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Wang H, Ding K, Zhang Y, Ren C, Huo H, Zhu Y, Zhang Q, Chen W. A Controlled Variable Study of the Biomechanical Properties of the Proximal Femur before and after Cancellous Bone Removal. Orthop Surg 2024; 16:1215-1229. [PMID: 38520122 PMCID: PMC11062879 DOI: 10.1111/os.14044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE The biomechanical characteristics of proximal femoral trabeculae are closely related to the occurrence and treatment of proximal femoral fractures. Therefore, it is of great significance to study its biomechanical effects of cancellous bone in the proximal femur. This study examines the biomechanical effects of the cancellous bone in the proximal femur using a controlled variable method, which provide a foundation for further research into the mechanical properties of the proximal femur. METHODS Seventeen proximal femoral specimens were selected to scan by quantitative computed tomography (QCT), and the gray values of nine regions were measure to evaluated bone mineral density (BMD) using Mimics software. Then, an intact femur was fixed simulating unilateral standing position. Vertical compression experiments were then performed again after removing cancellous bone in the femoral head, femoral neck, and intertrochanteric region, and data were recorded. According to the controlled variable method, the femoral head, femoral neck, and intertrochanteric trabeculae were sequentially removed based on the axial loading of the intact femur, and the displacement and strain changes of the femur samples under axial loading were recorded. Gom software was used to measure and record displacement and strain maps of the femoral surface. RESULTS There was a statistically significant difference in anteroposterior displacement of cancellous bone destruction in the proximal femur (p < 0.001). Proximal femoral bone mass explained 77.5% of the strength variation, in addition proximal femoral strength was mainly affected by bone mass at the level of the upper outer, lower inner, lower greater trochanter, and lesser trochanter of the femoral head. The normal stress conduction of the proximal femur was destroyed after removing cancellous bone, the stress was concentrated in the femoral head and lateral femoral neck, and the femoral head showed a tendency to subside after destroying cancellous bone. CONCLUSION The trabecular removal significantly altered the strain distribution and biomechanical strength of the proximal femur, demonstrating an important role in supporting and transforming bending moment under the vertical load. In addition, the strength of the proximal femur mainly depends on the bone density of the femoral head and intertrochanteric region.
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Affiliation(s)
- Haicheng Wang
- CangZhou Hospital of Integrated TCM‐WM in HebeiCangzhou CityChina
| | - Kai Ding
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Chuan Ren
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Haoyu Huo
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Qi Zhang
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
| | - Wei Chen
- Department of Orthopedic SurgeryHebei Medical University Third HospitalShijiazhuangChina
- NHC Key Laboratory of Intelligent Orthopedic EquipmentHebei Medical University Third HospitalShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceShijiazhuangChina
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Huo M, He S, Zhang Y, Liu Q, Liu M, Zhou G, Zhou P, Lu J. Mechano-driven intervertebral bone bridging via oriented mechanical stimulus in a twist metamaterial cage: An in silico study. Comput Biol Med 2024; 171:108149. [PMID: 38401455 DOI: 10.1016/j.compbiomed.2024.108149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/11/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
Stiffer cages provide sufficient mechanical support but fail to promote bone ingrowth due to stress shielding. It remains challenging for fusion cage to satisfy both bone bridging and mechanical stability. Here we designed a fusion cage based on twist metamaterial for improved bone ingrowth, and proved its superiority to the conventional diagonal-based cage in silico. The fusion process was numerically reproduced via an injury-induced osteogenesis model and the mechano-driven bone remodeling algorithm, and the outcomes fusion effects were evaluated by the morphological features of the newly-formed bone and the biomechanical behaviors of the bone-cage composite. The twist-based cages exhibited oriented bone formation in the depth direction, in comparison to the diagonal-based cages. The axial stiffness of the bone-cage composites with twist-based cages was notably higher than that with diagonal-based cages; meanwhile, the ranges of motion of the twist-based fusion segment were lower. It was concluded that the twist metamaterial cages led to oriented bone ingrowth, superior mechanical stability of the bone-cage composite, and less detrimental impacts on the adjacent bones. More generally, metamaterials with a tunable displacement mode of struts might provide more design freedom in implant designs to offer customized mechanical stimulus for osseointegration.
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Affiliation(s)
- Mengke Huo
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China; Department of Mechanical Engineering, City University of Hong Kong, Hong Kong, China; CityU-Shenzhen Futian Research Institute, Shenzhen, China
| | - Siyuan He
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China.
