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Yadav RN, Oravec DJ, Morrison CK, Bevins NB, Rao SD, Yeni YN. Digital wrist tomosynthesis (DWT)-based finite element analysis of ultra-distal radius differentiates patients with and without a history of osteoporotic fracture. Bone 2023; 177:116901. [PMID: 37714502 DOI: 10.1016/j.bone.2023.116901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023]
Abstract
Despite effective therapies for those at risk of osteoporotic fracture, low adherence to screening guidelines and limited accuracy of bone mineral density (BMD) in predicting fracture risk preclude identification of those at risk. Because of high adherence to routine mammography, bone health screening at the time of mammography using a digital breast tomosynthesis (DBT) scanner has been suggested as a potential solution. BMD and bone microstructure can be measured from the wrist using a DBT scanner. However, the extent to which biomechanical variables can be derived from digital wrist tomosynthesis (DWT) has not been explored. Accordingly, we measured stiffness from a DWT based finite element (DWT-FE) model of the ultra-distal (UD) radius and ulna, and correlate these to reference microcomputed tomography image based FE (μCT-FE) from five cadaveric forearms. Further, this method is implemented to determine in vivo reproducibility of FE derived stiffness of UD radius and demonstrate the in vivo utility of DWT-FE in bone quality assessment by comparing two groups of postmenopausal women with and without a history of an osteoporotic fracture (Fx; n = 15, NFx; n = 51). Stiffness obtained from DWT and μCT had a strong correlation (R2 = 0.87, p < 0.001). In vivo repeatability error was <5 %. The NFx and Fx groups were not significantly different in DXA derived minimum T-scores (p > 0.3), but stiffness of the UD radius was lower for the Fx group (p < 0.007). Logistic regression models of fracture status with stiffness of the nondominant arm as the predictor were significant (p < 0.01). In conclusion this study demonstrates the feasibility of fracture risk assessment in mammography settings using DWT imaging and FE modeling in vivo. Using this approach, bone and breast screening can be performed in a single visit, with the potential to improve both the prevalence of bone health screening and the accuracy of fracture risk assessment.
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Affiliation(s)
- Ram N Yadav
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA
| | | | | | | | - Sudhaker D Rao
- Division of Endocrinology, Diabetes and Bone, Mineral Disorders, and Bone, Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA
| | - Yener N Yeni
- Bone and Joint Center, Henry Ford Health, Detroit, MI, USA; Henry Ford Health + Michigan State University Health Sciences, Detroit, MI, USA.
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Stefanek P, Synek A, Dall'Ara E, Pahr DH. Comparison of linear and nonlinear stepwise μFE displacement predictions to digital volume correlation measurements of trabecular bone biopsies. J Mech Behav Biomed Mater 2023; 138:105631. [PMID: 36592570 DOI: 10.1016/j.jmbbm.2022.105631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Digital volume correlation (DVC) enables to evaluate the ability of μFE models in predicting experimental results on the mesoscale. In this study predicted displacement fields of three different linear and materially nonlinear μFE simulation methods were compared to DVC measured displacement fields at specific load steps in the elastic regime (StepEl) and after yield (StepUlt). Five human trabecular bone biopsies from a previous study were compressed in several displacement steps until failure. At every compression step, μCT images (resolution: 36 μm) were recorded. A global DVC algorithm was applied to compute the displacement fields at all loading steps. The unloaded 3D images were then used to generate homogeneous, isotropic, linear and materially nonlinear μFE models. Three different μFE simulation methods were used: linear (L), nonlinear (NL), and nonlinear stepwise (NLS). Regarding L and NL, the boundary conditions were derived from the interpolated displacement fields at StepEl and StepUlt, while for the NLS method nonlinear changes of the boundary conditions of the experiments were captured using the DVC displacement field of every available load step until StepEl and StepUlt. The predicted displacement fields of all μFE simulation methods were in good agreement with the DVC measured displacement fields (individual specimens: R2>0.83 at StepEl and R2>0.59 at StepUlt; pooled data: R2>0.97 at StepEl and R2>0.92 at StepUlt). At StepEl, all three simulation methods showed similar intercepts, slopes, and coefficients of determination while the nonlinear μFE models improved the prediction of the displacement fields slightly in all Cartesian directions at StepUlt (individual specimens: L: R2>0.59 and NL, NLS: R2>0.68; pooled data: L: R2>0.92 and NL, NLS: R2>0.94). Damaged/overstrained elements in L, NL, and NLS occurred at similar locations but the number of overstrained elements was overestimated when using the L simulation method. Considering the increased solving time of the nonlinear μFE models as well as the acceptable performance in displacement prediction of the linear μFE models, one can conclude that for similar use cases linear μFE models represent the best compromise between computational effort and accuracy of the displacement field predictions.
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Affiliation(s)
- Pia Stefanek
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria.
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism and Insigneo Institute for in Silico Medicine, University of Sheffield, UK
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria; Division Biomechanics, Karl Landsteiner University of Health Sciences, Austria
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Singhal V, Huynh C, Nimmala S, Mitchell DM, Pedreira CC, Bader A, Flanders K, Zheng J, Bouxsein ML, Misra M, Bredella MA. Load-to-strength ratio at the radius is higher in adolescent and young adult females with obesity compared to normal-weight controls. Bone 2022; 164:116515. [PMID: 35948256 PMCID: PMC9826712 DOI: 10.1016/j.bone.2022.116515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Among adolescents with extremity fractures, individuals with obesity have greater representation compared with individuals of normal-weight, despite having higher areal and volumetric bone mineral density (aBMD, vBMD) than their normal-weight counterparts. The relative increase in BMD in individuals with obesity may thus be insufficient to support the greater force generated upon falling. The load-to-strength ratio is a biomechanical approach for assessing the risk of fracture by comparing applied force to bone strength, with higher load-to-strength ratios indicating higher fracture risk. OBJECTIVE To assess the load-to-strength ratio at the distal radius in adolescent and young adult females with severe obesity (OB) compared with normal-weight healthy controls (HC). We hypothesized that OB have a higher load-to-strength ratio compared to HC. METHODS We examined bone parameters in 65 girls 14-21 years old: 33 OB and 32 HC. We used dual-energy X-ray absorptiometry (DXA) to assess body composition, high resolution peripheral quantitative CT (HR-pQCT) to estimate vBMD, and microfinite element analysis (μFEA) to assess bone strength at the distal radius. To quantify fracture risk, we computed the load-to-strength ratio, where the numerator is defined as the load applied to the outstretched hand during a forward fall and the denominator is the bone strength, as estimated by μFEA. RESULTS Although OB had higher total vBMD than HC (368.3 vs. 319.9 mgHA/cm3, p = 0.002), load-to-strength ratio at the radius was greater in OB than HC after controlling for age and race (0.66 vs. 0.54, p < 0.0001). In OB, impact force and load-to-strength ratio were associated negatively with % lean mass (r = -0.49; p = 0.003 and r = -0.65; p < 0.0001 respectively) and positively with visceral fat (r = 0.65; p < 0.0001 and r = 0.36; p = 0.04 respectively). CONCLUSIONS Adolescent and young adult females with obesity have higher load-to-strength ratio at the distal radius due to higher forces applied to bone in a fall combined with incomplete adaptation of bone to increasing body weight. This is differentially affected by lean mass, fat mass, and visceral fat mass.
