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Binney N. Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:128-146. [PMID: 38418083 PMCID: PMC10938540 DOI: 10.1093/jmp/jhae005] [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] [Indexed: 03/01/2024] Open
Abstract
Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.
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2
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Gross AM, Plotkin SR, Watts NB, Fisher MJ, Klesse LJ, Lessing AJ, McManus ML, Larson AN, Oberlander B, Rios JJ, Sarnoff H, Simpson BN, Ullrich NJ, Stevenson DA. Potential endpoints for assessment of bone health in persons with neurofibromatosis type 1. Clin Trials 2024; 21:29-39. [PMID: 37772407 PMCID: PMC10920397 DOI: 10.1177/17407745231201338] [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] [Indexed: 09/30/2023]
Abstract
Neurofibromatosis type 1 is a genetic syndrome characterized by a wide variety of tumor and non-tumor manifestations. Bone-related issues, such as scoliosis, tibial dysplasia, and low bone mineral density, are a significant source of morbidity for this population with limited treatment options. Some of the challenges to developing such treatments include the lack of consensus regarding the optimal methods to assess bone health in neurofibromatosis type 1 and limited data regarding the natural history of these manifestations. In this review, the Functional Committee of the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration: (1) presents the available techniques for measuring overall bone health and metabolism in persons with neurofibromatosis type 1, (2) reviews data for use of each of these measures in the neurofibromatosis type 1 population, and (3) describes the strengths and limitations for each method as they might be used in clinical trials targeting neurofibromatosis type 1 bone manifestations. The Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration supports the development of a prospective, longitudinal natural history study focusing on the bone-related manifestations and relevant biomarkers of neurofibromatosis type 1. In addition, we suggest that the neurofibromatosis type 1 research community consider adding the less burdensome measurements of bone health as exploratory endpoints in ongoing or planned clinical trials for other neurofibromatosis type 1 manifestations to expand knowledge in the field.
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Affiliation(s)
- Andrea M Gross
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Scott R Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA
| | - Michael J Fisher
- Division of Oncology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Laura J Klesse
- Division of Hematology/Oncology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Jonathan J Rios
- Center for Pediatric Bone Biology and Translational Research, Scottish Rite for Children, McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, TX, USA
| | - Herb Sarnoff
- Research and Development, Infixion Bioscience, Inc., San Diego, CA, USA
| | - Brittany N Simpson
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - David A Stevenson
- Division of Medical Genetics, Department of Pediatrics, Stanford University, Stanford, CA, USA
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3
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Anderson DE, Groff MW, Flood TF, Allaire BT, Davis RB, Stadelmann MA, Zysset PK, Alkalay RN. Evaluation of Load-To-Strength Ratios in Metastatic Vertebrae and Comparison With Age- and Sex-Matched Healthy Individuals. Front Bioeng Biotechnol 2022; 10:866970. [PMID: 35992350 PMCID: PMC9388746 DOI: 10.3389/fbioe.2022.866970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Vertebrae containing osteolytic and osteosclerotic bone metastases undergo pathologic vertebral fracture (PVF) when the lesioned vertebrae fail to carry daily loads. We hypothesize that task-specific spinal loading patterns amplify the risk of PVF, with a higher degree of risk in osteolytic than in osteosclerotic vertebrae. To test this hypothesis, we obtained clinical CT images of 11 cadaveric spines with bone metastases, estimated the individual vertebral strength from the CT data, and created spine-specific musculoskeletal models from the CT data. We established a musculoskeletal model for each spine to compute vertebral loading for natural standing, natural standing + weights, forward flexion + weights, and lateral bending + weights and derived the individual vertebral load-to-strength ratio (LSR). For each activity, we compared the metastatic spines' predicted LSRs with the normative LSRs generated from a population-based sample of 250 men and women of comparable ages. Bone metastases classification significantly affected the CT-estimated vertebral strength (Kruskal-Wallis, p < 0.0001). Post-test analysis showed that the estimated vertebral strength of osteosclerotic and mixed metastases vertebrae was significantly higher than that of osteolytic vertebrae (p = 0.0016 and p = 0.0003) or vertebrae without radiographic evidence of bone metastasis (p = 0.0010 and p = 0.0003). Compared with the median (50%) LSRs of the normative dataset, osteolytic vertebrae had higher median (50%) LSRs under natural standing (p = 0.0375), natural standing + weights (p = 0.0118), and lateral bending + weights (p = 0.0111). Surprisingly, vertebrae showing minimal radiographic evidence of bone metastasis presented significantly higher median (50%) LSRs under natural standing (p < 0.0001) and lateral bending + weights (p = 0.0009) than the normative dataset. Osteosclerotic vertebrae had lower median (50%) LSRs under natural standing (p < 0.0001), natural standing + weights (p = 0.0005), forward flexion + weights (p < 0.0001), and lateral bending + weights (p = 0.0002), a trend shared by vertebrae with mixed lesions. This study is the first to apply musculoskeletal modeling to estimate individual vertebral loading in pathologic spines and highlights the role of task-specific loading in augmenting PVF risk associated with specific bone metastatic types. Our finding of high LSRs in vertebrae without radiologically observed bone metastasis highlights that patients with metastatic spine disease could be at an increased risk of vertebral fractures even at levels where lesions have not been identified radiologically.
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Affiliation(s)
- Dennis E. Anderson
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Michael W. Groff
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Thomas F. Flood
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Brett T. Allaire
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Roger B. Davis
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Marc A. Stadelmann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Philippe K. Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Ron N. Alkalay
- Department of Orthopedic Surgery, Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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4
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Autio E, Oura P, Karppinen J, Paananen M, Junno JA, Niinimäki J. The association between physical activity and vertebral dimension change in early adulthood - The Northern Finland Birth Cohort 1986 study. Bone Rep 2021; 14:101060. [PMID: 33981808 PMCID: PMC8085667 DOI: 10.1016/j.bonr.2021.101060] [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: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
Small vertebral size is a well-known risk factor for vertebral fractures. To help understanding the factors behind vertebral size, we aimed to investigate whether physical activity and participation in high-impact exercise are associated with the growth rate of the vertebral cross-sectional area (CSA) among young adults. To conduct our study, we utilized the Northern Finland Birth Cohort 1986 as our study population (n = 375). Questionnaire data about physical activity was obtained at 16, 18 and 19 years of age and lumbar magnetic resonance imaging scans at two timepoints, 20 and 30 years of age. We used generalized estimating equation (GEE) models to conduct the analyses. We did not find any statistically significant associations between vertebral CSA, physical activity, and high-impact exercise in our study sample. We conclude that neither physical activity nor high-impact sports seem to influence the change in vertebral CSA among young adults. Physical activity does not influence the growth rate of the vertebral body. High-impact sports are not associated with the change in vertebral CSA among adults. The study was conducted using longitudinal MRI data.
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Affiliation(s)
- Elsi Autio
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Petteri Oura
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juho-Antti Junno
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Anatomy, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Radiology, Oulu University Hospital, Oulu, Finland
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5
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Gilmour RJ, Brickley MB, Hoogland M, Jurriaans E, Mays S, Prowse TL. Quantifying cortical bone in fragmentary archeological second metacarpals. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021; 174:812-821. [PMID: 33580992 DOI: 10.1002/ajpa.24248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/23/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Skeletal variation in cortical bone thickness is an indicator of bone quality and health in archeological populations. Second metacarpal radiogrammetry, which measures cortical thickness at the shaft midpoint, is traditionally used to evaluate bone loss in bioarcheological and some clinical contexts. However fragmentary elements are regularly omitted because the midpoint cannot be determined. This methodological limitation reduces sample sizes and biases them against individuals prone to fracture, such as older individuals with low bone mass. This study introduces a new technique for measuring cortical bone in second metacarpals, the "Region of Interest" (ROI) method, which quantifies bone in archeological remains with less-than-ideal preservation while accounting for cortical heterogeneity. MATERIALS AND METHODS The ROI method was adapted from digital X-ray radiogrammetry (DXR), a clinical method used to estimate bone mineral density, and tested using second metacarpals from Middenbeemster, Netherlands, a 19th century known age and sex skeletal collection. The ROI method quantifies cortical bone area within a 1.9 cm-long, mid-diaphyseal region, standardized for body size differences using total area (CAIROI ). CAIROI values were compared to traditional radiogrammetric cortical indices (CI) to assess the method's ability to identify age-related bone loss. RESULTS CAIROI values have high intra- and interobserver replicability and are strongly and significantly correlated with CI values for both males (r[n = 39] = 0.906, p = 0.000) and females (r[n = 58] = 0.925, p = 0.000). CONCLUSION The ROI method complements traditional radiogrammetry analyses and provides a reliable way to quantify cortical bone in incomplete second metacarpals, thereby maximizing sample sizes, allowing patterns in bone acquisition and loss to be more comprehensively depicted in archeological assemblages.
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Affiliation(s)
- Rebecca J Gilmour
- Department of Sociology and Anthropology, Mount Royal University, Calgary, Alberta, Canada.,Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
| | - Megan B Brickley
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
| | - Menno Hoogland
- Faculty of Archaeology, Leiden University, Leiden, The Netherlands
| | - Erik Jurriaans
- Department of Radiology, Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Simon Mays
- Research Department, Historic England, Fort Cumberland, Portsmouth, UK.,Department of Archaeology, University of Southampton, Avenue Campus, Southampton, UK.,Faculty of History, Classics and Archaeology, University of Edinburgh, Edinburgh, UK
| | - Tracy L Prowse
- Department of Anthropology, McMaster University, Hamilton, Ontario, Canada
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6
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Oura P, Junno JA, Autio E, Karppinen J, Niinimäki J. Baseline anthropometric indices predict change in vertebral size in early adulthood - A 10-year follow-up MRI study. Bone 2020; 138:115506. [PMID: 32603909 DOI: 10.1016/j.bone.2020.115506] [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: 04/03/2020] [Revised: 05/19/2020] [Accepted: 06/19/2020] [Indexed: 11/25/2022]
Abstract
The vertebral cross-sectional area (CSA) has an independent effect on vertebral strength. Recent evidence has shown that vertebral dimensions significantly increase in the third decade of life, and that lifestyle factors such as body size and composition are clearly associated with vertebral CSA. This study aimed to test the hypothesis that general anthropometric traits (stature, total body mass, lean body mass, fat mass, body mass index, waist circumference), each objectively measured at baseline, predict the change in vertebral CSA over the subsequent decade. A representative sample of young Northern Finnish adults was used (n = 371) with repeated magnetic resonance imaging (MRI) scans from ~20 and ~30 years (baseline and follow-up, respectively). Vertebral CSA was measured from the MRI scans with high reliability and low measurement error. The statistical analysis was performed using linear regression models adjusted for sex and exact length of MRI interval. According to the regression models, in descending order of effect size, lean body mass (standardized beta coefficient 0.243 [95% confidence interval 0.065-0.420]), total body mass (0.158 [0.043-0.273]), body mass index (0.125 [0.026-0.224]), waist circumference (0.119 [0.010-0.228]), and fat mass (0.104 [0.004-0.205]) were positively and significantly associated with CSA gain over the follow-up, whereas stature (0.079 [-0.066-0.224]) was not associated with CSA change. The results of this study suggest that anthropometric indices may be used for estimating subsequent change in vertebral size. In particular, greater lean body mass seems to be beneficial for vertebral size and thus potentially also for vertebral strength. Future studies should aim to replicate these associations in a dataset with longitudinal anthropometric trajectories and identify the potential common factors that influence both anthropometric traits and vertebral CSA gain.
