesias K, Krieg MA, Lamy O, Burnand B, Hans D. Reproducibility of Vertebral Fracture Assessment Readings From Dual-energy X-ray Absorptiometry in Both a Population-based and Clinical Cohort: Cohen's and Uniform Kappa. J Clin Densitom 2015; 18:233-8. [PMID: 25439454 DOI: 10.1016/j.jocd.2014.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 09/01/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
Vertebral fracture assessments (VFAs) using dual-energy X-ray absorptiometry increase vertebral fracture detection in clinical practice and are highly reproducible. Measures of reproducibility are dependent on the frequency and distribution of the event. The aim of this study was to compare 2 reproducibility measures, reliability and agreement, in VFA readings in both a population-based and a clinical cohort. We measured agreement and reliability by uniform kappa and Cohen's kappa for vertebral reading and fracture identification: 360 VFAs from a population-based cohort and 85 from a clinical cohort. In the population-based cohort, 12% of vertebrae were unreadable. Vertebral fracture prevalence ranged from 3% to 4%. Inter-reader and intrareader reliability with Cohen's kappa was fair to good (0.35-0.71 and 0.36-0.74, respectively), with good inter-reader and intrareader agreement by uniform kappa (0.74-0.98 and 0.76-0.99, respectively). In the clinical cohort, 15% of vertebrae were unreadable, and vertebral fracture prevalence ranged from 7.6% to 8.1%. Inter-reader reliability was moderate to good (0.43-0.71), and the agreement was good (0.68-0.91). In clinical situations, the levels of reproducibility measured by the 2 kappa statistics are concordant, so that either could be used to measure agreement and reliability. However, if events are rare, as in a population-based cohort, we recommend evaluating reproducibility using the uniform kappa, as Cohen's kappa may be less accurate.
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Affiliation(s)
| | | | | | - Katia Iglesias
- Département de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc-Antoine Krieg
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Olivier Lamy
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Département de Médecine Sociale et Préventive, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Centre for Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
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164
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Abstract
Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. For patients affected by these processes, radiologic imaging plays a central role in diagnosis, monitoring treatment, and risk stratification. Radiologists should be familiar with the diseases, intimately aware of the imaging findings, and possessive of multimodality expertise to wisely guide the best practice of medicine. The purpose of this paper is to review the imaging features and characteristics of the most common types of metabolic bone disease with highlights of clinically relevant information so that readers can better generate appropriate differential diagnoses and recommendations. For this review, a thorough literature search for the most up-to-date information was performed on several key types of metabolic bone disease: osteoporosis, osteomalacia, rickets, scurvy, renal osteodystrophy, hyperparathyroidism, Paget’s disease, osteogenesis imperfecta, acromegaly, and osteopetrosis. Although they all affect the bone, these diseases have both shared characteristic features that can be discerned through imaging.
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165
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Sarkar M, Bhardwaj R, Madabhavi I, Khatana J. Osteoporosis in chronic obstructive pulmonary disease. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2015; 9:5-21. [PMID: 25788838 PMCID: PMC4358421 DOI: 10.4137/ccrpm.s22803] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/28/2015] [Accepted: 02/11/2015] [Indexed: 12/21/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease associated with significant morbidity and mortality worldwide. COPD is associated with various comorbidities found in all stages of COPD. The comorbidities have significant impact in terms of morbidity, mortality, and economic burden in COPD. Management of comorbidities should be incorporated into the comprehensive management of COPD as this will also have an effect on the outcome in COPD patients. Various comorbidities reported in COPD include cardiovascular disease, skeletal muscle dysfunction, anemia, metabolic syndrome, and osteoporosis. Osteoporosis is a significant comorbidity in COPD patients. Various risk factors, such as tobacco smoking, systemic inflammation, vitamin D deficiency, and the use of oral or inhaled corticosteroids (ICSs) are responsible for its occurrence in patients with COPD. This review will focus on the prevalence, pathogenesis, risk factors, diagnosis, and treatment of osteoporosis in COPD patients.
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Affiliation(s)
- Malay Sarkar
- Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Rajeev Bhardwaj
- Department of Cardiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Irappa Madabhavi
- Department of Medical and Pediatric Oncology, GCRI, Ahmedabad, Gujarat, India
| | - Jasmin Khatana
- Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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166
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Maricic M. Use of DXA-based technology for detection and assessment of risk of vertebral fracture in rheumatology practice. Curr Rheumatol Rep 2015; 16:436. [PMID: 24938441 DOI: 10.1007/s11926-014-0436-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) is the recommended method for diagnosis of osteoporosis and assessment of future fracture risk. However, most patients who will suffer fractures do not have osteoporosis by DXA (T-score of -2.5 or less). Bone strength, which is most closely associated with resistance to fracture, is a composite of both bone density and bone quality, and the latter is not measured by DXA. Thus, other technology is needed for non-invasive and inexpensive assessment of bone strength and fracture risk. Vertebral fractures, the most common clinical fracture in the general population, are of even greater importance in rheumatoid arthritis and other rheumatic disorders. Vertebral fracture assessment (VFA) and trabecular bone scores (TBS), two techniques which can aid prediction of future fracture risk, can be used with currently available DXA machines. Description of these techniques and their potential application to clinical rheumatology practice will be the focus of this paper.
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Affiliation(s)
- Michael Maricic
- Catalina Pointe Rheumatology, 7520 N. Oracle Road, Suite 100, Tucson, AZ, 85704, USA,
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167
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Hassan NE, El-Masry SA, El-Banna RA, El Hussieny MS. Different Tools for the Assessment of Bone Mass among Egyptian Adults. Open Access Maced J Med Sci 2014. [DOI: 10.3889/oamjms.2014.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Several tools such as, dual X-ray absorptiometry (DXA), quantitative computed tomography (QCT) and self-assessment tool (OST), are being used for diagnosis of osteoporosis.OBJECTIVE: to compare the sensitivity and specify detection rate of bone mineral density (BMD) changes for DXA versus QCT and OST among a sample of Egyptian adults of both sexes.SUBJECTS AND METHODS: This study is a cross sectional one, which included 62 Egyptians, aged 20-65 years. Each individual was assessed for BMD using DXA at femur and spine sites; QCT and OST which take into account body weight and age. Accordingly they were diagnosed as either osteoporotic/osteopenic or normal.RESULTS: The highest prevalence of osteopenia or osteoporosis was diagnosed among menopause women. DXA at femur has diagnosed more cases of osteoporosis (both osteopenic and osteoporotic) as compared to spine DXA or QCT, but OST is out of rang; as it failed to diagnose any case.CONCLUSION: DXA has been found to be more efficacious than QCT scan in the diagnosis of osteoporosis. DXA in femur is better than DXA-spine and QCT. Generally, DXA is the "gold standard" when assessing osteoporosis. Further studies are needed to modify the equation of OST and confirm its efficiency in Egyptians population.