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Affiliation(s)
- Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; Division of Pediatric Endocrinology, Massachusetts General for Children, Harvard Medical School, United States of America; Massachusetts General Hospital Weight Center, United States of America.
| | - Carolyn Huynh
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Deborah M Mitchell
- Division of Pediatric Endocrinology, Massachusetts General for Children, Harvard Medical School, United States of America; Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Clarissa C Pedreira
- Division of Pediatric Endocrinology, Massachusetts General for Children, Harvard Medical School, United States of America
| | - Abeer Bader
- Massachusetts General Hospital Weight Center, United States of America
| | - Karen Flanders
- Massachusetts General Hospital Weight Center, United States of America
| | - Jane Zheng
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, United States of America; Division of Pediatric Endocrinology, Massachusetts General for Children, Harvard Medical School, United States of America
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, United States of America
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Unified validation of a refined second-generation HR-pQCT based homogenized finite element method to predict strength of the distal segments in radius and tibia. J Mech Behav Biomed Mater 2022; 131:105235. [DOI: 10.1016/j.jmbbm.2022.105235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/28/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022]
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Tsuji K, Kitamura M, Chiba K, Muta K, Yokota K, Okazaki N, Osaki M, Mukae H, Nishino T. Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis. Ren Fail 2022; 44:381-391. [PMID: 35220856 PMCID: PMC8890516 DOI: 10.1080/0886022x.2022.2043375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) negatively affects bone strength; however, the osteoporotic conditions in patients with CKD are not fully understood. Moreover, the changes in bone microstructure between pre-dialysis and dialysis are unknown. High-resolution peripheral quantitative computed tomography (HR-pQCT) reveals the three-dimensional microstructures of the bone. We aimed to evaluate bone microstructures in patients with different stages of CKD. This study included 119 healthy men and 40 men admitted to Nagasaki University Hospital for inpatient education or the initiation of hemodialysis. The distal radius and tibia were scanned with HR-pQCT. Patient clinical characteristics and bone microstructures were evaluated within 3 months of initiation of hemodialysis (in patients with CKD stage 5 D), patients with CKD stage 4–5, and healthy volunteers. Cortical bone parameters were lower in the CKD group than in healthy controls. Tibial cortical and trabecular bone parameters (cortical thickness, cortical area, trabecular volumetric bone mineral density, trabecular-bone volume fraction, and trabecular thickness) differed between patients with CKD stage 5 D and those with CKD stage 4–5 (p < 0.01). These differences were also observed between patients with CKD stage 5 and those with CKD stage 5 D (p < 0.017), but not between patients with CKD stage 4 and those with CKD stage 5, suggesting that the bone microstructure rapidly changed at the start of hemodialysis. Patients with CKD stage 5 D exhibited tibial microstructural impairment compared with those with CKD stage 4–5. HR-pQCT is useful for elucidation of the pathology of bone microstructures in patients with renal failure.
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Affiliation(s)
- Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuaki Yokota
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Cai X, Bernard S, Grimal Q. Documenting the Anisotropic Stiffness of Hard Tissues with Resonant Ultrasound Spectroscopy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:279-295. [DOI: 10.1007/978-3-030-91979-5_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Stipsitz M, Zysset PK, Pahr DH. Prediction of the Inelastic Behaviour of Radius Segments: Damage-based Nonlinear Micro Finite Element Simulation vs Pistoia Criterion. J Biomech 2021; 116:110205. [PMID: 33476984 DOI: 10.1016/j.jbiomech.2020.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
The Pistoia criterion (PC) is widely used to estimate the failure load of distal radius segments based on linear micro Finite Element (μFE) analyses. The advantage of the PC is that a simple strain-threshold and a tissue volume fraction can be used to predict failure properties. In this study, the PC is compared to materially nonlinear μFE analyses, where the bone tissue is modelled as an elastic, damageable material. The goal was to investigate for which outcomes the PC is sufficient and when a nonlinear (NL) simulation is required. Three types of simulation results were compared: (1) prediction of the failure load, (2) load sharing of cortical and trabecular regions, and (3) distribution of local damaged/overstrained tissue at the maximum sustainable load. The failure load obtained experimentally could be predicted well with both the PC and the NL simulations using linear regression. Although the PC strongly overestimated the failure load, it was sufficient to predict adequately normalized apparent results. An optimised PC (oPC) was proposed which uses experimental data to calibrate the individual volume of overstrained tissue. The main areas of local over-straining predicted by the oPC were the same as estimated by the NL simulation, although the oPC predicted more diffuse regions. However, the oPC relied on an individual calibration requiring the experimental failure load while the NL simulation required no a priori knowledge of the experimental failure load.
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Affiliation(s)
- Monika Stipsitz
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria
| | - Philippe K Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria; Division Biomechanics, Karl Landsteiner University, Austria
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8
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Kemp TD, de Bakker CMJ, Gabel L, Hanley DA, Billington EO, Burt LA, Boyd SK. Longitudinal bone microarchitectural changes are best detected using image registration. Osteoporos Int 2020; 31:1995-2005. [PMID: 32430614 DOI: 10.1007/s00198-020-05449-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/04/2020] [Indexed: 12/13/2022]
Abstract
UNLABELLED Longitudinal studies of bone using high-resolution medical imaging may result in non-physiological measurements of longitudinal changes. In this study, we determined that three-dimensional image processing techniques best capture realistic longitudinal changes in bone density and should therefore be used with high-resolution imaging when studying bone changes over time. INTRODUCTION The purpose of this study was to determine which longitudinal analysis technique (no registration (NR), slice-match (SM) registration, or three-dimensional registration (3DR)) produced the most realistic longitudinal changes in a 3-year study of bone density and structure using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS We assessed HR-pQCT scans of the distal radius and tibia for men and women (N = 40) aged 55-70 years at baseline and 6, 12, 24, and 36 months. To evaluate which longitudinal analysis technique (NR, SM, or 3DR) best captured physiologically reasonable 3-year changes, we calculated the standard deviation of the absolute rate of change in each bone parameter. The data were compared between longitudinal analysis techniques using repeated measures ANOVA and post hoc analysis. RESULTS As expected, both SM and 3DR better captured physiological longitudinal changes than NR. At the tibia, there were no differences between SM and 3DR; however, at the radius where precision was lower, 3DR produced better results for total bone mineral density. CONCLUSIONS At least SM or 3DR should be implemented in longitudinal studies using HR-pQCT. 3DR is preferable, particularly at the radius, to ensure that physiological changes in bone density are observed.