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Affiliation(s)
- Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Juho-Antti Junno
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Anatomy, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
| | - Elsi Autio
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland
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7
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Bailey S, Hackney D, Vashishth D, Alkalay RN. The effects of metastatic lesion on the structural determinants of bone: Current clinical and experimental approaches. Bone 2020; 138:115159. [PMID: 31759204 PMCID: PMC7531290 DOI: 10.1016/j.bone.2019.115159] [Citation(s) in RCA: 7] [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] [Received: 08/05/2019] [Revised: 10/31/2019] [Accepted: 11/18/2019] [Indexed: 01/30/2023]
Abstract
Metastatic bone disease is incurable with an associated increase in skeletal-related events, particularly a 17-50% risk of pathologic fractures. Current surgical and oncological treatments are palliative, do not reduce overall mortality, and therefore optimal management of adults at risk of pathologic fractures presents an unmet medical need. Plain radiography lacks specificity and may result in unnecessary prophylactic fixation. Radionuclide imaging techniques primarily supply information on the metabolic activity of the tumor or the bone itself. Magnetic resonance imaging and computed tomography provide excellent anatomical and structural information but do not quantitatively assess bone matrix. Research has now shifted to developing unbiased data-driven tools that can predict risk of impending fractures and guide individualized treatment decisions. This review discusses the state-of-the-art in clinical and experimental approaches for prediction of pathologic fractures with bone metastases. Alterations in bone matrix quality are associated with an age-related increase in skeletal fragility but the impact of metastases on the intrinsic material properties of bone is unclear. Engineering-based analyses are non-invasive with the capability to evaluate oncological treatments and predict failure due to the progression of metastasis. The combination of these approaches may improve our understanding of the underlying deterioration in mechanical performance.
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Affiliation(s)
- Stacyann Bailey
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States of America
| | - David Hackney
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States of America
| | - Deepak Vashishth
- Center for Biotechnology and Interdisciplinary Studies, Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, United States of America
| | - Ron N Alkalay
- Center for Advanced Orthopedic Studies, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America.
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8
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Harris D, Garrett K, Uppuganti S, Creecy A, Nyman JS. The BALB/c mouse as a preclinical model of the age-related deterioration in the lumbar vertebra. Bone 2020; 137:115438. [PMID: 32480022 PMCID: PMC7354228 DOI: 10.1016/j.bone.2020.115438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 02/08/2023]
Abstract
The likelihood of experiencing an osteoporotic fracture of one or more vertebral bodies increases with age, and this increase is not solely due to sex steroid deficiency. For the purpose of assessing the effectiveness of novel therapeutic strategies in the prevention of vertebral fractures among the elderly, we hypothesized that the BALB/c mouse model of aging phenocopies the age-related decrease in human VB strength. To test this hypothesis, we assessed the age-related changes in trabecular architecture of the L6 VB, with respect to those in the distal femur metaphysis, between 6-mo. (young adulthood, n = 20/sex) and 20-mo. of age (old age, n = 18/sex) and then determined how well the architectural characteristics, volumetric bone mineral density (vBMD), and predicted failure force from μCT-derived finite element analysis (μFEA) with linear elastic failure criteria explained the age-related variance in VB strength, which was the ultimate force during quasi-static loading of the VB in compression. While there was a pronounced age-related deterioration in trabecular architecture in the distal femur metaphysis of female and male BALB/c mice, the decrease in trabecular bone volume fraction and trabecular number between 6-mo. and 20-mo. of age occurred in male mice, but not in female mice. As such, the VB strength was lower with age in males only. Nonetheless, BV/TV and volumetric bone mineral density (vBMD) positively correlated with the ultimate compressive force of the L6 VB for both females and males. Whether using a fixed homogeneous distribution of tissue modulus (Et = 18 GPa) or a heterogeneous distribution of Et based on a positive relationship with TMD, the predicted failure force of the VB was not independent of age, thereby suggesting linear μFEA may not be a suitable replacement for mechanical-based measurements of strength with respect to age-related changes. Overall, the BALB/c mouse model of aging mimics the age-related in decline in human VB strength when comparing 6-mo. and 20-mo. old male mice. The decrease in VB strength in female mice may occur over a different age range.
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Affiliation(s)
- Dominique Harris
- Meharry Medical College, 1005 Dr. DB Todd Jr. Blvd., Nashville, TN 37208, USA
| | - Kate Garrett
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave. S., Suite 4200, Nashville, TN 37232, USA
| | - Sasidhar Uppuganti
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave. S., Suite 4200, Nashville, TN 37232, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Amy Creecy
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave. S., Suite 4200, Nashville, TN 37232, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA
| | - Jeffry S Nyman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave. S., Suite 4200, Nashville, TN 37232, USA; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN 37232, USA; Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA; Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24(th) Ave. S., Nashville, TN 37212, USA.
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9
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Subramaniam K, Babu T. Does Bone Mineral Apparent Density Facilitate Accurate Identification of Osteoporosis in the Short Postmenopausal Women? Indian J Endocrinol Metab 2020; 24:275-279. [PMID: 33083269 PMCID: PMC7539034 DOI: 10.4103/ijem.ijem_101_20] [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: 02/27/2020] [Revised: 04/08/2020] [Accepted: 05/25/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Height is one of the most important aspects affecting the areal bone mineral density (BMD). There are several height adjustments in children but none in widespread use for adults. This is specifically a problem in ethnic groups where mean height is substantially lower. We hypothesized that height adjustment of areal BMD would reduce the misclassification in short individuals. MATERIALS AND METHODS This is a retrospective study involving 373 postmenopausal women. Their records were reviewed and bone mineral apparent density (BMAD) were calculated. Areal BMD T-scores and BMAD T-scores were then compared. RESULTS The mean height of the cohort was 154.4 cm. There were 47 women who were defined as short (≤147 cm). In short women, BMAD neither showed improvement nor decrement in T-scores, and BMAD T-scores predicted more number of osteoporosis than BMD T-scores. When divided into height ranges, taller women (>160 cm) showed worsening of BMAD T-scores as compared to BMD T-scores (Chi-square test for trend P < 0.001). Hence, BMAD might actually "correct" for larger bone and not shorter bones. CONCLUSION BMAD was not found to be a suitable alternative in short postmenopausal women to accurately determine whether the low bone density in them is because of dual-energy X-ray absorptiometry artifact or whether they truly have a low density.
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Affiliation(s)
| | - Tom Babu
- Department of Endocrinology, Silverline Hospital, Kochi, Kerala, India
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10
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Eating Behavior Traits, Weight Loss Attempts, and Vertebral Dimensions Among the General Northern Finnish Population. Spine (Phila Pa 1976) 2019; 44:E1264-E1271. [PMID: 31205179 DOI: 10.1097/brs.0000000000003123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A population-based birth cohort study. OBJECTIVE To evaluate the associations of eating behavior traits and weight loss attempts with vertebral size among the general Northern Finnish population. SUMMARY OF BACKGROUND DATA Vertebral fragility fractures are a typical manifestation of osteoporosis, and small vertebral dimensions are a well-established risk factor for vertebral fracturing. Previous studies have associated cognitive eating restraint and diet-induced weight loss with deteriorated bone quality at various skeletal sites, but data on vertebral geometry are lacking. METHODS This study of 1338 middle-aged Northern Finns evaluated the associations of eating behavior traits (flexible and rigid cognitive restraint of eating, uncontrolled eating, emotional eating; assessed by the Three-Factor Eating Questionnaire-18) and weight loss attempts (assessed by a separate questionnaire item) with magnetic resonance imaging-derived vertebral cross-sectional area (CSA). Sex-stratified linear regression models were used to analyze the data, taking body mass index, leisure-time physical activity, general diet, smoking, and socioeconomic status as potential confounders. RESULTS Women with rigid or rigid-and-flexible cognitive eating restraints had 3.2% to 3.4% smaller vertebral CSA than those with no cognitive restraint (P ≤ 0.05). Similarly, the women who reported multiple weight loss attempts in adulthood and midlife had 3.5% smaller vertebral size than those who did not (P = 0.03). Other consistent findings were not obtained from either sex. CONCLUSION Rigid cognitive eating restraint and multiple weight loss attempts predict small vertebral size and thus decreased spinal health among middle-aged women, but not among men. Future longitudinal studies should confirm these findings. LEVEL OF EVIDENCE 3.
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11
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Oravec D, Flynn MJ, Zauel R, Rao S, Yeni YN. Digital tomosynthesis based digital volume correlation: A clinically viable noninvasive method for direct measurement of intravertebral displacements using images of the human spine under physiological load. Med Phys 2019; 46:4553-4562. [PMID: 31381174 DOI: 10.1002/mp.13750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/17/2019] [Accepted: 07/26/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE We have developed a clinically viable method for measurement of direct, patient-specific intravertebral displacements using a novel digital tomosynthesis based digital volume correlation technique. These displacements may be used to calculate vertebral stiffness under loads induced by a patient's body weight; this is particularly significant because, among biomechanical variables, stiffness is the strongest correlate of bone strength. In this proof of concept study, we assessed the feasibility of the method through a preliminary evaluation of the accuracy and precision of the method, identification of a range of physiological load levels for which displacements are measurable, assessment of the relationship of measured displacements with microcomputed tomography based standards, and demonstration of the in vivo application of the technique. METHODS Five cadaveric T11 vertebrae were allocated to three groups in order to study (a) the optimization of digital volume correlation algorithm input parameters, (b) accuracy and precision of the method and the ability to measure displacements at a range of physiological load levels, and (c) the correlation between displacements measured using tomosynthesis based digital volume correlation vs. high resolution microcomputed tomography based digital volume correlation and large scale finite element models. Tomosynthesis images of one patient (Female, 60 yr old) were used to calculate displacement maps, and in turn stiffness, using images acquired in both standing and standing-with-weight (8 kg) configurations. RESULTS We found that displacements were accurate (2.28 µm total error) and measurable at physiological load levels (above 267 N) with a linear response to applied load. Calculated stiffness among three tested vertebral bodies was within an acceptable range relative to reported values for vertebral stiffness (5651-13260 N/mm). Displacements were in good qualitative and quantitative agreement with both microcomputed tomography based finite element (r2 = 0.762, P < 0.001) and digital volume correlation (r2 = 0.799, P < 0.001) solutions. For one patient tested twice, once standing and once holding weights, results demonstrated excellent qualitative reproducibility of displacement distributions with superior endplate displacements increasing by 22% with added weight. CONCLUSIONS The results of this work collectively suggest the feasibility of the method for in vivo measurement of intravertebral displacements and stiffness in humans. These findings suggest that digital volume correlation using digital tomosynthesis imaging may be useful in understanding the mechanical response of bone to disease and may further enhance our ability to assess fracture risk and treatment efficacy for the spine.
