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Wáng YXJ, Blake GM, Tang SN, Guermazi A, Griffith JF. Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older East Asian women should be lower than the value for Caucasians. Skeletal Radiol 2024; 53:1473-1480. [PMID: 38411702 DOI: 10.1007/s00256-024-04632-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
For Caucasian women, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) cutpoint value for classifying osteoporosis is 80 mg/ml. At the age of approximate 78 years, US Caucasian women QCT LS BMD population mean is 80 mg/ml, while that of Chinese women and Japanese women is around 50 mg/ml. Correlation analyses show, for Chinese women and Japanese women, QCT LS BMD of 45 mg/ml corresponds to the dual-energy X-ray absorptiometry cutpoint value for classifying osteoporosis. For Chinese and Japanese women, if QCT LS BMD 80 mg/ml is used as the threshold to classify osteoporosis, then the specificity of classifying subjects with vertebral fragility fracture into the osteoporotic group is low, whereas threshold of 45 mg/ml approximately achieve a similar separation for women with and without vertebral fragility fracture as the reports for Caucasian women. Moreover, by using 80mg/ml as the cutpoint value, LS QCT leads to excessively high prevalence of osteoporosis for Chinese women, with the discordance between hip dual-energy X-ray absorptiometry and LS QCT measures far exceeding expectation. Considering the different bone properties and the much lower prevalence of fragility fractures in the East Asian women compared with Caucasians, we argue that the QCT cutpoint value for classifying osteoporosis among older East Asian women will be close to and no more than 50 mg/ml LS BMD. We suggest that it is also imperative the QCT osteoporosis classification criterion for East Asian male LS, and male and female hips be re-examined.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Sheng-Nan Tang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Wáng YXJ, Griffith JF, Blake GM, Diacinti D, Xiao BH, Yu W, Su Y, Jiang Y, Guglielmi G, Guermazi A, Kwok TCY. Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture. Skeletal Radiol 2024; 53:609-625. [PMID: 37889317 DOI: 10.1007/s00256-023-04481-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
The 1994 WHO criterion of a T-score ≤ -2.5 for densitometric osteoporosis was chosen because it results in a prevalence commensurate with the observed lifetime risk of fragility fractures in Caucasian women aged ≥ 50 years. Due to the much lower risk of fragility fracture among East Asians, the application of the conventional WHO criterion to East Asians leads to an over inflated prevalence of osteoporosis, particularly for spine osteoporosis. According to statistical modeling and when a local BMD reference is used, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.7 for Hong Kong Chinese women. Using radiographic osteoporotic vertebral fracture as a surrogate clinical endpoint, we empirically demonstrated that a femoral neck T-score of -2.77 for Chinese women was equivalent to -2.60 for Italian women, a spine T-score of -3.75 for Chinese women was equivalent to -2.44 for Italian women, and for Chinese men a femoral neck T-score of -2.77 corresponded to spine T-score of -3.37. For older Chinese men, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.2. With the BMD reference published by IKi et al. applied, T-score of femoral neck, total hip, and spine of -2.75, -3.0, and -3.9 for Japanese women will be more in line with the WHO osteoporosis definition. The revised definition of osteoporosis cutpoint T-scores for East Asians will allow a more meaningful international comparison of disease burden.
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Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Yebin Jiang
- VA Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Garrahan M, Gehman S, Rudolph SE, Tenforde AS, Ackerman KE, Popp KL, Bouxsein ML, Sahni S. Serum 25-Hydroxyvitamin D is Associated With Bone Microarchitecture and Strength in a Multiracial Cohort of Young Adults. J Clin Endocrinol Metab 2022; 107:e3679-e3688. [PMID: 35766873 PMCID: PMC9387703 DOI: 10.1210/clinem/dgac388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether 25-hydroxyvitamin D (25-OH D) levels are associated with bone outcomes in a multiracial cohort of young adults. METHODS This cross-sectional study included 165 participants (83 men, 82 women, 18-30 years of age) who self-identified as Asian, Black, or White. We measured bone microarchitecture and strength of the distal radius and tibia using high-resolution peripheral quantitative computed tomography. We used linear regression to estimate the association between 25-OH D (ng/mL) and bone measurements, adjusting for race, sex, age, weight, height, calcium intake, physical activity, and season. RESULTS A total of 43.6% of participants were 25-OH D deficient (<20 ng/mL) with greater prevalence in Asian (38.9%) and Black (43.1%) compared with White (18.0%) participants (P < 0.001). At the distal radius, 25-OH D was positively associated with cortical area, trabecular density, cortical thickness, cortical porosity, and failure load (P < 0.05 for all). At the distal tibia, higher 25-OH D was associated with higher cortical area, trabecular density, trabecular number, failure load, and lower trabecular separation and cortical density (P < 0.05 for all). After multivariable adjustment, those with 25-OH D deficiency had generally worse bone microarchitecture than those with 25-OH D sufficiency. Black individuals had largely more favorable bone outcomes than Asian and White individuals, despite higher prevalence of 25-OH D deficiency. CONCLUSIONS We found a high prevalence of 25-OH D deficiency in a multiracial cohort of young adults. Lower 25-OH D was associated with worse bone outcomes at the distal radius and tibia at the time of peak bone mass, warranting further attention to vitamin D status in young adults.
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Affiliation(s)
- Margaret Garrahan
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sarah Gehman
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sara E Rudolph
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, MA 02215, USA
- Spaulding Rehabilitation Hospital, Cambridge, MA 02138, USA
| | - Kathryn E Ackerman
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
- Boston Children’s Hospital, Boston, MA 02215, USA
| | - Kristin L Popp
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
- United StatesArmy Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Mary L Bouxsein
- Correspondence: Mary L. Bouxsein, PhD, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, RN115, 330 Brookline Avenue, Boston, MA 02215.