| | - Yun Zhang
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China; Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Qing Liu
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Mengxing Liu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd, Shenzhen, China; Wuhan Mindray Scientific Co., Ltd, Wuhan, China
| | - Guangquan Zhou
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Ping Zhou
- State Key Laboratory of Digital Medical Engineering, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Jian Lu
- Department of Mechanical Engineering, City University of Hong Kong, Hong Kong, China; CityU-Shenzhen Futian Research Institute, Shenzhen, China; Centre for Advanced Structural Materials, City University of Hong Kong Shenzhen Research Institute, Greater Bay Joint Division, Shenyang National Laboratory for Materials Science, Shenzhen, China
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Chan TJ, Rajapakse CS. A Super-Resolution Diffusion Model for Recovering Bone Microstructure from CT Images. Radiol Artif Intell 2023; 5:e220251. [PMID: 38074790 PMCID: PMC10698592 DOI: 10.1148/ryai.220251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 02/12/2024]
Abstract
Purpose To use a diffusion-based deep learning model to recover bone microstructure from low-resolution images of the proximal femur, a common site of traumatic osteoporotic fractures. Materials and Methods Training and testing data in this retrospective study consisted of high-resolution cadaveric micro-CT scans (n = 26), which served as ground truth. The images were downsampled prior to use for model training. The model was used to increase spatial resolution in these low-resolution images threefold, from 0.72 mm to 0.24 mm, sufficient to visualize bone microstructure. Model performance was validated using microstructural metrics and finite element simulation-derived stiffness of trabecular regions. Performance was also evaluated across a handful of image quality assessment metrics. Correlations between model performance and ground truth were assessed using intraclass correlation coefficients (ICCs) and Pearson correlation coefficients. Results Compared with popular deep learning baselines, the proposed model exhibited greater accuracy (mean ICC of proposed model, 0.92 vs ICC of next best method, 0.83) and lower bias (mean difference in means, 3.80% vs 10.00%, respectively) across the physiologic metrics. Two gradient-based image quality metrics strongly correlated with accuracy across structural and mechanical criteria (r > 0.89). Conclusion The proposed method may enable accurate measurements of bone structure and strength with a radiation dose on par with current clinical imaging protocols, improving the viability of clinical CT for assessing bone health.Keywords: CT, Image Postprocessing, Skeletal-Appendicular, Long Bones, Radiation Effects, Quantification, Prognosis, Semisupervised Learning Online supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Trevor J Chan
- From the Departments of Bioengineering (T.J.C.), Radiology (T.J.C., C.S.R.), and Orthopedic Surgery (C.S.R.), University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-6243
| | - Chamith S Rajapakse
- From the Departments of Bioengineering (T.J.C.), Radiology (T.J.C., C.S.R.), and Orthopedic Surgery (C.S.R.), University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-6243
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Biomechanical properties and clinical significance of cancellous bone in proximal femur: A review. Injury 2023:S0020-1383(23)00251-6. [PMID: 36922271 DOI: 10.1016/j.injury.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
Trabecular bone plays an important role in the load-bearing capacity of the femur. Understanding the structural characteristics, biomechanics, and mechanical conduction of the trabecular bone is of great value in studying the mechanism of fractures and formulating surgical plans. The past decade has witnessed unprecedented progress in imaging, biomechanics and finite element analysis techniques, translating into a better understanding of trabecular bone. This article reviews the research progress achieved over the years regarding femoral trabecular bone, especially on factors influencing the strength of the proximal femoral cancellous bone and cancellous bone microfractures and provides a comprehensive overview of the latest findings on proximal femoral trabecular bone and their clinical significance.
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Kim J, Chun BJ, Kim JJ. Quantitative Load Dependency Analysis of Local Trabecular Bone Microstructure to Understand the Spatial Characteristics in the Synthetic Proximal Femur. BIOLOGY 2023; 12:biology12020170. [PMID: 36829449 PMCID: PMC9953259 DOI: 10.3390/biology12020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023]
Abstract
Analysis of the dependency of the trabecular structure on loading conditions is essential for understanding and predicting bone structure formation. Although previous studies have investigated the relationship between loads and structural adaptations, there is a need for an in-depth analysis of this relationship based on the bone region and load specifics. In this study, the load dependency of the trabecular bone microstructure for twelve regions of interest (ROIs) in the synthetic proximal femur was quantitatively analyzed to understand the spatial characteristics under seven different loading conditions. To investigate the load dependency, a quantitative measure, called the load dependency score (LDS), was established based on the statistics of the strain energy density (SED) distribution. The results showed that for the global model and epiphysis ROIs, bone microstructures relied on the multiple-loading condition, whereas the structures in the metaphysis depended on single or double loads. These results demonstrate that a given ROI is predominantly dependent on a particular loading condition. The results confirm that the dependency analysis of the load effects for ROIs should be performed both qualitatively and quantitatively.
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Affiliation(s)
- Jisun Kim
- Department of Mechanical Engineering, Keimyung University, Daegu 42601, Republic of Korea
| | - Bong Ju Chun
- Cho Chun Shik Graduate School of Mobility, Korea Advanced Institute of Science and Technology (KAIST), Daejeon 34051, Republic of Korea
| | - Jung Jin Kim
- Department of Mechanical Engineering, Keimyung University, Daegu 42601, Republic of Korea
- Correspondence: ; Tel.: +82-53-580-5290; Fax: +82-53-715-2029
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Hoffmeister BK, Main EN, Newman WR, Ebron SC, Huang J. Frequency dependence of the ultrasonic power reflected from the water-tissue interface of human cancellous bone in vitro. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 152:2082. [PMID: 36319263 DOI: 10.1121/10.0014417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Numerous studies have performed in vitro ultrasonic measurements of cancellous bone in water to develop techniques for ultrasonic bone assessment. Because cancellous bone is a highly porous medium, ultrasonic reflections at the water-bone interface may be frequency dependent. The goal of this study was to investigate the effect of porosity on the frequency dependence of the reflected power. Ultrasonic measurements were performed in a water tank at room temperature on 15 specimens of cancellous bone prepared from the proximal end of 9 human femurs using single element, broadband transducers with center frequencies of 3.5, 5, 7.5, and 10 MHz. Power spectra of pulses reflected from the water-specimen interface were corrected for the frequency response of the measurement system to obtain the reflected power in decibels RdB(f). To suppress random phase cancellation effects, RdB(f) was averaged over multiple sites on multiple specimens. A frequency dependence of RdB(f) was observed in the 2.6-10 MHz range. The frequency dependence was moderate, with a maximum change of less than 6 dB over the entire frequency range. RdB(f) was greatest for low porosity specimens. The frequency averaged intensity reflection coefficient ranged from 7.4 × 10-4 to 7.8 × 10-3 for high and low porosity specimen groups, respectively.