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Affiliation(s)
- Daniel Oravec
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
| | - Michael J Flynn
- Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Roger Zauel
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
| | - Sudhaker Rao
- Department of Endocrinology, Henry Ford Hospital, Detroit, MI, USA
| | - Yener N Yeni
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, USA
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Autio E, Oura P, Karppinen J, Paananen M, Niinimäki J, Junno JA. Changes in vertebral dimensions in early adulthood - A 10-year follow-up MRI-study. Bone 2019; 121:196-203. [PMID: 30099153 DOI: 10.1016/j.bone.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/08/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
Previous studies have shown that vertebral height increases until the early twenties, but very few studies have been conducted on other vertebral dimensions. Growth in vertebral size is believed to take place in elderly age but not in early adulthood. In this study, we wanted to clarify the potential changes in the dimensions of the lumbar vertebrae during early adulthood. We used the Northern Finland Birth Cohort 1986 as our study material, with a final sample size of 375 individuals. We performed lumbar magnetic resonance imaging (MRI) when the participants were 20 and 30 years of age (baseline and follow-up, respectively). We recorded the width, depth, height, and cross-sectional area (CSA) of the fourth lumbar vertebra (L4) using the MRI scans. We used generalized estimating equation (GEE) models to analyse the data. Men had 7.6%-26.5% larger vertebral dimensions than women at both baseline and follow-up. The GEE models demonstrated that all the studied dimensions increased during the follow-up period among both sexes (p < 0.001). Men had a higher growth rate in vertebral depth and CSA than women (p < 0.001). Among women, small vertebral width (p = 0.001), depth (p = 0.05) and height (p = 0.02) at baseline were associated with a higher vertebral growth rate during the follow-up than among those with large dimensions at baseline. Among men, small baseline width was associated with higher vertebral growth rate (p = 0.001). Our results clearly indicate that vertebral dimensions increase after 20 years of age among both sexes.
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Affiliation(s)
- Elsi Autio
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland.
| | - Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Finnish Institute of Occupational Health, Oulu, Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juho-Antti Junno
- Cancer and Translational Medicine Research Unit, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Anatomy, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Archaeology, Faculty of Humanities, University of Oulu, Oulu, Finland
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Sims D, Onambélé-Pearson G, Burden A, Payton C, Morse C. Whole-body and segmental analysis of body composition in adult males with achondroplasia using dual X-ray absorptiometry. PLoS One 2019; 14:e0213806. [PMID: 30889196 PMCID: PMC6424418 DOI: 10.1371/journal.pone.0213806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/15/2019] [Indexed: 12/05/2022] Open
Abstract
Achondroplasia is a condition characterized by a genetic mutation affecting long bone endplate development. Current data suggests that the bone mineral content (BMC) and bone mineral density (BMD) of achondroplasic populations are below age matched individuals of average stature (controls). Due to the disproportionate limb-to-torso length compared to controls however, the lower BMC and BMD may be nullified when appropriately presented. The aim of this study was to measure whole-body and segmental body composition in adult males with achondroplasia (N = 10, 22 ±3 yrs), present data relative to whole-body and whole-limb values and compare all values to age matched controls (N = 17, 22 ±2 yrs). Dual X-ray absorptiometry (DEXA) was used to measure the in vivo mass of the whole-body and 15 segments, from which BMD, BMC, fat free mass (FFM) and body fat mass were measured. BMC of lumbar vertebrae (L1-4) was also measured and presented as a volumetric BMD (BMDVOL). The achondroplasic group had less BMC, BMD and FFM, and more body fat mass than controls as a whole-body measure. The lower achondroplasic BMC and BMD was somewhat nullified when presented relative to whole-body and whole-limb values respectively. There was no difference in lumbar BMDVOL between groups. Whole-body BMD measures presented the achondroplasic group as ‘osteopenic’. When relative to whole-limb measures however, achondroplasic BMD descriptions were normal. Further work is needed to create a body composition database for achondroplasic population’s, or for clinicians to present achondroplasic body composition values relative to the whole-limb.
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Affiliation(s)
- David Sims
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, England
- * E-mail:
| | - Gladys Onambélé-Pearson
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, England
| | - Adrian Burden
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, England
| | - Carl Payton
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, England
| | - Christopher Morse
- Health, Exercise and Active Living Research, Manchester Metropolitan University, Manchester, England
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14
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Yeni YN, Kim W, Oravec D, Nixon M, Divine GW, Flynn MJ. Assessment of vertebral wedge strength using cancellous textural properties derived from digital tomosynthesis and density properties from dual energy X-ray absorptiometry and high resolution computed tomography. J Biomech 2018; 79:191-197. [PMID: 30173933 DOI: 10.1016/j.jbiomech.2018.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/31/2018] [Accepted: 08/13/2018] [Indexed: 01/23/2023]
Abstract
The purpose of this study was to examine the potential of digital tomosynthesis (DTS) derived cancellous bone textural measures to predict vertebral strength under conditions simulating a wedge fracture. 40 vertebral bodies (T6, T8, T11, and L3 levels) from 5 male and 5 female cadaveric donors were utilized. The specimens were scanned using dual energy X-ray absorptiometry (DXA) and high resolution computed tomography (HRCT) to obtain measures of bone mineral density (BMD) and content (BMC), and DTS to obtain measures of bone texture. Using a custom loading apparatus designed to deliver a nonuniform displacement resulting in a wedge deformity similar to those observed clinically, the specimens were loaded to fracture and their fracture strength was recorded. Mixed model regressions were used to determine the associations between wedge strength and DTS derived textural variables, alone and in the presence of BMD or BMC information. DTS derived fractal, lacunarity and mean intercept length variables correlated with wedge strength, and individually explained up to 53% variability. DTS derived textural variables, notably fractal dimension and lacunarity, contributed to multiple regression models of wedge strength independently from BMC and BMD. The model from a scan orientation transverse to the spine axis and in the anterior-posterior view resulted in highest explanatory capability (R2adj = 0.91), with a scan orientation parallel to the spine axis and in the lateral view offering an alternative (R2adj = 0.88). In conclusion, DTS can be used to examine cancellous texture relevant to vertebral wedge strength, and potentially complement BMD in assessment of vertebral fracture risk.
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Affiliation(s)
- Yener N Yeni
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States.
| | - Woong Kim
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
| | - Daniel Oravec
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
| | - Mary Nixon
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
| | - George W Divine
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
| | - Michael J Flynn
- Bone and Joint Center, Henry Ford Hospital, Detroit, MI, United States
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15
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Oura P, Junno JA, Auvinen J, Niinimäki J, Karppinen J, Ojaniemi M, Paananen M. Body Mass Index Trajectories From Birth to Midlife and Vertebral Dimensions in Midlife: the Northern Finland Birth Cohort 1966 Study. JBMR Plus 2018; 3:37-44. [PMID: 30680362 DOI: 10.1002/jbm4.10065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/02/2018] [Accepted: 05/19/2018] [Indexed: 01/08/2023] Open
Abstract
Vertebral fracture risk is higher among individuals with small vertebral dimensions. Obesity is a global health problem and may also contribute to bone size and fracture risk. In this work we report the association between life course body mass index (BMI) and vertebral cross-sectional area (CSA) in midlife. The Northern Finland Birth Cohort 1966 study with its 46-year follow-up provided the material for this study. A subsample of 780 individuals had attended lumbar magnetic resonance imaging (MRI) at the age of 46 years, and had records of objectively measured BMI from the ages of 0, 7, 15, 31, and 46 years. Of these, MRI-derived data on vertebral size was available for 682 individuals. We identified latent lifelong BMI trajectories by performing latent class growth modeling (LCGM) on the BMI data, and then used sex-stratified linear regression models to compare the identified trajectory groups in terms of midlife vertebral CSA. Gestational age, education years, adult height, lifelong physical activity, lifelong smoking history, and adulthood diet were assessed as potential confounders. Three distinct trajectory groups ("stable slim," "stable average," and "early onset overweight") were identified among both sexes. Comparisons to the stable slim trajectory revealed that vertebral CSA was significantly (p < 0.001) larger among the stable average and early onset overweight trajectories (69.8 and 118.6 mm2 larger among men, 57.7 and 106.1 mm2 larger among women, respectively). We conclude that lifelong BMI has a positive association with midlife vertebral size among both sexes. Future studies should characterize the mediating factors of this association.
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Affiliation(s)
- Petteri Oura
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Juho-Antti Junno
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Cancer and Translational Medicine Research Unit, Faculty of Medicine University of Oulu Oulu Finland.,Department of Archaeology, Faculty of Humanities University of Oulu Oulu Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
| | - Jaro Karppinen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland.,Finnish Institute of Occupational Health Oulu Finland
| | - Marja Ojaniemi
- PEDEGO Research Unit, Faculty of Medicine University of Oulu Oulu Finland.,Department of Children and Adolescents Oulu University Hospital Oulu Finland
| | - Markus Paananen
- Center for Life Course Health Research, Faculty of Medicine University of Oulu Oulu Finland.,Medical Research Center Oulu Oulu University Hospital and University of Oulu Oulu Finland
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16
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Kiebzak G, Sassard WR. Smaller Radius Width in Women With Distal Radius Fractures Compared to Women Without Fractures. Cureus 2017; 9:e1950. [PMID: 29468105 PMCID: PMC5812524 DOI: 10.7759/cureus.1950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Bone mineral density (BMD) measured using dual-energy x-ray absorptiometry (DXA) is typically used to assess fracture risk. However, other factors such as bone size and the forward momentum of a fall (a function of body size) can also potentially influence fracture risk, but are understudied. This report describes the characteristics of a cohort of Caucasian pre- and postmenopausal women with distal radius fractures (DRF) after falling onto an outstretched hand. Methods The fracture cohort comprised entries in an institutional review board-approved registry of study patients who had had DXA scans. For patients with DRF, the contralateral radius was scanned and BMD, T-scores (used to define bone status as normal, osteopenic, or osteoporotic), and radius width were recorded. Generally, side-to-side (left-right) differences in bone size and BMD are small and, hence, the contralateral radius was considered a surrogate for bone status of the fractured radius. Apparently healthy women without fractures were used as race-, age-, and BMI-matched controls. Results Premenopausal women < 49 years of age (mean age, 38 years) with DRF had significanty smaller radii width compared to matched controls. Mean radius BMD was in the normal range. As a group, the cohort was overweight based on mean BMI. Postmenopausal women > 50 years (mean age, 64 years) with DRF also had low radius width, but in contrast to the first group, this group had low peripheral and central BMD. Conclusions Women with DRF had contralateral and presumably fractured radii of bone width smaller than matched controls. As a group, these women were also overweight based on BMI. The smaller radius width may increase the risk for fracture irrespective of BMD, especially since larger body size would result in greater inertial force when falling while ambulating.