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Alvarenga JC, Caparbo VF, Domiciano DS, Pereira RMR. Age-related reference data of bone microarchitecture, volumetric bone density, and bone strength parameters in a population of healthy Brazilian men: an HR-pQCT study. Osteoporos Int 2022; 33:1309-1321. [PMID: 35059775 DOI: 10.1007/s00198-021-06288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED In a cross-sectional cohort of 340 healthy Brazilian men aged 20 to 92 years, data on density, structure, and strength of the distal radius and tibia were obtained using high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop age- and site-specific reference curves. Age-dependent changes differed between the sites and bone compartments (trabecular and cortical). INTRODUCTION The aim of this study was to establish age-related reference curves for bone densities, microarchitectural properties, and estimated failure load measured by HR-pQCT (distal radius and tibia) in men. Also, to correlate bone stiffness with the other HR-pQCT parameters, areal bone mineral density (BMD) by DXA and trabecular bone score (TBS). METHODS Healthy Brazilian men (n = 340) between the ages of 20 and 92 years were recruited. Non-dominant radius and left tibia were scanned using HR-pQCT (Xtreme CT I). Standard and automated segmentation methods were performed, and bone strength estimated by FE analysis. Bone mineral density at lumbar spine, total hip, femoral neck, and TBS were measured using DXA (Hologic, QDR4500). RESULTS Age-related reference curves were constructed at the distal radius and tibia for volumetric bone density, morphometry, and estimated bone strength parameters. There was a linear relationship with age only for thickness measurements of distal radius (trabecular: R2 0.108, p<0.001; cortical: R2 0.062, p=0.002) and tibia (trabecular: R2 0.109, p<0.001; cortical: R2 0.063, p=0.010), and bone strength at distal radius (R2 0.157, p<0.001). The significant correlations (p <0.05) found by Pearson's correlations (r) between bone stiffness and all other variables measured by HR-pQCT and DXA showed to be stronger at the tibia site than the distal radius. CONCLUSION The current study expands the HR-pQCT worldwide database and presents an adequate methodology for the construction of reference data in other populations. Moreover, the correlation of bone strength estimated by FEA with other bone microstructural parameters provided by HR-pQCT helps to determine the contribution of each of these variables to fracture risk prediction in men.
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Affiliation(s)
- J C Alvarenga
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil.
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Loundagin LL, Bredbenner TL, Jepsen KJ, Edwards WB. Bringing Mechanical Context to Image-Based Measurements of Bone Integrity. Curr Osteoporos Rep 2021; 19:542-552. [PMID: 34269975 DOI: 10.1007/s11914-021-00700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Image-based measurements of bone integrity are used to estimate failure properties and clinical fracture risk. This paper (1) reviews recent imaging studies that have enhanced our understanding of the mechanical pathways to bone fracture and (2) discusses the influence that inter-individual differences in image-based measurements may have on the clinical assessment of fracture risk RECENT FINDINGS: Increased tissue mineralization is associated with improved bone strength but reduced fracture toughness. Trabecular architecture that is important for fatigue resistance is less important for bone strength. The influence of porosity on bone failure properties is heavily dependent on pore location and size. The interaction of various characteristics, such as bone area and mineral content, can further complicate their influence on bone failure properties. What is beneficial for bone strength is not always beneficial for bone toughness or fatigue resistance. Additionally, given the large amount of imaging data that is clinically available, there is a need to develop effective translational strategies to better interpret non-invasive measurements of bone integrity.
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Affiliation(s)
- Lindsay L Loundagin
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, 105 Administration Place, Saskatoon, SK, S7N 5A2, Canada
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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Okazaki N, Chiba K, Burghardt AJ, Kondo C, Doi M, Yokota K, Yonekura A, Tomita M, Osaki M. Differences in bone mineral density and morphometry measurements by fixed versus relative offset methods in high-resolution peripheral quantitative computed tomography. Bone 2021; 149:115973. [PMID: 33895434 DOI: 10.1016/j.bone.2021.115973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION High-resolution peripheral quantitative computed tomography (HR-pQCT), which enables in vivo analysis of bone morphometry, is widely used in osteoporosis research. The scan position is usually determined by the fixed offset method; however, there are concerns that the scan position can become relatively proximal if limb length is short. The present study compared bone mineral density and morphometry measured using the fixed and relative offset methods, in which the scan position is determined based on the lengths of the forearm and lower leg, and investigated factors responsible for measurement differences between the two methods. METHODS A total of 150 healthy Japanese subjects, comprising 75 men and 75 women, with a mean age of 45.1 years, were enrolled in this study. The distal radius and tibia were scanned using the fixed and relative offset methods; the fixed offset method involved scanning the radius and tibia at 9 mm and 22 mm, respectively, proximal to their distal articular surfaces. By contrast, the relative offset method entailed scanning the radius at 4% of the forearm length and the tibia at 7.3% of the lower leg length, proximal to their respective distal articular surfaces. The percent overlap between the scan positions of the two methods was measured using the scout views. Measurement values obtained with the two methods were compared. The correlation between the differences in the values among the two methods and forearm length, lower leg length, and body height was examined. RESULTS The subjects had a mean height of 164.3 ± 14.3 cm, mean forearm length of 252.9 ± 17.3 mm, and mean lower leg length of 346.7 ± 22.3 mm. The mean percent overlap was 85.0 ± 9.1% (59.2-99.6%) for the radius and 79.8 ± 12.5% (48.3-99.8%) for the tibia. Fixed offset scanning yielded higher total volumetric bone mineral density (Tt.vBMD) and cortical vBMD (Ct.vBMD) and greater cortical thickness (Ct.Th) (all p < 0.001). The differences between the two methods in terms of Tt.vBMD, Ct.vBMD and Ct.Th were significantly greater with shorter forearm length, lower leg length, and body height (radius: 0.51 < |r| < 0.63, tibia: 0.61 < |r| < 0.95). CONCLUSION Measurements of bone mineral density and morphometry obtained using the fixed offset method differed from those obtained using the relative offset method, which takes body size into account. Shorter body height, forearm length, and lower leg length were found to correlate with greater measurement differences. In populations with smaller stature, use of the fixed offset method results in relatively proximal images; thus, caution should be exercised when comparing groups of different height.
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Affiliation(s)
- Narihiro Okazaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Choko Kondo
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsuru Doi
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuaki Yokota
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Yonekura
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Tomita
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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van den Bergh JP, Szulc P, Cheung AM, Bouxsein M, Engelke K, Chapurlat R. The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions. Osteoporos Int 2021; 32:1465-1485. [PMID: 34023944 PMCID: PMC8376700 DOI: 10.1007/s00198-021-05999-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity; (2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.