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168
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Evans BAJ, James TW, James K, Cox A, Farr L, Paisey SJ, Dempster DW, Stone MD, Griffiths PA, Hugtenburg RP, Brady SM, Wells T. Preclinical assessment of a new magnetic resonance-based technique for determining bone quality by characterization of trabecular microarchitecture. Calcif Tissue Int 2014; 95:506-20. [PMID: 25380571 DOI: 10.1007/s00223-014-9922-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
The utility of HR-CT to study longitudinal changes in bone microarchitecture is limited by subject radiation exposure. Although MR is not subject to this limitation, it is limited both by patient movement that occurs during prolonged scanning at distal sites, and by the signal-to-noise ratio that is achievable for high-resolution images in a reasonable scan time at proximal sites. Recently, a novel MR-based technique, fine structure analysis (FSA) (Chase et al. Localised one-dimensional magnetic resonance spatial frequency spectroscopy. PCT/US2012/068284 2012, James and Chase Magnetic field gradient structure characteristic assessment using one-dimensional (1D) spatial frequency distribution analysis. 7932720 B2, 2011) has been developed which provides both high-resolution and fast scan times, but which generates at a designated set of spatial positions (voxels) a one-dimensional signal of spatial frequencies. Appendix 1 provides a brief introduction to FSA. This article describes an initial exploration of FSA for the rapid, non-invasive characterization of trabecular microarchitecture in a preclinical setting. For L4 vertebrae of sham and ovariectomized (OVX) rats, we compared FSA-generated metrics with those from CT datasets and from CT-derived histomorphometry parameters, trabecular number (Tb.N), bone volume density (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). OVX caused a reduction of the higher frequency structures that correspond to a denser trabecular lattice, while increasing the preponderance of lower frequency structures, which correspond to a more open lattice. As one example measure, the centroid of the FSA spectrum (which we refer to as fSAcB) showed strong correlation in the same region with CT-derived histomorphometry values: Tb.Sp: r -0.63, p < 0.001; Tb.N: r 0.71, p < 0.001; BV/TV: r 0.64, p < 0.001, Tb.Th: r 0.44, p < 0.05. Furthermore, we found a 17.5% reduction in fSAcB in OVX rats (p < 0.0001). In a longitudinal study, FSA showed that the age-related increase in higher frequency structures was abolished in OVX rats, being replaced with a 78-194% increase in lower frequency structures (2.4-2.8 objects/mm range), indicating a more sparse trabecular lattice (p < 0.05). The MR-based fine structure analysis enables high-resolution, radiation-free, rapid quantification of bone structures in one dimension (the specific point and direction being chosen by the clinician) of the spine.
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Affiliation(s)
- B A J Evans
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
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169
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Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom 2014; 17:438-48. [PMID: 24880494 DOI: 10.1016/j.jocd.2014.04.119] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/22/2023]
Abstract
Quantitative computed tomography (QCT) is currently undergoing a renaissance, with an increasing number of studies being published and the definition of both QCT-specific osteoporosis thresholds and treatment criteria. Compared with dual-energy X-ray absorptiometry, the current standard bone mineral density technique, QCT has a number of pertinent advantages, including volumetric measurements, less susceptibility to degenerative spine changes, and higher sensitivity to changes in bone mass. Disadvantages include the higher radiation doses and less experience with fracture prediction and therapy monitoring. Over the last 10 yr, a number of novel applications have been described allowing assessment of bone mineral density and bone quality in larger patient populations, developments that may substantially improve patient care.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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170
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Bredbenner TL, Mason RL, Havill LM, Orwoll ES, Nicolella DP. Fracture risk predictions based on statistical shape and density modeling of the proximal femur. J Bone Miner Res 2014; 29:2090-100. [PMID: 24692132 PMCID: PMC4357175 DOI: 10.1002/jbmr.2241] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/15/2014] [Accepted: 03/24/2014] [Indexed: 11/10/2022]
Abstract
Increased risk of skeletal fractures due to bone mass loss is a major public health problem resulting in significant morbidity and mortality, particularly in the case of hip fractures. Current clinical methods based on two-dimensional measures of bone mineral density (areal BMD or aBMD) are often unable to identify individuals at risk of fracture. We investigated predictions of fracture risk based on statistical shape and density modeling (SSDM) methods using a case-cohort sample of individuals from the Osteoporotic Fractures in Men (MrOS) study. Baseline quantitative computed tomography (QCT) data of the right femur were obtained for 513 individuals, including 45 who fractured a hip during follow-up (mean 6.9 year observation, validated by physician review). QCT data were processed for 450 individuals (including 40 fracture cases) to develop individual models describing three-dimensional bone geometry and density distribution. Comparison of mean fracture and non-case models indicated complex structural differences that appear to be responsible for resistance to hip fracture. Logistic regressions were used to model the relation of baseline hip BMD and SSDM weighting factors to the occurrence of hip fracture. Area under the receiver operating characteristic (ROC) curve (AUC) for a prediction model based on weighting factors and adjusted by age was significantly greater than AUC for a prediction model based on aBMD and age (0.94 versus 0.83, respectively). The SSDM-based prediction model adjusted by age correctly identified 55% of the fracture cases (and 94.7% of the non-cases), whereas the clinical standard aBMD correctly identified 10% of the fracture cases (and 91.3% of the non-cases). SSDM identifies subtle changes in combinations of structural bone traits (eg, geometric and BMD distribution traits) that appear to indicate fracture risk. Investigation of important structural differences in the proximal femur between fracture and no-fracture cases may lead to improved prediction of those at risk for future hip fracture.
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171
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Souza AHO, Farias MIT, Salvatori R, Silva GMF, Santana JAM, Pereira FA, de Paula FJA, Valença EHO, Melo EV, Barbosa RAA, Pereira RMC, Gois-Junior MB, Aguiar-Oliveira MH. Lifetime, untreated isolated GH deficiency due to a GH-releasing hormone receptor mutation has beneficial consequences on bone status in older individuals, and does not influence their abdominal aorta calcification. Endocrine 2014; 47:191-7. [PMID: 24272598 DOI: 10.1007/s12020-013-0118-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/06/2013] [Indexed: 12/26/2022]
Abstract
The GH/IGF-I axis has essential roles in regulating bone and vascular status. The age-related decrease in GH secretion ("somatopause") may contribute to osteoporosis and atherosclerosis, commonly observed in the elderly. Adult-onset GH deficiency (GHD) has been reported to be associated with reduced bone mineral density (BMD), increased risk of fractures, and premature atherosclerosis. We have shown the young adult individuals with isolated GHD (IGHD) due to a homozygous for the c.57+1G>A GHRH receptor gene mutation have normal volumetric BMD (vBMD), and not develop premature atherosclerosis, despite adverse risk factor profile. However, the bone and vascular impact of lifetime GHD on the aging process remains unknown. We studied a group of ten older IGHD subjects (≥60 years) homozygous for the mutation, comparing them with 20 age- and gender-matched controls (CO). Areal BMD was measured, and vBMD was calculated at the lumbar spine and total hip. Vertebral fractures and abdominal aortic calcifications (expressed as calcium score) were also assessed. Areal BMD was lower in IGHD, but vBMD was similar in the two groups. The percent of fractured individuals was similar, but the mean number of fractures per individual was lower in IGHD than CO. Calcium score was similar in the two groups. A positive correlation was found between calcium score and number of fractures. Untreated lifetime IGHD has beneficial consequences on bone status and does not have a deleterious effect on abdominal aorta calcification.