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17
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Kim W, Oravec D, Divine GW, Flynn MJ, Yeni YN. Effect of View, Scan Orientation and Analysis Volume on Digital Tomosynthesis (DTS) Based Textural Analysis of Bone. Ann Biomed Eng 2017; 45:1236-1246. [DOI: 10.1007/s10439-017-1792-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/05/2017] [Indexed: 12/20/2022]
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18
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Das C, Newcomb AGUS, Gaudin DP, Crawford NR. Densitometric comparison of 3 occipital regions for suitability of fixation. J Neurosurg Spine 2016; 24:565-9. [PMID: 26722952 DOI: 10.3171/2015.7.spine141142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atlantooccipital fixation is an important technique in the treatment of upper cervical spine instability. Important considerations for implant devices are obtrusiveness and propagation of torque through the device caused by cervical rotation. The authors evaluated the feasibility of 3 regions of the occiput as sites for occipitocervical fixation by examining bone mineral density at these locations. METHODS Unembalmed occiputs of 9 male and 4 female cadavers were used (mean age at time of death was 61.6 years, range 36-68 years). Studies were undertaken using caliper measurements and dual-energy x-ray absorptiometry of the superior nuchal line (SNL), the external occipital protuberance (EOP), and the inferior nuchal line (INL). RESULTS Data indicate that the bone at the INL has a similar volumetric bone density as the bone at the SNL, despite having half the thickness. Also, the volumetric bone density increases laterally along the nuchal lines. CONCLUSIONS Most hardware fixation is centered on stabilization at the EOP and the SNL. On the basis of these radiological results, the INL shows promise as a potential alternative site for screw placement in occipitocervical fixation.
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Affiliation(s)
- Chandan Das
- Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio; and.,Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Anna G U S Newcomb
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Daniel P Gaudin
- Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio; and
| | - Neil R Crawford
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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19
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Digital tomosynthesis (DTS) for quantitative assessment of trabecular microstructure in human vertebral bone. Med Eng Phys 2015; 37:109-20. [DOI: 10.1016/j.medengphy.2014.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/27/2014] [Accepted: 11/14/2014] [Indexed: 01/23/2023]
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20
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Hazrati Marangalou J, Eckstein F, Kuhn V, Ito K, Cataldi M, Taddei F, van Rietbergen B. Locally measured microstructural parameters are better associated with vertebral strength than whole bone density. Osteoporos Int 2014; 25:1285-96. [PMID: 24306231 DOI: 10.1007/s00198-013-2591-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 11/25/2013] [Indexed: 01/30/2023]
Abstract
UNLABELLED Whole vertebrae areal and volumetric bone mineral density (BMD) measurements are not ideal predictors of vertebral fractures. We introduce a technique which enables quantification of bone microstructural parameters at precisely defined anatomical locations. Results show that local assessment of bone volume fraction at the optimal location can substantially improve the prediction of vertebral strength. INTRODUCTION Whole vertebrae areal and volumetric BMD measurements are not ideal predictors of vertebral osteoporotic fractures. Recent studies have shown that sampling bone microstructural parameters in smaller regions may permit better predictions. In such studies, however, the sampling location is described only in general anatomical terms. Here, we introduce a technique that enables the quantification of bone volume fraction and microstructural parameters at precisely defined anatomical locations. Specific goals of this study were to investigate at what anatomical location within the vertebrae local bone volume fraction best predicts vertebral-body strength, whether this prediction can be improved by adding microstructural parameters and to explore if this approach could better predict vertebral-body strength than whole bone volume fraction and finite element (FE) analyses. METHODS Eighteen T12 vertebrae were scanned in a micro-computed tomography (CT) system and FE meshes were made using a mesh-morphing tool. For each element, bone microstructural parameters were measured and correlated with vertebral compressive strength as measured experimentally. Whole bone volume fraction and FE-predicted vertebral strength were also compared to the experimental measurements. RESULTS A significant association between local bone volume fraction measured at a specific central region and vertebral-body strength was found that could explain up to 90% of the variation. When including all microstructural parameters in the regression, the predictive value of local measurements could be increased to 98%. Whole bone volume fraction could explain only 64% and FE analyses 76% of the variation in bone strength. CONCLUSIONS A local assessment of volume fraction at the optimal location can substantially improve the prediction of bone strength. Local assessment of other microstructural parameters may further improve this prediction but is not clinically feasible using current technology.
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Affiliation(s)
- J Hazrati Marangalou
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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21
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Bowen AJ, Burd MA, Craig JJ, Craig M. Radiographic Calibration for Analysis of Bone Mineral Density of the Equine Third Metacarpal Bone. J Equine Vet Sci 2013. [DOI: 10.1016/j.jevs.2013.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Miller LE, Ramp WK, Steele CR, Nickols-Richardson SM, Herbert WG. Rationale, design and clinical performance of the mechanical response tissue analyser: a non-invasive technology for measurement of long bone bending stiffness. J Med Eng Technol 2013; 37:144-9. [DOI: 10.3109/03091902.2012.753128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Xiao SM, Gao Y, Cheung CL, Bow CH, Lau KS, Sham PC, Tan KCB, Kung AWC. Association of CDX1 binding site of periostin gene with bone mineral density and vertebral fracture risk. Osteoporos Int 2012; 23:1877-87. [PMID: 22215184 PMCID: PMC3368110 DOI: 10.1007/s00198-011-1861-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 09/12/2011] [Indexed: 12/03/2022]
Abstract
SUMMARY Periostin (POSTN) as a regulator of osteoblast differentiation and bone formation may affect susceptibility to osteoporosis. This study suggests POSTN as a candidate gene for bone mineral density (BMD) variation and vertebral fracture risk, which could better our understanding about the genetic pathogenesis of osteoporosis and will be useful in clinic in the future. INTRODUCTION The genetic determination of osteoporosis is complex and ill-defined. Periostin (POSTN), an extracellular matrix secreted by osteoblasts and a regulator of osteoblast differentiation and bone formation, may affect susceptibility to osteoporosis. METHODS We adopted a tag-single nucleotide polymorphism (SNP) based association method followed by imputation-based verification and identification of a causal variant. The association was investigated in 1,572 subjects with extreme-BMD and replicated in an independent population of 2,509 subjects. BMD was measured by dual X-ray absorptiometry. Vertebral fractures were identified by assessing vertebral height from X-rays of the thoracolumbar spine. Association analyses were performed with PLINK toolset and imputation analyses with MACH software. The top imputation finding was subsequently validated by genotyping. Interactions between POSTN and another BMD-related candidate gene sclerostin (SOST) were analyzed using MDR program and validated by logistical regression analyses. The putative transcription factor binding with target sequence was confirmed by electrophoretic mobility shift assay (EMSA). RESULTS Several SNPs of POSTN were associated with BMD or vertebral fractures. The most significant polymorphism was rs9547970, located at the -2,327 bp upstream (P = 6.8 × 10(-4)) of POSTN. Carriers of the minor allele G per copy of rs9547970 had 1.33 higher risk of vertebral fracture (P = 0.007). An interactive effect between POSTN and SOST upon BMD variation was suggested (P < 0.01). A specific binding of CDX1 to the sequence of POSTN with the major allele A of rs9547970 but not the variant G allele was confirmed by EMSA. CONCLUSIONS Our results suggest POSTN as a candidate gene for BMD variation and vertebral fracture risk.
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Affiliation(s)
- S-M Xiao
- Department of Medicine, Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Nicolella DP, Bredbenner TL. Development of a parametric finite element model of the proximal femur using statistical shape and density modelling. Comput Methods Biomech Biomed Engin 2011; 15:101-10. [PMID: 21360361 DOI: 10.1080/10255842.2010.515984] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Skeletal fractures associated with bone mass loss are a major clinical problem and economic burden, and lead to significant morbidity and mortality in the ageing population. Clinical image-based measures of bone mass show only moderate correlative strength with bone strength. However, engineering models derived from clinical image data predict bone strength with significantly greater accuracy. Currently, image-based finite element (FE) models are time consuming to construct and are non-parametric. The goal of this study was to develop a parametric proximal femur FE model based on a statistical shape and density model (SSDM) derived from clinical image data. A small number of independent SSDM parameters described the shape and bone density distribution of a set of cadaver femurs and captured the variability affecting proximal femur FE strength predictions. Finally, a three-dimensional FE model of an 'unknown' femur was reconstructed from the SSDM with an average spatial error of 0.016 mm and an average bone density error of 0.037 g/cm(3).
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Affiliation(s)
- Daniel P Nicolella
- Materials Engineering Department, Southwest Research Institute, 6220 Culebra Road, San Antonio, TX 78238-5166, USA
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25
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Walsh JS, Henry YM, Fatayerji D, Eastell R. Lumbar spine peak bone mass and bone turnover in men and women: a longitudinal study. Osteoporos Int 2009; 20:355-62. [PMID: 18629566 DOI: 10.1007/s00198-008-0672-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 05/28/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED Peak bone mass is an important determinant of bone mass in later life, but the age of peak bone mass is still unclear. We found that bone size and density increase and bone turnover decreases until age 25. It may be possible to influence bone accrual into the third decade. INTRODUCTION Peak bone mass is a major determinant of bone mass in later life. Bone growth and maturation is site-specific, and the age of peak bone mass is still unclear. It is important to know the age to which bone accrual continues so strategies to maximise bone mass can be targeted appropriately. This study aims to ascertain the age of lumbar spine peak bone mass. METHODS We measured lumbar spine BMC, estimated volume and BMAD by DXA and biochemical markers of bone turnover in 116 healthy males and females ages 11 to 40, followed up at an interval of five to nine years. RESULTS The majority of peak bone mass was attained by the mid-twenties. Increases in BMC in adolescents and young adults were mostly due to increases in bone size. Bone turnover markers decreased through adolescence and the third decade and the decreasing rate of change in bone turnover corresponded with the decreasing rate of change in lumbar spine measurements. CONCLUSIONS Skeletal maturation and bone mineral accrual at the lumbar spine continues into the third decade.
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Affiliation(s)
- J S Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, Northern General Hospital, Herries Road, Sheffield S57AU, UK.
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Horn J, Steen H, Reikerås O. Role of the fibula in lower leg fractures: an in vivo investigation in rats. J Orthop Res 2008; 26:1027-31. [PMID: 18302250 DOI: 10.1002/jor.20605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Whether or not the fibula should be fixated in combined fractures of the tibia and fibula remains controversial. Several clinical and biomechanical studies have investigated the role of the fibula in lower leg fractures without leading to a common conclusion. We assumed that an intact or stable fibula would provide better healing conditions in lower leg fractures treated with an intramedullary nail. In an in vivo study, 40 male Wistar rats were randomly assigned to two groups. In both groups, the tibia was osteotomized, whereas the fibula was left intact in one group and osteotomized in the other group. The tibia fracture was fixated with an intramedullary nail. After sacrifice of the animals, mineral density, mineral content, and mechanical characteristics of the healing osteotomies were evaluated. We found that a combination of tibia and fibula fracture significantly impaired fracture healing during the early phase after the incident, when treated with an intramedullary nail, suggesting that an intact or stabilized fibula provides additional support and better healing conditions to a tibia fracture.
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Affiliation(s)
- Joachim Horn
- Department of Orthopaedics, Rikshospitalet University Hospital, Sognsvannsveien 20, N0027 Oslo, Norway.