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Affiliation(s)
| | - Evan N Main
- Department of Physics, Rhodes College, Memphis, Tennessee 38112, USA
| | - Will R Newman
- Department of Physics, Rhodes College, Memphis, Tennessee 38112, USA
| | - Sheldon C Ebron
- Department of Physics, Rhodes College, Memphis, Tennessee 38112, USA
| | - Jinsong Huang
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
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Simulation on bone remodeling with stochastic nature of adult and elderly using topology optimization algorithm. J Biomech 2022; 136:111078. [DOI: 10.1016/j.jbiomech.2022.111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022]
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Cvetković D, Jadžić J, Milovanović P, Djonić D, Djurić M, Ivović M, Nikolić S, Živković V. Comparative Analysis of Femoral Macro- and Micromorphology in Males and Females With and Without Hyperostosis Frontalis Interna: A Cross-Sectional Cadaveric Study. Calcif Tissue Int 2020; 107:464-473. [PMID: 32748007 DOI: 10.1007/s00223-020-00740-0] [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: 05/13/2020] [Accepted: 07/25/2020] [Indexed: 01/03/2023]
Abstract
We hypothesized that subjects with hyperostosis frontalis interna (HFI), which represents local, endocranial thickening of the frontal bone, would express extra-calvarial manifestations of this condition. Therefore, we compared femoral bone mineral density, geometry, and microarchitecture of males and females with HFI to those without this condition as well as between males and females with HFI. The sample was taken from human donor cadavers, 38 males (19 with and 19 without HFI) and 34 females (17 with and 17 without HFI) that were age-matched within the same sex. The specimens of femoral bones were scanned using microcomputed tomography and dual-energy X-ray absorptiometry (DXA). Parameters of hip structure analysis (HSA) were calculated from data derived from DXA scans. Females with HFI had increased cortical bone volume fraction and their cortical bone was less porous compared to females without HFI. Males with HFI showed microarchitectural differences only with the trabecular bone. They had increased bone volume fraction and decreased trabecular separation compared to males without HFI, although with borderline significance. These microarchitectural changes did not have significant impact on femoral geometry and bone mineral density. The same, still unknown etiological factor behind HFI might be inducing changes at the level of bone microarchitecture at a remote skeletal site (femoral bone), in both sexes. These alterations still do not have the magnitude to induce obvious, straightforward overall increase of bone mineral density measured by DXA. HFI could be a systemic phenomenon that affects both males and females in a similar manner.
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Affiliation(s)
- Danica Cvetković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia
| | - Jelena Jadžić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Petar Milovanović
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Danijela Djonić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Marija Djurić
- Laboratory for Anthropology and Skeletal Biology, Institute for Anatomy, University of Belgrade - School of Medicine, Dr. Subotica 4/2, 11000, Belgrade, Serbia
| | - Miomira Ivović
- Clinic for Endocrinology, Clinical Center of Serbia, Dr. Subotica 13, 11000, Belgrade, Serbia
| | - Slobodan Nikolić
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia
| | - Vladimir Živković
- Institute of Forensic Medicine, University of Belgrade - School of Medicine, 31a Deligradska Str., 11000, Belgrade, Serbia.
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Cirovic A, Cirovic A, Djonic D, Zivkovic V, Nikolic S, Djuric M, Milovanovic P. Three-Dimensional Microstructural Basis for Differential Occurrence of Subcapital versus Basicervical Hip Fractures in Men. Calcif Tissue Int 2020; 107:240-248. [PMID: 32601840 DOI: 10.1007/s00223-020-00717-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/20/2020] [Indexed: 12/29/2022]
Abstract
We analyzed the bone microarchitecture of the subcapital and basicervical subregions of the femoral neck in men, to determine whether microarchitectural differences of cortical or trabecular bone can explain differential frequency of subcapital vs. basicervical fractures, especially in aged persons. The study sample encompassed twenty male proximal femora obtained during autopsy. They were divided in two age groups: young (< 40 years, n = 10) and aged (> 60 years, n = 10). Micro-computed tomography was used to evaluate cortical and trabecular microarchitecture of the subcapital and basicervical regions of the superolateral femoral neck-typical fracture initiation site. Basicervical region showed significantly thicker and less porous cortex than subcapital region (p = 0.02, p < 0.001, respectively), along with increased distance between cortical pores (p = 0.004) and smaller pore diameters (p = 0.069). Higher trabecular number (Tb.N: p = 0.042), lower trabecular thickness (Tb.Th: p < 0.001), and lower trabecular separation (p = 0.003) were also hallmarks of the basicervical compared to subcapital region, although BV/TV was similar in both regions (p = 0.133). Age-related deterioration was mostly visible in trabecular bone (for BV/TV, Tb.Th, Tb.N and fractal dimension: p = 0.026, p = 0.049, p = 0.059, p = 0.009, respectively). Moreover, there were tendencies to age-specific patterns of trabecular separation (more pronounced inter-site differences in aged) and cortical thickness (more pronounced inter-site differences in young). Trabecular microarchitecture corresponded to cortical characteristics of each region. Our study revealed the microarchitectural basis for higher incidence of subcapital than basicervical fractures of the femoral neck. This is essential for better understanding of the fracture risk, as well as for future strategies to prevent hip fractures and their complications.