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Affiliation(s)
- Anita H O Souza
- Division of Endocrinology, Department of Medicine, School of Medicine, Federal University of Sergipe, Aracaju, Brazil
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172
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Warriner AH, Outman RC, Feldstein AC, Roblin DW, Allison JJ, Curtis JR, Redden DT, Rix MM, Robinson BE, Rosales AG, Safford MM, Saag KG. Effect of self-referral on bone mineral density testing and osteoporosis treatment. Med Care 2014; 52:743-50. [PMID: 24984211 PMCID: PMC4101066 DOI: 10.1097/mlr.0000000000000170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite national guidelines recommending bone mineral density screening with dual-energy x-ray absorptiometry (DXA) in women aged 65 years and older, many women do not receive initial screening. OBJECTIVE To determine the effectiveness of health system and patient-level interventions designed to increase appropriate DXA testing and osteoporosis treatment through (1) an invitation to self-refer for DXA (self-referral); (2) self-referral plus patient educational materials; and (3) usual care (UC, physician referral). RESEARCH DESIGN Parallel, group-randomized, controlled trials performed at Kaiser Permanente Northwest (KPNW) and Kaiser Permanente Georgia (KPG). SUBJECTS Women aged 65 years and older without a DXA in past 5 years. MEASURES DXA completion rates 90 days after intervention mailing and osteoporosis medication receipt 180 days after initial intervention mailing. RESULTS From >12,000 eligible women, those randomized to self-referral were significantly more likely to receive a DXA than UC (13.0%-24.1% self-referral vs. 4.9%-5.9% UC, P<0.05). DXA rates did not significantly increase with patient educational materials. Osteoporosis was detected in a greater proportion of self-referral women compared with UC (P<0.001). The number needed to receive an invitation to result in a DXA in KPNW and KPG regions was approximately 5 and 12, respectively. New osteoporosis prescription rates were low (0.8%-3.4%) but significantly greater among self-referral versus UC in KPNW. CONCLUSIONS DXA rates significantly improved with a mailed invitation to schedule a scan without physician referral. Providing women the opportunity to self-refer may be an effective, low-cost strategy to increase access for recommended osteoporosis screening.
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Affiliation(s)
- Amy H. Warriner
- Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham
| | - Ryan C. Outman
- Division of Preventive Medicine, University of Alabama at Birmingham
| | | | | | - Jeroan J. Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Jeffrey R. Curtis
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham
| | - Mary M. Rix
- Kaiser Permanente Center for Health Research/Northwest, Portland, OR
| | | | | | - Monika M. Safford
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Kenneth G. Saag
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham
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173
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Chaplais E, Greene D, Hood A, Telfer S, du Toit V, Singh-Grewal D, Burns J, Rome K, Schiferl DJ, Hendry GJ. Reproducibility of a peripheral quantitative computed tomography scan protocol to measure the material properties of the second metatarsal. BMC Musculoskelet Disord 2014; 15:242. [PMID: 25037451 PMCID: PMC4108224 DOI: 10.1186/1471-2474-15-242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 07/16/2014] [Indexed: 11/17/2022] Open
Abstract
Background Peripheral quantitative computed tomography (pQCT) is an established technology that allows for the measurement of the material properties of bone. Alterations to bone architecture are associated with an increased risk of fracture. Further pQCT research is necessary to identify regions of interest that are prone to fracture risk in people with chronic diseases. The second metatarsal is a common site for the development of insufficiency fractures, and as such the aim of this study was to assess the reproducibility of a novel scanning protocol of the second metatarsal using pQCT. Methods Eleven embalmed cadaveric leg specimens were scanned six times; three times with and without repositioning. Each foot was positioned on a custom-designed acrylic foot plate to permit unimpeded scans of the region of interest. Sixty-six scans were obtained at 15% (distal) and 50% (mid shaft) of the second metatarsal. Voxel size and scan speed were reduced to 0.40 mm and 25 mm.sec-1. The reference line was positioned at the most distal portion of the 2nd metatarsal. Repeated measurements of six key variables related to bone properties were subject to reproducibility testing. Data were log transformed and reproducibility of scans were assessed using intraclass correlation coefficients (ICC) and coefficients of variation (CV%). Results Reproducibility of the measurements without repositioning were estimated as: trabecular area (ICC 0.95; CV% 2.4), trabecular density (ICC 0.98; CV% 3.0), Strength Strain Index (SSI) - distal (ICC 0.99; CV% 5.6), cortical area (ICC 1.0; CV% 1.5), cortical density (ICC 0.99; CV% 0.1), SSI – mid shaft (ICC 1.0; CV% 2.4). Reproducibility of the measurements after repositioning were estimated as: trabecular area (ICC 0.96; CV% 2.4), trabecular density (ICC 0.98; CV% 2.8), SSI - distal (ICC 1.0; CV% 3.5), cortical area (ICC 0.99; CV%2.4), cortical density (ICC 0.98; CV% 0.8), SSI – mid shaft (ICC 0.99; CV% 3.2). Conclusions The scanning protocol generated excellent reproducibility for key bone properties measured at the distal and mid-shaft regions of the 2nd metatarsal. This protocol extends the capabilities of pQCT to evaluate bone quality in people who may be at an increased risk of metatarsal insufficiency fractures.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gordon J Hendry
- Institute for Applied Health Research, Glasgow Caledonian University, Glasgow G4 0BA, UK.
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174
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Vezzoli G, Rubinacci A, Lazzaroni M, Soldati L. It's time for a practical method quantifying vascular calcification. J Transl Med 2014; 12:172. [PMID: 24934280 PMCID: PMC4065603 DOI: 10.1186/1479-5876-12-172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/15/2022] Open
Affiliation(s)
- Giuseppe Vezzoli
- Nephrology and Dialysis Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.
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175
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Erskine RM, Morse CI, Day SH, Williams AG, Onambele-Pearson GL. The human patellar tendon moment arm assessed in vivo using dual-energy X-ray absorptiometry. J Biomech 2014; 47:1294-8. [DOI: 10.1016/j.jbiomech.2014.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/29/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
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176
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Adams JE, Engelke K, Zemel BS, Ward KA. Quantitative computer tomography in children and adolescents: the 2013 ISCD Pediatric Official Positions. J Clin Densitom 2014; 17:258-74. [PMID: 24792821 DOI: 10.1016/j.jocd.2014.01.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
In 2007, International Society of Clinical Densitometry Pediatric Positions Task Forces reviewed the evidence for the clinical application of peripheral quantitative computed tomography (pQCT) in children and adolescents. At that time, numerous limitations regarding the clinical application of pQCT were identified, although its use as a research modality for investigation of bone strength was highlighted. The present report provides an updated review of evidence for the clinical application of pQCT, as well as additional reviews of whole body QCT scans of the central and peripheral skeletons, and high-resolution pQCT in children. Although these techniques remain in the domain of research, this report summarizes the recent literature and evidence of the clinical applicability and offers general recommendations regarding the use of these modalities in pediatric bone health assessment.