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Affiliation(s)
- J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
- Faculty of Medicine, Hasselt University, Hasselt, Belgium.
| | - P Szulc
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
| | - A M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network; and Department of Medicine and Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - M Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
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Heilmeier U, Joseph GB, Pasco C, Dinh N, Torabi S, Darakananda K, Youm J, Carballido-Gamio J, Burghardt AJ, Link TM, Kazakia GJ. Longitudinal Evolution of Bone Microarchitecture and Bone Strength in Type 2 Diabetic Postmenopausal Women With and Without History of Fragility Fractures-A 5-Year Follow-Up Study Using High Resolution Peripheral Quantitative Computed Tomography. Front Endocrinol (Lausanne) 2021; 12:599316. [PMID: 33796067 PMCID: PMC8008748 DOI: 10.3389/fendo.2021.599316] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/11/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Diabetic bone disease is characterized by an increased fracture risk which may be partly attributed to deficits in cortical bone quality such as higher cortical porosity. However, the temporal evolution of bone microarchitecture, strength, and particularly of cortical porosity in diabetic bone disease is still unknown. Here, we aimed to prospectively characterize the 5-year changes in bone microarchitecture, strength, and cortical porosity in type 2 diabetic (T2D) postmenopausal women with (DMFx) and without history of fragility fractures (DM) and to compare those to nondiabetic fracture free controls (Co) using high resolution peripheral quantitative computed tomography (HR-pQCT). Methods Thirty-two women underwent baseline HR-pQCT scanning of the ultradistal tibia and radius and a FU-scan 5 years later. Bone microarchitectural parameters, including cortical porosity, and bone strength estimates via µFEA were calculated for each timepoint and annualized. Linear regression models (adjusted for race and change in BMI) were used to compare the annualized percent changes in microarchitectural parameters between groups. Results At baseline at the tibia, DMFx subjects exhibited the highest porosity of the three groups (66.3% greater Ct.Po, 71.9% higher Ct.Po.Volume than DM subjects, p < 0.022). Longitudinally, porosity increased significantly over time in all three groups and at similar annual rates, while DMFx exhibited the greatest annual decreases in bone strength indices (compared to DM 4.7× and 6.7× greater decreases in failure load [F] and stiffness [K], p < 0.025; compared to Co 14.1× and 22.2× greater decreases in F and K, p < 0.020). Conclusion Our data suggest that despite different baseline levels in cortical porosity, T2D women with and without fractures experienced long-term porosity increases at a rate similar to non-diabetics. However, the annual loss in bone strength was greatest in T2D women with a history of a fragility fractures. This suggests a potentially non-linear course of cortical porosity development in T2D bone disease: major porosity may develop early in the course of disease, followed by a smaller steady annual increase in porosity which in turn can still have a detrimental effect on bone strength-depending on the amount of early cortical pre-damage.
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Affiliation(s)
- Ursula Heilmeier
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Gabby B. Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Courtney Pasco
- Department of Bioengineering, University of California Berkeley, Berkeley, CA, United States
| | - Nhan Dinh
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Soheyla Torabi
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Karin Darakananda
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Jiwon Youm
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrew J. Burghardt
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Thomas M. Link
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
| | - Galateia J. Kazakia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, CA, United States
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Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 2020; 15:147. [PMID: 32955674 DOI: 10.1007/s11657-020-00822-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture determinants differ between Canadians of Chinese and White descent, the former constituting the second largest visible minority group in Canada. The results of this study support the importance of characterizing bone health predictors in Canadians of different ethnicity to improve population-specific fracture prevention and treatment strategies. PURPOSE We aimed to compare clinical risk factors, bone mineral density, prevalence of osteoporosis, and fractures between Chinese and White Canadians to identify ethnicity-specific risks. METHODS We studied 236 Chinese and 8945 White Canadians aged 25+ years from the Canadian Multicentre Osteoporosis Study (CaMos). The prevalence of osteoporosis using ethnicity-specific peak bone mass (PBM), and of prior and incident low trauma fractures were assessed and compared between groups. Linear regressions, adjusting for age and anthropometric measures, were used to examine the association between baseline and 5-year changes in BMD and ethnicity. RESULTS Chinese participants had shorter stature, lower BMI, and lower rate of falls than White participants. Adjusted models showed no significant differences in baseline BMD between ethnic groups except in younger men where total hip BMD was 0.059 g/cm2 (0.009; 0.108) lower in Chinese. Adjusted 5-year BMD change at lumbar spine was higher in older Chinese women and men compared with Whites. When using Chinese-specific PBM, the prevalence of osteoporosis in Chinese women was 2-fold lower than when using that of White women The prevalence of fractures was higher in White women compared with Chinese with differences up to 14.5% (95% CI 9.2; 19.7) and 10.5% (95% CI 4.5-16.4) in older White men. Incident fractures were rare in young Chinese compared with White participants and not different in the older groups. CONCLUSION Our results support the importance of characterizing bone strength predictors in Chinese Canadians and the development of ethnicity-specific fracture prediction and prevention strategies.
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Nguyen HH, Lakhani A, Shore-Lorenti C, Zebaze R, Vincent AJ, Milat F, Ebeling PR. Asian ethnicity is associated with atypical femur fractures in an Australian population study. Bone 2020; 135:115319. [PMID: 32179169 DOI: 10.1016/j.bone.2020.115319] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 02/07/2023]
Abstract
Asian race, younger age, higher body mass index (BMI) and antiresorptive drugs have all been associated with atypical femur fractures (AFFs). This increased risk of AFF in Asians is important as by 2050, >50% of hip fractures globally will occur in Asia, with an increased demand for antiresorptive drugs being likely. It is also currently unclear whether AFF risk is increased in all Asian subgroups. We therefore aimed to identify the incidence of AFFs in an Australian tertiary hospital, the contribution of ethnic origin to AFF risk, and determine other clinical risk factors for AFF. From January 1, 2009 to December 31, 2017, 97 AFFs (82 complete and 15 incomplete) occurred in 71 individuals in the overall study population of 204,358. Patients with AFF were more likely to be female (88.7% vs 69.1%, p < 0.001) and younger [median (IQR): 74(52-92) years vs 83(75-88) years, p < 0.001] than the "typical" femur fracture group (n = 3330). The cumulative incidence rate of AFF was 4.2 per 100,000 person-years, far lower than for any ICD-10 AM coded "typical" femur fracture (202.9 per 100,000 person-years). Asians were 3.4 (95%CI, 2.1-5.6) times more likely to sustain an AFF than non-Asians, the highest incidence being in those from South East Asian countries (16.6 per 100,000 person years), suggesting differences in risk between Asian countries. In the nested case-control study, bisphosphonate use was an independent association with AFF development. We conclude Asian ethnicity is an important association with AFF in this large Australian cohort.
