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Sano H, Whitmarsh T, Skingle L, Shimakura T, Yamamoto N, Compston JE, Takahashi HE, Poole KES. Buds of new bone formation within the Femoral Head of Hip Fracture Patients Coincide with Zones of Low Osteocyte Sclerostin. J Bone Miner Res 2023; 38:1603-1611. [PMID: 37548352 DOI: 10.1002/jbmr.4898] [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: 02/19/2023] [Revised: 06/19/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
Romosozumab treatment reduces the rate of hip fractures and increases hip bone density, increasing bone formation by inhibiting sclerostin protein. We studied the normal pattern of bone formation and osteocyte expression in the human proximal femur because it is relevant to both antisclerostin treatment effects and fracture. Having visualized and quantified buds of new bone formation in trabeculae, we hypothesized that they would coincide with areas of (a) higher mechanical stress and (b) low sclerostin expression by osteocytes. In patients with hip fracture, we visualized each bud of active modeling-based formation (forming minimodeling structure [FMiS]) in trabecular cores taken from different parts of the femoral head. Trabecular bone structure was also measured with high-resolution imaging. More buds of new bone formation (by volume) were present in the higher stress superomedial zone (FMiS density, N.FMiS/T.Ar) than lower stress superolateral (p < 0.05), and inferomedial (p < 0.001) regions. There were fewer sclerostin expressing osteocytes close to or within FMiS. FMiS density correlated with greater amount, thickness, number, and connectivity of trabeculae (bone volume BV/TV, r = 0.65, p < 0.0001; bone surface BS/TV, r = 0.47, p < 0.01; trabecular thickness Tb.Th, r = 0.55, p < 0.001; trabecular number Tb.N, r = 0.47, p < 0.01; and connectivity density Conn.D, r = 0.40, p < 0.05) and lower trabecular separation (Tb.Sp, r = -0.56, p < 0.001). These results demonstrate modeling-based bone formation in femoral trabeculae from patients with hip fracture as a potential therapeutic target to enhance bone structure. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Hiroshige Sano
- Department of Medicine, University of Cambridge, Cambridge, UK
- Niigata Bone Science Institute, Niigata, Japan
- Uchino Orthopedic Clinic, Niigata, Japan
| | | | - Linda Skingle
- Department of Medicine, University of Cambridge, Cambridge, UK
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Zhao J, Liu Z, Ren Q, Nie G, Zhao D. Measurement of Hounsfield units on proximal femur computed tomography for predicting regional osteoporosis. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:90-97. [PMID: 37603067 DOI: 10.1007/s00117-023-01190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/15/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE This study was designed to investigate the use of proximal femoral Hounsfield units (HU) in conventional abdominal and pelvic computed tomography (CT) to predict hip osteoporosis by coupling with data from quantitative CT (QCT). METHODS In this study, 315 patients who underwent routine abdominal and pelvic CT with the proximal femur included in the scanning range were also subjected to QCT of the proximal femur. Pearson correlation test was performed to analyze the correlations of the femoral head, femoral neck, proximal femur, and femoral trochanter CT HU with the femoral neck, femoral trochanter, and intertrochanteric femur bone mineral density (BMD) values from QCT. The diagnostic performance of CT HU measurement of the proximal femur for osteoporosis was analyzed using receiver operating characteristic (ROC) curves. RESULTS The CT HU of the proximal femur showed the highest correlation with the BMD value of the hip (r = 0.826; p < 0.01). The mean CT HU of the proximal femur differed significantly (all p < 0.01) for the three QCT-defined BMD categories of osteoporosis (192.23 HU vs. 188.71), of osteopenia (247.86 HU vs. 248.36 HU), and of normal individuals (308.13 HU vs. 310.41 HU) in left and right sides, respectively. In the ROC curve analysis, the area under the ROC curve values to predict osteoporosis in the left and right proximal femurs were 0.942 and 0.941, respectively. CONCLUSION The CT HU of the proximal femur was significantly associated with the BMD value of the hip measured by QCT. The CT HU of the proximal femur is highly effective in diagnosing osteoporosis and could be used for hip osteoporosis screening.
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Affiliation(s)
- Junlu Zhao
- Department of Radiology, The First Hospital of Hebei Medical University, 050031, Shijiazhuang, Hebei Province, China
| | - Zhai Liu
- Department of Radiology, The First Hospital of Hebei Medical University, 050031, Shijiazhuang, Hebei Province, China
| | - Qingyun Ren
- Department of Radiology, The First Hospital of Hebei Medical University, 050031, Shijiazhuang, Hebei Province, China.
| | - Guanwei Nie
- Operating room, The First Hospital Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Deyuan Zhao
- Department of Radiology, The First Hospital of Hebei Medical University, 050031, Shijiazhuang, Hebei Province, China
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Atkins PR, Morris A, Elhabian SY, Anderson AE. A Correspondence-Based Network Approach for Groupwise Analysis of Patient-Specific Spatiotemporal Data. Ann Biomed Eng 2023; 51:2289-2300. [PMID: 37357248 PMCID: PMC11047278 DOI: 10.1007/s10439-023-03270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
Methods for statistically analyzing patient-specific data that vary both spatially and over time are currently either limited to summary statistics or require elaborate surface registration. We propose a new method, called correspondence-based network analysis, which leverages particle-based shape modeling to establish correspondence across a population and preserve patient-specific measurements and predictions through statistical analysis. Herein, we evaluated this method using three published datasets of the hip describing cortical bone thickness of the proximal femur, cartilage contact stress, and dynamic joint space between control and patient cohorts to evaluate activity- and group-based differences, as applicable, using traditional statistical parametric mapping (SPM) and our proposed spatially considerate correspondence-based network analysis approach. The network approach was insensitive to correspondence density, while the traditional application of SPM showed decreasing area of the region of significance with increasing correspondence density. In comparison to SPM, the network approach identified broader and more connected regions of significance for all three datasets. The correspondence-based network analysis approach identified differences between groups and activities without loss of subject and spatial specificity which could improve clinical interpretation of results.