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Affiliation(s)
- T D Kemp
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - C M J de Bakker
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - L Gabel
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - D A Hanley
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - E O Billington
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - L A Burt
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S K Boyd
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:1607-1627. [PMID: 32458029 PMCID: PMC7429313 DOI: 10.1007/s00198-020-05438-5] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems. METHODS A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document. RESULTS An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems. CONCLUSION This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.
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Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J Paccou
- Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - A Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Bioclinica, Inc., Hamburg, Germany
| | - M L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Westbury LD, Shere C, Edwards MH, Cooper C, Dennison EM, Ward KA. Cluster Analysis of Finite Element Analysis and Bone Microarchitectural Parameters Identifies Phenotypes with High Fracture Risk. Calcif Tissue Int 2019; 105:252-262. [PMID: 31187198 PMCID: PMC6694037 DOI: 10.1007/s00223-019-00564-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/10/2019] [Indexed: 12/02/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HRpQCT) is increasingly used for exploring associations between bone microarchitectural and finite element analysis (FEA) parameters and fracture. We hypothesised that combining bone microarchitectural parameters, geometry, BMD and FEA estimates of bone strength from HRpQCT may improve discrimination of fragility fractures. The analysis sample comprised of 359 participants (aged 72-81 years) from the Hertfordshire Cohort Study. Fracture history was determined by self-report and vertebral fracture assessment. Participants underwent HRpQCT scans of the distal radius and DXA scans of the proximal femur and lateral spine. Poisson regression with robust variance estimation was used to derive relative risks for the relationship between individual bone microarchitectural and FEA parameters and previous fracture. Cluster analysis of these parameters was then performed to identify phenotypes associated with fracture prevalence. Receiver operating characteristic analysis suggested that bone microarchitectural parameters improved fracture discrimination compared to aBMD alone, whereas further inclusion of FEA parameters resulted in minimal improvements. Cluster analysis (k-means) identified four clusters. The first had lower Young modulus, cortical thickness, cortical volumetric density and Von Mises stresses compared to the wider sample; fracture rates were only significantly greater among women (relative risk [95%CI] compared to lowest risk cluster: 2.55 [1.28, 5.07], p = 0.008). The second cluster in women had greater trabecular separation, lower trabecular volumetric density and lower trabecular load with an increase in fracture rate compared to lowest risk cluster (1.93 [0.98, 3.78], p = 0.057). These findings may help inform intervention strategies for the prevention and management of osteoporosis.
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Affiliation(s)
- Leo D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clare Shere
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mark H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Queen Alexandra Hospital, Portsmouth, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
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11
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Fink HA, Langsetmo L, Vo TN, Orwoll ES, Schousboe JT, Ensrud KE. Association of High-resolution Peripheral Quantitative Computed Tomography (HR-pQCT) bone microarchitectural parameters with previous clinical fracture in older men: The Osteoporotic Fractures in Men (MrOS) study. Bone 2018; 113:49-56. [PMID: 29751130 PMCID: PMC6040812 DOI: 10.1016/j.bone.2018.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/02/2018] [Accepted: 05/07/2018] [Indexed: 01/09/2023]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) assesses both volumetric bone mineral density (vBMD) and trabecular and cortical microarchitecture. However, studies of the association of HR-pQCT parameters with fracture history have been small, predominantly limited to postmenopausal women, often performed limited adjustment for potential confounders including for BMD, and infrequently assessed strength or failure measures. We used data from the Osteoporotic Fractures in Men (MrOS) study, a prospective cohort study of community-dwelling men aged ≥65 years, to evaluate the association of distal radius, proximal (diaphyseal) tibia and distal tibia HR-pQCT parameters measured at the Year 14 (Y14) study visit with prior clinical fracture. The primary HR-pQCT exposure variables were finite element analysis estimated failure loads (EFL) for each skeletal site; secondary exposure variables were total vBMD, total bone area, trabecular vBMD, trabecular bone area, trabecular thickness, trabecular number, cortical vBMD, cortical bone area, cortical thickness, and cortical porosity. Clinical fractures were ascertained from questionnaires administered every 4 months between MrOS study baseline and the Y14 visit and centrally adjudicated by masked review of radiographic reports. We used multivariate-adjusted logistic regression to estimate the odds of prior clinical fracture per 1 SD decrement for each Y14 HR-pQCT parameter. Three hundred forty-four (19.2%) of the 1794 men with available HR-pQCT measures had a confirmed clinical fracture between baseline and Y14. After multivariable adjustment, including for total hip areal BMD, decreased HR-pQCT finite element analysis EFL for each site was associated with significantly greater odds of prior confirmed clinical fracture and major osteoporotic fracture. Among other HR-pQCT parameters, decreased cortical area appeared to have the strongest independent association with prior clinical fracture. Future studies should explore associations of HR-pQCT parameters with specific fracture types and risk of incident fractures and the impact of age and sex on these relationships.
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Affiliation(s)
- Howard A Fink
- Geriatric Research Education & Clinical Center, Veterans Affairs Health Care System, Minneapolis, MN, USA; Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Tien N Vo
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - John T Schousboe
- Park Nicollet Institute, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Center for Chronic Disease Outcomes Research, Veterans Affairs Health Care System, Minneapolis, MN, USA; Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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12
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Troy KL, Mancuso ME, Butler TA, Johnson JE. Exercise Early and Often: Effects of Physical Activity and Exercise on Women's Bone Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E878. [PMID: 29710770 PMCID: PMC5981917 DOI: 10.3390/ijerph15050878] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/20/2018] [Accepted: 04/24/2018] [Indexed: 12/31/2022]
Abstract
In 2011 over 1.7 million people were hospitalized because of a fragility fracture, and direct costs associated with osteoporosis treatment exceeded 70 billion dollars in the United States. Failure to reach and maintain optimal peak bone mass during adulthood is a critical factor in determining fragility fracture risk later in life. Physical activity is a widely accessible, low cost, and highly modifiable contributor to bone health. Exercise is especially effective during adolescence, a time period when nearly 50% of peak adult bone mass is gained. Here, we review the evidence linking exercise and physical activity to bone health in women. Bone structure and quality will be discussed, especially in the context of clinical diagnosis of osteoporosis. We review the mechanisms governing bone metabolism in the context of physical activity and exercise. Questions such as, when during life is exercise most effective, and what specific types of exercises improve bone health, are addressed. Finally, we discuss some emerging areas of research on this topic, and summarize areas of need and opportunity.
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Affiliation(s)
- Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01545 USA.
| | - Megan E Mancuso
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01545 USA.
| | - Tiffiny A Butler
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01545 USA.
| | - Joshua E Johnson
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01545 USA.