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Affiliation(s)
- Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
| | - Amar Lakhani
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Catherine Shore-Lorenti
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Roger Zebaze
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria, Australia; Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia; Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
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11
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Muscle-Bone Interactions in Chinese Men and Women Aged 18-35 Years. J Osteoporos 2020; 2020:8126465. [PMID: 32454965 PMCID: PMC7238353 DOI: 10.1155/2020/8126465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 12/20/2022] Open
Abstract
To characterize bone mineral density (BMD), bone strength, muscle and fat mass, and muscle strength and power in Chinese women (n = 25) and men (n = 28) classified as in the bone accrual phase (18-25 years) or in the peak bone mass phase (26-35 years). Calcium intakes, physical activity levels, and serum vitamin D were measured. Dual-energy X-ray absorptiometry (DXA) assessed body composition, lumbar spine, and hip areal BMD (aBMD) variables and peripheral quantitative computed tomography (pQCT) assessed cortical and trabecular volumetric BMD (vBMD) and bone strength. Muscle strength and power were assessed by grip strength, leg press, and vertical jump tests. Calcium, serum vitamin D, and physical activity levels were similar across age and sex groups. Significant sex differences (p < 0.05) were found for most body composition variables, hip aBMD, tibia variables, and muscle strength and power. Adjusting for height and weight eliminated most of the significant sex differences. Women showed stronger positive correlations between body composition and bone variables (r = 0.44 to 0.78) than men. Also, correlations between muscle strength/power were stronger in women vs. men (r = 0.43 to 0.82). Bone traits were better related to body composition and muscle function in Chinese women compared to Chinese men aged 18 to 35 years, and peak bone mass seems to be achieved by 25 years of age in both Chinese men and women since there were no differences between the two age groups.
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12
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Wang W, Nie M, Jiang Y, Li M, Meng X, Xing X, Wang O, Xia W. Impaired geometry, volumetric density, and microstructure of cortical and trabecular bone assessed by HR-pQCT in both sporadic and MEN1-related primary hyperparathyroidism. Osteoporos Int 2020; 31:165-173. [PMID: 31642976 DOI: 10.1007/s00198-019-05186-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 10/01/2019] [Indexed: 12/31/2022]
Abstract
UNLABELLED This study evaluated bone features of PHPT using HR-pQCT. The results showed both cortical and trabecular bones were significantly impaired in PHPT patients. Male and female PHPT patients suffered similar damages in bone. HR-pQCT indices were not observed to differ in MEN1 and sporadic PHPT patients. INTRODUCTION High-resolution peripheral quantitative CT is a novel imaging technique used to separately assess trabecular and cortical bone status of the radius and tibia in vivo. Using HR-pQCT, we aimed to evaluate bone features of primary hyperparathyroidism patients in a Chinese population and reveal similarities and differences in bone features in multiple endocrine neoplasia type 1-related PHPT and sporadic PHPT patients in the Chinese population. METHODS A case-control study was designed. In 58 PHPT patients and 58 sex- and age-matched healthy controls, the distal radius and tibia were scanned using HR-pQCT. Areal bone mineral density (aBMD) was also determined in PHPT patients using dual-energy X-ray absorptiometry (DXA). RESULTS In comparison with controls, PHPT patients were observed to exhibit reduced volumetric BMD at the cortical and trabecular compartments, thinner cortices, and more widely spaced trabeculae. Significant differences were still observed when comparing data of female and male patients with age-matched controls separately. MHPT patients (n = 11) were found to have lower aBMD Z-scores in the lumbar spine, trochanteric region, and total hip compared with sporadic PHPT patients (n = 47), while no differences were observed in HR-pQCT indices between the two groups. In multiple linear regression models, no significant correlations were identified between PTH and HR-pQCT indices. However, height was found to positively correlate with HR-pQCT-derived trabecular indices at both the radius and tibia. CONCLUSIONS PHPT affects geometry, volumetric density, and microstructure in both the cortical and trabecular bones in both male and female Chinese patients. MHPT patients were observed to have reduced aBMD as determined by DXA in the lumbar spine and hip in comparison with sporadic PHPT patients. However, HR-pQCT indices were not observed to differ.
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Affiliation(s)
- W Wang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
- Key Laboratory of Diabetes Mellitus Prevention and Research, Department of Endocrinology, Beijing Luhe Hospital, Capital Medical University, Beijing, People's Republic of China
| | - M Nie
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - Y Jiang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - M Li
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - X Meng
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - X Xing
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China
| | - O Wang
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China.
| | - W Xia
- Key laboratory of Endocrinology, Ministry of Health, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shuai Fuyuan 1#, Dongdan, Dongcheng district, Beijing, 100730, People's Republic of China.
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Wang XF, Ghasem-Zadeh A, Zhou B, Guo XE, Zhang Z, Seeman E. Dimorphism in axial and appendicular dimensions, cortical and trabecular microstructure and matrix mineral density in Chinese and Caucasian women. Bone 2019; 128:115039. [PMID: 31437567 DOI: 10.1016/j.bone.2019.115039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/02/2019] [Accepted: 08/16/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Appendicular fractures are less common in Chinese than Caucasian women. Bone mineral density (BMD) is lower, not higher than in Caucasians because Chinese have smaller appendicular dimensions than Caucasians. However, smaller bones may offset the liability to fracture by being assembled with a more robust microstructure. We hypothesized that Chinese assemble an appendicular skeleton with a thicker, less porous and more mineralized cortex that is less deteriorated in advanced age than in Caucasians. METHODS We compared anthropometry in 477 Chinese and 278 Caucasian women and compared bone microstructure using high-resolution peripheral quantitative computed tomography in another cohort of 186 Chinese and 381 Caucasian women aged 18 to 86 years, all living in Melbourne, Australia. Trabecular plate (p) and rod (r) bone volume/total volume (BV/TV) were quantified using individual trabecula segmentation (ITS). Bone strength was estimated using micro-finite element analysis (μFEA). RESULTS Premenopausal Chinese were shorter than Caucasian women, mainly due to shorter leg length. Distal radial total cross sectional area (CSA) was 14.8% smaller (p < 0.001). After adjusting for age and total CSA, Chinese had similar cortical and medullary areas but 0.30 SD lower cortical porosity and 0.27 SD higher matrix mineral density (both p < 0.05). Trabecular plate-to-rod ratio was 0.55 SD higher due to a 0.41 SD higher pBV/TV and 0.36 SD lower rBV/TV (p ranging 0.001 to 0.023). Chinese also had 0.36 SD greater whole bone stiffness and 0.36 SD greater failure load than Caucasians (both p < 0.05). After adjusting for age and total CSA, postmenopausal Chinese had 3.3% smaller cortical area, medullary area was 2.1% larger, cortical porosity was no lower, matrix mineral density and pBV/TV were no higher compared with Caucasians at the distal radius. Whole bone stiffness was 0.39 SD lower and failure load was 0.40 SD lower in Chinese (both p < 0.05). CONCLUSION Chinese build a more robust skeleton than Caucasians during growth, an advantage not observed in advanced age due to greater bone loss or race-specific secular trends in bone morphology.