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Affiliation(s)
- Penny R Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alan Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Andrew E Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
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Jung S, Yun H, Chung CH, Kim K, Chang Y. A computed tomography-based analysis of the structure of the mandible according to age and sex. Arch Craniofac Surg 2022; 23:103-110. [PMID: 35811341 PMCID: PMC9271652 DOI: 10.7181/acfs.2022.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background The primary objectives of mandibular surgery are to achieve optimal occlusion, low sensory disturbance, and adequate fixation with early movement. In-depth knowledge of the mandibular structure is required to achieve these goals. This study used computed tomography (CT) to evaluate the mandibular cortical thickness and cancellous space according to age and sex. Methods We enrolled 230 consecutive patients, aged 20 to 50 years, who underwent CT scanning. The cortex and cancellous space centered around the inferior alveolar nerve (IAN) canal were measured at two specific locations: the lingula and second molar region. Statistical analysis of differences according to increasing age and sex was performed. Results The t-test revealed that the cancellous space and cortical thickness differed significantly with respect to the threshold of 35 years of age. Both cortical thickness and cancellous space in the molar region were negatively correlated with age. Meanwhile, both cortical thickness and cancellous space in the lingula region showed a positive correlation with age. With respect to sex, significant differences in the cancellous space at the molar region and the cortical thickness at the lingula were observed. However, no further statistically significant differences were observed in other variables with respect to sex. The sum of each measurement on the mandibular body reflected the safe distance from the surface of the outer cortex to the IAN canal. The safe distances also showed statistically significant differences between those above and below 35 years of age. Conclusion Knowledge of the anatomical structure of the mandible and of changes in bone structure is crucial to ensure optimal surgical outcomes and avoid damage to the IAN. CT examination is useful to identify changes in the bone structure, and these should be taken into account in the planning of surgery for older patients.
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Affiliation(s)
- Soyeon Jung
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Hyunjong Yun
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Chul Hoon Chung
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Kuylhee Kim
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Yongjoon Chang
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
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Multiple cannulated screw fixation of femoral neck fractures with comminution in young- and middle-aged patients. J Orthop Surg Res 2022; 17:280. [PMID: 35585631 PMCID: PMC9118618 DOI: 10.1186/s13018-022-03157-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/02/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate the distribution and influence of comminution in femoral neck fracture (FNF) patients after cannulated screw fixation (CSF). Methods From January 2019 to June 2020, a total of 473 patients aged 23–65 years with FNF treated by CSF were included in the present study. Based on location of the cortical comminution, FNF patients were assigned to two groups: the comminution group (anterior comminution, posterior comminution, superior comminution, inferior comminution, multiple comminutions) or the without comminution group. The incidence of postoperative complications, quality of life and functional outcomes was recorded at 1-year follow-up. Results Comminution was more likely to appear in displaced FNF patients (86.8%) compared with non-displaced FNF patients (8.9%), and the rate of comminution was closely associated with Pauwels classification (3.2% vs 53.5% vs 83.9%, P < 0.05). The incidence of osteonecrosis of the femoral head (ONFH, 11.3% vs 2.9%, P < 0.05), nonunion (7.5% vs 1.7%, P < 0.05), femoral neck shortening (21.6% vs 13.4%, P < 0.05) and internal fixation failure (11.8% vs 2.9%, P < 0.05) was significantly higher in FNF patients with comminutions, especially with multiple comminutions, than those without. Furthermore, there was a significant difference in the Harris hip score (HHS, 85.6 ± 15.6 vs 91.3 ± 10.8, P < 0.05) and EuroQol five dimensions questionnaire (EQ-5D, 0.85 ± 0.17 vs 0.91 ± 0.18, P < 0.05) between FNF patients with comminution and those without. There was no significant difference in Visual analogue scale scores (VAS, 1.46 ± 2.49 vs 1.13 ± 1.80, P > 0.05) between two groups at 1 year post-surgery. Conclusion Comminution is a risk factor for postoperative complications in young- and middle-aged patients with displaced and Pauwels type III FNF who undergo CSF. This can influence the recovery of hip function, thereby impacting quality of life. Further evaluation with a more comprehensive study design, larger sample and long-term follow-up is needed.
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Deng Y, Wang L, Zhao C, Tang S, Cheng X, Deng HW, Zhou W. A deep learning-based approach to automatic proximal femur segmentation in quantitative CT images. Med Biol Eng Comput 2022; 60:1417-1429. [PMID: 35322343 DOI: 10.1007/s11517-022-02529-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Automatic CT segmentation of proximal femur has a great potential for use in orthopedic diseases, especially in the imaging-based assessments of hip fracture risk. In this study, we proposed an approach based on deep learning for the fast and automatic extraction of the periosteal and endosteal contours of proximal femur in order to differentiate cortical and trabecular bone compartments. A three-dimensional (3D) end-to-end fully convolutional neural network (CNN), which can better combine the information among neighbor slices and get more accurate segmentation results by 3D CNN, was developed for our segmentation task. The separation of cortical and trabecular bones derived from the QCT software MIAF-Femur was used as the segmentation reference. Two models with the same network structures were trained, and they achieved a dice similarity coefficient (DSC) of 97.82% and 96.53% for the periosteal and endosteal contours, respectively. Compared with MIAF-Femur, it takes half an hour to segment a case, and our CNN model takes a few minutes. To verify the excellent performance of our model for proximal femoral segmentation, we measured the volumes of different parts of the proximal femur and compared it with the ground truth, and the relative errors of femur volume between predicted result and ground truth are all less than 5%. This approach will be expected helpful to measure the bone mineral densities of cortical and trabecular bones, and to evaluate the bone strength based on FEA.
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Affiliation(s)
- Yu Deng
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, 710121, Shaanxi, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chen Zhao
- College of Computing, Michigan Technological University, Houghton, MI, 49931, USA
| | - Shaojie Tang
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, 710121, Shaanxi, China. .,Xi'an Key Laboratory of Advanced Controlling and Intelligent Processing (ACIP), Xi'an, , 71021, Shaanxi, China.
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Hong-Wen Deng
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, 70118, USA
| | - Weihua Zhou
- College of Computing, Michigan Technological University, Houghton, MI, 49931, USA
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Nissen FI, Andreasen C, Borgen TT, Bjørnerem Å, Hansen AK. Cortical bone structure of the proximal femur and incident fractures. Bone 2022; 155:116284. [PMID: 34875395 DOI: 10.1016/j.bone.2021.116284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE Fracture risk is most frequently assessed using Dual X-ray absorptiometry to measure areal bone mineral density (aBMD) and using the Fracture Risk Assessment Tool (FRAX). However, these approaches have limitations and additional bone measurements may enhance the predictive ability of these existing tools. Increased cortical porosity has been associated with incident fracture in some studies, but not in others. In this prospective study, we examined whether cortical bone structure of the proximal femur predicts incident fractures independent of aBMD and FRAX score. METHODS We pooled 211 postmenopausal women with fractures aged 54-94 years at baseline and 232 fracture-free age-matched controls based on a prior nested case-control study from the Tromsø Study in Norway. We assessed baseline femoral neck (FN) aBMD, calculated FRAX 10-year probability of major osteoporotic fracture (MOF), and quantified femoral subtrochanteric cortical parameters: porosity, area, thickness, and volumetric BMD (vBMD) from CT images using the StrAx1.0 software. Associations between bone parameters and any incident fracture, MOF and hip fracture were determined using Cox's proportional hazard models to calculate hazard ratio (HR) with 95% confidence interval. RESULTS During a median follow-up of 7.2 years, 114 (25.7%) of 443 women suffered one or more incident fracture. Cortical bone structure did not predict any incident fracture or MOF after adjustment for age, BMI, and previous fracture. Each SD higher total cortical porosity, thinner cortices, and lower cortical vBMD predicted hip fracture with increased risk of 46-62% (HRs ranging from 1.46 (1.01-2.11) to 1.62 (1.02-2.57)). After adjustment for FN aBMD or FRAX score no association remained significant. Both lower FN aBMD and higher FRAX score predicted any incident fracture, MOF and hip fractures with HRs ranging from 1.45-2.56. CONCLUSIONS This study showed that cortical bone measurements using clinical CT did not add substantial insight into fracture risk beyond FN aBMD and FRAX. We infer from these results that fracture risk related to the deteriorated bone structure seems to be largely captured by a measurement of FN aBMD and the FRAX tool.