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Stiger F, Brändström H, Gillberg P, Melhus H, Wolk A, Michaelsson K, Kindmark A. Association between repeat length of exon 1 CAG microsatellite in the androgen receptor and bone density in men is modulated by sex hormone levels. Calcif Tissue Int 2008; 82:427-35. [PMID: 18484228 DOI: 10.1007/s00223-008-9128-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 03/30/2008] [Indexed: 10/22/2022]
Abstract
In this study we examined whether the androgen receptor (AR) gene CAG repeat polymorphism and serum androgen levels are associated with bone mineral density (BMD) and changes in BMD during 2-3 years in 229 healthy men 41-76 years old. Microsatellite analysis was performed on an automated sequencer. Indices of bioavailable testosterone (free testosterone [FT] and free androgen index) were calculated. BMD was measured using both dual-energy Xray absorptiometry and quantitative ultrasound. All participants completed a questionnaire regarding major possible osteoporosis risk factors. In linear regression analysis there was a modest positive association, which was independent of age and body mass index (BMI), between AR repeat length and BMD at all sites. Although this association was significant independent of BMI, analyses in the subgroup of obese men (BMI > 30) did not reach significance, while the effect was enhanced when analyzing only nonobese men (BMI < or = 30). There was no association between the AR gene polymorphism and rate of bone loss, FT, and BMD or testosterone and bone loss. Interestingly, the association between AR and BMD was modified by total testosterone. The lowest age- and BMI-adjusted average femoral neck BMD was found among men in the lowest tertile for both AR repeat length and FT, whereas men within the higher categories of these variables displayed the highest BMD. In conclusion, there is a positive association between the AR CAG repeat polymorphism and BMD, which is modified by androgen levels in healthy men.
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Affiliation(s)
- Fredrik Stiger
- Department of Medical Sciences, University Hospital, MMS Ing 40 by, Uppsala SE-75185, Sweden
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Guijarro M, Valero C, Paule B, Gonzalez-Macias J, Riancho JA. Bone mass in young adults with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:182-189. [PMID: 18261017 DOI: 10.1111/j.1365-2788.2007.00992.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Down syndrome (DS) is a frequent cause of intellectual disability. With the increasing life expectancy of these patients, concerns have been raised about the risk of osteoporosis. In fact, several investigators have reported a reduced bone mass in DS. However, the results may be confounded by comorbid diseases, and differences in lifestyle habits and body size. Therefore, we planned to determine anthropometric and lifestyle factors influencing bone mineral density (BMD) in young adults with DS. METHODS Thirty-nine patients with DS (mean age 26 years) and 78 controls were studied. Areal BMD was measured by dual x-ray densitometry (DXA); volumetric BMD at the lumbar spine and femoral neck was estimated with published formulae. RESULTS DS patients had lower areal BMD than controls at all regions (spine, hip and total body). Height and projected bone area were also lower. There were no differences between both groups regarding estimated volumetric BMD at the femoral neck. However, spine volumetric BMD was also lower in DS than controls. In multivariate analysis, DS, male sex, little physical activity and low sunlight exposure were associated with lower spine volumetric BMD; on the other hand, fat mass and sunlight exposure were associated with femoral neck volumetric BMD. CONCLUSION This study shows that patients with DS had a reduced areal BMD, but it is in part a consequence of the reduced body size, particularly at the femoral neck. Physical activity and sunlight exposure are associated to volumetric BMD and should be stimulated in order to maintain an adequate bone mass in these patients.
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Affiliation(s)
- M Guijarro
- Department of Internal Medicine, Hospital U.M. Valdecilla, University of Cantabria, Santander, Spain
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Willaert A, Van Pottelbergh I, Zmierczak H, Goemaere S, Kaufman JM, De Paepe A, Coucke P. A genome-wide linkage scan for low spinal bone mineral density in a single extended family confirms linkage to 1p36.3. Eur J Hum Genet 2008; 16:970-6. [PMID: 18285824 DOI: 10.1038/ejhg.2008.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Osteoporotic fractures are an increasing cause of mortality and morbidity in ageing populations. A major risk determinant for these fractures is bone mineral density (BMD). Variation on BMD is thought, on the basis of twin and family studies, to be subject to a large amount of genetic variation and it has been hypothesised that this may be due to the influence of multiple genes. However, in families showing segregation of low or high BMD, single major genes have been shown to play a crucial role. We performed a genome-wide screen using 380 microsatellite markers in a single extended family (n=34) in which early-onset low spinal areal BMD segregates in an autosomal dominant-like fashion. A two-point linkage analysis was performed, revealing a maximum LOD score of 3.07 on 1p36.3 (D1S468), confirming results of previous linkage studies of BMD, while no other suggestive linkage peaks (LOD>2.2) were detected elsewhere in the genome. Microsatellite markers were subsequently genotyped for a +/-6.9 Mb region surrounding D1S468. This revealed critical recombination events restricting the candidate region to 1.2 Mb and 19 genes. Sequencing analysis of the coding region of candidate genes WDR8 and EGFL3 revealed no mutations or disease-associated polymorphisms. Our results provide some evidence supporting the hypothesis that there are genetic determinants for spinal BMD on 1p36.3. Although no specific disease causing mutation has yet been found, the delineation of a relatively small candidate region in a single extended family opens perspectives to identify a major gene for spinal BMD.
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Affiliation(s)
- Andy Willaert
- Department of Medical Genetics, Ghent University Hospital, Ghent, Belgium
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30
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Miller LE, Wootten DF, Nickols-Richardson SM, Ramp WK, Steele CR, Cotton JR, Carneal JP, Herbert WG. Isokinetic training increases ulnar bending stiffness and bone mineral in young women. Bone 2007; 41:685-9. [PMID: 17693150 DOI: 10.1016/j.bone.2007.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Revised: 05/23/2007] [Accepted: 07/06/2007] [Indexed: 11/19/2022]
Abstract
Numerous studies have investigated the effects of physical activity on bone health; however, little is known about the effects of isokinetic strength training on bone. While bone mineral density (BMD) is widely used to assess bone health and fracture risk, there are several limitations of this measure that warrant new technology development to measure bone strength. The mechanical response tissue analyzer (MRTA) assesses bone strength by measuring maximal bending stiffness (EI). We hypothesized that isokinetic strength training of the elbow flexors and extensors would increase ulnar EI, BMD, and bone mineral content (BMC) in young women. Fifty-four women trained the nondominant arm 3 times per week for 20 weeks; 32 trained concentrically (CON) and 22 trained eccentrically (ECC). Subjects were assessed for the following variables pre- and post-training: CON and ECC peak torque of the elbow flexors and extensors with isokinetic dynamometry, ulnar mineral content and density using dual-energy X-ray absorptiometry, and ulnar EI using MRTA. Isokinetic training increased CON (17%) and ECC (17%) peak torque, even when controlling for changes in the untrained arm. Eccentric training increased CON and ECC peak torque while CON training improved CON peak torque only. Isokinetic training increased ulnar EI 28%, which was statistically greater than the untrained arm. Ulnar EI increased 25% with CON training and 32% with ECC training. Both training modes resulted in greater EI gains compared to the untrained limb. Isokinetic training increased ulnar BMC (2.7%) and BMD (2.3%), even when controlling for untrained ulna changes. Both training modalities resulted in BMC and BMD increases; however, only CON training yielded gains when controlling for changes in the untrained limb. In conclusion, isokinetic strength training increases ulnar EI, BMC, and BMD in young women; no statistical differences were noted between CON and ECC training modes.
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Affiliation(s)
- Larry E Miller
- Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
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Zebaze RMD, Jones A, Knackstedt M, Maalouf G, Seeman E. Construction of the femoral neck during growth determines its strength in old age. J Bone Miner Res 2007; 22:1055-61. [PMID: 17501625 DOI: 10.1359/jbmr.070329] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Study of the design of the FN in vivo in 697 women and in vitro in 200 cross-sections of different sizes and shapes along each of 13 FN specimens revealed that strength in old age was largely achieved during growth by differences in the distribution rather than the amount of bone material in a given FN cross-section from individual to individual. INTRODUCTION We studied the design of the femoral neck (FN) to gain insight into the structural basis of FN strength in adulthood and FN fragility in old age. MATERIALS AND METHODS Studies in vivo were performed using densitometry in 697 women and in vitro using high-resolution microCT and direct measurements in 13 pairs of postmortem specimens. RESULTS The contradictory needs of strength for loading yet lightness for mobility were met by varying FN size, shape, spatial distribution, and proportions of its trabecular and cortical bone in a cross-section, not its mass. Wider and narrower FNs were constructed with similar amounts of bone material. Wider FNs were relatively lighter: a 1 SD higher FN volume had a 0.67 (95% CI, 0.61-0.72) SD lower volumetric BMD (vBMD). A 1 SD increment in height was achieved by increasing FN volume by 0.32 (95% CI, 0.25-0.39) SD with only 0.15 (95% CI, 0.08-0.22) SD more bone, so taller individuals had a relatively lighter FN (vBMD was 0.13 [95% CI, 0.05-0.20 SD] SD lower). Greater periosteal apposition constructing a wider FN was offset by even greater endocortical resorption so that the same net amount of bone was distributed as a thinner cortex further from the neutral axis, increasing resistance to bending and lowering vBMD. This was recapitulated at each point along the FN; varying absolute and relative degrees of periosteal apposition and endocortical resorption focally used the same amount of material to fashion an elliptical FN of mainly cortical bone near the femoral shaft to offset bending but a more circular FN of proportionally more trabecular and less cortical bone to accommodate compressive loads adjacent to the pelvis. This structural heterogeneity was largely achieved by adaptive modeling and remodeling during growth-most of the variance in FN volume, BMC, and vBMD was growth related. CONCLUSIONS Altering structural design while minimizing mass achieves FN strength and lightness. Bone fragility may be the result of failure to adapt bone's architecture to loading, not just low bone mass.
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Affiliation(s)
- Roger M D Zebaze
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Melbourne, Australia
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Wang YB, Lei SF, Dvornyk V, Sun X, Jiang DK, Li MX, Deng HW. The genetic, environmental and phenotypic correlations of bone phenotypes at the spine and hip in Chinese. Ann Hum Biol 2007; 33:500-9. [PMID: 17060072 DOI: 10.1080/03014460600814135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Bone mineral density (BMD), bone mineral content (BMC), and bone size have been widely studied individually as important risk factors for osteoporotic fracture, but little is known about the correlation and the degree of sharing genetic and environmental factors between the pairs of the three phenotypes. AIM The study investigated genetic correlation (rhoG), environmental correlation (rhoE) and phenotypic correlation (rhoP) between BMD, BMC and bone size. SUBJECTS AND METHODS Bivariate variance decomposition analyses were performed in 904 subjects from 287 Chinese nuclear families. RESULTS Significant rhoE, rhoG and rhoP were detected between BMD, BMC and bone size, except for rhoE between BMD and bone size at the hip (rhoE = 0.121, p = 0.361). Common shared genetic factors explained 86.1% and 60% of BMD and BMC genetic variations at the spine and hip, respectively. However, the genetic and environmental correlations between BMD and bone size were limited. rhoE and rhoG at the spine were 0.392 and 0.381, and at the hip were 0.121 and -0.205, respectively. Only 14.5% and 4.2% of variations between BMD and bone size at the spine and hip may be due to the shared genetic factors. CONCLUSION The obtained results suggested that bone size may be used as another surrogate phenotype independently of BMD for eventual elucidation of the pathogenesis of osteoporosis because of the limited correlations between BMD and bone size.