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Affiliation(s)
- Judith E Adams
- Department of Clinical Radiology, The Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, England, UK.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany and Synarc A/S, Germany
| | - Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kate A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
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177
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Cann CE, Adams JE, Brown JK, Brett AD. CTXA hip--an extension of classical DXA measurements using quantitative CT. PLoS One 2014; 9:e91904. [PMID: 24637515 PMCID: PMC3956816 DOI: 10.1371/journal.pone.0091904] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 02/18/2014] [Indexed: 01/22/2023] Open
Abstract
Bone mineral density (BMD) estimates for the proximal femur using Dual Energy X-ray Absorptiometry (DXA) are currently considered the standard for making a diagnosis of osteoporosis in an individual patient using BMD alone. We have compared BMD results from a commercial Quantitative CT (QCT) BMD analysis system, "CTXA Hip", which provides clinical data for the proximal femur, to results from DXA. We have also used CTXA Hip to determine cortical and trabecular contributions to total BMD. Sixty-nine patients were scanned using 3D QCT and DXA. CTXA Hip BMD measurements for Total Hip and Femoral Neck were compared to DXA results. Twenty-two women were scanned at 0, 1, 2 years and CTXA Hip and DXA results analyzed for long-term reproducibility. Long-term reproducibility calculated as root-mean-square averages of SDs in vivo was 0.012 g/cm2 (CV = 1.8%) for CTXA Total Hip and 0.011 g/cm2 (CV = 2.0%) for CTXA Femoral Neck compared to 0.014 g/cm2 (CV = 2.0%) and 0.016 g/cm2 (CV = 2.7%), respectively, for DXA. The correlation of Total Hip BMD CTXA vs. DXA was R = 0.97 and for Femoral Neck was R = 0.95 (SEE 0.044 g/cm2 in both cases). Cortical bone comprised 62±5% (mean ± SD) of total hipbone mass in osteoporotic women. CTXA Hip provides substantially the same clinical information as conventional DXA and in addition provides estimates of BMD in separate cortical and trabecular bone compartments, which may be useful in evaluation of bone strength.
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Affiliation(s)
- Christopher E. Cann
- Mindways Software, Inc., Austin, Texas, United States of America
- Department of Radiology, University of California San Francisco, San Francisco, California, United States of America
| | - Judith E. Adams
- Department of Clinical Radiology, University of Manchester, Manchester, United Kingdom
| | - J. Keenan Brown
- Mindways Software, Inc., Austin, Texas, United States of America
| | - Alan D. Brett
- Mindways Software, Inc., Austin, Texas, United States of America
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178
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Sgambat K, Moudgil A. Optimization of Bone Health in Children before and after Renal Transplantation: Current Perspectives and Future Directions. Front Pediatr 2014; 2:13. [PMID: 24605319 PMCID: PMC3932433 DOI: 10.3389/fped.2014.00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/11/2014] [Indexed: 11/29/2022] Open
Abstract
The accrual of healthy bone during the critical period of childhood and adolescence sets the stage for lifelong skeletal health. However, in children with chronic kidney disease (CKD), disturbances in mineral metabolism and endocrine homeostasis begin early on, leading to alterations in bone turnover, mineralization, and volume, and impairing growth. Risk factors for CKD-mineral and bone disorder (CKD-MBD) include nutritional vitamin D deficiency, secondary hyperparathyroidism, increased fibroblast growth factor 23 (FGF-23), altered growth hormone and insulin-like growth factor-1 axis, delayed puberty, malnutrition, and metabolic acidosis. After kidney transplantation, nutritional vitamin D deficiency, persistent hyperparathyroidism, tertiary FGF-23 excess, hypophosphatemia, hypomagnesemia, immunosuppressive therapy, and alteration of sex hormones continue to impair bone health and growth. As function of the renal allograft declines over time, CKD-MBD associated changes are reactivated, further impairing bone health. Strategies to optimize bone health post-transplant include healthy diet, weight-bearing exercise, correction of vitamin D deficiency and acidosis, electrolyte abnormalities, steroid avoidance, and consideration of recombinant human growth hormone therapy. Other drug therapies have been used in adult transplant recipients, but there is insufficient evidence for use in the pediatric population at the present time. Future therapies to be explored include anti-FGF-23 antibodies, FGF-23 receptor blockers, and treatments targeting the colonic microbiota by reduction of generation of bacterial toxins and adsorption of toxic end products that affect bone mineralization.
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Affiliation(s)
| | - Asha Moudgil
- Children National Medical Center, Washington, DC, USA
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Wichmann JL, Booz C, Wesarg S, Kafchitsas K, Bauer RW, Kerl JM, Lehnert T, Vogl TJ, Khan MF. Dual-energy CT-based phantomless in vivo three-dimensional bone mineral density assessment of the lumbar spine. Radiology 2014; 271:778-84. [PMID: 24475863 DOI: 10.1148/radiol.13131952] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the feasibility of phantomless in vivo dual-energy computed tomography (CT)-based three-dimensional (3D) bone mineral density (BMD) assessment in comparison with dual x-ray absorptiometry (DXA). MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and the requirement to obtain informed consent was waived. Data from clinically indicated dual-energy CT and DXA examinations within 2 months, comprising the lumbar spine of 40 patients, were included. By using automated dedicated postprocessing dual-energy CT software, the trabecular bone of lumbar vertebrae L1-L4 were analyzed and segmented. A mixed-effects model was used to assess the correlations between BMD values derived from dual-energy CT and DXA. RESULTS One hundred sixty lumbar vertebrae were analyzed in 40 patients (mean age, 57.1 years; range, 24-85 years), 21 male (mean age, 54.3 years; range, 24-85 years) and 19 female (mean age, 58.5 years; range, 31-80 years). Mean BMD of L1-L4 determined with DXA was 0.995 g/cm(2), and 18 patients (45%) showed an osteoporotic BMD (T score less than -2.5) of at least two vertebrae. Mean dual-energy CT-based BMD of L1-L4 was 0.254 g/cm(3). Bland-Altman analysis with mixed effects demonstrated a lack of correlation between dual-energy CT-based and DXA-based BMD values, with a mean difference of 0.7441 and 95% limits of agreement of 0.7441 ± 0.4080. CONCLUSION Dedicated postprocessing of dual-energy CT data allows for phantomless in vivo BMD assessment of the trabecular bone of lumbar vertebrae and enables freely rotatable color-coded 3D visualization of intravertebral BMD distribution.
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Affiliation(s)
- Julian L Wichmann
- From the University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany (J.L.W., C.B., R.W.B., J.M.K., T.L., T.J.V., M.F.K.); Fraunhofer IGD, Cognitive Computing & Medical Imaging, Darmstadt, Germany (S.W.); and University Medical Center Mainz, Clinic and Policlinic for Orthopedics and Orthopedic Surgery, Mainz, Germany (K.K.)