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Affiliation(s)
- Frida Igland Nissen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.
| | - Camilla Andreasen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Tove Tveitan Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway; Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Ann Kristin Hansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
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Wang L, Yang M, Liu Y, Ge Y, Zhu S, Su Y, Cheng X, Wu X, Blake GM, Engelke K. Differences in Hip Geometry Between Female Subjects With and Without Acute Hip Fracture: A Cross-Sectional Case-Control Study. Front Endocrinol (Lausanne) 2022; 13:799381. [PMID: 35282435 PMCID: PMC8907418 DOI: 10.3389/fendo.2022.799381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Although it is widely recognized that hip BMD is reduced in patients with hip fracture, the differences in geometrical parameters such as cortical volume and thickness between subjects with and without hip fracture are less well known. MATERIALS AND METHODS Five hundred and sixty two community-dwelling elderly women with hip CT scans were included in this cross-sectional study, of whom 236 had an acute hip fracture. 326 age matched women without hip fracture served as controls. MIAF-Femur software was used for the measurement of the intact contralateral femur in patients with hip fracture and the left femur of the controls. Integral and cortical volumes (Vols) of the total hip (TH), femoral head (FH), femoral neck (FN), trochanter (TR) and intertrochanter (IT) were analyzed. In the FH and FN the volumes were further subdivided into superior anterior (SA) and posterior (SP) as well as inferior anterior (IA) and posterior (IP) quadrants. Cortical thickness (CortThick) was determined for all sub volumes of interest (VOIs) listed above. RESULTS The average age of the control and fracture groups was 71.7 and 72.0 years, respectively. The fracture patients had significantly lower CortThick and Vol of all VOIs except for TRVol. In the fracture patients, cortical thickness and volume at the FN were significantly lower in all quadrants except for cortical volume of quadrant SA (p= 0.635). Hip fracture patients had smaller integral FN volume and cross-sectional area (CSA) before and after adjustment of age, height and weight. With respect to hip fracture discrimination, cortical volume performed poorer than cortical thickness across the whole proximal femur. The ratio of Cort/TrabMass (RCTM), a measure of the internal distribution of bone, performed better than cortical thickness in discriminating hip fracture risk. The highest area under curve (AUC) value of 0.805 was obtained for the model that included THCortThick, FHVol, THRCTM and FNCSA. CONCLUSION There were substantial differences in total and cortical volume as well as cortical thickness between fractured and unfractured women across the proximal femur. A combination of geometric variables resulted in similar discrimination power for hip fracture risk as aBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yufeng Ge
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Glen M. Blake
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Abraham AG, Sun J, Sharma A, Yin MT, Brown JK, Demehri S, Garza J, Shah JG, Palella FJ, Kingsley L, Jamieson BD, Althoff KN, Brown TT. The combined effects of age and HIV on the anatomic distribution of cortical and cancellous bone in the femoral neck among men and women. AIDS 2021; 35:2513-2522. [PMID: 34482349 PMCID: PMC8649032 DOI: 10.1097/qad.0000000000003061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate HIV-related and age-related differences in hip bone structure in men and women. DESIGN Cross sectional study of bone structure and HIV serostatus. METHODS We used Quantitative Computed Tomography (QCT) data from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) to examine cortical thickness (CT) and cortical (CBMD), trabecular (TBMD), and integral (IBMD) bone mineral density across anatomic quadrants of the femoral neck in older adult MSM and women with (PWH) and without (PWOH) HIV infection. The percentage difference (%diff) in the means for CT and BMD overall and by quadrant between PWH and PWOH were estimated. RESULTS Among 322 MSM (median age 60 years) with bone measures, distributions were similar between HIV serostatus groups with %diff in the quadrant means ranging from -7 to -1% for CT and from -1 to 4% for BMD, and overall lower hip cortical thickness than expected. In contrast, in 113 women (median age 51 years), PWH had lower CT, IBMD and TBMD consistently across all quadrants, with differences ranging from -10 to -20% for CT, -6 to -11% for IBMD and -3 to -6% for TBMD. Estimates reached statistical significance in superoanterior quadrant for CT and IBMD and inferoposterior for CT. CONCLUSION Among women, PWH appear to have a thinner cortex and less dense integral bone compared with PWOH, particularly in the superior quadrants whereas MSM overall had a thinner than expected hip cortex.
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Affiliation(s)
- Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Jing Sun
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Shadpour Demehri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Garza
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jayesh G Shah
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence Kingsley
- Infectious Diseases and Microbiology Department, University of Pittsburgh, Pennsylvania
| | - Beth D Jamieson
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Keri N Althoff
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ling M, Li X, Xu Y, Fan Y. Spatial distribution of hip cortical thickness in postmenopausal women with different osteoporotic fractures. Arch Osteoporos 2021; 16:172. [PMID: 34779934 DOI: 10.1007/s11657-021-01039-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Few studies h ave discussed the association between cortical bone outside the fracture site and the fracture itself. Focusing on hip cortical thickness, this study revealed distinct distributions of the parameters for hip (trochanteric or femoral neck), vertebral, and peripheral osteoporotic fractures and suggested that the spatial distribution of hip cortical thickness was fracture-specific. PURPOSE Cortical bone is critical for bone strength. Hip cortical thickness is reported to be closely associated with the incidence of hip fractures, but its relationship with nonhip fractures is rarely studied. As the hip is a major site for fracture risk assessment, it would be of great benefit to investigate the association between hip cortical thickness and different osteoporotic fractures. METHODS One hundred age-matched postmenopausal women were equally assigned to 4 osteoporotic fracture groups (trochanteric, femoral neck, vertebral, and peripheral fractures) and a nonfracture group. Each subject had a clinical quantitative computed tomography scan of the bilateral hips and the lumbar spine. A cortical bone mapping algorithm was adopted to calculate hip cortical thickness. Hip and lumbar trabecular density and the hip cortical thickness distribution were compared among the groups. RESULTS All the fracture groups presented lower lumbar trabecular density. Compared with nonfracture controls, patients with hip or vertebral fractures but not peripheral fractures showed decreased cortical thickness and trabecular density of the hip. Fracture-specific distributions of cortical thickness were revealed, including zonal defects on the neck-intertrochanter junction, greater trochanter, and the periphery of the lesser trochanter for trochanteric fractures, a focal defect on the anterosuperior neck for femoral neck fractures, a moderate and average distribution for vertebral fractures, and focally thicker cortices on the anterosuperior greater trochanter and the periphery of the lesser trochanter for peripheral fractures. CONCLUSION The spatial distribution of hip cortical thickness was different for each type of osteoporotic fracture, and patients with centrally located fractures demonstrated more severe cortical deterioration. This finding needs to be validated in a larger sample.