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Affiliation(s)
- Yan-Bo Wang
- Laboratory of Molecular and Statistical Genetics and the Key Laboratory of Protein Chemistry and Developmental Biology of Ministry of Education, College of Life Sciences, Hunan Normal University, Changsha, Hunan, PR China
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Erbas B, Ristevski S, Poon C, Yeung S, Ebeling PR. Decreased spinal and femoral neck volumetric bone mineral density (BMD) in men with primary osteoporosis and their first-degree male relatives: familial effect on BMD in men. Clin Endocrinol (Oxf) 2007; 66:78-84. [PMID: 17201805 DOI: 10.1111/j.1365-2265.2006.02690.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Low bone mass may be caused by a reduction in the amount of bone or density of bone or both. The purpose of this study was to examine differences in bone volume and volumetric bone mineral density (vBMD) in men with primary osteoporosis and their first-degree male relatives (FDMR). DESIGN We used dual-energy X-ray absorptiometry (DXA) to measure areal density, then calculated bone volume and volumetric density in 121 men with primary osteoporosis, 73 FDMR and 66 normal men. We used regression methods adjusting for age, height and weight to determine deficits in bone volume and vBMD at the spine and femoral neck between men with spinal fractures due to primary osteoporosis, FDMR and normal men. RESULTS Men with osteoporosis had a tendency to smaller bone volume in the spine and femoral neck (P = 0.08 and P = 0.09, respectively) and lower volumetric bone density at the spine (by about 50%) and femoral neck (by about 30%) compared with healthy controls (P < 0.0001). FDMR had no deficit in bone volume but did have lower volumetric density at the spine (by 10.2%) compared with healthy controls (P < 0.0001). CONCLUSIONS A deficit in bone mineral accrual may underlie the pathogenesis of primary osteoporosis in men, resulting in low vBMD. This is likely to be determined by genetic factors, although shared common environmental factors may also be important.
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Affiliation(s)
- Bircan Erbas
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health, University of Melbourne, Parkville, Australia
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Duan Y, Duboeuf F, Munoz F, Delmas PD, Seeman E. The fracture risk index and bone mineral density as predictors of vertebral structural failure. Osteoporos Int 2006; 17:54-60. [PMID: 16021527 DOI: 10.1007/s00198-005-1893-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2004] [Accepted: 02/23/2005] [Indexed: 10/25/2022]
Abstract
Structural failure becomes increasingly likely as the load on bone approximates or exceeds the bone's ability to withstand it. The vertebral fracture risk index (FRI) expresses the risk for structural failure as a ratio of compressive stress (load per unit area) to estimated failure stress, and so should be a more sensitive and specific predictor of vertebral fracture than spine areal BMD (aBMD) or volumetric BMD (vBMD), surrogates of bone strength alone. To address this issue, we analyzed the results of a case-control study of 89 postmenopausal women with vertebral fractures and 306 controls in Melbourne, Australia, and a 10-year community-based prospective study in which 30 postmenopausal women who had incident vertebral fractures were compared with 150 controls in Lyon, France. The FRI and vBMD of the third lumbar vertebral body and spine aBMD were derived using dual X-ray absorptiometry. In the cross-sectional analysis, each SD increase in FRI was associated with 2.1-fold (95% confidence interval [CI], 1.55-2.73) increased vertebral fracture risk, while each SD decrease in aBMD or vBMD was associated with 4.0-fold (95% CI, 2.69-6.18 and 2.65-6.94, respectively) increase in risk. Using receiver operating characteristic (ROC) analysis, the FRI was less sensitive and specific than aBMD in discriminating cases and controls (area under ROC, 0.76 vs 0.84, p<0.01). The area under ROC curve did not differ between FRI and vBMD (0.76 vs 0.79, NS). In the prospective data set, the FRI was not predictive [hazard ratio, HR, 1.20 (95% CI, 0.9-1.7)] and was in contrast to aBMD [HR, 2.4 (95% CI, 1.5-3.8)] and vBMD [HR, 2.1 (95% CI, 1.39-3.17)]. There was also lower sensitivity using a cutoff value of FRI>or=1 compared with aBMD T-score of -2.5 SD in both studies. There was poor agreement (kappa=0.13-0.18) between FRI and aBMD T -scores in detecting fractures; each method only identified around 50% of fractured cases. Within the constraints of the sample size, we concluded that applying a biomechanical index such as FRI at the spine is no better in discriminating fracture cases and controls than conventional aBMD or vBMD. The FRI may not predict incident vertebral fractures.
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Affiliation(s)
- Yunbo Duan
- Department of Endocrinology, Austin Health, The University of Melbourne, 3084, Melbourne, Australia.
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Kolta S, Le Bras A, Mitton D, Bousson V, de Guise JA, Fechtenbaum J, Laredo JD, Roux C, Skalli W. Three-dimensional X-ray absorptiometry (3D-XA): a method for reconstruction of human bones using a dual X-ray absorptiometry device. Osteoporos Int 2005; 16:969-76. [PMID: 15599494 DOI: 10.1007/s00198-004-1782-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Accepted: 09/22/2004] [Indexed: 12/13/2022]
Abstract
Three-dimensional accurate evaluation of the geometry of the proximal femur may be helpful for hip fracture risk evaluation. The purpose of this study was to apply and validate a stereo-radiographic 3D reconstruction method of the proximal femur, using contours identification from biplanar DXA images. Twenty-five excised human proximal femurs were investigated using a standard DXA unit. Three-dimensional personalized models were reconstructed using a dedicated non-stereo corresponding contours (NSCC) algorithm. Three-dimensional CT-scan reconstructions obtained on a clinical CT-scan unit were defined as geometric references for the comparison protocol, in order to assess accuracy and reproducibility of the 3D stereo-radiographic reconstructions. The precision of a set of 3D geometric parameters (femoral-neck axis length, mid-neck cross-section area, neck-shaft angle), obtained from stereo-radiographic models was also evaluated. This study shows that the NSCC method may be applied to obtain 3D reconstruction from biplanar DXA acquisitions. Applied to the proximal femur, this method showed good accuracy as compared with high-resolution personalized CT-scan models (mean error = 0.8 mm). Moreover, precision study for the set of 3D parameters yielded coefficients of variation lower than 5%. This is the first study providing 3D geometric parameters from standard 2D DXA images using the NSCC method. It has good accuracy and reproducibility in the present study on cadaveric femurs. In vivo prospective studies are needed to evaluate its discriminating potential on hip fracture risk prediction.
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Affiliation(s)
- S Kolta
- Rheumatology Department, Cochin Hospital, Assistance Publique, Hôpitaux de Paris-Université René Descartes, Paris, France.
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Lei SF, Deng FY, Xiao SM, Chen XD, Deng HW. Association and haplotype analyses of the COL1A2 and ER-alpha gene polymorphisms with bone size and height in Chinese. Bone 2005; 36:533-41. [PMID: 15777651 DOI: 10.1016/j.bone.2004.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Revised: 11/01/2004] [Accepted: 11/09/2004] [Indexed: 11/23/2022]
Abstract
Bone size (BS) is another risk factor of fracture independent of BMD in determining bone strength, and height is highly related with BS. To test the effect of the estrogen receptor-alpha (ER-alpha) and collagen type I alpha 2 (COL1A2) genes on the variation of BS and height, we genotyped the PvuII and XbaI polymorphisms in the intron 1 of the ER-alpha gene and the MspI and (GT)n markers in the intron 47 and intron 1 of the COL1A2 gene in 400 Chinese nuclear families with a total of 1256 individuals. The BS at the hip and spine was measured using a Hologic QDR 2000 dual-energy X-ray absorptiometry (DXA) scanner. Population stratification, total-family association, and within-family association were used to test the relationship of BS (at the spine and hip) and height with the four polymorphisms. We also performed these association analyses with the haplotypes of the MspI and (GT)n polymorphisms in the COL1A2 gene, and with the haplotypes of the PvuII and XbaI markers in the ER-alpha gene. Weak within-family association was found between the COL1A2-MspI (P = 0.05) and the femoral neck BS, between the ER-alpha-PX (P = 0.04) and the intertrochanter BS, and between the COL1A2-(GT)(17) (P = 0.02), COL1A2-m(GT)(17) (P = 0.009) and height. Subsequent permutation tests generally confirmed the suggestive within-family association. For the weak within-family association, the proportions of phenotypic variance accounted by the COL1A2-MspI, ER-alpha-PX, COL1A2-(GT)(17), COL1A2-m(GT)(17) markers were 1.50%, 1.51%, 2.15%, and 2.43% for the corresponding phenotypes. The association results indicate that the (GT)n and MspI markers of COL1A2 gene may have some influence on the variation of both BS and height, and the XbaI and PvuII markers of ER-alpha gene may have some effect on the variation of height in Chinese but not on the variation of BS.
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Affiliation(s)
- Shu-Feng Lei
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, P. R. China
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Lei SF, Wang YB, Liu MY, Mo XY, Deng HW. The VDR, COL1A1, PTH, and PTHR1 gene polymorphisms are not associated with bone size and height in Chinese nuclear families. J Bone Miner Metab 2005; 23:501-5. [PMID: 16261459 DOI: 10.1007/s00774-005-0635-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 04/08/2005] [Indexed: 10/25/2022]
Abstract
We tested the relationship of the ApaI, Eco31I, BstBI, and (AAAG)n polymorphisms in the vitamin D receptor (VDR), collagen type I alpha-1 (COL1A1), parathyroid hormone (PTH), and parathyroid hormone (PTH)/PTH-related peptide receptor (PTHR1) genes with variations in bone size (BS) and height. Population stratification, total-family association, and within-family association were used to test these relationships in 400 Chinese nuclear families with a total of 1256 individuals. The BS at hip and spine was measured using a Hologic QDR 2000 dual-energy X-ray absorptiometry (DXA) scanner. The minor allele frequencies were 29.2%, 36.0%, and 14.0% for the VDR-ApaI, COL1A1-Eco31I, and PTH-BstBI markers, respectively. (AAAG)5 and (AAAG)6 of the PTHR1 gene are two major alleles in the Chinese people. Significant population stratification was found between the spine BS and PTHR1-(AAAG)5 (P = 0.048) and PTHR1-(AAAG)6 (P = 0.023), as well as between PTHR1-(AAAG)5 and height (P = 0.048), but we did not detect any significant within-family association or total-family association between the VDR, COL1A1, PTH, and PTHR1 gene polymorphisms and the variations in BS and height in our sample. Our results do not support that the VDR, COL1A1, PTH, and PTHR1 genes have an important influence on the variation in BS and height in our Chinese population.