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13
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Klintström E, Klintström B, Pahr D, Brismar TB, Smedby Ö, Moreno R. Direct estimation of human trabecular bone stiffness using cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:72-82. [PMID: 29735401 DOI: 10.1016/j.oooo.2018.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 03/04/2018] [Accepted: 03/16/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the possibility of estimating the biomechanical properties of trabecular bone through finite element simulations by using dental cone beam computed tomography data. STUDY DESIGN Fourteen human radius specimens were scanned in 3 cone beam computed tomography devices: 3-D Accuitomo 80 (J. Morita MFG., Kyoto, Japan), NewTom 5 G (QR Verona, Verona, Italy), and Verity (Planmed, Helsinki, Finland). The imaging data were segmented by using 2 different methods. Stiffness (Young modulus), shear moduli, and the size and shape of the stiffness tensor were studied. Corresponding evaluations by using micro-CT were regarded as the reference standard. RESULTS The 3-D Accuitomo 80 (J. Morita MFG., Kyoto, Japan) showed good performance in estimating stiffness and shear moduli but was sensitive to the choice of segmentation method. NewTom 5 G (QR Verona, Verona, Italy) and Verity (Planmed, Helsinki, Finland) yielded good correlations, but they were not as strong as Accuitomo 80 (J. Morita MFG., Kyoto, Japan). The cone beam computed tomography devices overestimated both stiffness and shear compared with the micro-CT estimations. CONCLUSIONS Finite element-based calculations of biomechanics from cone beam computed tomography data are feasible, with strong correlations for the Accuitomo 80 scanner (J. Morita MFG., Kyoto, Japan) combined with an appropriate segmentation method. Such measurements might be useful for predicting implant survival by in vivo estimations of bone properties.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.
| | - Benjamin Klintström
- School of Technology and Health, KTH Royal Institute of Technology, Hälsovägen, Stockholm, Sweden
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, Technical University Vienna, Vienna, Austria
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institute and Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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14
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Ramezanzadehkoldeh M, Skallerud BH. MicroCT-based finite element models as a tool for virtual testing of cortical bone. Med Eng Phys 2017; 46:12-20. [PMID: 28528791 DOI: 10.1016/j.medengphy.2017.04.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 03/27/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to assess a virtual biomechanics testing approach purely based on microcomputed tomography (microCT or µCT) data, providing non-invasive methods for determining the stiffness and strength of cortical bone. Mouse femurs were µCT scanned prior to three-point-bend tests. Then microCT-based finite element models were generated with spatial variation in bone elastoplastic properties and subject-specific femur geometries. Empirical relationships of density versus Young's moduli and yield stress were used in assigning elastoplastic properties to each voxel. The microCT-based finite element modeling (µFEM) results were employed to investigate the model's accuracy through comparison with experimental tests. The correspondence of elastic stiffness and strength from the µFE analyses and tests was good. The interpretation of the derived data showed a 6.1%, 1.4%, 1.5%, and 1.6% difference between the experimental test result and µFEM output on global stiffness, nominal Young's modulus, nominal yield stress, and yield force, respectively. We conclude that virtual testing outputs could be used to predict global elastic-plastic properties and may reduce the cost, time, and number of test specimens in performing physical experiments.
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Affiliation(s)
- Masoud Ramezanzadehkoldeh
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway.
| | - Bjørn H Skallerud
- Department of Structural Engineering, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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15
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Contribution of high resolution peripheral quantitative CT to the management of bone and joint diseases. Joint Bone Spine 2017; 85:301-306. [PMID: 28512004 DOI: 10.1016/j.jbspin.2017.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/26/2017] [Indexed: 01/08/2023]
Abstract
Many imaging modalities have been described to diagnose and monitor osteoporosis (OP), osteoarthritis and inflammatory rheumatic diseases. Over the last ten years, High Resolution peripheral Quantitative Computerized Tomography (HR-pQCT) was shown to be a precise and non invasive technique to study bone and joint diseases in clinical research. It allows the study of both cortical and trabecular bone microarchitecture at the distal tibia and radius, and further applications have been developed such as the study of mechanical properties by the finite element analysis. Thus, in case-control and cross-sectional studies, microarchitecture parameters discriminated fractured individuals independently of areal BMD. Also, microstructure parameters can predict incident fracture in postmenopausal women. In metabolic diseases associated with bone fragility, HR-pQCT may also be used to explore bone changes. In joint disease studies, HR-pQCT was a remarkable tool to assess bone erosion and joint space narrowing at the hand. This article gives an overview of this imaging technique.
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16
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Manhard MK, Nyman JS, Does MD. Advances in imaging approaches to fracture risk evaluation. Transl Res 2017; 181:1-14. [PMID: 27816505 PMCID: PMC5357194 DOI: 10.1016/j.trsl.2016.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 01/23/2023]
Abstract
Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.
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Affiliation(s)
- Mary Kate Manhard
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN
| | - Jeffry S Nyman
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN; Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Mark D Does
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN; Electrical Engineering, Vanderbilt University, Nashville, TN.
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17
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Bonaretti S, Vilayphiou N, Chan CM, Yu A, Nishiyama K, Liu D, Boutroy S, Ghasem-Zadeh A, Boyd SK, Chapurlat R, McKay H, Shane E, Bouxsein ML, Black DM, Majumdar S, Orwoll ES, Lang TF, Khosla S, Burghardt AJ. Operator variability in scan positioning is a major component of HR-pQCT precision error and is reduced by standardized training. Osteoporos Int 2017; 28:245-257. [PMID: 27475931 PMCID: PMC5568957 DOI: 10.1007/s00198-016-3705-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED In this study, we determined that operator positioning precision contributes significant measurement error in high-resolution peripheral quantitative computed tomography (HR-pQCT). Moreover, we developed software to quantify intra- and inter-operator variability and demonstrated that standard positioning training (now available as a web-based application) can significantly reduce inter-operator variability. INTRODUCTION HR-pQCT is increasingly used to assess bone quality, fracture risk, and anti-fracture interventions. The contribution of the operator has not been adequately accounted in measurement precision. Operators acquire a 2D projection ("scout view image") and define the region to be scanned by positioning a "reference line" on a standard anatomical landmark. In this study, we (i) evaluated the contribution of positioning variability to in vivo measurement precision, (ii) measured intra- and inter-operator positioning variability, and (iii) tested if custom training software led to superior reproducibility in new operators compared to experienced operators. METHODS To evaluate the operator in vivo measurement precision, we compared precision errors calculated in 64 co-registered and non-co-registered scan-rescan images. To quantify operator variability, we developed software that simulates the positioning process of the scanner's software. Eight experienced operators positioned reference lines on scout view images designed to test intra- and inter-operator reproducibility. Finally, we developed modules for training and evaluation of reference line positioning. We enrolled six new operators to participate in a common training, followed by the same reproducibility experiments performed by the experienced group. RESULTS In vivo precision errors were up to threefold greater (Tt.BMD and Ct.Th) when variability in scan positioning was included. The inter-operator precision errors were significantly greater than the short-term intra-operator precision (p < 0.001). New trained operators achieved comparable intra-operator reproducibility to experienced operators and lower inter-operator reproducibility (p < 0.001). Precision errors were significantly greater for the radius than for the tibia. CONCLUSION Operator reference line positioning contributes significantly to in vivo measurement precision and is significantly greater for multi-operator datasets. Inter-operator variability can be significantly reduced using a systematic training platform, now available online ( http://webapps.radiology.ucsf.edu/refline/ ).