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Affiliation(s)
- Aleksandar Cirovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Ana Cirovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, 11000, Serbia
| | - Marija Djuric
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia
| | - Petar Milovanovic
- Laboratory for Anthropology and Skeletal Biology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, Dr Subotica 4/2, Belgrade, 11000, Serbia.
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Colabella L, Cisilino A, Fachinotti V, Capiel C, Kowalczyk P. Multiscale design of artificial bones with biomimetic elastic microstructures. J Mech Behav Biomed Mater 2020; 108:103748. [PMID: 32310104 DOI: 10.1016/j.jmbbm.2020.103748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/26/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
Cancellous bone is a highly porous, heterogeneous, and anisotropic material which can be found at the epiphyses of long bones and in the vertebral bodies. The hierarchical architecture makes cancellous bone a prime example of a lightweight natural material that combines strength with toughness. Better understanding the mechanics of cancellous bone is of interest for the diagnosis of bone diseases, the evaluation of the risk of fracture, and for the design of artificial bones and bone scaffolds for tissue engineering. A multiscale optimization method to maximize the stiffness of artificial bones using biomimetic cellular microstructures described by a finite set of geometrical micro-parameters is presented here. The most outstanding characteristics of its implementation are the use of: an interior point optimization algorithm, a precalculated response surface methodology for the evaluation of the elastic tensor of the microstructure as an analytical function of the micro-parameters, and the adjoint method for the computation of the sensitivity of the macroscopic mechanical response to the variation of the micro-parameters. The performance and effectiveness of the tool are evaluated by solving a problem that consists in finding the optimal distribution of the microstructures for a proximal end of a femur subjected to physiological loads. Two strategies for the specification of the solid volume fraction constraints are assessed. The results are compared with data of a computed tomography study of an actual human bone. The model successfully predicts the main features of the spatial arrangement of the trabecular and cortical microstructures of the natural bone.
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Affiliation(s)
- Lucas Colabella
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales (INTEMA), Universidad Nacional de Mar del Plata (UNMdP)/Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Juan B. Justo, 4302, Mar del Plata, Argentina.
| | - Adriáan Cisilino
- Instituto de Investigaciones en Ciencia y Tecnología de Materiales (INTEMA), Universidad Nacional de Mar del Plata (UNMdP)/Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Juan B. Justo, 4302, Mar del Plata, Argentina
| | - Victor Fachinotti
- Centro de Investigación de Métodos Computacionales (CIMEC), Universidad Nacional del Litoral (UNL)/Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Predio CCT-CONICET Santa Fe, Ruta 168, Paraje El Pozo, 3000, Santa Fe, Argentina
| | - Carlos Capiel
- Departmento de Radiología, Instituto Radiológico, Catamarca, 1542, Mar del Plata, Argentina
| | - Piotr Kowalczyk
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Pawinskiego 5B, 02-106, Warsaw, Poland
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11
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Liu G, Ge J, Zheng X, Wu C, Yan Q, Yang H, Zou J. Proximal femur lag screw placement based on bone mineral density determined by quantitative computed tomography. Exp Ther Med 2020; 19:2720-2724. [PMID: 32256754 DOI: 10.3892/etm.2020.8480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/22/2019] [Indexed: 01/23/2023] Open
Abstract
Following internal fixations for intertrochanteric fractures in elderly patients, lag screws or screw blades frequently cut the femoral head, leading to surgical failure. The bone mineral density (BMD) at various parts of the proximal femur is significantly correlated with the holding force of the lag screw, which in turn is closely associated with the stability of the fixation. However, the appropriate placement of the lag screw has been controversial. As a novel detection method for BMD, quantitative computed tomography (QCT) may provide relatively accurate measurements of three-dimensional structures and may provide an easy way to determine the appropriate lag screw placement. A total of 50 elderly patients with intertrochanteric fractures were selected for the present study. The BMD of the proximal femur on the healthy side, including the femoral intertrochanter, neck and head, was measured using QCT. For testing, the femoral head was divided into medial, central and lateral sections. The BMD of the femoral head was determined to be the highest, while the BMD of the femoral neck was the lowest. In the femoral head, the central section had the highest BMD, while the lateral section had the lowest BMD. The present study used QCT to detect differences in the BMD at various regions of the proximal femur and provided a novel theoretical reference for the placement of lag screws. To obtain maximum holding power, the lag screw must be placed in the central section of the femoral head.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China.,Department of Emergency Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Jun Ge