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Affiliation(s)
- Xiao-Fang Wang
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Ali Ghasem-Zadeh
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Zhendong Zhang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Ego Seeman
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia; Mary MacKillop Institute of Heathly Aging, Australian Catholic University, Melbourne, Australia
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Blank M, Sims NA. Cellular Processes by Which Osteoblasts and Osteocytes Control Bone Mineral Deposition and Maturation Revealed by Stage-Specific EphrinB2 Knockdown. Curr Osteoporos Rep 2019; 17:270-280. [PMID: 31401710 DOI: 10.1007/s11914-019-00524-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW We outline the diverse processes contributing to bone mineralization and bone matrix maturation by describing two mouse models with bone strength defects caused by restricted deletion of the receptor tyrosine kinase ligand EphrinB2. RECENT FINDINGS Stage-specific EphrinB2 deletion differs in its effects on skeletal strength. Early-stage deletion in osteoblasts leads to osteoblast apoptosis, delayed initiation of mineralization, and increased bone flexibility. Deletion later in the lineage targeted to osteocytes leads to a brittle bone phenotype and increased osteocyte autophagy. In these latter mice, although mineralization is initiated normally, all processes involved in matrix maturation, including mineral accrual, carbonate substitution, and collagen compaction, progress more rapidly. Osteoblasts and osteocytes control the many processes involved in bone mineralization; defining the contributing signaling activities may lead to new ways to understand and treat human skeletal fragilities.
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Affiliation(s)
- Martha Blank
- St. Vincent's Institute of Medical Research, and the Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, Melbourne, VIC, 3065, Australia
| | - Natalie A Sims
- St. Vincent's Institute of Medical Research, and the Department of Medicine at St. Vincent's Hospital, The University of Melbourne, Fitzroy, Melbourne, VIC, 3065, Australia.
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Ramalho J, Marques IDB, Hans D, Dempster D, Zhou H, Patel P, Pereira RMR, Jorgetti V, Moyses RMA, Nickolas TL. The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease. Bone 2018; 116:215-220. [PMID: 30098418 DOI: 10.1016/j.bone.2018.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients. We obtained tetracycline double labeled transiliac crest bone biopsy, areal BMD of the spine, total hip, femoral neck (FN) and spine TBS by dual energy X-ray absorptiometry (DXA), and cortical and trabecular volumetric density and microarchitecture by high resolution peripheral quantitative computed tomography (HR-pQCT) in CKD patients from two centers: twenty-two patients from Columbia University Medical Center, USA and thirty patients from Hospital das Clinicas - Universidade de São Paulo, Brazil. Two patients were excluded for outlier status. Univariate and multivariate relationships between TBS and measures from DXA, HR-pQCT and histomorphometry were determined. Patients were 50.2 ± 15.8 years old, 23 (46%) were men, and 33 (66%) were on dialysis. TBS was <1.31 in 21 (42%) patients and 22%, 14% and 10% had T-scores ≤ -2.5 at spine, FN and total hip respectively. In univariate regression, TBS was significantly associated with trabecular bone volume (BV/TV), trabecular width (Tb.Wi), trabecular spacing, cortical width but not with trabecular number or cortical porosity. FN Z-score and height were also associated with cancellous BV/TV and Tb.Wi, In multivariate analysis, TBS remained an independent predictor of BV/TV and Tb.Wi. There were no relationships between TBS and dynamic parameters from histomorphometry. These data suggest that TBS reflected trabecular microarchitecture and cortical width measured by bone biopsy in CKD patients. Future studies should address its utility in the identification of CKD patients who may benefit from fracture prevention strategies.
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Affiliation(s)
- J Ramalho
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - I D B Marques
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Didier Hans
- Center of bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA; Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, NY, USA
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, NY, USA
| | - Parth Patel
- Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - R M R Pereira
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - V Jorgetti
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil; Hospital Samaritano Americas Serviços Médicos, Sao Paulo, SP, Brazil
| | - R M A Moyses
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil; Universidade Nove de Julho, São Paulo, SP, Brazil
| | - Thomas L Nickolas
- Department of Medicine, Columbia University Medical Center, New York, NY, USA.
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16
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Chiang CY, Zebaze R, Wang XF, Ghasem-Zadeh A, Zajac JD, Seeman E. Cortical Matrix Mineral Density Measured Noninvasively in Pre- and Postmenopausal Women and a Woman With Vitamin D-Dependent Rickets. J Bone Miner Res 2018; 33:1312-1317. [PMID: 29489033 DOI: 10.1002/jbmr.3415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/05/2018] [Accepted: 02/12/2018] [Indexed: 12/26/2022]
Abstract
Reduced bone mineral density (BMD) may be due to reduced mineralized bone matrix volume, incomplete secondary mineralization, or reduced primary mineralization. Because bone biopsy is invasive, we hypothesized that noninvasive image acquisition at high resolution can accurately quantify matrix mineral density (MMD). Quantification of MMD was confined to voxels attenuation photons above 80% of that produced by fully mineralized bone matrix because attenuation at this level is due to variation in mineralization, not porosity. To assess accuracy, 9 cadaveric distal radii were imaged at a voxel size of 82 microns using high-resolution peripheral quantitative computed tomography (HR-pQCT; XtremeCT, Scanco Medical AG, Bruttisellen, Switzerland) and compared with VivaCT 40 (µCT) at 19-micron voxel size. Associations between MMD and porosity were studied in 94 healthy vitamin D-replete premenopausal women, 77 postmenopausal women, and in a 27-year-old woman with vitamin D-dependent rickets (VDDR). Microstructure and MMD were quantified using StrAx (StraxCorp, Melbourne, Australia). MMD measured by HR-pQCT and µCT correlated (R = 0.87; p < 0.0001). The precision error for MMD was 2.43%. Cortical porosity and MMD were associated with age (r2 = 0.5 and -0.4, respectively) and correlated inversely in pre- and postmenopausal women (both r2 = 0.9, all p < 0.001). Porosity was higher, and MMD was lower, in post- than in premenopausal women (porosity 40.3% ± 7.0 versus 34.7% ± 3.5, respectively; MMD 65.4% ± 1.8 versus 66.6% ± 1.4, respectively, both p < 0.001). In the woman with VDDR, MMD was 5.6 SD lower and porosity was 5.6 SD higher than the respective trait means in premenopausal women. BMD was reduced (Z-scores femoral neck -4.3 SD, lumbar spine -3.8 SD). Low-radiation HR-pQCT may facilitate noninvasive quantification of bone's MMD and microstructure in health, disease, and during treatment. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Cherie Y Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Roger Zebaze
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Xiao-Fang Wang
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Ali Ghasem-Zadeh
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Jeffrey D Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Ego Seeman
- Department of Endocrinology, Austin Health, Heidelberg, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia.,Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia
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Bonaretti S, Majumdar S, Lang TF, Khosla S, Burghardt AJ. The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions. Osteoporos Int 2017; 28:2115-2128. [PMID: 28391447 PMCID: PMC5526099 DOI: 10.1007/s00198-017-4010-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/13/2017] [Indexed: 12/16/2022]
Abstract
UNLABELLED We investigated the sensitivity of distal bone density, structure, and strength measurements by high-resolution peripheral quantitative computed tomography (HR-pQCT) to variability in limb length. Our results demonstrate that HR-pQCT should be performed at a standard %-of-total-limb-length to avoid substantial measurement bias in population study comparisons and the evaluation of individual skeletal status in a clinical context. INTRODUCTION High-resolution peripheral quantitative computed tomography (HR-pQCT) measures of bone do not account for anatomic variability in bone length: a 1-cm volume is acquired at a fixed offset from an anatomic landmark. Our goal was to evaluate HR-pQCT measurement variability introduced by imaging fixed vs. proportional volumes and to propose a standard protocol for relative anatomic positioning. METHODS Double-length (2-cm) scans were acquired in 30 adults. We compared measurements from 1-cm sub-volumes located at the default fixed offset, and the average %-of-length offset. The average position corresponded to 4.0% ± 1.1 mm for radius, and 7.2% ± 2.2 mm for tibia. We calculated the RMS difference in bone parameters and T-scores to determine the measurement variability related to differences in limb length. We used anthropometric ratios to estimate the mean limb length for published HR-pQCT reference data, and then calculated mean %-of-length offsets. RESULTS Variability between fixed vs. relative scan positions was highest in the radius, and for cortical bone in general (RMS difference Ct.Th = 19.5%), while individuals had T-score differentials as high as +3.0 SD (radius Ct.BMD). We estimated that average scan position for published HR-pQCT reference data corresponded to 4.0% at the radius, and 7.3% at tibia. CONCLUSION Variability in limb length introduces significant bias to HR-pQCT measures, confounding cross-sectional analyses and limiting the clinical application for individual assessment of skeletal status. We propose to standardize scan positioning using 4.0 and 7.3% of total bone length for the distal radius and tibia, respectively.