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Affiliation(s)
- S Bonaretti
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
- Department of Radiology, Stanford University, Stanford, CA, USA.
| | | | - C M Chan
- University of California Berkeley, Berkeley, CA, USA
| | - A Yu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - D Liu
- University of British Columbia, Vancouver, BC, Canada
| | - S Boutroy
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - A Ghasem-Zadeh
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia
| | - S K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
| | - H McKay
- University of British Columbia, Vancouver, BC, Canada
| | - E Shane
- Division of Endocrinology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - M L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - D M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - S Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - E S Orwoll
- Division of Endocrinology, Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - T F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - S Khosla
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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18
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Wong AKO. A Comparison of Peripheral Imaging Technologies for Bone and Muscle Quantification: a Mixed Methods Clinical Review. Curr Osteoporos Rep 2016; 14:359-373. [PMID: 27796924 DOI: 10.1007/s11914-016-0334-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Bone and muscle peripheral imaging technologies are reviewed for their association with fractures and frailty. A narrative systematized review was conducted for bone and muscle parameters from each imaging technique. In addition, meta-analyses were performed across all bone quality parameters. RECENT FINDINGS The current body of evidence for bone quality's association with fractures is strong for (high-resolution) peripheral quantitative computed tomography (pQCT), with trabecular separation (Tb.Sp) and integral volumetric bone mineral density (vBMD) reporting consistently large associations with various fracture types across studies. Muscle has recently been linked to fractures and frailty, but the quality of evidence remains weaker from studies of small sample sizes. It is increasingly apparent that musculoskeletal tissues have a complex relationship with interrelated clinical endpoints such as fractures and frailty. Future studies must concurrently address these relationships in order to decipher the relative importance of one causal pathway from another.
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Affiliation(s)
- Andy Kin On Wong
- Joint Department of Medical Imaging, Toronto General Research Institute, University Health Network, Toronto General Hospital, 200 Elizabeth St. 7EN-238, Toronto, ON, M5G 2C4, Canada.
- McMaster University, Department of Medicine, Faculty of Health Sciences, Hamilton, ON, Canada.
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19
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Badilatti SD, Christen P, Parkinson I, Müller R. Load-adaptive bone remodeling simulations reveal osteoporotic microstructural and mechanical changes in whole human vertebrae. J Biomech 2016; 49:3770-3779. [PMID: 27793404 DOI: 10.1016/j.jbiomech.2016.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 10/04/2016] [Accepted: 10/04/2016] [Indexed: 02/04/2023]
Abstract
Osteoporosis is a major medical burden and its impact is expected to increase in our aging society. It is associated with low bone density and microstructural deterioration. Treatments are available, but the critical factor is to define individuals at risk from osteoporotic fractures. Computational simulations investigating not only changes in net bone tissue volume, but also changes in its microstructure where osteoporotic deterioration occur might help to better predict the risk of fractures. In this study, bone remodeling simulations with a mechanical feedback loop were used to predict microstructural changes due to osteoporosis and their impact on bone fragility from 50 to 80 years of age. Starting from homeostatic bone remodeling of a group of seven, mixed sex whole vertebrae, five mechanostat models mimicking different biological alterations associated with osteoporosis were developed, leading to imbalanced bone formation and resorption with a total net loss of bone tissue. A model with reduced bone formation rate and cell sensitivity led to the best match of morphometric indices compared to literature data and was chosen to predict postmenopausal osteoporotic bone loss in the whole group. Thirty years of osteoporotic bone loss were predicted with changes in morphometric indices in agreement with experimental measurements, and only showing major deviations in trabecular number and trabecular separation. In particular, although being optimized to match to the morphometric indices alone, the predicted bone loss revealed realistic changes on the organ level and on biomechanical competence. While the osteoporotic bone was able to maintain the mechanical stability to a great extent, higher fragility towards error loads was found for the osteoporotic bones.
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Affiliation(s)
| | | | - Ian Parkinson
- SA Pathology and University of Adelaide, Adelaide, South Australia, Australia
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
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20
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Chen Y, Dall Ara E, Sales E, Manda K, Wallace R, Pankaj P, Viceconti M. Micro-CT based finite element models of cancellous bone predict accurately displacement once the boundary condition is well replicated: A validation study. J Mech Behav Biomed Mater 2016; 65:644-651. [PMID: 27741494 DOI: 10.1016/j.jmbbm.2016.09.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 07/13/2016] [Accepted: 09/09/2016] [Indexed: 11/30/2022]
Abstract
Non-destructive 3D micro-computed tomography (microCT) based finite element (microFE) models are used to estimate bone mechanical properties at tissue level. However, their validation remains challenging. Recent improvements in the quantification of displacements in bone tissue biopsies subjected to staged compression, using refined Digital Volume Correlation (DVC) techniques, now provide a full field displacement information accurate enough to be used for microFE validation. In this study, three specimens (two humans and one bovine) were tested with two different experimental set-ups, and the resulting data processed with the same DVC algorithm. The resulting displacement vector field was compared to that predicted by microFE models solved with three different boundary conditions (BC): nominal force resultant, nominal displacement resultant, distributed displacement. The first two conditions were obtained directly from the measurements provided by the experimental jigs, whereas in the third case the displacement field measured by the DVC in the top and bottom layer of the specimen was applied. Results show excellent relationship between the numerical predictions (x) and the experiments (y) when using BC derived from the DVC measurements (UX: y=1.07x-0.002, RMSE: 0.001mm; UY: y=1.03x-0.001, RMSE: 0.001mm; UZ: y=x+0.0002, RMSE: 0.001 mm for bovine specimen), whereas only poor correlation was found using BCs according to experiment set-ups. In conclusion, microFE models were found to predict accurately the vectorial displacement field using interpolated displacement boundary condition from DVC measurement.