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Lazzari AA, Dussault PM, Thakore-James M, Gagnon D, Baker E, Davis SA, Houranieh AM. Prevention of bone loss and vertebral fractures in patients with chronic epilepsy--antiepileptic drug and osteoporosis prevention trial. Epilepsia 2013; 54:1997-2004. [PMID: 24010637 DOI: 10.1111/epi.12351] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE To evaluate whether use of a bisphosphonate (risedronate) in addition to calcium and vitamin D in male veterans with epilepsy who were taking antiepileptic drugs (AEDs) long term can prevent the loss of bone mass (BMD, bone mineral density) associated with AED use compared to patients who were treated with a placebo plus calcium and vitamin D. As a secondary end point we studied the incidence of new morphometric vertebral and nonvertebral fractures. METHODS Antiepileptic drug and osteoporosis prevention trial (ADOPT) was designed as a prospective 2-year double-blind, randomized placebo controlled study involving 80 male veterans with epilepsy who were being treated with AEDs such as phenytoin, phenobarbital, sodium valproate, or carbamazepine for a minimum of 2 years. All enrolled participants received calcium and vitamin D supplementation, and were randomized to risedronate or matching placebo. Total body, bilateral proximal femora, and anteroposterior (AP) lumbar spine BMDs in addition to morphometric lateral vertebral assessments (LVAs) were evaluated by a dual energy x-ray absorptiometry (DXA) instrument. Comparisons of BMDs were made between baseline, 1 year, and after 2 years of enrollment in the study. The incidence of new vertebral and nonvertebral fractures was secondary end point. KEY FINDINGS Of the 80 patients initially enrolled in the study, 53 patients completed the study. Baseline characteristics of the two groups were similar. At the end of the study, in the placebo plus calcium and vitamin D group, we observed a significant improvement in BMD at any of the evaluated sites when compared to their baseline scans in 69% (18/26) of the participants. In the risedronate plus calcium and vitamin D group, we observed significant improvement of BMDs in 70% (19/27) of the participants. At the end of the study, the risedronate group experienced a significant increase of BMD at the lumbar spine L1-4 (1.267-1.332 g/cm(2)), which was significantly larger than that seen in the placebo group) (1.229 g/cm(2) vs. 1.245 g/cm(2) ; p = 0.0066).There were nonsignificant differences between the two groups regarding changes of total body BMD or at the proximal bilateral femora. Five new vertebral fractures and one nonvertebral fracture were observed only in the placebo group. SIGNIFICANCE Calcium and vitamin D supplementation or calcium and vitamin D supplementation in addition to risedronate improved BMD in more than 69% of male veterans with epilepsy who were taking AEDs. In the group receiving risedronate plus calcium and vitamin D there was a significant improvement of BMD at the lumbar spine as compared to the placebo group, which also received calcium and vitamin D. The use of risedronate plus calcium and vitamin D prevented the incidence of new vertebral fractures and one nonvertebral fracture in this cohort.
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Affiliation(s)
- Antonio A Lazzari
- Primary Care Service, Boston VA Healthcare System, Boston, Massachusetts, U.S.A; Osteoporosis Clinic, Boston VA Healthcare System, Boston, Massachusetts, U.S.A; Rheumatology Section, Boston VA Healthcare System, Boston, Massachusetts, U.S.A; Department of Medicine, Boston VA Healthcare System, Boston, Massachusetts, U.S.A; Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, U.S.A; Department of Medicine, Harvard Medical School, Boston, Massachusetts, U.S.A
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182
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Bandirali M, Lanza E, Messina C, Sconfienza LM, Brambilla R, Maurizio R, Marchelli D, Piodi LP, Di Leo G, Ulivieri FM, Sardanelli F. Dose absorption in lumbar and femoral dual energy X-ray absorptiometry examinations using three different scan modalities: an anthropomorphic phantom study. J Clin Densitom 2013; 16:279-282. [PMID: 23535250 DOI: 10.1016/j.jocd.2013.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 02/05/2013] [Indexed: 11/29/2022]
Abstract
The aim of this study was to measure the effective dose on an anthropomorphic phantom undergoing lumbar and femoral dual energy X-ray absorption (DXA) examinations, using 3 different scan modalities (fast-array [FA], array [A], high-definition [HD]), and assess the differences in the lifetime attributable risk (LAR) of cancer due to radiation. An anthropomorphic phantom was used. Thermoluminescent dosimeters were placed over 12 anatomic phantom regions and outside the room (to measure background radiation). Fifty scans on the femur and spine were performed for each mode. The dose relative to a single DXA scan for each dosimeter was measured (mean over the 50 scans) and the background radiation was then subtracted. The equivalent dose per organ was obtained. The total body effective dose was calculated by adding the equivalent doses. We estimated the lifetime dose absorption and LAR for cancer for a male and a female patient undergoing 36 DXA studies (18 lumbar, 18 femoral) every 21 months for 32 years. The effective dose for lumbar scans was FA = 17.79 μSv, A = 32.88 μSv, HD = 31.08 μSv; for femoral scans, FA = 5.29 μSv, A = 9.55 μSv, HD = 7.54 μSv. LAR estimation showed a minimal increase in cancer risk (range 4.55 × 10⁻⁴% [FA, femoral, male] to 4.02 × 10⁻³% [A, lumbar, female]). The lifetime dose absorption and LAR for cancer for a male and a female patient undergoing 36 DXA studies (18 lumbar, 18 femoral) every 21 months for 32 years were 0.756 mSv, 3.82 × 10(-3)% and 0.756 mSv, 5.11 × 10⁻³%, respectively. DXA examinations cause radiation levels that are comparable to the background radiation. Regardless of the scan modality or the anatomic site, a patient undergoing DXA scans for a lifetime has a negligible increased risk of developing cancer.
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Affiliation(s)
- Michele Bandirali
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy.
| | - Ezio Lanza
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy; Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Roberto Brambilla
- Servizio di Fisica Sanitaria, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Rozza Maurizio
- Servizio di Fisica Sanitaria, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Daniele Marchelli
- Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina Nucleare, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Petruccio Piodi
- Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina Nucleare, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Giovanni Di Leo
- Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Fabio Massimo Ulivieri
- Mineralometria Ossea Computerizzata e Ambulatorio Malattie Metabolismo Minerale e Osseo, Servizio di Medicina Nucleare, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy
| | - Francesco Sardanelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy; Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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183
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Damilakis J, Solomou G, Manios GE, Karantanas A. Pediatric radiation dose and risk from bone density measurements using a GE Lunar Prodigy scanner. Osteoporos Int 2013; 24:2025-31. [PMID: 23306822 DOI: 10.1007/s00198-012-2261-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
UNLABELLED Effective radiation doses associated with bone mineral density examinations performed on children using a GE Lunar Prodigy fan-beam dual-energy X-ray absorptiometry (DXA) scanner were found to be comparable to doses from pencil-beam DXA devices, i.e., lower than 1 μSv. Cancer risks associated with acquisitions obtained in this study are negligible. INTRODUCTION No data were found in the literature on radiation doses and potential risks following pediatric DXA performed on GE Lunar DXA scanners. This study aimed to estimate effective doses and associated cancer risks involved in pediatric examinations performed on a GE Lunar Prodigy scanner. METHODS Four physical anthropomorphic phantoms representing newborn, 1-, 5-, and 10-year-old patients were employed to simulate DXA exposures. All acquisitions were carried out using the Prodigy scanner. Dose measurements were performed for spine and dual femur using the phantoms simulating the 5- and 10-year-old child. Moreover, doses associated with whole-body examinations were measured for the four phantoms used in the current study. RESULTS The gender-average effective dose for spine and hip examinations were 0.65 and 0.36 μSv, respectively, for the phantom representing the 5-year-old child and 0.93 and 0.205 μSv, respectively, for the phantom representing the 10-year-old child. Effective doses for whole-body examinations were 0.25, 0.22, 0.19, and 0.15 μSv for the neonate, 1-, 5-, and 10-year old child, respectively. The estimated lifetime cancer risks were negligible, i.e., 0.02-0.25 per million, depending on the sex, age, and type of DXA examination. A formula is presented for the estimation of effective dose from examinations performed on GE Lunar Prodigy scanners installed in other institutions. CONCLUSIONS The effective doses and potential cancer risks associated with pediatric DXA examinations performed on a GE Lunar Prodigy fan-beam scanner were found to be comparable to doses and risks reported from pencil-beam DXA devices.