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Xiaohan Zheng
- Department of Emergency Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Cenhao Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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McGivern H, Greenwood C, Márquez-Grant N, Kranioti EF, Xhemali B, Zioupos P. Age-Related Trends in the Trabecular Micro-Architecture of the Medial Clavicle: Is It of Use in Forensic Science? Front Bioeng Biotechnol 2020; 7:467. [PMID: 32039176 PMCID: PMC6988573 DOI: 10.3389/fbioe.2019.00467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/19/2019] [Indexed: 12/02/2022] Open
Abstract
The mechanical and structural properties of bone are known to change significantly with age. Within forensic and archaeological investigations, the medial end of the clavicle is typically used for estimating the age-at-death of an unknown individual. Although, this region of the skeleton is of interest to forensic and clinical domains, alterations beyond the macro-scale have not been fully explored. For this study, non-destructive micro-computed tomography (μ-CT) was employed to characterize structural alterations to the cancellous bone of the medial clavicle. Fresh human cadaveric specimens (12-59 years) obtained at autopsy were utilized for this study, and were scanned with a voxel size of ~83 μm. Morphometric properties were quantified and indicated that the bone volume, connectivity density, mineral density, and number of trabeculae decreased with age, while the spacing between the trabeculae increased with age. In contrast to other sub-regions of the skeleton, trabecular thickness, and degree of anisotropy did not correlate with age. Collectively, this could suggest that the network is becoming increasingly perforated with age rather than exhibiting trabecular thinning. These results are used in the context of deriving a potential protocol for forensic investigations by using this particular and largely unexplored region of the skeleton, and provide inspiration for future experiments concerning micro-architectural and small scale changes in other regions of the human skeleton.
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Affiliation(s)
- Hannah McGivern
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
| | - Charlene Greenwood
- School of Chemistry and Physical Sciences, Keele University, Keele, United Kingdom
| | - Nicholas Márquez-Grant
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
| | - Elena F. Kranioti
- Edinburgh Unit for Forensic Anthropology, School of History Classics and Archaeology, University of Edinburgh, Edinburgh, United Kingdom
- Forensic Medicine Unit, Department of Forensic Sciences, Faculty of Medicine, University of Crete, Heraklion, Greece
| | | | - Peter Zioupos
- Cranfield Forensic Institute, Cranfield University, Defence Academy of the United Kingdom, Shrivenham, United Kingdom
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Monma Y, Shimada Y, Nakayama H, Zang L, Nishimura N, Tanaka T. Aging-associated microstructural deterioration of vertebra in zebrafish. Bone Rep 2019; 11:100215. [PMID: 31388517 PMCID: PMC6676153 DOI: 10.1016/j.bonr.2019.100215] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/07/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
Zebrafish, a small teleost fish, is currently emerging as an animal model of local and systemic aging. In this study, we assessed age-related degenerative changes in the vertebral bone of zebrafish (3–12 month-post-fertilisation [mpf]) using micro-CT scanning. The bone volume (BV) of the trabecular bone in the male and female fish peaked at 6 mpf and reduced with age. In contrast to BV, bone mineral density and tissue volume did not change after 6 mpf, implying that the total mineral volume in the trabecular area remains unchanged, retaining the strength of vertebra. In addition, we performed micro-structural analysis of the trabecular thickness, trabecular number, and star volume of the tissue space and trabeculae, and found that the size of the trabecular bone reduced with age. Furthermore, aged zebrafish (45 mpf) exhibited ectopic ossification inside or outside of their vertebrae. In summary, we analysed bone structural parameters in adult zebrafish vertebra, which are also used in humans, and demonstrated that aged zebrafish have deteriorated microarchitecture (trabecular thickness and number, tissue space star volume and trabecular star volume) with reduction of trabecular bones, similar to that observed during aging in humans. Zebrafish can be utilised as an animal model to understand the pathology of human bone aging, and the discovery of new therapeutic agents against age-related osteoporosis. We analysed bone structural parameters in adult zebrafish vertebrae. Microstructural changes in aged-zebrafish are similar to those in humans. Aged zebrafish exhibited ectopic ossification inside or outside of their vertebrae.
