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Gabel L, Kent K, Hosseinitabatabaei S, Burghardt AJ, Leonard MB, Rauch F, Willie BM. Recommendations for High-resolution Peripheral Quantitative Computed Tomography Assessment of Bone Density, Microarchitecture, and Strength in Pediatric Populations. Curr Osteoporos Rep 2023; 21:609-623. [PMID: 37428435 PMCID: PMC10543577 DOI: 10.1007/s11914-023-00811-9] [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: 06/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current approaches and provide recommendations for imaging bone in pediatric populations using high-resolution peripheral quantitative computed tomography (HR-pQCT). RECENT FINDINGS Imaging the growing skeleton is challenging and HR-pQCT protocols are not standardized across centers. Adopting a single-imaging protocol for all studies is unrealistic; thus, we present three established protocols for HR-pQCT imaging in children and adolescents and share advantages and disadvantages of each. Limiting protocol variation will enhance the uniformity of results and increase our ability to compare study results between different research groups. We outline special cases along with tips and tricks for acquiring and processing scans to minimize motion artifacts and account for growing bone. The recommendations in this review are intended to help researchers perform HR-pQCT imaging in pediatric populations and extend our collective knowledge of bone structure, architecture, and strength during the growing years.
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Affiliation(s)
- L Gabel
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - K Kent
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - S Hosseinitabatabaei
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - M B Leonard
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - F Rauch
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - B M Willie
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
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Zheng Y, Rostami Haji Abadi M, Ghafouri Z, Meira Goes S, Johnston JJD, Nour M, Kontulainen S. Bone deficits in children and youth with type 1 diabetes: A systematic review and meta-analysis. Bone 2022; 163:116509. [PMID: 35914713 DOI: 10.1016/j.bone.2022.116509] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/13/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Deficits in bone mineral and weaker bone structure in children with type 1 diabetes (T1D) may contribute to a lifelong risk of fracture. However, there is no meta-analysis comparing bone properties beyond density between children with T1D and typically developing children (TDC). This meta-analysis aimed to assess differences and related factors in bone mineral content (BMC), density, area, micro-architecture and estimated strength between children with T1D and TDC. We systematically searched MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cochrane Library databases, and included 36 in the meta-analysis (2222 children and youth with T1D, 2316 TDC; mean age ≤18 yrs., range 1-24). We estimated standardized mean differences (SMD) using random-effects models and explored the role of age, body size, sex ratio, disease duration, hemoglobin A1c in relation to BMC and areal density (aBMD) SMD using meta-regressions. Children and youth with T1D had lower total body BMC (SMD: -0.21, 95% CI: -0.37 to -0.05), aBMD (-0.30, -0.50 to -0.11); lumbar spine BMC (-0.17, -0.28 to -0.06), aBMD (-0.20, -0.32 to -0.08), bone mineral apparent density (-0.30, -0.48 to -0.13); femoral neck aBMD (-0.21, -0.33 to -0.09); distal radius and tibia trabecular density (-0.38, -0.64 to -0.12 and -0.35, -0.51 to -0.18, respectively) and bone volume fraction (-0.33, -0.56 to -0.09 and -0.37, -0.60 to -0.14, respectively); distal tibia trabecular thickness (-0.41, -0.67 to -0.16); and tibia shaft cortical content (-0.33, -0.56 to -0.10). Advanced age was associated with larger SMD in total body BMC (-0.13, -0.21 to -0.04) and aBMD (-0.09; -0.17 to -0.01) and longer disease duration with larger SMD in total body aBMD (-0.14; -0.24 to -0.04). Children and youth with T1D have lower BMC, aBMD and deficits in trabecular density and micro-architecture. Deficits in BMC and aBMD appeared to increase with age and disease duration. Bone deficits may contribute to fracture risk and require attention in diabetes research and care. STUDY REGISTRATION: PROSPERO (CRD42020200819).
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Affiliation(s)
- Yuwen Zheng
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2
| | | | - Zahra Ghafouri
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2
| | - Suelen Meira Goes
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2; College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5
| | - James J D Johnston
- College of Engineering, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5A9
| | - Munier Nour
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5E5
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada S7N 5B2.