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Affiliation(s)
- J Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
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184
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Yesil P, Durmaz B, Atamaz FC. Normative data for quantitative calcaneal ultrasonometry in Turkish children aged 6 to 14 years: relationship of the stiffness index with age, pubertal stage, physical characteristics, and lifestyle. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1191-1197. [PMID: 23804341 DOI: 10.7863/ultra.32.7.1191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES Quantitative ultrasonometry is commonly used to assess bone health. The aim of this study was to define normative data for the stiffness index of the calcaneus in healthy Turkish children. METHODS Quantitative ultrasonometric measurements of the calcaneus were obtained in 1617 healthy schoolchildren (811 boys and 806 girls) aged 6 to 14 years. RESULTS The stiffness index increased by 19.3% and 12% in boys and girls, respectively. The greatest increases were seen in the age groups of 12 to 13 and 13 to 14 years in boys (3.9%) and 11 to 12 and 12 to 13 years in girls (4.1%). There was a significant increase in stiffness index values among all Tanner stages except stage 4 (P < .05). Although the stiffness index was related to age, weight, and height, no correlation was seen between the stiffness index and calcium intake or physical activity. CONCLUSIONS This study provides stiffness index data by age group and Tanner stage that may be useful for assessment of the bone status of Turkish children and can serve as comparative data for other patient groups.
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Affiliation(s)
- Pinar Yesil
- Department of Physical Medicine and Rehabilitation, Ege University Medical Faculty, Bornova, 35040 Izmir, Turkey
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185
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Cecelja M, Frost ML, Spector TD, Chowienczyk P. Abdominal aortic calcification detection using dual-energy X-ray absorptiometry: validation study in healthy women compared to computed tomography. Calcif Tissue Int 2013; 92:495-500. [PMID: 23407824 DOI: 10.1007/s00223-013-9704-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
Abdominal aortic calcification (AAC) is an independent determinant of cardiovascular events. Computed tomography (CT) is currently the gold standard measure of AAC but is limited by high radiation exposure. Lateral dual-energy X-ray absorptiometry (DXA) has the potential to detect AAC at a fraction of the radiation dose. Our objective was to determine the accuracy of lateral-DXA in detecting AAC compared to CT in healthy women. Women from the TwinsUK registry aged 52-80 years (n = 105) underwent noncontrast CT and lateral-DXA imaging of the abdominal aorta at lumbar vertebrae L1-L4. Presence of calcium on CT was scored using the volume method. Lateral-DXA images were scored using the previously validated semiquantitative 24-point score and simplified 8-point score. Calcification was present in 81 % of women as determined by CT and 49 % with lateral-DXA. The mean volume score and the 24- and 8-point scores of AAC were 0.20 ± 0.41 cm(2), 2.39 ± 3.91 arbitrary units, and 1.47 ± 2.13 arbitrary units, respectively. There was moderate agreement between CT and 24-point lateral-DXA (Spearman's rank correlation coefficient r = 0.58, P < 0.0001). The sensitivity of lateral-DXA for detecting AAC was 56 % and specificity was 80 %. Sensitivity and specificity of lateral-DXA improved to 64 and 84 % when analysis was limited to calcium volumes ≥0.008 cm(3) as detected by CT. Lateral-DXA imaging may provide a useful alternative to CT in detecting AAC with minimal radiation exposure, which may be used with concurrent bone mineral density assessment.
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Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
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Lu Y, Wang L, Hao Y, Wang Z, Wang M, Ge S. Analysis of trabecular distribution of the proximal femur in patients with fragility fractures. BMC Musculoskelet Disord 2013; 14:130. [PMID: 23570243 PMCID: PMC3674935 DOI: 10.1186/1471-2474-14-130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 03/28/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Multi-detector computed tomography (MDCT) was used in order to assess the trabecular distribution of proximal femur and its relationship with hip fragility fractures. METHODS A total of 99 elderly women were scanned by MDCT including: 27 trochanteric hip fractures (group A), 40 femoral neck fractures (group B), and 32 non-fractures (group C). A mid-coronal MPR image of the proximal femur was reconstructed for every patient by e-Film95 software. Four regions of interest (ROI) were chosen in the images including compressive trabecula (ComT), tensile trabecula (TenT), trochanteric trabecula (TroT) and Ward's triangle (WT) region. The mean CT values were measured by the software. RESULTS The mean age was 81.44, 74.10 and 69.25 years for groups A, B and C, respectively. There was significant inter-group differences based on one-way ANOVA (P<0.05). The CT values in the four ROIs had significant differences in the groups except for TenT between group A and B (P>0.05). After the age adjustment with ANCOVA, the mean CT values of TroT and WT were significantly lower in group A as compared to that of the group B (P<0.05). However, there were no significant differences for ComT and TenT between groups A and B (P>0.05). CONCLUSIONS The occurrence of femoral neck fracture was closely related to the degeneration of ComT and TenT. Trochanteric hip fractures were associated with a more severe degeneration in TroT as well as an enlargement of WT region besides the ComT and TenT degeneration. We concluded that the hip fragility fractures might be predicted by the measurement of the mean CT values in ComT, TenT, TroT and WT region.
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Affiliation(s)
- Yaogang Lu
- Department of Orthopedics, Pudong New Area District Zhoupu Hospital, Shanghai 201318, People’s Republic of China
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187
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Gervaise A, Teixeira P, Villani N, Lecocq S, Louis M, Blum A. CT dose optimisation and reduction in osteoarticular disease. Diagn Interv Imaging 2013; 94:371-88. [DOI: 10.1016/j.diii.2012.05.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA.
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189
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Huh SY, Gordon CM. Fractures in hospitalized children. Metabolism 2013; 62:315-25. [PMID: 22959479 DOI: 10.1016/j.metabol.2012.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 07/25/2012] [Accepted: 07/25/2012] [Indexed: 10/27/2022]
Abstract
Hospitalized children have multiple risk factors for fragility fractures, related to disease pathophysiology, treatments, nutritional status and immobilization. Recognition and treatment of these risk factors are important to prevent morbidity associated with fractures and to promote current and future bone health. Many knowledge gaps remain regarding the ideal nutrition, physical activity, and medication regimens needed to optimize bone health and reduce the risk of fractures over the life course. This article reviews the pathogenesis, risk factors, treatment and prevention strategies for fractures in hospitalized infants and children.
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Affiliation(s)
- Susanna Y Huh
- Harvard Medical School, and the Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston, MA 02115, USA.