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Affiliation(s)
- S Bonaretti
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA, 94158, USA
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - S Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA, 94158, USA
| | - T F Lang
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA, 94158, USA
| | - S Khosla
- Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - A J Burghardt
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA, 94158, USA.
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Walker MD, Kepley A, Nishiyama K, Zhou B, Guo E, Nickolas TL. Cortical microstructure compensates for smaller bone size in young Caribbean Hispanic versus non-Hispanic white men. Osteoporos Int 2017; 28:2147-2154. [PMID: 28341899 DOI: 10.1007/s00198-017-4013-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Hispanic men have smaller bone size but thicker and denser cortices compared to white men, leading to similar mechanical competence. INTRODUCTION The purpose of this study was to assess differences in vBMD and microarchitecture in young Caribbean Hispanic (n = 30) and non-Hispanic Caucasian (n = 30) men. METHODS We measured areal bone mineral density (aBMD) at the spine, total hip (TH), femoral neck (FN), and forearm by dual-energy X-ray absorptiometry (DXA) and bone geometry, mass, microarchitecture, and mechanical competence by high-resolution peripheral quantitative computed tomography (HRpQCT), individual trabecula segmentation (ITS), and finite element analysis (FEA). RESULTS Hispanic men were slightly older, shorter, and heavier and had higher BMI compared with white men. aBMD, measured by DXA, did not differ at the spine, TH, or forearm before or after adjustment for age, height, weight, and the interaction of height and weight. At the FN, marginally significant higher BMD in Hispanics prior to adjustment was attenuated and no longer differed after adjustment for covariates. Adjusted HRpQCT indices indicated smaller total and trabecular area at the radius but greater total volumetric density and cortical thickness in Hispanic versus white men. The adjusted difference in cortical density at the radius was of borderline significance. Trabecular and ITS microstructure tended not to differ at the radius. At the tibia, results were similar. Bone size tended to be smaller and covariate-adjusted cortical density and cortical thickness were greater in Hispanic versus white men. Additionally, cortical porosity was lower at the tibia in Hispanic compared to white men. Stiffness and failure load did not differ at either skeletal site by ethnicity. CONCLUSION In conclusion, greater cortical thickness and density as well as lower cortical porosity tend to compensate for smaller bone size in Hispanic men, leading to similar mechanical competence compared with white men.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA.
| | - A Kepley
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - K Nishiyama
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - B Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - E Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - T L Nickolas
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
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19
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Eneh CTM, Malo MKH, Karjalainen JP, Liukkonen J, Töyräs J, Jurvelin JS. Effect of porosity, tissue density, and mechanical properties on radial sound speed in human cortical bone. Med Phys 2017; 43:2030. [PMID: 27147315 DOI: 10.1118/1.4942808] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the effect of simultaneous changes in cortical porosity, tissue mineral density, and elastic properties on radial speed of sound (SOS) in cortical bone. The authors applied quantitative pulse-echo (PE) ultrasound techniques that hold much potential especially for screening of osteoporosis at primary healthcare facilities. Currently, most PE measurements of cortical thickness, a well-known indicator of fracture risk, use a predefined estimate for SOS in bone to calculate thickness. Due to variation of cortical bone porosity, the use of a constant SOS value propagates to an unknown error in cortical thickness assessment by PE ultrasound. METHODS The authors conducted 2.25 and 5.00 MHz focused PE ultrasound time of flight measurements on femoral diaphyses of 18 cadavers in vitro. Cortical porosities of the samples were determined using microcomputed tomography and related to SOS in the samples. Additionally, the effect of cortical bone porosity and mechanical properties of the calcified matrix on SOS was investigated using numerical finite difference time domain simulations. RESULTS Both experimental measurements and simulations demonstrated significant negative correlation between radial SOS and cortical porosity (R(2) ≥ 0.493, p < 0.01 and R(2) ≥ 0.989, p < 0.01, respectively). When a constant SOS was assumed for cortical bone, the error due to variation of cortical bone porosity (4.9%-16.4%) was about 6% in the cortical thickness assessment in vitro. CONCLUSIONS Use of a predefined, constant value for radial SOS in cortical bone, i.e., neglecting the effect of measured variation in cortical porosity, propagated to an error of 6% in cortical thickness. This error can be critical as characteristic cortical thinning of 1.10% ± 1.06% per yr decreases bending strength of the distal radius and results in increased fragility in postmenopausal women. Provided that the cortical porosity can be estimated in vivo, the relationship between radial SOS and cortical porosity can be utilized and a porosity based radial SOS estimate could be implemented to determine cortical thickness. This would constitute a step toward individualized quantitative ultrasound diagnostics of osteoporosis.