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Affiliation(s)
- Ming Ling
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xianlong Li
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yueyang Xu
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yongqian Fan
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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Baptista F, Lopes E, Matute-Llorente Á, Teles J, Zymbal V. Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA. J Clin Densitom 2020; 23:73-81. [PMID: 30274880 DOI: 10.1016/j.jocd.2018.07.012] [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: 07/03/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Abstract
Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these regions diverge from those defined by the dual-energy X-ray absorptiometry manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA). The participants were 134 young adults divided into 2 groups according to the impact of PA performed in the last 12 mo: high-impact PA and low-impact PA. The aBMD of the proximal femur was assessed by dual-energy X-ray absorptiometry at the standard femoral neck, intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck and intertrochanteric region. The bone-specific physical activity questionnaire was used to estimate the impact load of PA. Comparisons between groups were adjusted for body height and body lean mass. Interaction analysis between sex and PA groups were conducted with analysis of variance. Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures analysis of variance. In the high-impact PA group, men benefit more than women at all bone regions, except the aBMD at intertrochanteric region. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs specific) and PA groups (low vs high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.
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Affiliation(s)
- Fátima Baptista
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
| | - Edgar Lopes
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Ángel Matute-Llorente
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Department of Physiatry and Nursing, Faculty of Health and Sports Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Júlia Teles
- Mathematics Unit, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Vera Zymbal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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12
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Väänänen SP, Grassi L, Venäläinen MS, Matikka H, Zheng Y, Jurvelin JS, Isaksson H. Automated segmentation of cortical and trabecular bone to generate finite element models for femoral bone mechanics. Med Eng Phys 2019; 70:19-28. [PMID: 31280927 DOI: 10.1016/j.medengphy.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/16/2019] [Accepted: 06/23/2019] [Indexed: 02/02/2023]
Abstract
Finite element (FE) models based on quantitative computed tomography (CT) images are better predictors of bone strength than conventional areal bone mineral density measurements. However, FE models require manual segmentation of the femur, which is not clinically applicable. This study developed a method for automated FE analyses from clinical CT images. Clinical in-vivo CT images of 13 elderly female subjects were collected to evaluate the method. Secondly, proximal cadaver femurs were harvested and imaged with clinical CT (N = 17). Of these femurs, 14 were imaged with µCT and three had earlier been tested experimentally in stance-loading, while collecting surface deformations with digital image correlation. Femurs were segmented from clinical CT images using an automated method, based on the segmentation tool Stradwin. The method automatically distinguishes trabecular and cortical bone, corrects partial volume effect and generates input for FE analysis. The manual and automatic segmentations agreed within about one voxel for in-vivo subjects (0.99 ± 0.23 mm) and cadaver femurs (0.21 ± 0.07 mm). The strains from the FE predictions closely matched with the experimentally measured strains (R2 = 0.89). The method can automatically generate meshes suitable for FE analysis. The method may bring us one step closer to enable clinical usage of patient-specific FE analyses.
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Affiliation(s)
- Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB 100, FIN-70029 Kuopio, Finland; Department of Medical Physics, Central Finland Central Hospital, Keskussairaalantie 19, FIN-40620 Jyväskylä, Finland.
| | - Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
| | - Mikko S Venäläinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Tykistökatu 6, FIN-20520 Turku, Finland.
| | - Hanna Matikka
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland.
| | - Yi Zheng
- Department of Physics, Technical University of Denmark, Fysikvej, building 311, 2800 Kgs. Lyngby, Denmark.
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
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13
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Carballido-Gamio J, Yu A, Wang L, Su Y, Burghardt AJ, Lang TF, Cheng X. Hip Fracture Discrimination Based on Statistical Multi-parametric Modeling (SMPM). Ann Biomed Eng 2019; 47:2199-2212. [PMID: 31240508 DOI: 10.1007/s10439-019-02298-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023]
Abstract
Studies using quantitative computed tomography (QCT) and data-driven image analysis techniques have shown that trabecular and cortical volumetric bone mineral density (vBMD) can improve the hip fracture prediction of dual-energy X-ray absorptiometry areal BMD (aBMD). Here, we hypothesize that (1) QCT imaging features of shape, density and structure derived from data-driven image analysis techniques can improve the hip fracture discrimination of classification models based on mean femoral neck aBMD (Neck.aBMD), and (2) that data-driven cortical bone thickness (Ct.Th) features can improve the hip fracture discrimination of vBMD models. We tested our hypotheses using statistical multi-parametric modeling (SMPM) in a QCT study of acute hip fracture of 50 controls and 93 fragility fracture cases. SMPM was used to extract features of shape, vBMD, Ct.Th, cortical vBMD, and vBMD in a layer adjacent to the endosteal surface to develop hip fracture classification models with machine learning logistic LASSO. The performance of these classification models was evaluated in two aspects: (1) their hip fracture classification capability without Neck.aBMD, and (2) their capability to improve the hip fracture classification of the Neck.aBMD model. Assessments were done with 10-fold cross-validation, areas under the receiver operating characteristic curve (AUCs), differences of AUCs, and the integrated discrimination improvement (IDI) index. All LASSO models including SMPM-vBMD features, and the majority of models including SMPM-Ct.Th features performed significantly better than the Neck.aBMD model; and all SMPM features significantly improved the hip fracture discrimination of the Neck.aBMD model (Hypothesis 1). An interesting finding was that SMPM-features of vBMD also captured Ct.Th patterns, potentially explaining the superior classification performance of models based on SMPM-vBMD features (Hypothesis 2). Age, height and weight had a small impact on model performances, and the model of shape, vBMD and Ct.Th consistently yielded better performances than the Neck.aBMD models. Results of this study clearly support the relevance of bone density and quality on the assessment of hip fracture, and demonstrate their potential on patient and healthcare cost benefits.
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Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Room 1208, Mail Stop C278, Aurora, CO, 80045, USA.