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Key Words
- Aging
- BMC, bone mineral content
- BMD, bone mineral density
- BV, bone volume
- CT, Computed Tomography
- FCV, first caudal vertebra
- Micro CT
- Osteoporosis
- TV, tissue volume
- Tb, trabecular bone
- Tb.N, trabecular number
- Tb.Th, trabecular thickness
- Teleost
- V*m, tissue space star volume
- V*tr, trabecular star volume
- mpf, month-post-fertilisation
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Affiliation(s)
- Yasuyuki Monma
- Department of Systems Pharmacology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yasuhito Shimada
- Department of Integrative Pharmacology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- Department of Bioinformatics, Mie University Advanced Science Research Promotion Center, Tsu, Mie, Japan
- Mie University Zebrafish Drug Screening Center, Tsu, Mie, Japan
| | - Hiroko Nakayama
- Mie University Zebrafish Drug Screening Center, Tsu, Mie, Japan
- Graduate School of Regional Innovation Studies, Mie University, Tsu, Mie, Japan
| | - Liqing Zang
- Mie University Zebrafish Drug Screening Center, Tsu, Mie, Japan
- Graduate School of Regional Innovation Studies, Mie University, Tsu, Mie, Japan
| | - Norihiro Nishimura
- Mie University Zebrafish Drug Screening Center, Tsu, Mie, Japan
- Graduate School of Regional Innovation Studies, Mie University, Tsu, Mie, Japan
| | - Toshio Tanaka
- Department of Systems Pharmacology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
- Mie University Zebrafish Drug Screening Center, Tsu, Mie, Japan
- Corresponding author at: Department of Systems Pharmacology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, Japan.
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14
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A cross-sectional study on the age-related cortical and trabecular bone changes at the femoral head in elderly female hip fracture patients. Sci Rep 2019; 9:305. [PMID: 30670734 PMCID: PMC6343024 DOI: 10.1038/s41598-018-36299-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
Bone is in a continuous state of remodeling whereby old bone is absorbed and new bone is formed in its place. During this process, new formations reinforce the bone in the direction of the dominant stress trajectories through a functional adaptation. In normal aging, the balance between bone resorption and formation can be shifted. How this affects the functional adaptation remains to be investigated. Furthermore, how or whether the bone continues to change beyond the age of 85 is not yet studied in detail. In this study we examined the age-related changes in the cortical and trabecular bone in old age, and assessed whether we can find evidence of the presence of functional adaptation. We measured cortical and trabecular parameters from micro-computed tomography scans of the femoral head extracted from hip fracture patients between the age of 70 and 93 years. A significant decrease in global trabecular bone mineral density (38.1%) and cortical thickness (13.0%) was seen from the 9th to the 10th decade of life. The degree of anisotropy was maintained globally as well as locally in both high and low stress regions. The local trabecular bone mineral density decreased in both high stress and low stress regions between the 9th and 10th decade of life with similar trends. This suggests that the role of functional adaptation in maintaining the bone structural integrity in old age may be limited. This study highlights the need for a controlled clinical trial examining the cause of the continued bone degradation throughout old age.
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Chang G, Rajapakse CS, Chen C, Welbeck A, Egol K, Regatte RR, Saha PK, Honig S. 3-T MR Imaging of Proximal Femur Microarchitecture in Subjects with and without Fragility Fracture and Nonosteoporotic Proximal Femur Bone Mineral Density. Radiology 2018; 287:608-619. [PMID: 29457963 DOI: 10.1148/radiol.2017170138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To determine if 3-T magnetic resonance (MR) imaging of proximal femur microarchitecture can allow discrimination of subjects with and without fragility fracture who do not have osteoporotic proximal femur bone mineral density (BMD). Materials and Methods Sixty postmenopausal women (30 with and 30 without fragility fracture) who had BMD T scores of greater than -2.5 in the hip were recruited. All subjects underwent dual-energy x-ray absorptiometry to assess BMD and 3-T MR imaging of the same hip to assess bone microarchitecture. World Health Organization Fracture Risk Assessment Tool (FRAX) scores were also computed. We used the Mann-Whitney test, receiver operating characteristics analyses, and Spearman correlation estimates to assess differences between groups, discriminatory ability with parameters, and correlations among BMD, microarchitecture, and FRAX scores. Results Patients with versus without fracture showed a lower trabecular plate-to-rod ratio (median, 2.41 vs 4.53, respectively), lower trabecular plate width (0.556 mm vs 0.630 mm, respectively), and lower trabecular thickness (0.114 mm vs 0.126 mm) within the femoral neck, and higher trabecular rod disruption (43.5 vs 19.0, respectively), higher trabecular separation (0.378 mm vs 0.323 mm, respectively), and lower trabecular number (0.158 vs 0.192, respectively), lower trabecular connectivity (0.015 vs 0.027, respectively) and lower trabecular plate-to-rod ratio (6.38 vs 8.09, respectively) in the greater trochanter (P < .05 for all). Trabecular plate-to-rod ratio, plate width, and thickness within the femoral neck (areas under the curve [AUCs], 0.654-0.683) and trabecular rod disruption, number, connectivity, plate-to-rod ratio, and separation within the greater trochanter (AUCs, 0.662-0.694) allowed discrimination of patients with fracture from control subjects. Femoral neck, total hip, and spine BMD did not differ between and did not allow discrimination between groups. FRAX scores including and not including BMD allowed discrimination between groups (AUCs, 0.681-0.773). Two-factor models (one MR imaging microarchitectural parameter plus a FRAX score without BMD) allowed discrimination between groups (AUCs, 0.702-0.806). There were no linear correlations between BMD and microarchitectural parameters (Spearman ρ, -0.198 to 0.196). Conclusion 3-T MR imaging of proximal femur microarchitecture allows discrimination between subjects with and without fragility fracture who have BMD T scores of greater than -2.5 and may provide different information about bone quality than that provided by dual-energy x-ray absorptiometry. © RSNA, 2018.