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Affiliation(s)
- C T M Eneh
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, Kuopio FI-70211, Finland and Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, Kuopio FI-70029, Finland
| | - M K H Malo
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, Kuopio FI-70211, Finland
| | - J P Karjalainen
- Bone Index Finland Ltd., P.O. Box 1188, Kuopio FI-70211, Finland
| | - J Liukkonen
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, Kuopio FI-70211, Finland
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, Kuopio FI-70211, Finland and Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, Kuopio FI-70029, Finland
| | - J S Jurvelin
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, Kuopio FI-70211, Finland and Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, Kuopio FI-70029, Finland
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20
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Ghasem-Zadeh A, Seeman E. Challenges in the Use of Cross-Sectional Data to Quantify Growth and Deterioration of Bone Structure During Advancing Age. J Clin Densitom 2017; 20:5-7. [PMID: 27618369 DOI: 10.1016/j.jocd.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/13/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ali Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Ego Seeman
- Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Institute for Health and Aging, Australian Catholic University, Melbourne, Australia
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21
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Eneh CTM, Afara IO, Malo MKH, Jurvelin JS, Töyräs J. Porosity predicted from ultrasound backscatter using multivariate analysis can improve accuracy of cortical bone thickness assessment. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 141:575. [PMID: 28147588 DOI: 10.1121/1.4973572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A rapidly growing area of interest in quantitative ultrasound assessment of bone is to determine cortical bone porosity from ultrasound backscatter. Current backscatter analyses are based on numerical simulations, while there are no published reports of successful experimental measurements. In this study, multivariate analysis is applied to ultrasound reflections and backscatter to predict cortical bone porosity. The porosity is then applied to estimate cortical bone radial speed of sound (SOS) and thickness using ultrasound backscatter signals obtained at 2.25 and 5 MHz center frequencies from cortical bone samples (n = 43) extracted from femoral diaphyses. The study shows that the partial least squares regression technique could be employed to successfully predict (R2 = 0.71-0.73) cortical porosity. It is found that this multivariate approach can reduce uncertainty in pulse-echo assessment of cortical bone thickness from 0.220 to 0.045 mm when porosity based radial SOS was applied, instead of a constant value from literature. Upon further validation, accurate estimation of cortical bone porosity and thickness may be applied as a financially viable option for fracture risk assessment of individuals.
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Affiliation(s)
- Chibuzor T M Eneh
- Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI-70029, Kuopio, Finland
| | - Isaac O Afara
- Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, FI-70029, Kuopio, Finland
| | - Markus K H Malo
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland
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22
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Seeman E, Ghasem-Zadeh A. Challenges in the Acquisition and Analysis of Bone Microstructure During Growth. J Bone Miner Res 2016; 31:2239-2241. [PMID: 27736022 DOI: 10.1002/jbmr.3015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/04/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Ego Seeman
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia.,Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.,Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia
| | - Ali Ghasem-Zadeh
- Department of Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
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23
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Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK. Sex- and Site-Specific Normative Data Curves for HR-pQCT. J Bone Miner Res 2016; 31:2041-2047. [PMID: 27192388 DOI: 10.1002/jbmr.2873] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to develop age-, site-, and sex-specific centile curves for common high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite-element (FE) parameters for males and females older than 16 years. Participants (n = 866) from the Calgary cohort of the Canadian Multicentre Osteoporosis Study (CaMos) between the ages of 16 and 98 years were included in this study. Participants' nondominant radius and left tibia were scanned using HR-pQCT. Standard and automated segmentation methods were performed and FE analysis estimated apparent bone strength. Centile curves were generated for males and females at the tibia and radius using the generalized additive models for location, scale, and shape (GAMLSS) package in R. After GAMLSS analysis, age-, sex-, and site-specific centiles (10th, 25th, 50th, 75th, 90th) for total bone mineral density and trabecular number as well as failure load have been calculated. Clinicians and researchers can use these reference curves as a tool to assess bone health and changes in bone quality. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lauren A Burt
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Zhiying Liang
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - David A Hanley
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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24
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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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25
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Hung VWY, Zhu TY, Cheung WH, Fong TN, Yu FWP, Hung LK, Leung KS, Cheng JCY, Lam TP, Qin L. Age-related differences in volumetric bone mineral density, microarchitecture, and bone strength of distal radius and tibia in Chinese women: a high-resolution pQCT reference database study. Osteoporos Int 2015; 26:1691-703. [PMID: 25627115 DOI: 10.1007/s00198-015-3045-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/18/2015] [Indexed: 01/23/2023]
Abstract
UNLABELLED In a cohort of 393 Chinese women, by using high-resolution peripheral quantitative computed tomography (HR-pQCT), we found that significant cortical bone loss occurred after midlife. Prominent increase in cortical porosity began at the fifth decade but reached a plateau before the sixth decade. Trabecular bone loss was already evident in young adulthood and continued throughout life. INTRODUCTION This study aimed to investigate age-related differences in volumetric bone mineral density (vBMD), microarchitecture, and estimated bone strength at peripheral skeleton in Chinese female population. METHODS In a cross-sectional cohort of 393 Chinese women aged 20-90 years, we obtained vBMD, microarchtecture, and micro-finite element-derived bone strength at distal radius and tibia using HR-pQCT. RESULTS The largest predictive age-related difference was found for cortical porosity (Ct.Po) which showed over four-fold and two-fold differences at distal radius and tibia, respectively, over the adulthood. At both sites, cortical bone area, vBMD, and thickness showed significant quadratic association with age with significant decrease beginning after midlife. Change of Ct.Po became more prominent between age of 50 and 57 (0.26 %/year at distal radius, 0.54 %/year at distal tibia, both p ≤ 0.001) but thereafter, reached a plateau (0.015 and 0.028 %/year, both p > 0.05). In contrast, trabecular vBMD and microarchitecture showed linear association with age with significant deterioration observed throughout adulthood. Estimated age of peak was around age of 20 for trabecular vBMD and microarchitecture and Ct.Po and age of 40 for cortical vBMD and microarchitecture. Estimated stiffness and failure load peaked at mid-30s at the distal radius and at age 20 at distal tibia. CONCLUSIONS Age-related differences in vBMD and microarchitecture in Chinese women differed by bone compartments. Significant cortical bone loss occurred after midlife. Prominent increase in Ct.Po began at the fifth decade but appeared to be arrested before the sixth decade. Loss of trabecular bone was already evident in young adulthood and continued throughout life.