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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14
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Narloch J, Glinkowski WM. Osteoarthritis Changes Hip Geometry and Biomechanics Regardless of Bone Mineral Density—A Quantitative Computed Tomography Study. J Clin Med 2019; 8:jcm8050669. [PMID: 31083644 PMCID: PMC6572464 DOI: 10.3390/jcm8050669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 12/16/2022] Open
Abstract
We aimed to compare proximal femur geometry and biomechanics in postmenopausal women with osteoarthritis (OA) and/or osteoporosis (OP), using quantitative computed tomography (QCT). A retrospective analysis of QCT scans of the proximal femur of 175 postmenopausal women was performed. Morphometric and densitometric data of the proximal femur were used to evaluate its biomechanics. We found, 21 had a normal bone mineral density (BMD), 72 had osteopenia, and 81 were diagnosed with OP. Radiographic findings of hip OA were seen in 43.8%, 52.8%, and 39.5% of the normal BMD, osteopenic, and OP groups, respectively (p < 0.05). OA was significantly correlated with total hip volume (r = 0.21), intertrochanteric cortical volume (r = 0.25), and trochanteric trabecular volume (r = 0.20). In each densitometric group, significant differences in hip geometry and BMD were found between the OA and non-OA subgroups. Hip OA and OP often coexist. In postmenopausal women, these diseases coexist in 40% of cases. Both OA and OP affect hip geometry and biomechanics. OA does so regardless of densitometric status. Changes are mostly reflected in the cortical bone. OA leads to significant changes in buckling ratio (BR) in both OP and non-OP women.
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Affiliation(s)
- Jerzy Narloch
- Chair and Department of Orthopaedics and Traumatology of the Locomotor System, Medical University of Warsaw, 02-005 Warsaw, Poland.
- Polish Telemedicine and eHealth Society, 03-728 Warsaw, Poland.
| | - Wojciech M Glinkowski
- Chair and Department of Orthopaedics and Traumatology of the Locomotor System, Medical University of Warsaw, 02-005 Warsaw, Poland.
- Polish Telemedicine and eHealth Society, 03-728 Warsaw, Poland.
- Centre of Excellence "TeleOrto" for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-005 Warsaw, Poland.
- Department of Orthopaedics and Traumatology of the Locomotor System, Baby Jesus Clinical Hospital, 02-005 Warsaw, Poland.
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15
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Rajapakse CS, Chang G. Micro-Finite Element Analysis of the Proximal Femur on the Basis of High-Resolution Magnetic Resonance Images. Curr Osteoporos Rep 2018; 16:657-664. [PMID: 30232586 PMCID: PMC6234089 DOI: 10.1007/s11914-018-0481-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Hip fractures have catastrophic consequences. The purpose of this article is to review recent developments in high-resolution magnetic resonance imaging (MRI)-guided finite element analysis (FEA) of the hip as a means to determine subject-specific bone strength. RECENT FINDINGS Despite the ability of DXA to predict hip fracture, the majority of fractures occur in patients who do not have BMD T scores less than - 2.5. Therefore, without other detection methods, these individuals go undetected and untreated. Of methods available to image the hip, MRI is currently the only one capable of depicting bone microstructure in vivo. Availability of microstructural MRI allows generation of patient-specific micro-finite element models that can be used to simulate real-life loading conditions and determine bone strength. MRI-based FEA enables radiation-free approach to assess hip fracture strength. With further validation, this technique could become a potential clinical tool in managing hip fracture risk.
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Affiliation(s)
- Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA, 19104, USA.
| | - Gregory Chang
- Department of Radiology, New York University, 426 1st Avenue, New York, NY, 10010, USA
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16
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Johannesdottir F, Allaire B, Bouxsein ML. Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives. Curr Osteoporos Rep 2018; 16:411-422. [PMID: 29846870 DOI: 10.1007/s11914-018-0450-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. RECENT FINDINGS CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA.
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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17
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Touloupakis G, Maione A, Lettera MG, Stuflesser W, Ferrara F, Antonini G, Crippa C. Preliminary report of the characteristics of the upper thigh spur area of the femoral neck in Garden I and II subcapital fractures. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:249-254. [PMID: 29957759 PMCID: PMC6179030 DOI: 10.23750/abm.v89i2.5660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/01/2016] [Indexed: 12/03/2022]
Abstract
The “heart” of the calcar is the internal cortical septum called “femoral thigh spur”. Nevertheless, the integrity of the femoral thigh spur and its extensions in Garden I and II femoral neck fractures has not been examined in depth, in CT scan-based studies. The aim of this retrospective study is to analyze characteristics as integrity of upper thigh spur area of the intra-capsular femoral neck using precise CT scans, as well as features of the medial cortical bone interruption of orthopedic calcar, in femoral fractures that are radiographically defined as Garden type I-II.A total number of 23 patients was finally included in our study. We called it the “upper thigh spur area” the area around a 360 degree perimeter of the upper thigh spur. The above-mentioned area is a cylindrical intracapsular structure oriented parallel to the intertrocanteric line of the proximal femur . We analyzed the modification of the cortical bone in this specific intra-capsular area of the femoral neck. In all the cases the upper thigh spur area (the internal cortical septum) was intact. The medial cortical (the known “orthopedic calcar”) was evaluated by CT scans in coronal views; it was found to be interrupted in 14 patients and intact in 9; among patients of the first group, 50% were classified as Garden I and 50% as Garden II. The cortical integrity on 360° of the upper thigh spur area was evaluated by CT scans in axial views through different cuts, and it was found to be intact in all cases. More extended studies including CT scans of Garden I-II-III and IV fractures are needed so as to obtain more complete results. In conclusion, it seems that the integrity of the upper thigh spur zone is associated with stable fractures. (www.actabiomedica.it)
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Affiliation(s)
- Georgios Touloupakis
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | - Alessio Maione
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | | | - Wilfried Stuflesser
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | - Fabrizio Ferrara
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | - Guido Antonini
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
| | - Cornelio Crippa
- Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
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18
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Kuroda T, Ishikawa K, Nagai T, Fukui T, Hirano T, Inagaki K. Quadrant Analysis of Quantitative Computed Tomography Scans of the Femoral Neck Reveals Superior Region-Specific Weakness in Young and Middle-Aged Men With Type 1 Diabetes Mellitus. J Clin Densitom 2018; 21:172-178. [PMID: 28302354 DOI: 10.1016/j.jocd.2017.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/26/2016] [Accepted: 01/17/2017] [Indexed: 02/06/2023]
Abstract
We have previously shown that the intertrochanter of young and middle-aged patients with type 1 diabetes mellitus (T1DM) showed higher buckling ratio (an index of cortical instability) and lower volumetric bone mineral density (vBMD). However, we have not yet reported the detailed findings regarding the mechanical and density properties of the femoral neck. Therefore, we present a subanalysis of our previous study with the aim of further evaluating the middle third of the femoral neck via quadrant quantitative computed tomography in young and middle-aged patients with T1DM. Bone parameters in 4 anatomical quadrants (superoanterior [SA], inferoanterior [IA], inferoposterior [IP], and superoposterior [SP]) were cross-sectionally evaluated in 17 male T1DM patients and 18 sex-matched healthy controls aged between 18 and 49 yr using quadrant quantitative computed tomography analysis. Patients with T1DM had a thinner cortical thickness in the SP quadrant and a significantly lower cortical vBMD in the SA quadrant than the controls. The serum insulin-like growth factor-1 values in patients with T1DM were positively correlated with the average cortical thickness in the SA quadrant and the average trabecular vBMD in the SP quadrant of the femoral neck. The cortical thickness in controls was negatively correlated with age in the SP and IP quadrants. The cortical thickness in patients with T1DM showed no correlation with age in all quadrants. The fragility of the femoral neck was remarkable in the superior region of patients with T1DM. Insulin-like growth factor-1 may play an important role in superior cortical thinning and in lowering cortical vBMD. Furthermore, in young and middle-aged men with T1DM, the structure of the femoral neck exhibits similar changes as those observed with aging.