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Affiliation(s)
- Yuan Chen
- Department of Mechanical Engineering and INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | - Enrico Dall Ara
- Department of Human Metabolism and INSIGNEO Institute for in silico Medicine, University of Sheffield, UK
| | - Erika Sales
- Institute for Bioengineering, School of Engineering, The University of Edinburgh, UK
| | - Krishnagoud Manda
- Institute for Bioengineering, School of Engineering, The University of Edinburgh, UK
| | - Robert Wallace
- Department of Orthopaedics, The University of Edinburgh, UK
| | - Pankaj Pankaj
- Institute for Bioengineering, School of Engineering, The University of Edinburgh, UK
| | - Marco Viceconti
- Department of Mechanical Engineering and INSIGNEO Institute for in silico Medicine, University of Sheffield, UK.
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21
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Klintström E, Klintström B, Moreno R, Brismar TB, Pahr DH, Smedby Ö. Predicting Trabecular Bone Stiffness from Clinical Cone-Beam CT and HR-pQCT Data; an In Vitro Study Using Finite Element Analysis. PLoS One 2016; 11:e0161101. [PMID: 27513664 PMCID: PMC4981445 DOI: 10.1371/journal.pone.0161101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
Stiffness and shear moduli of human trabecular bone may be analyzed in vivo by finite element (FE) analysis from image data obtained by clinical imaging equipment such as high resolution peripheral quantitative computed tomography (HR-pQCT). In clinical practice today, this is done in the peripheral skeleton like the wrist and heel. In this cadaveric bone study, fourteen bone specimens from the wrist were imaged by two dental cone beam computed tomography (CBCT) devices and one HR-pQCT device as well as by dual energy X-ray absorptiometry (DXA). Histomorphometric measurements from micro-CT data were used as gold standard. The image processing was done with an in-house developed code based on the automated region growing (ARG) algorithm. Evaluation of how well stiffness (Young’s modulus E3) and minimum shear modulus from the 12, 13, or 23 could be predicted from the CBCT and HR-pQCT imaging data was studied and compared to FE analysis from the micro-CT imaging data. Strong correlations were found between the clinical machines and micro-CT regarding trabecular bone structure parameters, such as bone volume over total volume, trabecular thickness, trabecular number and trabecular nodes (varying from 0.79 to 0.96). The two CBCT devices as well as the HR-pQCT showed the ability to predict stiffness and shear, with adjusted R2-values between 0.78 and 0.92, based on data derived through our in-house developed code based on the ARG algorithm. These findings indicate that clinically used CBCT may be a feasible method for clinical studies of bone structure and mechanical properties in future osteoporosis research.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Benjamin Klintström
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
| | - Torkel B. Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Dieter H. Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Örjan Smedby
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
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22
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Chapurlat R. In vivo evaluation of bone microstructure in humans: Clinically useful? BONEKEY REPORTS 2016; 5:813. [PMID: 27347398 DOI: 10.1038/bonekey.2016.40] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 02/13/2016] [Accepted: 02/22/2016] [Indexed: 11/09/2022]
Abstract
In vivo evaluation of bone microstructure with high-resolution peripheral quantitative tomography (HRpQCT) has been used for a decade in research settings. In this review, we examine the value this technique could have in clinical practice. Bone microstructure parameters obtained with HRpQCT are associated with prevalent fracture in men and women. In postmenopausal women, some parameters also predict incident fracture, independently of areal bone mineral density. In specific population groups including patients with diabetes, chronic kidney disease, glucocorticosteroid therapy and rheumatic diseases, abnormal microstructure parameters from HRpQCT have been reported. Findings from HRpQCT studies may also explain ethnic differences in bone fragility. Treatment monitoring has been challenging in the various clinical trials with available HRpQCT data. The improvements were of small magnitude but tended to be proportional to the potency of antiresorptive agents. Microfinite element analysis was a better predictor of treatment efficacy than the microarchitectural parameters. In conclusion, HRpQCT remains a valuable research tool, but more work is needed to be able to use it in clinical practice.
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Affiliation(s)
- Roland Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot , Lyon, France
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23
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Boutroy S, Khosla S, Sornay-Rendu E, Zanchetta MB, McMahon DJ, Zhang CA, Chapurlat RD, Zanchetta J, Stein EM, Bogado C, Majumdar S, Burghardt AJ, Shane E. Microarchitecture and Peripheral BMD are Impaired in Postmenopausal White Women With Fracture Independently of Total Hip T-Score: An International Multicenter Study. J Bone Miner Res 2016; 31:1158-66. [PMID: 26818785 PMCID: PMC4891284 DOI: 10.1002/jbmr.2796] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/23/2015] [Accepted: 12/29/2015] [Indexed: 11/06/2022]
Abstract
Because single-center studies have reported conflicting associations between microarchitecture and fracture prevalence, we included high-resolution peripheral quantitative computed tomography (HR-pQCT) data from five centers worldwide into a large multicenter analysis of postmenopausal women with and without fracture. Volumetric BMD (vBMD) and microarchitecture were assessed at the distal radius and tibia in 1379 white postmenopausal women (age 67 ± 8 years); 470 (34%) had at least one fracture including 349 with a major fragility fracture. Age, height, weight, and total hip T-score differed across centers and were employed as covariates in analyses. Women with fracture had higher BMI, were older, and had lower total hip T-score, but lumbar spine T-score was similar between groups. At the radius, total and trabecular vBMD and cortical thickness were significantly lower in fractured women in three out of five centers, and trabecular number in two centers. Similar results were found at the tibia. When data from five centers were combined, however, women with fracture had significantly lower total, trabecular, and cortical vBMD (2% to 7%), lower trabecular number (4% to 5%), and thinner cortices (5% to 6%) than women without fracture after adjustment for covariates. Results were similar at the radius and tibia. Similar results were observed with analysis restricted to major fragility fracture, vertebral and hip fractures, and peripheral fracture (at the radius). When focusing on osteopenic women, each SD decrease of total and trabecular vBMD was associated with a significantly increased risk of major fragility fracture (OR = 1.55 to 1.88, p < 0.01) after adjustment for covariates. Moreover, trabecular architecture modestly improved fracture discrimination beyond peripheral total vBMD. In conclusion, we observed differences by center in the magnitude of fracture/nonfracture differences at both the distal radius and tibia. However, when data were pooled across centers and the sample size increased, we observed significant and consistent deficits in vBMD and microarchitecture independent of total hip T-score in all postmenopausal white women with fracture and in the subgroup of osteopenic women, compared to women who never had a fracture. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Stephanie Boutroy
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.,INSERM UMR1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Sundeep Khosla
- Endocrine Research Unit, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Maria Belen Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina
| | - Donald J McMahon
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Chiyuan A Zhang
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Roland D Chapurlat
- INSERM UMR1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | - Jose Zanchetta
- Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina
| | - Emily M Stein
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Cesar Bogado
- Instituto de Diagnóstico e Investigaciones Metabolicas (IDIM), Universidad del Salvador, Buenos Aires, Argentina
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Elizabeth Shane
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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Dhainaut A, Hoff M, Syversen U, Haugeberg G. Technologies for assessment of bone reflecting bone strength and bone mineral density in elderly women: an update. ACTA ACUST UNITED AC 2016; 12:209-16. [PMID: 26900798 DOI: 10.2217/whe.15.94] [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] [Indexed: 01/03/2023]
Abstract
Reduced bone mineral density is a strong risk factor for fracture. The WHO's definition of osteoporosis is based on bone mineral density measurements assessed by dual x-ray absorptiometry. Several on other techniques than dual x-ray absorptiometry have been developed for quantitative assessment of bone, for example, quantitative ultrasound and digital x-ray radiogrammetry. Some of these techniques may also capture other bone properties than bone mass that contribute to bone strength, for example, bone porosity and microarchitecture. In this article we give an update on technologies which are available for evaluation primarily of bone mass and bone density, but also describe methods which currently are validated or are under development for quantitative assessment of other bone properties.