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190
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Grimal Q, Grondin J, Guérard S, Barkmann R, Engelke K, Glüer CC, Laugier P. Quantitative ultrasound of cortical bone in the femoral neck predicts femur strength: results of a pilot study. J Bone Miner Res 2013; 28:302-12. [PMID: 22915370 DOI: 10.1002/jbmr.1742] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 07/24/2012] [Accepted: 08/13/2012] [Indexed: 11/10/2022]
Abstract
A significant risk of femoral neck (FN) fracture exists for men and women with an areal bone mineral density (aBMD) higher than the osteoporotic range, as measured with dual-energy X-ray absorptiometry (DXA). Separately measuring the cortical and trabecular FN compartments and combining the results would likely be a critical aspect of enhancing the diagnostic capabilities of a new technique. Because the cortical shell determines a large part of FN strength a novel quantitative ultrasound (QUS) technique that probes the FN cortical compartment was implemented. The sensitivity of the method to variations of FN cortical properties and FN strength was tested. Nine femurs (women, mean age 83 years) were subjected to QUS to measure the through transmission time-of-flight (TOF) at the FN and mechanical tests to assess strength. Quantitative computed tomography (QCT) scans were performed to enable analysis of the dependence of TOF on bone parameters. DXA was also performed for reference. An ultrasound wave propagating circumferentially in the cortical shell was measured in all specimens. Its TOF was not influenced by the properties of the trabecular compartment. Averaged TOF for nine FN measurement positions/orientations was significantly correlated to strength (R2 = 0.79) and FN cortical QCT variables: total BMD (R(2) = 0.54); regional BMD in the inferoanterior (R2 = 0.90) and superoanterior (R2 = 0.57) quadrants; and moment of inertia (R2 = 0.71). The results of this study demonstrate that QUS can perform a targeted measurement of the FN cortical compartment. Because the method involves mechanical guided waves, the QUS variable is related to the geometric and material properties of the cortical shell (cortical thickness, tissue elasticity, and porosity). This work opens the way to a multimodal QUS assessment of the proximal femur, combining our approach targeting the cortical shell with the existing modality sensitive to the trabecular compartment. In vivo feasibility of our approach has to be confirmed with experimental data in patients.
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Affiliation(s)
- Quentin Grimal
- UPMC University Paris 06, UMR 7623, Laboratoire d'Imagerie Paramétrique, Paris, France.
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191
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Robinson PJ, Bell RJ, Lanzafame A, Segal L, Kirby C, Piterman L, Davis SR. Comparison of plain vertebral X-ray and dual-energy X-ray absorptiometry for the identification of older women for fracture prevention in primary care. Intern Med J 2013; 43:38-45. [DOI: 10.1111/j.1445-5994.2012.02930.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 07/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- P. J. Robinson
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | - R. J. Bell
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
| | | | - L. Segal
- Health Economics and Social Policy Group; Division of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - C. Kirby
- Research Fellow, Office of the Pro Vice-Chancellor; Monash University; Victoria
| | - L. Piterman
- Pro Vice-Chancellor (Berwick and Peninsula campuses); Monash University; Victoria
| | - S. R. Davis
- Women's Health Research Program; School of Public Health and Preventive Medicine; Monash University; Melbourne
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192
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Lee VR, Blew RM, Farr JN, Tomas R, Lohman TG, Going SB. Estimation of whole body fat from appendicular soft tissue from peripheral quantitative computed tomography in adolescent girls. INTERNATIONAL JOURNAL OF BODY COMPOSITION RESEARCH 2013; 11:1-8. [PMID: 25147482 PMCID: PMC4137877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Assess the utility of peripheral quantitative computed tomography (pQCT) for estimating whole body fat in adolescent girls. RESEARCH METHODS AND PROCEDURES Our sample included 458 girls (aged 10.7 ± 1.1y, mean BMI = 18.5 ± 3.3 kg/m2) who had DXA scans for whole body percent fat (DXA %Fat). Soft tissue analysis of pQCT scans provided thigh and calf subcutaneous percent fat and thigh and calf muscle density (muscle fat content surrogates). Anthropometric variables included weight, height and BMI. Indices of maturity included age and maturity offset. The total sample was split into validation (VS; n = 304) and cross-validation (CS; n = 154) samples. Linear regression was used to develop prediction equations for estimating DXA %Fat from anthropometric variables and pQCT-derived soft tissue components in VS and the best prediction equation was applied to CS. RESULTS Thigh and calf SFA %Fat were positively correlated with DXA %Fat (r = 0.84 to 0.85; p <0.001) and thigh and calf muscle densities were inversely related to DXA %Fat (r = -0.30 to -0.44; p < 0.001). The best equation for estimating %Fat included thigh and calf SFA %Fat and thigh and calf muscle density (adj. R2 = 0.90; SEE = 2.7%). Bland-Altman analysis in CS showed accurate estimates of percent fat (adj. R2 = 0.89; SEE = 2.7%) with no bias. DISCUSSION Peripheral QCT derived indices of adiposity can be used to accurately estimate whole body percent fat in adolescent girls.
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Affiliation(s)
- Vinson R. Lee
- University of Arizona, College of Medicine, Department of Physiology, Tucson, AZ
| | - Rob M. Blew
- University of Arizona, College of Medicine, Department of Physiology, Tucson, AZ
| | - Josh N. Farr
- University of Arizona, College of Medicine, Department of Physiology, Tucson, AZ
| | - Rita Tomas
- University of Arizona, College of Medicine, Department of Physiology, Tucson, AZ
| | - Timothy G. Lohman
- University of Arizona, College of Medicine, Department of Physiology, Tucson, AZ
| | - Scott B. Going
- University of Arizona, College of Agriculture and Life Sciences, Department of Nutritional Sciences, Tucson, AZ
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Abstract
The diagnosis and management of osteoporosis have been improved by the development of new quantitative methods of skeletal assessment and by the availability of an increasing number of therapeutic options, respectively. A number of imaging methods exist and all have advantages and disadvantages. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly utilized method for clinical diagnosis of osteoporosis and will remain so for the foreseeable future. The WHO 10-year fracture risk assessment tool (FRAX(®)) will improve clinical use of DXA and the cost-effectiveness of therapeutic intervention. Improved reporting of radiographic features that suggest osteoporosis and the presence of vertebral fracture, which are powerful predictors of future fractures, could increase the frequency of appropriate DXA referrals. Quantitative CT remains predominantly a research tool, but has advantages over DXA--allowing measurement of volumetric density, separate measures of cortical and trabecular bone density, and evaluation of bone shape and size. High resolution imaging, using both CT and MRI, has been introduced to measure trabecular and cortical bone microstructure. Although these methods provide detailed insights into the effects of disease and therapies on bone, they are technically challenging and not widely available, so they are unlikely to be used in clinical practice.
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Affiliation(s)
- Judith E Adams
- Manchester Academic Health Science Centre, The Royal Infirmary and University of Manchester, Department of Radiology, The Royal Infirmary, Manchester M13 9WL, UK.