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Affiliation(s)
- Takuma Kuroda
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koji Ishikawa
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Takashi Nagai
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomoyasu Fukui
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
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19
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Narra N, Abe S, Dimitrov V, Nikander R, Kouhia R, Sievänen H, Hyttinen J. Ricci-flow based conformal mapping of the proximal femur to identify exercise loading effects. Sci Rep 2018; 8:4823. [PMID: 29555952 PMCID: PMC5859094 DOI: 10.1038/s41598-018-23248-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/07/2018] [Indexed: 11/26/2022] Open
Abstract
The causal relationship between habitual loading and adaptive response in bone morphology is commonly explored by analysing the spatial distribution of mechanically relevant features. In this study, 3D distribution of features in the proximal femur of 91 female athletes (5 exercise loading groups representing habitual loading) is contrasted with 20 controls. A femur specific Ricci-flow based conformal mapping procedure was developed for establishing correspondence among the periosteal surfaces. The procedure leverages the invariance of the conformal mapping method to isometric shape differences to align surfaces in the 2D parametric domain, to produce dense correspondences across an isotopological set of surfaces. This is implemented through a multi-parametrisation approach to detect surface features and to overcome the issue of inconsistency in the anatomical extent present in the data. Subsequently, the group-wise distribution of two mechanically relevant features was studied – cortical thickness and surface principal strains (simulation results of a sideways fall). Statistical inferences over the surfaces were made by contrasting the athlete groups with the controls through statistical parametric mapping. With the aid of group-wise and composite-group maps, proximal femur regions affected by specific loading groups were identified with a high degree of spatial localisation.
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Affiliation(s)
- Nathaniel Narra
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland.
| | - Shinya Abe
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland
| | - Vassil Dimitrov
- Department of Electrical and Computer Engineering, University of Calgary, Calgary, Canada.,Geometric Energy Corporation, Calgary, Canada
| | - Riku Nikander
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland.,Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Reijo Kouhia
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Hyttinen
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
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20
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Wang L, Cheng XG, Su YB, Brown K, Xu L, Li K, Zhang CX, Zhang Y, Duanmu YY, Wu XB, Wang MY. Sex-related variations in cortical and trabecular bone of the femoral neck in an elderly Chinese population. Osteoporos Int 2017; 28:2391-2399. [PMID: 28405730 DOI: 10.1007/s00198-017-4043-y] [Citation(s) in RCA: 9] [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: 07/20/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) was used to investigate sex-related variations in cortical and trabecular bone of the femoral neck. Cortical bone thickness of women in the superior quadrant was thinner than that of men, and the cortex in all four quadrants was negatively associated with age in women. INTRODUCTION This cross-sectional study aimed to investigate sex-related similarities and differences in femoral neck structure in an elderly Chinese population by QCT bone investigational toolkit (BIT) analysis. METHODS This study included 207 male (67.9 ± 7.7 years; range, 55-87 years) and 400 female subjects (68.0 ± 8.7 years; range, 55-96 years). BIT module was used to measure cortical and trabecular bone in anatomic quadrants of the femoral neck. Measurements of cortical thickness (Ct.Th), cortical vBMD (Ct.vBMD), trabecular vBMD (Tb.vBMD), and integral vBMD (It.vBMD) at the femoral neck were determined in four anatomical sectors. RESULTS The greatest difference between sexes, after adjusting for age, height, and weight, was in Ct.Th of Quadrant Supero-anterior (SA), which was 27.4% lower in women (p<0.001). Ct.Th of Quadrant Supero-posterior (SP) was 15.1% lower in women (p = 0.027). Ct.Th and Tb.vBMD in all four quadrants appeared to be negatively associated with age in females, whereas no significant relationship was observed in males, except Ct.Th of Quadrant SP. CONCLUSIONS The superior femoral neck geometry between males and females was significantly different, even after adjustment for body size and age, and the sub-regional cortical and trabecular bone negatively age-related changes in women indicated that women apparently have a more vulnerable geometrical outcome with age for fractures than men.
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Affiliation(s)
- L Wang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X G Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China.
| | - Y B Su
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - L Xu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Li
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - C X Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Y Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X B Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - M Y Wang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
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21
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Nazaran A, Carl M, Ma Y, Jerban S, Zhu Y, Lu X, Du J, Chang EY. Three-dimensional adiabatic inversion recovery prepared ultrashort echo time cones (3D IR-UTE-Cones) imaging of cortical bone in the hip. Magn Reson Imaging 2017; 44:60-64. [PMID: 28716680 DOI: 10.1016/j.mri.2017.07.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/13/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE We present three-dimensional adiabatic inversion recovery prepared ultrashort echo time Cones (3D IR-UTE-Cones) imaging of cortical bone in the hip of healthy volunteers using a clinical 3T scanner. METHODS A 3D IR-UTE-Cones sequence, based on a short pulse excitation followed by a 3D Cones trajectory, with a nominal TE of 32μs, was employed for high contrast morphological imaging of cortical bone in the hip of heathy volunteers. Signals from soft tissues such as muscle and marrow fat were suppressed via adiabatic inversion and signal nulling. T2⁎ value of the cortical bone was also calculated based on 3D IR-UTE-Cones acquisitions with a series of TEs ranging from 0.032 to 0.8ms. A total of four healthy volunteers were recruited for this study. Average T2⁎ values and the standard deviation for four regions of interests (ROIs) at the greater trochanter, the femoral neck, the femoral head and the lesser trochanter were calculated. RESULTS The 3D IR-UTE-Cones sequence provided efficient suppression of soft tissues with excellent image contrast for cortical bone visualization in all volunteer hips. Exponential single component decay was observed for all ROIs, with averaged T2⁎ values ranging from 0.33 to 0.45ms, largely consistent with previously reported T2⁎ values of cortical bone in the tibial midshaft. CONCLUSIONS The 3D IR-UTE-Cones sequence allows in vivo volumetric imaging and quantitative T2⁎ measurement of cortical bone in the hip using a clinical 3T scanner.