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Affiliation(s)
- Shu-Feng Lei
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, 410081, PR China
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Ho AYY, Kung AWC. Determinants of peak bone mineral density and bone area in young women. J Bone Miner Metab 2005; 23:470-5. [PMID: 16261454 DOI: 10.1007/s00774-005-0630-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Accepted: 06/08/2005] [Indexed: 10/25/2022]
Abstract
Osteoporosis is a disease caused by compromised bone strength, and individuals with a high peak bone mass at a young age are likely to have a high bone mass in old age. To identify the clinical determinants of peak bone mass in young adult women, 418 southern Chinese women, aged 20-39 years, were studied. Low bone mass was defined as areal bone mineral density (aBMD) Z-score < -1 at either the spine or total hip. Within the cohort, 62 (19.0%) and 86 (26.4%) women had low aBMD at the spine and hip, respectively. Regression model analysis revealed that low body weight (<44 kg) was associated with an 8.3-fold (95% CI, 3.7-18.9) and a 6.8-fold (95% CI, 3.0-15.6) risk of having low aBMD at the spine and hip, respectively. Low body weight was also predictive of low volumetric BMD (vBMD) at the spine (odds ratio (OR) 7.8, 95% CI, 3.1-20.1) and femoral neck (OR 3.0, 95% CI, 1.3-7.1). A body height below 153 cm was associated with a 4.8-fold risk in the small L2-4 bone area (95% CI, 2.3-9.8) and a 3.9-fold risk in the small femoral neck area (95% CI, 1.9-8.1). Delayed puberty (onset of menstruation beyond 14 years) was associated with a 2.2-fold (95% CI, 1.0-4.9) increased risk of having low aBMD at the hip. Physical inactivity was associated with a 2.8-fold risk of low spine vBMD (OR 2.8, 95% CI, 1.1-6.7) and a 3.3-fold risk of low hip aBMD (95% CI, 1.0-10.0). Pregnancy protected against low spine aBMD (OR 0.4, 95% CI, 0.1-1.2) and spine vBMD (OR 0.1, 95% CI, 0.0-1.0), low femoral neck vBMD (OR 0.3, 95% CI, 0.1-1.1) and small L2-4 bone area vBMD (OR 0.3, 95% CI, 0.1-1.1). In conclusion, this study identified a number of modifiable determinants of low peak bone mass in young adult women. Maintaining an ideal body weight, engaging in an active lifestyle, and diagnosing late menarche may enable young women to maximize their peak bone mass and so reduce their risk of osteoporosis in later life.
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Affiliation(s)
- Andrew Y Y Ho
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
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Zhang YY, Liu PY, Lu Y, Davies KM, Dvornyk V, Recker RR, Deng HW. Race and sex differences and contribution of height: A study on bone size in healthy Caucasians and Chinese. Am J Hum Biol 2005; 17:568-75. [PMID: 16136538 DOI: 10.1002/ajhb.20427] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Osteoporosis is characterized by a loss of bone strength, of which bone size (BS) is an important determinant. However, studies on the factors determining BS are relatively few. The present study evaluated the independent effects of height, age, weight, sex, and race on areal BS at the hip and spine, measured by dual-energy X-ray absorptiometry, while focusing on the differential contributions of height to BS across sex, race, and skeletal site. The subjects were aged 40 years or older, including 763 Chinese (384 males and 379 females) from Shanghai, People's Republic of China, and 424 Caucasians (188 males and 236 females) from Omaha, Nebraska. Basically, Caucasians had significantly larger BS than Chinese. After adjusting for height, age, and weight, the Chinese had similar spine BS, but significantly larger intertrochanter BS in both sexes and larger total hip BS in females compared with Caucasians. Males had significantly larger BS than females before and after adjustment in both ethnic groups. The effects of age, weight, and race varied, depending on skeletal site. As expected, height had major effects on BS variation in both sexes and races. Height tended to account for larger BS variation at the spine than at the hip (except for Chinese females), and larger BS variation in Caucasians than in Chinese of the same sex (except for the trochanter in females). We conclude that height is a major predictor for BS, and its contributions vary across sex, race, and skeletal site.
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Affiliation(s)
- Yuan-Yuan Zhang
- Osteoporosis Research Center, Creighton University, Omaha, Nebraska 68131, USA
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Jian WX, Long JR, Deng HW. High heritability of bone size at the hip and spine in Chinese. J Hum Genet 2004; 49:87-91. [PMID: 14727155 DOI: 10.1007/s10038-003-0113-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2003] [Accepted: 11/13/2003] [Indexed: 10/26/2022]
Abstract
Bone size, an independent determinant of bone strength, is an important risk factor for osteoporotic fracture. In the present study, we investigated the magnitude of the genetic determination of bone size at the spine and hip and their genetic covariation (if any) in a population of Chinese residing in Shanghai City of P.R. China. The subjects were 50 healthy full-sib pairs of females, 188 mother-daughter pairs, and 128 husband-wife pairs selected from 401 nuclear families. Bone size (centimeters squared) was measured at the spine and hip by dual-energy X-ray absorptiometry (DEXA). The narrow-sense heritabilities h2 (SE) of bone size at the spine and hip were 0.63 (0.14) and 0.45 (0.14) respectively when estimated by full-sib pairs, and 0.60 (0.07) and 0.69 (0.07) respectively when estimated by mother-daughter pairs. Marginally significant genetic correlation was observed between the spine and hip bone size. The significantly and moderately high h2 values for bone size demonstrated in this study warrant a subsequent genetic study to search for the genes or genomic regions underlying the phenotype in Chinese.
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Affiliation(s)
- Wei-Xia Jian
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, 410081, Changsha Hunan, P.R. China
| | - Ji-Rong Long
- Osteoporosis Research Center and Department of Biomedical Sciences, Suite 6787, Creighton University, 601 N. 30th St., Omaha, NE 68131, USA
| | - Hong-Wen Deng
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, 410081, Changsha Hunan, P.R. China.
- Osteoporosis Research Center and Department of Biomedical Sciences, Suite 6787, Creighton University, 601 N. 30th St., Omaha, NE 68131, USA.
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Bachrach LK, Neely EK. Pitfalls in the hunt for osteoporosis. Am J Med 2003; 115:322-3. [PMID: 12967698 DOI: 10.1016/s0002-9343(03)00401-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
STUDY DESIGN Biomechanical properties within cadaveric vertebral bodies were parametrically studied using finite element analysis after calibration to experimental data. OBJECTIVES To develop and validate three-dimensional finite element models of the human thoracolumbar spine based on quantitative computed tomography scans. Specifically, combine finite element modeling together with biomechanical testing circumventing problems associated with direct measurements of shell properties. SUMMARY OF BACKGROUND DATA Finite element methods can help to understand injury mechanisms and stress distribution patterns within vertebral bodies as an important part in clinical evaluation of spinal injuries. Because of complications in modeling the vertebral shell, it is not clear if quantitative computed tomography-based finite element models of the spine could accurately predict biomechanical properties. METHODS We developed a novel finite element modeling technique based on quantitative computed tomography scans of 19 radiographically normal human vertebra bodies and mechanical property data from empirical studies on cylindrical trabecular bone specimens. Structural properties of the vertebral shell were recognized as parametric variables and were calibrated to provide agreement in whole vertebral body stiffness between model and experiment. The mean value of the shell properties thus obtained was used in all models to provide predictions of whole vertebral strength and stiffness. RESULTS Calibration of n = 19 computer models to experimental stiffness yielded a mean effective modulus of the vertebral shell of 457 +/- 931 MPa ranging from 9 to 3216 MPa. No significant correlation was found between vertebral shell effective modulus and either the experimentally measured stiffness or the average trabecular modulus. Using the effective vertebral shell modulus for all 19 models, the predicted vertebral body stiffness was an excellent predictor of experimental measurements of both stiffness (r2= 0.81) and strength (r2 = 0.79). CONCLUSION These findings indicate that modeling of the vertebral shell using a constant thickness of 0.35 mm and an effective modulus of 457 MPa, combined with quantitative computed tomography-based modeling of trabecular properties and vertebral geometry, can accurately predict whole vertebral biomechanical properties. Use of this modeling technique, therefore, should produce substantial insight into vertebral body biomechanical behavior and may ultimately improve clinical indications of fracture risk of this cohort.
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Van Pottelbergh I, Goemaere S, Zmierczak H, De Bacquer D, Kaufman JM. Deficient acquisition of bone during maturation underlies idiopathic osteoporosis in men: evidence from a three-generation family study. J Bone Miner Res 2003; 18:303-11. [PMID: 12568407 DOI: 10.1359/jbmr.2003.18.2.303] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To address the issue whether deficient acquisition of bone during maturation or adult-onset bone loss is primarily to blame for idiopathic osteoporosis in men, we assessed indices of bone mineral density and size, as well as biochemical markers of bone turnover in 61 probands (ages 20-65 years) with idiopathic osteoporosis (z-score < or = -2.0 at the spine or hip), their first-degree relatives (n = 130), and age-matched controls. There was no indication of accelerated bone loss. Indeed, in probands, the observed bone deficit versus controls was unrelated to the age of probands, and indices of bone turnover were not significantly different from controls. On the other hand, a specific deficit in bone acquisition was suggested by findings of lower bone mineral density values in three generations of male and female relatives of the probands, including their offspring; bone turnover in relatives was not different from controls. The bone mineral density deficit was more pronounced in male compared with female relatives; approximately 60% of the sons had a spinal bone mineral density z-score of less than -2.0. There also was a skeletal site-specificity in probands and their male relatives with a larger areal bone mineral density deficit at the spine compared with the hip and the forearm. The deficit at the spine corresponded to a reduction of both volumetric bone mineral density and bone size; a similar less pronounced deficit in volumetric bone mineral density, but not in bone size, was observed at the femoral neck. These findings in probands and their first-degree relatives point toward a major contributory role of a genetically determined maturational defect in bone acquisition in the pathogenesis of idiopathic osteoporosis in men.
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Affiliation(s)
- I Van Pottelbergh
- Department of Endocrinology, Ghent University Hospital, De Pintelaan, Ghent, Belgium.
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Nakamura O, Ishii T, Ando Y, Amagai H, Oto M, Imafuji T, Tokuyama K. Potential role of vitamin D receptor gene polymorphism in determining bone phenotype in young male athletes. J Appl Physiol (1985) 2002; 93:1973-9. [PMID: 12391072 DOI: 10.1152/japplphysiol.00663.2002] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The genetic difference among individuals partly explains variance in adaptive response to exercise through gene-environment interaction. The aim of this cross-sectional study was to evaluate the role of the vitamin D receptor (VDR) gene polymorphism, which locates at the translation initiation site, in the adaptations of bone to long-term impact loading. The VDR genotypes, as detected by endonuclease Fok I, and bone phenotypes of the lumbar spine and femoral neck were examined in 44 highly trained young male athletes and 44 age-matched nonathletic controls. As a whole, the athletes had a significantly higher bone mineral content resulting from a combination of increased volume and density at both sites than the controls. When the athletes were compared with the controls within each VDR genotype, however, the increased spinal volume was found only in the athletes with the FF but not in those with the Ff genotype("F" for the absence of the endonuclease Fok I restriction site and "f" for its presence). Differences in bone mineral content in the lumbar spine and femoral neck between the controls and the athletes were greater in subjects with FF than those with Ff. Our results suggest a gene-environment interaction in that the bone phenotypes in individuals with FF adapt to impact loading by producing stronger bone structure than those with the Ff do.
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Ambrose CG, Kiebzak GM, Sabonghy EP, Tabor OB, Peindl RD, Clanton TO, Anderson RA, Davis WH. Biomechanical testing of cadaveric specimens: importance of bone mineral density assessment. Foot Ankle Int 2002; 23:850-5. [PMID: 12356184 DOI: 10.1177/107110070202300913] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The bone density of cadaveric specimens is highly variable and has a significant effect on the results of biomechanical testing but it is not often assessed before testing is performed in the lab. Bone mineral density (BMD) tests such as dual X-ray absorptiometry (DXA) are widely available, easy to perform and correlate highly and significantly with bone strength in many modes of failure. We present the results of two different studies performed on cadaveric foot and ankle specimens. In these studies the results vary significantly according to BMD, and this effect is not always eliminated with the use of matched pairs of cadaveric specimens.