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Affiliation(s)
- Alvilde Dhainaut
- Department of Neuroscience (INM) Norwegian University of Science & Technology (NTNU), Trondheim, Norway.,Department of Public Health & General Practice (ISM), Norwegian University of Science & Technology, Trondheim Norway
| | - Mari Hoff
- Department of Public Health & General Practice (ISM), Norwegian University of Science & Technology, Trondheim Norway.,Department of Rheumatology, St Olav's Hospital, Trondheim, Norway
| | - Unni Syversen
- Department of Cancer Research & Molecular Medicine (IKM), NTNU, Trondheim, Norway.,Department of Endocrinology, St. Olav's Hospital, Norway
| | - Glenn Haugeberg
- Department of Neuroscience (INM) Norwegian University of Science & Technology (NTNU), Trondheim, Norway.,Department of Rheumatology, Hospital of Southern Norway, Kristiansand S, Norway
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26
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Bridging external fixation versus non-bridging external fixation for unstable distal radius fractures: A systematic review and meta-analysis. J Orthop Sci 2016; 21:24-31. [PMID: 26686771 DOI: 10.1016/j.jos.2015.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 08/18/2015] [Accepted: 10/10/2015] [Indexed: 02/09/2023]
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to compare the relative effectiveness of bridging external fixation and non-bridging external fixation for distal radius fractures treatment. METHOD Relevant literature were comprehensively searched using the PubMed, Springer Link, Karger Medical and Scientific Publishers, Chinese Biomedical Database (CBM) and Chinese National Knowledge Infrastructure (CNKI) databases without any language restrictions. STATA Version 12.0 software and Comprehensive Meta-analysis 2.0 were applied. RESULTS A total of 905 patients with distal radius fracture from six eligible cohort studies were selected for statistical analysis. Our meta-analysis results indicate that the non-bridging cases had a higher risk of pin track infection, rupture of the extensor pollicis longus and nerve injury than the bridging cases. Subgroup analysis stratified by country indicated non-bridging patients showed evidence of an increased risk of pin track infection and higher risk of rupture of the extensor pollicis longus compared with the patients treated with bridging external fixation in the UK population. The follow-up results showed flexion degree of patients treated with non-bridging external fixation was slightly better than that of patients treated with bridging external fixation (P < 0.05). CONCLUSION There is evidence in our systematic review and meta-analysis to support that bridging external fixation can reduce the incidence of pin tract infections and nerve injury compared to non-bridging external fixation, but have no significant difference in other complications and the recovery of wrist joint function. Bridging external fixation could therefore be a better choice in patients with distal radius fractures.
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Qiu WJ, Li YF, Ji YH, Xu W, Zhu XD, Tang XZ, Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities. Sci Rep 2015; 5:15318. [PMID: 26549312 PMCID: PMC4637827 DOI: 10.1038/srep15318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined.
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Affiliation(s)
- Wen-Jun Qiu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yi-Fan Li
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yun-Han Ji
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Wei Xu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xiao-Dong Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xian-Zhong Tang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Huan-Li Zhao
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Gui-Bin Wang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yue-Qing Jia
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Shi-Cai Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Feng-Fang Zhang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Hong-Mei Liu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
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Manske SL, Zhu Y, Sandino C, Boyd SK. Human trabecular bone microarchitecture can be assessed independently of density with second generation HR-pQCT. Bone 2015; 79:213-21. [PMID: 26079995 DOI: 10.1016/j.bone.2015.06.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 05/16/2015] [Accepted: 06/09/2015] [Indexed: 12/18/2022]
Abstract
The second generation HR-pQCT scanner (XtremeCTII, Scanco Medical) can assess human bone microarchitecture of peripheral limbs with a 61 μm nominal isotropic voxel size. This is a marked improvement from the first generation HR-pQCT that had a nominal isotropic voxel size of 82 μm, which is at the limit to accurately determine the thickness of individual human trabeculae. We sought to determine the accuracy of a direct morphometric approach to measure trabecular bone microarchitecture with three-dimensional morphological techniques using second generation HR-pQCT, and to compare this with the approach currently applied by the first generation HR-pQCT scanner based on derived indices using ex vivo scans of human cadaveric radii. We also compared images acquired and resampled to mimic the first generation HR-pQCT with those obtained directly from the first generation HR-pQCT. We evaluated 20 human cadaveric radii and a micro-CT performance phantom using the first (XtremeCT, Scanco Medical) and second generation HR-pQCT scanner (XtremeCTII) and compared a patient evaluation (XCTII, 61 μm) with a high resolution ex vivo protocol (HR, 30μm). We generated 82 μm scans of the same specimens to mimic a first-generation HR-pQCT evaluation (XCTIM, 82 μm) and compared these with a first-generation patient evaluation (XCTI, 82 μm). A standard structural extraction approach was applied to both XCTII and HR evaluations for assessment of bone volume fraction (BV/TV), and a distance transform was used to assess trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). For XCTI and XCTIM evaluations we followed the manufacturer's standard procedure and assessed bone mineral density (BMD), Tb.N with a distance transform, and then derived bone volume ratio (BV/TV(d)), trabecular thickness (Tb.Th(d)) and separation (Tb.Sp(d)). The spatial resolution (10% MTF) was 142.2 μm for XCTI, 108.9 μm for XCTIM, 95.2μm for XCTII, and 55.9 μm for HR. XCTI and XCTIM provided strongly associated measurements of BMD and microarchitectural outcomes (R(2)>0.97), however there were systematic differences in all outcomes. The Tb.N was highly associated with HR by both XCTII (R(2)=0.93, mean error=-0.12 mm(-1)) and XCTIM (R(2)=0.98, mean error=0.25 mm(-1)). Also, both XCTII (R(2)=0.99, mean error=0.20mm) and XCTIM (R(2)=0.99, mean error=-0.18 mm) had Tb.Sp that were strongly related to HR. For Tb.Th, the XCTII was more closely related to HR (R(2)=0.94, mean error=0.04 mm) than the relatively weak XCTIM (R(2)=0.16, mean error=- 0.076 mm). We found that trabecular microarchitecture assessment following the XCTII direct morphometric approach accurately represented the HR data. In particular, the measure of Tb.Th was markedly improved for XCTII compared with the derived approach of XCTIM. These data support the application of analysis techniques in HR-pQCT that are analogous to those traditionally used for micro-CT to assess trabecular microarchitecture. The decreased dependence of structural outcomes on density provides a new, important opportunity to monitor human in vivo bone microarchitecture.