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Affiliation(s)
- Amin Nazaran
- Department of Radiology, University of California, San Diego, CA, United States.
| | - Michael Carl
- Applied Science Lab, GE Healthcare, San Diego, CA, United States
| | - Yajun Ma
- Department of Radiology, University of California, San Diego, CA, United States
| | - Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, United States
| | - Yanchun Zhu
- Department of Radiology, University of California, San Diego, CA, United States
| | - Xing Lu
- Department of Radiology, University of California, San Diego, CA, United States
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, United States
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, CA, United States; Department of Radiology, University of California, San Diego, CA, United States
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22
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Høiberg MP, Rubin KH, Hermann AP, Brixen K, Abrahamsen B. Diagnostic devices for osteoporosis in the general population: A systematic review. Bone 2016; 92:58-69. [PMID: 27542659 DOI: 10.1016/j.bone.2016.08.011] [Citation(s) in RCA: 32] [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: 07/06/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A diagnostic gap exists in the current dual photon X-ray absorptiometry (DXA) based diagnostic approach to osteoporosis. Other diagnostic devices have been developed, but no comprehensive review concerning the applicability of these diagnostic devices for population-based screening have been performed. MATERIAL AND METHODS A systematic review of Embase, Medline and the Cochrane Central Register for Controlled Trials was performed for population-based studies that focused on technical methods that could either indicate bone mineral density (BMD) by DXA, substitute for DXA in prediction of fracture risk, or that could have an incremental value in fracture prediction in addition to DXA. Quality of included studies was rated by QUADAS 2. RESULTS Many other technical devices have been tested in a population-based setting. Five studies aiming to indicate BMD and 17 studies aiming to predict fractures were found. Overall, the latter studies had higher methodological quality. The highest number of studies was found for quantitative ultrasound (QUS). The ability to indicate BMD or predict fractures was moderate to minor for all examined devices, using reported area under the curve (AUC) of Receiver Operating Characteristic curves values as standard. CONCLUSIONS Of the methods assessed, only QUS appears capable of perhaps replacing DXA as standalone examination in the future whilst radiographic absorptiometry could provide important information in areas with scarcity of DXA. QUS may be of added value even after DXA has been performed. Evaluation of proposed cutoff-values from population-based studies in separate population-based cohorts is still lacking for most examination devices.
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Affiliation(s)
- M P Høiberg
- Department of Research, Hospital of Southern Norway, Kristiansand, Norway; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - K H Rubin
- OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark.
| | - A P Hermann
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark.
| | - K Brixen
- Department of Medical Endocrinology, Odense University Hospital, Odense, Denmark.
| | - B Abrahamsen
- OPEN, Odense Patient Data Explorative Network, Department of Clinical Research, University of Southern Denmark, Odense University hospital, Denmark; Department of Medicine, Holbæk Hospital, Holbæk, Denmark.
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23
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Li C, Jin D, Chen C, Letuchy EM, Janz KF, Burns TL, Torner JC, Levy SM, Saha PK. Automated cortical bone segmentation for multirow-detector CT imaging with validation and application to human studies. Med Phys 2016; 42:4553-65. [PMID: 26233184 DOI: 10.1118/1.4923753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Cortical bone supports and protects human skeletal functions and plays an important role in determining bone strength and fracture risk. Cortical bone segmentation at a peripheral site using multirow-detector CT (MD-CT) imaging is useful for in vivo assessment of bone strength and fracture risk. Major challenges for the task emerge from limited spatial resolution, low signal-to-noise ratio, presence of cortical pores, and structural complexity over the transition between trabecular and cortical bones. An automated algorithm for cortical bone segmentation at the distal tibia from in vivo MD-CT imaging is presented and its performance and application are examined. METHODS The algorithm is completed in two major steps-(1) bone filling, alignment, and region-of-interest computation and (2) segmentation of cortical bone. After the first step, the following sequence of tasks is performed to accomplish cortical bone segmentation-(1) detection of marrow space and possible pores, (2) computation of cortical bone thickness, detection of recession points, and confirmation and filling of true pores, and (3) detection of endosteal boundary and delineation of cortical bone. Effective generalizations of several digital topologic and geometric techniques are introduced and a fully automated algorithm is presented for cortical bone segmentation. RESULTS An accuracy of 95.1% in terms of volume of agreement with manual outlining of cortical bone was observed in human MD-CT scans, while an accuracy of 88.5% was achieved when compared with manual outlining on postregistered high resolution micro-CT imaging. An intraclass correlation coefficient of 0.98 was obtained in cadaveric repeat scans. A pilot study was conducted to describe gender differences in cortical bone properties. This study involved 51 female and 46 male participants (age: 19-20 yr) from the Iowa Bone Development Study. Results from this pilot study suggest that, on average after adjustment for height and weight differences, males have thicker cortex (mean difference 0.33 mm and effect size 0.92 at the anterior region) with lower bone mineral density (mean difference -28.73 mg/cm(3) and effect size 1.35 at the posterior region) as compared to females. CONCLUSIONS The algorithm presented is suitable for fully automated segmentation of cortical bone in MD-CT imaging of the distal tibia with high accuracy and reproducibility. Analysis of data from a pilot study demonstrated that the cortical bone indices allow quantification of gender differences in cortical bone from MD-CT imaging. Application to larger population groups, including those with compromised bone, is needed.
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Affiliation(s)
- Cheng Li
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Dakai Jin
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Cheng Chen
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Elena M Letuchy
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Kathleen F Janz
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, Iowa City, Iowa 52242
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - James C Torner
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, Iowa 52242 and Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242 and Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
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24
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Kubicek L, Vanderhart D, Wirth K, An Q, Chang M, Farese J, Bova F, Sudhyadhom A, Kow K, Bacon NJ, Milner R. ASSOCIATION BETWEEN COMPUTED TOMOGRAPHIC CHARACTERISTICS AND FRACTURES FOLLOWING STEREOTACTIC RADIOSURGERY IN DOGS WITH APPENDICULAR OSTEOSARCOMA. Vet Radiol Ultrasound 2016; 57:321-30. [PMID: 26916056 DOI: 10.1111/vru.12351] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 11/07/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022] Open
Abstract
The objective of this observational, descriptive, retrospective study was to report CT characteristics associated with fractures following stereotactic radiosurgery in canine patients with appendicular osteosarcoma. Medical records (1999 and 2012) of dogs that had a diagnosis of appendicular osteosarcoma and undergone stereotactic radiosurgery were reviewed. Dogs were included in the study if they had undergone stereotactic radiosurgery for an aggressive bone lesion with follow-up information regarding fracture status, toxicity, and date and cause of death. Computed tomography details, staging, chemotherapy, toxicity, fracture status and survival data were recorded. Overall median survival time (MST) and fracture rates of treated dogs were calculated. CT characteristics were evaluated for association with time to fracture. Forty-six dogs met inclusion criteria. The median overall survival time was 9.7 months (95% CI: 6.9-14.3 months). The fracture-free rates at 3, 6, and 9 months were 73%, 44%, and 38% (95% CI: 60-86%, 29-60%, and 22-54%), respectively. The region of bone affected was significantly associated with time to fracture. The median time to fracture was 4.2 months in dogs with subchondral bone involvement and 16.3 months in dogs without subchondral bone involvement (P-value = 0.027, log-rank test). Acute and late skin effects were present in 58% and 16% of patients, respectively. Findings demonstrated a need for improved patient selection for this procedure, which can be aided by CT-based prognostic factors to predict the likelihood of fracture.