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Affiliation(s)
- Gregory Chang
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Chamith S Rajapakse
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Cheng Chen
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Arakua Welbeck
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Kenneth Egol
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Ravinder R Regatte
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Punam K Saha
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
| | - Stephen Honig
- From the Department of Radiology, Center for Biomedical Imaging (G.C., A.W., R.R.R.), Department of Orthopaedic Surgery, Hospital for Joint Diseases (K.E.), and Division of Rheumatology, Osteoporosis Center, Hospital for Joint Diseases (S.H.), NYU Langone Medical Center, 660 First Ave, New York, NY 10016; Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pa (C.S.R.); and College of Engineering, University of Iowa, Iowa City, Iowa (C.C., P.K.S.)
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Achievable accuracy of hip screw holding power estimation by insertion torque measurement. Clin Biomech (Bristol, Avon) 2018; 52:57-65. [PMID: 29360050 DOI: 10.1016/j.clinbiomech.2018.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To ensure stability of proximal femoral fractures, the hip screw must firmly engage into the femoral head. Some studies suggested that screw holding power into trabecular bone could be evaluated, intraoperatively, through measurement of screw insertion torque. However, those studies used synthetic bone, instead of trabecular bone, as host material or they did not evaluate accuracy of predictions. We determined prediction accuracy, also assessing the impact of screw design and host material. METHODS We measured, under highly-repeatable experimental conditions, disregarding clinical procedure complexities, insertion torque and pullout strength of four screw designs, both in 120 synthetic and 80 trabecular bone specimens of variable density. For both host materials, we calculated the root-mean-square error and the mean-absolute-percentage error of predictions based on the best fitting model of torque-pullout data, in both single-screw and merged dataset. FINDINGS Predictions based on screw-specific regression models were the most accurate. Host material impacts on prediction accuracy: the replacement of synthetic with trabecular bone decreased both root-mean-square errors, from 0.54 ÷ 0.76 kN to 0.21 ÷ 0.40 kN, and mean-absolute-percentage errors, from 14 ÷ 21% to 10 ÷ 12%. However, holding power predicted on low insertion torque remained inaccurate, with errors up to 40% for torques below 1 Nm. INTERPRETATION In poor-quality trabecular bone, tissue inhomogeneities likely affect pullout strength and insertion torque to different extents, limiting the predictive power of the latter. This bias decreases when the screw engages good-quality bone. Under this condition, predictions become more accurate although this result must be confirmed by close in-vitro simulation of the clinical procedure.
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17
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Yoon BH, Kim JG, Lee YK, Ha YC, Koo KH, Kim JH. Femoral head trabecular micro-architecture in patients with osteoporotic hip fractures: Impact of bisphosphonate treatment. Bone 2017; 105:148-153. [PMID: 28842364 DOI: 10.1016/j.bone.2017.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/04/2017] [Accepted: 08/21/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Bisphosphonates are effective in preventing osteoporotic fractures. However, their limited efficacy of bisphosphonates has been suggested as a result of these drugs, which prevent the resorption of bone without improving bone connectivity. The trabecular microarchitecture in patients with osteoporotic hip fractures was evaluated according to their history of bisphosphonate treatment (BT). METHODS One hundred thirty-three patients with hip fractures admitted and treated between November 2014 and September 2016. The patients were divided into two groups based on whether they had received treatment with bisphosphonates for >3years or not [non-bisphosphonate-treated patients (NT)]. One-to-one propensity score matching generated 15 matched pairs of patients. Microstructural parameters of femoral head were measured by using micro-computed tomography (μCT). Mechanical compression test (Young's modulus, yield strength, and maximum compressive force) was performed following μCT. RESULTS Trabecular bone pattern factor (1.15±0.7mm-1 versus 1.61±0.5mm-1, p=0.037) and specific bone surface (14.1±0.8mm-1 versus 15.4±1.9mm-1, p=0.050) were significantly lower in the BT group than in the NT group. Furthermore, Young's modulus was significantly higher in the BT group than in the NT group (72.14±30.75MPa versus 47.89±29.89MPa, p=0.037). In both groups, trabecular bone pattern was the most closely correlated microstructural parameter to bone strength. Microstructural analysis demonstrated that bone connectivity was better preserved in the BT group than in the NT group. CONCLUSIONS Bisphosphonate treatment preserves bone mass and bone quality. The factors influencing osteoporotic hip fractures in patients treated with bisphosphonates warrant further research.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Jae Hwa Kim
- Department of Orthopedics & Joint Center, CHA Bundang Medical Center, Seongnam, South Korea.