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194
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Bart ZR, Wallace JM. Microcomputed Tomography Applications in Bone and Mineral Research. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/act.2013.23021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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195
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196
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Diacinti D, Del Fiacco R, Pisani D, Todde F, Cattaruzza MS, Diacinti D, Arima S, Romagnoli E, Pepe J, Cipriani C, Minisola S. Diagnostic performance of vertebral fracture assessment by the lunar iDXA scanner compared to conventional radiography. Calcif Tissue Int 2012; 91:335-42. [PMID: 22965625 DOI: 10.1007/s00223-012-9643-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 07/31/2012] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate the diagnostic performance of vertebral fracture assessment (VFA) using the Lunar iDXA scanner. Conventional spinal radiographs and images acquired by dual-energy X-ray absorptiometry (DXA) of 350 subjects (269 females, 81 males) were evaluated by two different readers. We visualized 4,476/4,550 (98.4 %) vertebrae from T4 to L4 on VFA images compared to 4,535/4,550 (99.7 %) on radiographs. Among the visualized vertebrae, 205/4,535 (4.5 %) and 190/4,476 (4.2 %) were identified as nonfracture deformities by reading of radiographs and VFA, respectively. Vertebral fractures (VFs) were 231 in 126 patients and 228 in 125 patients by semiquantitative assessment of radiographs (SQ-Rx) and by VFA, respectively. There was excellent agreement between the two techniques and high diagnostic performance of VFA both on a per-vertebra basis (k score = 0.984, 95 % CI 0.972-0.996, sensitivity 98.68 %, specificity 99.91 %, PPV 98.25 %, NPV 99.93 %) and on a per-patient basis (k score = 0.957, 95 % CI 0.925-0.988, sensitivity 96.83 %, specificity 98.66 %, PPV 97.60 %, NPV 98.22 %). In older patients (≥65 years) affected by moderate or severe osteoarthritis, SQ-Rx and VFA identified 96 VFs and 95 versus 90 vertebral deformities, respectively. This study demonstrates that most vertebrae are evaluable using the iDXA scanner, with improved VFA diagnostic performance even in discriminating mild VFs from vertebral deformities. Therefore, VFA may be appropriate as an alternative to conventional radiography in patients at high risk of VF who are undergoing DXA bone densitometry and in the follow-up of osteoporotic patients on treatment.
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Affiliation(s)
- Daniele Diacinti
- Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, RM, Italy
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197
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Quality assurance of imaging techniques used in the clinical management of osteoporosis. LA RADIOLOGIA MEDICA 2012; 117:1347-54. [PMID: 23090242 DOI: 10.1007/s11547-012-0881-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
Recent advances in the densitometric and imaging techniques involved in the management of osteoporosis are associated with increasing accuracy and precision as well as with higher exposure to ionising radiation. Therefore, special attention to quality assurance (QA) procedures is needed in this field. The development of effective and efficient QA programmes is mandatory to guarantee optimal image quality while reducing radiation exposure levels to the ALARA principle (as low as reasonably achievable). In this review article, the basic QA procedures are discussed for the techniques applied to everyday clinical practice.
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Mueller MA, Hengg C, Hirschmann M, Schmid D, Sprecher C, Audigé L, Suhm N. Mechanical torque measurement for in vivo quantification of bone strength in the proximal femur. Injury 2012; 43:1712-7. [PMID: 22795727 DOI: 10.1016/j.injury.2012.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 06/08/2012] [Accepted: 06/15/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Bone strength determines fracture risk and fixation strength of osteosynthesis implants. In vivo, bone strength is currently measured indirectly by quantifying bone mineral density (BMD) which is however only one determinant of the bone's biomechanical competence besides the bone's macro- and micro-architecture and tissue related parameters. We have developed a measurement principle (DensiProbe™ Hip) for direct, mechanical quantification of bone strength within the proximal femur upon hip fracture fixation. Previous cadaver tests indicated a close correlation between DensiProbe™ Hip measurements, 3D micro-CT analysis and biomechanical indicators of bone strength. The goal of this study was to correlate DensiProbe™ Hip measurements with areal bone mineral density (BMD). METHODS Forty-three hip fracture patients were included in this study. Intraoperatively, DensiProbe™ Hip was inserted to the subsequent hip screw tip position within the femoral head. Peak torque to breakaway of local cancellous bone was registered. Thirty-seven patients underwent areal BMD measurements of the contralateral proximal femur. Failure of fixation was assessed radio graphically 6 and 12 weeks postoperatively. RESULTS Peak torque and femoral neck BMD showed significant correlations (R=0.60, P=0.0001). In regression analysis, areal BMD explained 46% of femoral neck BMD variance in a quadratic relationship. Throughout the 12-week follow-up period, no failure of fixation was observed. CONCLUSIONS DensiProbe™ Hip may capture variations of bone strength beyond areal BMD which are currently difficult to measure in vivo. A multicenter study will clarify if peak torque predicts fixation failure.
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Affiliation(s)
- Marc Andreas Mueller
- Department of Orthopedic Surgery and Traumatology, University Hospital of Basel, Switzerland.
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Oei L, Rivadeneira F, Ly F, Breda SJ, Zillikens MC, Hofman A, Uitterlinden AG, Krestin GP, Oei EHG. Review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings. Eur Radiol 2012; 23:476-86. [DOI: 10.1007/s00330-012-2622-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 01/23/2023]
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Diacinti D, Guglielmi G, Pisani D, Diacinti D, Argirò R, Serafini C, Romagnoli E, Minisola S, Catalano C, David V. Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). Radiol Med 2012; 117:1374-85. [PMID: 22744340 DOI: 10.1007/s11547-012-0835-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/26/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE This study was done to evaluate the diagnostic accuracy of dual-energy X-ray absorptiometry (DXA) compared with conventional radiography for identifying vertebral fractures. MATERIALS AND METHODS A total of 930 postmenopausal women underwent conventional radiography and DXA imaging of the spine. The images were evaluated by two expert skeletal radiologists using the semiquantitative (SQ) method for conventional radiography and the morphometric vertebral fracture assessment (VFA) for DXA. RESULTS The SQ method for radiography (SQ-Rx) analysed 99.1% of vertebrae, identifying 442 vertebral fractures; VFA analysed 97.5% vertebrae, detecting 420 vertebral fractures. Agreement between SQ-Rx and VFA reached 98.76%, and the κ-score was 0.96 [95% confidence interval (CI), 0.95-0.98]. Assessing the grading of vertebral fractures, agreement reached 97.5% and the κ-score was 0.841 (95% CI, 0.821-0.891). Considering SQ-Rx method as "gold standard", VFA had a sensitivity of 97.85 % and a specificity of 99.81%. The negative (NPV) and positive (PPV) predictive value for VFA were 99.83 % and 98.15%, respectively. Fractures were identified in 251 (27 %) and 242 (26 %) of patients on SQ-Rx and VFA, respectively. On a per-patient basis, the agreement between the two methods was 97% and the κ-score was 0.95 (95% CI, 0.920-0.968). The diagnostic parameters for VFA were 97.23% sensitivity, 98.86% specificity, 97.60% PPV and 98.84% NPV. CONCLUSIONS This study demonstrated that VFA with DXA may reach a high level of accuracy for diagnosing vertebral fractures, suggesting that VFA should be introduced in the screening of individuals with a risk of osteoporosis and in the follow-up of osteoporotic patients receiving treatment.
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Affiliation(s)
- D Diacinti
- Department of Radiology, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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