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Affiliation(s)
- Lyndsay Kubicek
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611.,Angell Animal Medical Center, Jamaica Plain, MA, Boston, MA, 02130
| | - Daniel Vanderhart
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611
| | - Kimberly Wirth
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611
| | - Qi An
- Department of Biostatistics, University of Florida, Gainesville, FL, 32611
| | - Myron Chang
- Department of Biostatistics, University of Florida, Gainesville, FL, 32611
| | - James Farese
- Pet Emergency and Specialty Center of Marin, San Rafael, CA, 94901
| | - Francis Bova
- Department of Neurosurgery, McKnight Brain Institute, University of Florida, Gainesville, FL, 32611
| | - Atchar Sudhyadhom
- the Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143
| | - Kelvin Kow
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611
| | - Nicholas J Bacon
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611
| | - Rowan Milner
- Department of Small Animal Clinical Sciences, University of Florida, Gainesville, FL, 32611
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25
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Valassi E, Crespo I, Malouf J, Llauger J, Aulinas A, Marín AM, Biagetti B, Webb SM. Reduction of trabecular and cortical volumetric bone mineral density at the proximal femur in patients with acromegaly. Eur J Endocrinol 2016; 174:107-14. [PMID: 26530355 DOI: 10.1530/eje-15-0931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 11/03/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Data on dual energy absorptiometry (DXA)-measured bone mineral density (BMD) at the level of the total hip (TH) and femoral neck (FN) in patients with acromegaly (ACRO) are conflicting. Increase in bone size associated with ACRO may limit the reliability of DXA. Our objective is to evaluate trabecular and cortical volumetric BMD (vBMD) across the proximal femur in ACRO patients. DESIGN Cross sectional study in a clinical research center. PATIENTS Thirty-five ACRO patients (19 males; mean age, 48±7 years; BMI, 27.5±4.4 kg/m(2); 17 with active disease) and 35 age, gender, and BMI-matched controls. RESULTS vBMD was assessed by quantitative computed tomography at the level of the TH, FN, trochanter (TR), and intertrochanteric (IT). Trabecular vBMD was lower in both total and active ACRO as compared with controls (P<0.01). Cortical vBMD was lower in ACRO patients (active and controlled) vs controls at both TH and TR sites (P<0.05). These findings were confirmed when only eugonadal patients were analyzed. Both total cross sectional area (CSA) and average cortical thickness (ACT) were greater in ACRO patients vs controls (P<0.05). An inverse association between disease duration and trabecular vBMD at TH (r=-0.42, P=0.023) and IT (r=-0.41, P=0.026) was also found. CONCLUSION Both cortical and trabecular vBMD are reduced at the proximal femur in ACRO patients, regardless of gender, gonadal status, and disease activity. Disease duration is negatively associated with trabecular vBMD at the TH and IT.
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Affiliation(s)
- Elena Valassi
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Iris Crespo
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Jorge Malouf
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Jaume Llauger
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Anna Aulinas
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Ana Maria Marín
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Betina Biagetti
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
| | - Susan M Webb
- Endocrinology/Medicine DepartmentCentro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER, Unidad 747), Research Center for Pituitary Diseases, Hospital Sant Pau, IIB-Sant Pau, ISCIII and Universitat Autònoma de Barcelona (UAB), c/Sant Antoni Maria Claret 167, 08025 Barcelona, SpainMineral Metabolism UnitMedicine Department, Hospital Sant Pau, Barcelona, SpainRadiology DepartmentHospital Sant Pau, Barcelona, SpainEndocrinology DepartmentHospital Vall d'Hebron, Barcelona, Spain
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26
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Yoo JH, Moon SH, Ha YC, Lee DY, Gong HS, Park SY, Yang KH. Osteoporotic Fracture: 2015 Position Statement of the Korean Society for Bone and Mineral Research. J Bone Metab 2015; 22:175-81. [PMID: 26713308 PMCID: PMC4691591 DOI: 10.11005/jbm.2015.22.4.175] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/11/2022] Open
Abstract
Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.
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Affiliation(s)
- Je-Hyun Yoo
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seong-Hwan Moon
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Dong Yeon Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Si Young Park
- Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
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27
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Long Y, Leslie WD, Luo Y. Study of DXA-derived lateral-medial cortical bone thickness in assessing hip fracture risk. Bone Rep 2015; 2:44-51. [PMID: 28377953 PMCID: PMC5365175 DOI: 10.1016/j.bonr.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 11/23/2022] Open
Abstract
The currently available clinical tools have limited accuracy in predicting hip fracture risk in individuals. We investigated the possibility of using normalized cortical bone thickness (NCBT) estimated from the patient's hip DXA (dual energy X-ray absorptiometry) as an alternative predictor of hip fracture risk. Hip fracture risk index (HFRI) derived from subject-specific DXA-based finite element model was used as a guideline in constructing the mathematical expression of NCBT. We hypothesized that if NCBT has stronger correlations with HFRI than the single risk factors such as areal BMD (aBMD), then NCBT can be a better predictor. The hypothesis was studied using 210 clinical cases, including 60 hip fracture cases, obtained from the Manitoba Bone Mineral Density Database. The results showed that, in general HFRI has much stronger correlations with NCBT than any of the single risk factors; the strongest correlation was observed at the superior side of the narrowest femoral neck with r2 = 0.81 (p < 0.001), which is much higher than the correlation with femoral aBMD, r2 = 0.50 (p < 0.001). The capability of aBMD, NCBT, and HFRI in discriminating the hip fracture cases from the non-fracture ones, expressed as the area under the curve with 95% confidence interval, AUC (95% CI), is respectively 0.627 (0.593–0.657), 0.714 (0.644–0.784) and 0.839 (0.787–0.892). The short-term repeatability of aBMD, NCBT, and HFRI, measured by the coefficient of variation (CV, %), was found to be in the range of (0.64–1.22), (1.93–3.41), (3.10–4.16), respectively. We thus concluded that NCBT is potentially a better predictor of hip fracture risk. A new algorithm developed for estimating cortical bone thickness from clinical DXA images. Validation of the algorithm with QCT Pro, a commercial software for processing QCT scans. A more effective risk predictor constructed from finite element studies. The risk predictor can be readily integrated into the current clinical procedure.
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Affiliation(s)
- Yujia Long
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - William D Leslie
- Department of Radiology, Faculty of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6 Canada; Department of Internal Medicine, Faculty of Medicine, University of Manitoba, Winnipeg, MB R2H 2A6 Canada
| | - Yunhua Luo
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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