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Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Ying Zhu
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Clara Sandino
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
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Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments. Med Sci Monit 2015; 21:2837-44. [PMID: 26391617 PMCID: PMC4588632 DOI: 10.12659/msm.894075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background To compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis. Material/Methods An exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software. Results The literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%). Conclusions Our network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients.
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Affiliation(s)
- Huan-Li Zhao
- Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Gui-Bin Wang
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Yue-Qing Jia
- Department of Traumatic Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Shi-Cai Zhu
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Feng-Fang Zhang
- Department of Radiology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, China (mainland)
| | - Hong-Mei Liu
- Department of Surgery, Linyi People's Hospital, Linyi, Shandong, China (mainland)
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Chevalier Y. Numerical Methodology to Evaluate the Effects of Bone Density and Cement Augmentation on Fixation Stiffness of Bone-Anchoring Devices. J Biomech Eng 2015; 137:2382283. [PMID: 26121601 DOI: 10.1115/1.4030943] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Indexed: 01/02/2023]
Abstract
Bone quality is one of the reported factors influencing the success of bone anchors in arthroscopic repairs of torn rotator cuffs at the shoulder. This work was aimed at developing refined numerical methods to investigate how bone quality can influence the fixation stiffness of bone anchors. To do that bone biopsies were scanned at 26-μm resolution with a high-resolution microcomputer tomography (micro-CT) scanner and their images were processed for virtual implantation of a typical design of bone anchor. These were converted to microfinite element (μFE) and homogenized classical FE models, and analyses were performed to simulate pulling on the bone anchor with and without cement augmentation. Quantification of structural stiffness for each implanted specimen was then computed, as well as stress distributions within the bone structures, and related to the bone volume fraction of the specimens. Results show that the classical method is excellently correlated to structural predictions of the more refined μFE method, despite the qualitative differences in local stresses in the bone surrounding the implant. Predictions from additional loading cases suggest that structural fixation stiffness in various directions is related to apparent bone density of the surrounding bone. Augmentation of anchoring with bone cement stiffens the fixation and alters these relations. This work showed the usability of homogenized FE (hFE) in the evaluation of bone anchor fixation and will be used to develop new methodologies for virtual investigations leading to optimized repairs of rotator cuff and glenoid Bankart lesions.
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Affiliation(s)
- Yan Chevalier
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistrasse 15, Munich D-81377, Germany e-mail:
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Badilatti SD, Christen P, Levchuk A, Marangalou JH, van Rietbergen B, Parkinson I, Müller R. Large-scale microstructural simulation of load-adaptive bone remodeling in whole human vertebrae. Biomech Model Mechanobiol 2015; 15:83-95. [PMID: 26255055 DOI: 10.1007/s10237-015-0715-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
Identification of individuals at risk of bone fractures remains challenging despite recent advances in bone strength assessment. In particular, the future degradation of the microstructure and load adaptation has been disregarded. Bone remodeling simulations have so far been restricted to small-volume samples. Here, we present a large-scale framework for predicting microstructural adaptation in whole human vertebrae. The load-adaptive bone remodeling simulations include estimations of appropriate bone loading of three load cases as boundary conditions with microfinite element analysis. Homeostatic adaptation of whole human vertebrae over a simulated period of 10 years is achieved with changes in bone volume fraction (BV/TV) of less than 5%. Evaluation on subvolumes shows that simplifying boundary conditions reduces the ability of the system to maintain trabecular structures when keeping remodeling parameters unchanged. By rotating the loading direction, adaptation toward new loading conditions could be induced. This framework shows the possibility of using large-scale bone remodeling simulations toward a more accurate prediction of microstructural changes in whole human bones.
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Affiliation(s)
- Sandro D Badilatti
- Institute for Biomechanics, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Patrik Christen
- Institute for Biomechanics, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Alina Levchuk
- Institute for Biomechanics, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland
| | - Javad Hazrati Marangalou
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB, Eindhoven, The Netherlands
| | - Ian Parkinson
- SA Pathology and University of Adelaide, Adelaide, SA, 5005, Australia
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Vladimir-Prelog-Weg 3, 8093, Zurich, Switzerland.
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van Rietbergen B, Ito K. A survey of micro-finite element analysis for clinical assessment of bone strength: the first decade. J Biomech 2014; 48:832-41. [PMID: 25553670 DOI: 10.1016/j.jbiomech.2014.12.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/13/2022]
Abstract
Micro-Finite Element (micro-FE) analysis is now widely used in biomedical research as a tool to derive bone mechanical properties as they relate to its microstructure. With the development of in vivo high-resolution peripheral quantitative CT (HR-pQCT) scanners, it can now be applied to analyze bone in-vivo in the peripheral skeleton. In this survey, the results of several experimental and clinical studies are summarized that addressed the feasibility of this approach to predict bone strength in-vivo. Specific questions that will be addressed are: how accurate are strength predictions based on micro-FE; how reproducible are the results; and, is it a better predictor of bone fracture risk than DXA based measures? Based on results of experimental studies, it is first concluded that micro-FE based on HR-pQCT images can accurately predict the strength of the distal radius during a fall on the outstretched hand using either linear elastic analysis, implementing a 'Pistoia criterion' or similar criterion in combination with an 'effective' Young's modulus or using non-linear analyses. When evaluating results of clinical reproducibility studies, it is concluded that for single-center studies, errors at the radius are less than 4.4% and 3.7% and at the tibia less than 3.6% and 2.3% for stiffness and strength, respectively. In multicenter trials, however, these errors can be increased by some 1.8% and 1.4% for stiffness and strength, respectively. Finally, based on the results of large cohort studies, it is concluded that micro-FE calculated stiffness better separates cases from controls than bone density parameters for subjects with fragility fractures at any site, but not for subjects with only radius fractures. In this latter case, however, combinations of micro-FE derived parameters can significantly improve the separation.
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Affiliation(s)
- B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, University of Eindhoven, Eindhoven, The Netherlands.
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, University of Eindhoven, Eindhoven, The Netherlands
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Christen D, Zwahlen A, Müller R. Reproducibility for linear and nonlinear micro-finite element simulations with density derived material properties of the human radius. J Mech Behav Biomed Mater 2014; 29:500-7. [DOI: 10.1016/j.jmbbm.2013.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/28/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
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