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Affiliation(s)
- Catherine G Ambrose
- Department of Orthopaedics, University of Texas Houston Health Science Center, 77030, USA.
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Lau HHL, Ho AYY, Luk KDK, Kung AWC. Estrogen receptor beta gene polymorphisms are associated with higher bone mineral density in premenopausal, but not postmenopausal southern Chinese women. Bone 2002; 31:276-81. [PMID: 12151079 DOI: 10.1016/s8756-3282(02)00827-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Bone mineral density (BMD), the main determining risk factor for osteoporotic fractures, has a strong genetic component. Estrogen and its receptors play a critical role in both skeletal maturity and bone loss. We investigated the association between dinucleotide (cytosine-adenine; CA) repeat polymorphisms located in the flanking region of the estrogen receptor beta gene and bone mineral density (BMD) in 325 healthy southern Chinese women. BMD at the lumbar spine and hip region were measured using dual-energy X-ray absorptiometry (DEXA). The number of the repeats observed in our population ranged from 16 to 28. After adjusting for age, height, weight, and years of estrogen exposure, we observed that premenopausal subjects (n = 120) bearing at least one allele of 20 CA repeats had significantly higher BMD at the L2-4 lumbar spine (1.049 +/- 0.016 vs. 0.984 +/- 0.015; p = 0.01), total hip (0.836 +/- 0.014 vs. 0.813 +/- 0.013; p < 0.02), femoral neck (0.773 +/- 0.014 vs. 0.728 +/- 0.013; p = 0.02), trochanter (0.665 +/- 0.013 vs. 0.614 +/- 0.012; p = 0.01), and Ward's triangle (0.715 +/- 0.017 vs. 0.651 +/- 0.016; p = 0.02). There was no difference in the vertebral area of L-3 and femoral neck width in these premenopausal women with or without 20 CA repeats. However, in postmenopausal women (n = 205), Estrogen receptor beta (ER beta) gene polymorphisms were not related to BMD at any skeletal site. We conclude that ER beta gene polymorphisms are associated with higher BMD in premenopausal women, suggesting that the ER beta gene may have a modulatory role in bone metabolism in young adulthood.
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Affiliation(s)
- H H L Lau
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, PRC
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Koo WWK, Hammami M, Hockman EM. Use of fan beam dual energy x-ray absorptiometry to measure body composition of piglets. J Nutr 2002; 132:1380-3. [PMID: 12042462 DOI: 10.1093/jn/132.6.1380] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A piglet model was used to determine whether the fan beam dual energy X-ray absorptiometry technique (DXA) could be adapted for the measurement of body composition of small subjects. Commercial domestic swine piglets (n = 14) with weights between 1.95 and 21.1 kg had duplicate fan beam-DXA scans followed by chemical analysis of body composition. Each scan required 2-3 min to complete. DXA-measured total body weight was validated against scale weights of the piglets (with and without blanket and other covering), DXA bone mineral content validated against carcass ash and calcium, and DXA lean and fat mass validated against chemical lean and fat contents. Measurements from duplicate DXA scans were highly reproducible with adjusted r(2) values from 0.992 to 1.000. Each DXA measurement was highly predictive of the scale weight or specific chemical body composition with adjusted r(2) values from 0.974 to 0.999. The intraclass reliability coefficient among measurements from individual scans with scale weight or the weight of individual chemical components was extremely high at > or =0.99 for all comparisons. The SD of residuals for DXA prediction of scale weights (with and without covering) were 168 and 157 g, respectively, and were 27, 8.8, 122 and 72 g for the prediction of carcass ash, calcium, lean and fat tissue content, respectively. We conclude that rapid scan acquisition, accurate and precise prediction of scale weight and components of body composition would support the use of fan beam-DXA for body composition studies in growing humans or animals.
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Affiliation(s)
- Winston W K Koo
- Department of Pediatrics, Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.
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Boyanov M, Papivanov P, Gentchev G. Assessment of forearm volumetric bone mineral density from standard areal densitometry data. J Clin Densitom 2002; 5:391-402. [PMID: 12665640 DOI: 10.1385/jcd:5:4:391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2001] [Revised: 02/19/2002] [Accepted: 02/22/2002] [Indexed: 11/11/2022]
Abstract
The common bone density measurement procedures produce areal bone mineral density data (BMD) alone. Volumetric bone density is thought to offer a different diagnostic perspective and is usually measured by peripheral quantitative computed tomography. We developed a calculation procedure for radial and ulnar volumetric densities based on single X-ray absorptiometry. The study consisted of 418 healthy Bulgarian females (ages 20 83 yr). Forearm bone density was measured on a DTX-100 densitometer at the 8-mm distal site, and the total volumetric bone densities of radius and ulna were calculated. The accuracy error determined on cadaveric bones was 10 14%. The in vivo precision error was 1.0 1.1%. Age-matched reference curves for volumetric BMD (vBMD) were built. Peak values were registered in the age 30 34 group: 0.403 (radius) and 0.469 g/cm(3) (ulna). Ulnar volumetric density exceeded the radial one, representing an interesting finding to be further investigated. For the age 70 74 group, vBMD was reduced by approx 30% compared with the age 30 34 group. Our data confirmed the fact that volumetric density was much less affected by age and menopause. Correlations between forearm vBMD and axial BMD were moderate. The proposed calculation procedure could become an extra option in forearm bone densitometry to be applied in pediatric populations or adults of extremely large or small body size.
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Affiliation(s)
- Mihail Boyanov
- Endocrinology Clinic, Alexandrov's University Hospital, Medical University of Sofia, Bulgaria.
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Duan Y, Turner CH, Kim BT, Seeman E. Sexual dimorphism in vertebral fragility is more the result of gender differences in age-related bone gain than bone loss. J Bone Miner Res 2001; 16:2267-75. [PMID: 11760841 DOI: 10.1359/jbmr.2001.16.12.2267] [Citation(s) in RCA: 149] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spine fractures usually occur less commonly in men than in women. To identify the structural basis for this gender difference in vertebral fragility, we studied 1013 healthy subjects (327 men and 686 women) and 76 patients with spine fractures (26 men and 50 women). Bone mineral content (BMC), cross-sectional area (CSA), and volumetric bone mineral density (vBMD) of the third lumbar vertebral body (L3) were measured by posteroanterior (PA) and lateral scanning using dual-energy X-ray absorptiometry (DXA). In this cross-sectional study, the diminution in peak vertebral body BMC from young adulthood to old age was less in men than in women (6% vs. 27%). This diminution was the net result of two opposing changes occurring concurrently throughout adult life: the removal of bone adjacent to marrow on the inner (endosteal) surface by bone resorption and the deposition of bone on the outer (periosteal) surface by bone formation. For L3, we estimated that men resorbed 3.7 g and deposited 3.1 g, producing a net loss of 0.6 g from young adulthood to old age and women resorbed 3.1 g and deposited only 1.2 g, producing a net loss of 1.9 g. Thus, based on our indirect estimates of periosteal gain and endosteal loss across life, the observed net diminution in BMC during aging was less in men than women because absolute periosteal bone formation was greater in men than women (3.1 g vs. 1.2 g) not because absolute bone resorption was less in men. On the contrary, the absolute amount of bone resorbed was greater in men than women (3.7 g vs. 3.1 g). Periosteal bone formation also increased vertebral body CSA 3-fold more in men than in women, distributing loads onto a larger CSA, so that the load imposed per unit CSA decreased twice as much in men than in women (13% vs. 5%). In men and women with spine fractures, CSA and vBMD were reduced relative to age-matched controls. However, vBMD was no different to the adjusted vBMD in age-matched controls derived assuming controls had no periosteal bone formation during aging. Thus, large amounts of bone are resorbed in men as well as in women, accounting for the age-related increase in spine fractures in both genders. Periosteal bone formation increases CSA and offsets bone loss in both genders but more greatly in men, accounting for the lower incidence of spine fractures in men than in women. We speculate that reduced periosteal bone formation, during growth or aging, may be in part responsible for both reduced vertebral size and reduced vBMD in men and women with spine fractures. Sexual dimorphism in vertebral fragility is more the result of gender differences in age-related bone gain than age-related bone loss.
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Affiliation(s)
- Y Duan
- Department of Endocrinology, Austin and Repatriation Medical Center, University of Melbourne, Heidelberg, Australia
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Abstract
The aim of this study was to quantify the biomechanical basis for vertebral fracture risk in elderly men and women. A bone is likely to fracture when the loads imposed are similar to or greater than its strength. To quantify this risk, we developed a fracture risk index (FRI) based on the ratio of the vertebral body compressive load and strength. Loads were determined by upper body weight, height, and the muscle moment arm, and strength was estimated from cross-sectional area (CSA) and volumetric bone mineral density (vBMD). With loads less than the strength of the bone, the FRI remains < 1. For any given load, once bone strength diminishes due to a falling vBMD, the FRI will increase. Should FRI approach or exceed unity, structural failure of the vertebra is likely. We measured vertebral body CSA vBMD of the middle zone of third lumbar vertebra by lateral and posteroanterior (PA) scanning using dual-energy X-ray absorptiometry (DXA) and calculated vertebral compressive stress (load per unit area) in 327 healthy men and 686 healthy women and 26 men and 55 postmenopausal women with vertebral fractures. Activities that require forward bending of the upper body caused approximately 10-fold more compressive stress on the vertebra compared with standing upright. Men and women had similar peak vBMD in young adulthood. Because men have greater stature than women, the loads imposed on the vertebral body are higher (3,754 +/- 65 N vs. 3,051 +/- 31 N; p < 0.001). However, because CSA also was higher in men than women, peak load per unit CSA (stress) did not differ by gender (317.4 +/- 4.7 N/cm2 vs. 321.9 +/- 3.3 N/cm2, NS). The FRI was similar in young men and women and well below unity (0.42 +/- 0.02 vs. 0.43 +/- 0.01; NS). Gender differences emerged during aging; CSA increased in both men and women but more so in men, so load per unit area (stress) diminished but more so in men than in women. vBMD decreased in both genders but less so in men. These changes were captured in the FRI, which increased by only 21% in men and by 102% in women so that only 9% of elderly men but 26% of elderly women had an FRI > or = 1. Men and women with vertebral fractures had an FRI that was greater than or equal to unity (1.03 +/- 0.13 vs. 1.35 +/- 0.13; p < 0.05) and was 2.04 SD and 2.26 SD higher than age-matched men and women, respectively. In summary and conclusion, young men and women have a similar vBMD, vertebral stress, and FRI. During aging, CSA increases more, and vBMD decreases less in men than in women. Thus, fewer men than women are at risk for fracture because fewer men than women have these structural determinants of bone strength below a level at which the loads exceed the bone's ability to tolerate them. Men and women with vertebral fractures have FRIs that are equal to or exceed unity. The results show that a fracture threshold for vertebrae can be defined using established biomechanical principles; whether this approach has greater sensitivity and specificity than the current BMD T score of -2.5 SD is unknown.
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Affiliation(s)
- Y Duan
- Department of Endocrinology, Austin and Repatriation Medical Center, University of Melbourne, Australia
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