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Affiliation(s)
- V W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T Y Zhu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - W-H Cheung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Joint ACC-CUHK Space Medicine Center on Health Maintenance of Musculoskeletal System (Shenzhen Base of ACC-CUHK State Key Lab of Basic and Applied Space Medicine), The Chinese University Shenzhen Research Institute, Shenzhen, China
| | - T-N Fong
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - F W P Yu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L-K Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - K-S Leung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Joint ACC-CUHK Space Medicine Center on Health Maintenance of Musculoskeletal System (Shenzhen Base of ACC-CUHK State Key Lab of Basic and Applied Space Medicine), The Chinese University Shenzhen Research Institute, Shenzhen, China
| | - J C Y Cheng
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Joint ACC-CUHK Space Medicine Center on Health Maintenance of Musculoskeletal System (Shenzhen Base of ACC-CUHK State Key Lab of Basic and Applied Space Medicine), The Chinese University Shenzhen Research Institute, Shenzhen, China
| | - T-P Lam
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - L Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, SAR, China.
- Translational Medicine Research and Development Center, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
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26
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Bjørnerem Å, Bui M, Wang X, Ghasem-Zadeh A, Hopper JL, Zebaze R, Seeman E. Genetic and environmental variances of bone microarchitecture and bone remodeling markers: a twin study. J Bone Miner Res 2015; 30:519-27. [PMID: 25407438 DOI: 10.1002/jbmr.2365] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/05/2014] [Accepted: 09/18/2014] [Indexed: 12/30/2022]
Abstract
All genetic and environmental factors contributing to differences in bone structure between individuals mediate their effects through the final common cellular pathway of bone modeling and remodeling. We hypothesized that genetic factors account for most of the population variance of cortical and trabecular microstructure, in particular intracortical porosity and medullary size - void volumes (porosity), which establish the internal bone surface areas or interfaces upon which modeling and remodeling deposit or remove bone to configure bone microarchitecture. Microarchitecture of the distal tibia and distal radius and remodeling markers were measured for 95 monozygotic (MZ) and 66 dizygotic (DZ) white female twin pairs aged 40 to 61 years. Images obtained using high-resolution peripheral quantitative computed tomography were analyzed using StrAx1.0, a nonthreshold-based software that quantifies cortical matrix and porosity. Genetic and environmental components of variance were estimated under the assumptions of the classic twin model. The data were consistent with the proportion of variance accounted for by genetic factors being: 72% to 81% (standard errors ∼18%) for the distal tibial total, cortical, and medullary cross-sectional area (CSA); 67% and 61% for total cortical porosity, before and after adjusting for total CSA, respectively; 51% for trabecular volumetric bone mineral density (vBMD; all p < 0.001). For the corresponding distal radius traits, genetic factors accounted for 47% to 68% of the variance (all p ≤ 0.001). Cross-twin cross-trait correlations between tibial cortical porosity and medullary CSA were higher for MZ (rMZ = 0.49) than DZ (rDZ = 0.27) pairs before (p = 0.024), but not after (p = 0.258), adjusting for total CSA. For the remodeling markers, the data were consistent with genetic factors accounting for 55% to 62% of the variance. We infer that middle-aged women differ in their bone microarchitecture and remodeling markers more because of differences in their genetic factors than differences in their environment.
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Affiliation(s)
- Åshild Bjørnerem
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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27
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Bala Y, Zebaze R, Ghasem-Zadeh A, Atkinson EJ, Iuliano S, Peterson JM, Amin S, Bjørnerem Å, Melton LJ, Johansson H, Kanis JA, Khosla S, Seeman E. Cortical porosity identifies women with osteopenia at increased risk for forearm fractures. J Bone Miner Res 2014; 29:1356-62. [PMID: 24519558 PMCID: PMC4156822 DOI: 10.1002/jbmr.2167] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 11/10/2022]
Abstract
Most fragility fractures arise among the many women with osteopenia, not the smaller number with osteoporosis at high risk for fracture. Thus, most women at risk for fracture assessed only by measuring areal bone mineral density (aBMD) will remain untreated. We measured cortical porosity and trabecular bone volume/total volume (BV/TV) of the ultradistal radius (UDR) using high-resolution peripheral quantitative computed tomography, aBMD using densitometry, and 10-year fracture probability using the country-specific fracture risk assessment tool (FRAX) in 68 postmenopausal women with forearm fractures and 70 age-matched community controls in Olmsted County, MN, USA. Women with forearm fractures had 0.4 standard deviations (SD) higher cortical porosity and 0.6 SD lower trabecular BV/TV. Compact-appearing cortical porosity predicted fracture independent of aBMD; odds ratio (OR) = 1.92 (95% confidence interval [CI] 1.10–3.33). In women with osteoporosis at the UDR, cortical porosity did not distinguish those with fractures from those without because high porosity was present in 92% and 86% of each group, respectively. By contrast, in women with osteopenia at the UDR, high porosity of the compact-appearing cortex conferred an OR for fracture of 4.00 (95% CI 1.15–13.90). In women with osteoporosis, porosity is captured by aBMD, so measuring UDR cortical porosity does not improve diagnostic sensitivity. However, in women with osteopenia, cortical porosity was associated with forearm fractures.
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28
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Geusens P, Chapurlat R, Schett G, Ghasem-Zadeh A, Seeman E, de Jong J, van den Bergh J. High-resolution in vivo imaging of bone and joints: a window to microarchitecture. Nat Rev Rheumatol 2014; 10:304-13. [DOI: 10.1038/nrrheum.2014.23] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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29
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Cong E, Walker MD. The Chinese skeleton: insights into microstructure that help to explain the epidemiology of fracture. Bone Res 2014; 2:14009. [PMID: 26273521 PMCID: PMC4472143 DOI: 10.1038/boneres.2014.9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 01/12/2023] Open
Abstract
Osteoporotic fractures are a major public health problem worldwide, but incidence varies greatly across racial groups and geographic regions. Recent work suggests that the incidence of osteoporotic fracture is rising among Asian populations. Studies comparing areal bone mineral density and fracture across races generally indicate lower bone mineral density in Asian individuals including the Chinese, but this does not reflect their relatively low risk of non-vertebral fractures. In contrast, the Chinese have relatively high vertebral fracture rates similar to that of Caucasians. The paradoxically low risk for some types of fractures among the Chinese despite their low areal bone mineral density has been elucidated in part by recent advances in skeletal imaging. New techniques for assessing bone quality non-invasively demonstrate that the Chinese compensate for smaller bone size by differences in hip geometry and microstructural skeletal organization. Studies evaluating factors influencing racial differences in bone remodeling, as well as bone acquisition and loss, may further elucidate racial variation in bone microstructure. Advances in understanding the microstructure of the Chinese skeleton have not only helped to explain the epidemiology of fracture in the Chinese, but may also provide insight into the epidemiology of fracture in other races as well.
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Affiliation(s)
- Elaine Cong
- New York Presbyterian Hospital, New York, USA
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