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Hosseinitabatabaei S, Mikolajewicz N, Zimmermann EA, Rummler M, Steyn B, Julien C, Rauch F, Willie BM. 3D Image Registration Marginally Improves the Precision of HR-pQCT Measurements Compared to Cross-Sectional-Area Registration in Adults With Osteogenesis Imperfecta. J Bone Miner Res 2022; 37:908-924. [PMID: 35258112 DOI: 10.1002/jbmr.4541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/05/2022] [Accepted: 03/04/2022] [Indexed: 11/09/2022]
Abstract
Repositioning error in longitudinal high-resolution peripheral-quantitative computed tomography (HR-pQCT) imaging can lead to different bone volumes being assessed over time. To identify the same bone volumes at each time point, image registration is used. While cross-sectional area image registration corrects axial misalignment, 3D registration additionally corrects rotations. Other registration methods involving matched angle analysis (MA) or boundary transformations (3D-TB) can be used to limit interpolation error in 3D-registering micro-finite-element data. We investigated the effect of different image registration methods on short-term in vivo precision in adults with osteogenesis imperfecta, a collagen-related genetic disorder resulting in low bone mass, impaired quality, and increased fragility. The radii and tibiae of 29 participants were imaged twice on the same day with full repositioning. We compared the precision error of different image registration methods for density, microstructural, and micro-finite-element outcomes with data stratified based on anatomical site, motion status, and scanner generation. Regardless of the stratification, we found that image registration improved precision for total and trabecular bone mineral densities, trabecular and cortical bone mineral contents, area measurements, trabecular bone volume fraction, separation, and heterogeneity, as well as cortical thickness and perimeter. 3D registration marginally outperformed cross-sectional area registration for some outcomes, such as trabecular bone volume fraction and separation. Similarly, precision of micro-finite-element outcomes was improved after image registration, with 3D-TB and MA methods providing greatest improvements. Our regression model confirmed the beneficial effect of image registration on HR-pQCT precision errors, whereas motion had a detrimental effect on precision even after image registration. Collectively, our results indicate that 3D registration is recommended for longitudinal HR-pQCT imaging in adults with osteogenesis imperfecta. Since our precision errors are similar to those of healthy adults, these results can likely be extended to other populations, although future studies are needed to confirm this. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Seyedmahdi Hosseinitabatabaei
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Canada
| | | | - Elizabeth A Zimmermann
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| | - Maximilian Rummler
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Canada
| | - Beatrice Steyn
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Canada
| | - Catherine Julien
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Canada
| | - Frank Rauch
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
| | - Bettina M Willie
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada.,Department of Pediatric Surgery, McGill University, Montreal, Canada
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Hosseinitabatabaei S, Kawalilak CE, McDonald MP, Kontulainen SA, Johnston JD. Distal radius sections offer accurate and precise estimates of forearm fracture load. Clin Biomech (Bristol, Avon) 2020; 80:105144. [PMID: 32829235 DOI: 10.1016/j.clinbiomech.2020.105144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/08/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Forearm fracture risk can be estimated via factor-of-risk: the ratio of applied impact force to forearm fracture load. Simple techniques are available for estimating impact force associated with a fall; estimating forearm fracture load is more challenging. Our aim was to assess whether failure load estimates of sections of the distal radius (acquired using High-Resolution peripheral Quantitative Computed Tomography and finite element modeling) offer accurate and precise estimates of forearm fracture load. METHODS We scanned a section of the distal radius of 19 cadaveric forearms (female, mean age 83.7, SD 8.3), and 34 women (75.0, 7.7). Sections were converted to finite element models and failure loads were acquired for different failure criteria. We assessed forearm fracture load using experimental testing simulating a fall on the outstretched hand. We used linear regression to derive relationships between ex vivo forearm fracture load and finite element derived distal radius failure load. We used derived regression coefficients to estimate forearm fracture load, and assessed explained variance and prediction error. We used root-mean-squared coefficients of variation to assess in vivo precision errors of estimated forearm fracture load. FINDINGS Failure load estimates of sections of the distal radius, used in conjunction with derived regression coefficients, explained 89-90% of the variance in experimentally-measured forearm fracture load with prediction errors <6.8% and precision errors <5.0%. INTERPRETATION Failure load estimates of distal radius sections can reliably estimate forearm fracture load experienced during a fall. Forearm fracture load estimates can be used to improve factor-of-risk predictions for forearm fracture.
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Affiliation(s)
- Seyedmahdi Hosseinitabatabaei
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - Chantal E Kawalilak
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - Matthew P McDonald
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada
| | - Saija A Kontulainen
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada; College of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK S7N 5B2, Canada
| | - James D Johnston
- Division of Biomedical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada; Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 5A9, Canada.
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