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18
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Taghizadeh E, Chandran V, Reyes M, Zysset P, Büchler P. Statistical analysis of the inter-individual variations of the bone shape, volume fraction and fabric and their correlations in the proximal femur. Bone 2017; 103:252-261. [PMID: 28732775 DOI: 10.1016/j.bone.2017.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 10/19/2022]
Abstract
Including structural information of trabecular bone improves the prediction of bone strength and fracture risk. However, this information is available in clinical CT scans, only for peripheral bones. We hypothesized that a correlation exists between the shape of the bone, its volume fraction (BV/TV) and fabric, which could be characterized using statistical modeling. High-resolution peripheral computed tomography (HR-pQCT) images of 73 proximal femurs were used to build a combined statistical model of shape, BV/TV and fabric. The model was based on correspondence established by image registration and by morphing of a finite element mesh describing the spatial distribution of the bone properties. Results showed no correlation between the distribution of bone shape, BV/TV and fabric. Only the first mode of variation associated with density and orientation showed a strong relationship (R2>0.8). In addition, the model showed that the anisotropic information of the proximal femur does not vary significantly in a population of healthy, osteoporotic and osteopenic samples. In our dataset, the average anisotropy of the population was able to provide a close approximation of the patient-specific anisotropy. These results were confirmed by homogenized finite element (hFE) analyses, which showed that the biomechanical behavior of the proximal femur was not significantly different when the average anisotropic information of the population was used instead of patient-specific fabric extracted from HR-pQCT. Based on these findings, it can be assumed that the fabric information of the proximal femur follows a similar structure in an elderly population of healthy, osteopenic and osteoporotic proximal femurs.
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Affiliation(s)
- Elham Taghizadeh
- Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Switzerland
| | - Vimal Chandran
- Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Switzerland
| | - Mauricio Reyes
- Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Switzerland
| | - Philippe Zysset
- Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Switzerland
| | - Philippe Büchler
- Institute for Surgical Technology and Biomechanics (ISTB), University of Bern, Switzerland.
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19
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Helfen T, Sprecher CM, Eberli U, Gueorguiev B, Müller PE, Richards RG, Schmidutz F. High-Resolution Tomography-Based Quantification of Cortical Porosity and Cortical Thickness at the Surgical Neck of the Humerus During Aging. Calcif Tissue Int 2017; 101:271-279. [PMID: 28432379 DOI: 10.1007/s00223-017-0279-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
Fractures of the proximal humerus are highly related to age and osteoporotic bone remodeling. Previous studies have highlighted the cortex as a major side of the bone loss, but the microstructural changes of the humerus have not been evaluated entirely. Sixty-four (n = 64) humeri of a representative collective (18-100 years) were scanned with high-resolution peripheral quantitative computed tomography (82 µm). Bone mineral density (BMD), trabecular bone volume fraction (Tb.BV/TV), cortical thickness (Ct.Th), and cortical porosity (Ct.Po) were determined with respect to four age groups. The BMD (r = -0.42), Ct.Th (r = 0.57), and Tb.BV/TV (r = 0.68) showed an age group-related decrease, while the Ct.Po increased (r = -0.55). The oldest group (80-100 years) revealed an extensively higher Ct.Po of +87% compared to the youngest group (18-44 years), while the Ct.Th and Tb.BV/TV were significantly lower by -35 and -49% (p < 0.05). The main cortical bone loss occurred after 65 years with the Ct.Th (-34%) and Tb.BV/TV (-40%) being clearly lower and the Ct.Po (+93%) clearly higher compared to the youngest group. In summary, osteoporosis leads to an age-related higher Ct.Po and reduced Ct.Th at the humeral cortex of the surgical neck. The bone loss of the cortex predominantly occurs around the age of 65 years and is very likely to reduce the mechanical strength and highly increases the fracture risk.
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Affiliation(s)
- Tobias Helfen
- AO Research Institute Davos, Davos, Switzerland
- Department of General-, Trauma- and Reconstructive Surgery, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Florian Schmidutz
- AO Research Institute Davos, Davos, Switzerland.
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
- BG Trauma Center, University of Tübingen, Tübingen, Germany.
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Milovanovic P, Vukovic Z, Antonijevic D, Djonic D, Zivkovic V, Nikolic S, Djuric M. Porotic paradox: distribution of cortical bone pore sizes at nano- and micro-levels in healthy vs. fragile human bone. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:71. [PMID: 28357689 DOI: 10.1007/s10856-017-5878-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
Bone is a remarkable biological nanocomposite material showing peculiar hierarchical organization from smaller (nano, micro) to larger (macro) length scales. Increased material porosity is considered as the main feature of fragile bone at larger length-scales. However, there is a shortage of quantitative information on bone porosity at smaller length-scales, as well as on the distribution of pore sizes in healthy vs. fragile bone. Therefore, here we investigated how healthy and fragile bones differ in pore volume and pore size distribution patterns, considering a wide range of mostly neglected pore sizes from nano to micron-length scales (7.5 to 15000 nm). Cortical bone specimens from four young healthy women (age: 35 ± 6 years) and five women with bone fracture (age: 82 ± 5 years) were analyzed by mercury porosimetry. Our findings showed that, surprisingly, fragile bone demonstrated lower pore volume at the measured scales. Furtnermore, pore size distribution showed differential patterns between healthy and fragile bones, where healthy bone showed especially high proportion of pores between 200 and 15000 nm. Therefore, although fragile bones are known for increased porosity at macroscopic level and level of tens or hundreds of microns as firmly established in the literature, our study with a unique assessment range of nano-to micron-sized pores reveal that osteoporosis does not imply increased porosity at all length scales. Our thorough assessment of bone porosity reveals a specific distribution of porosities at smaller length-scales and contributes to proper understanding of bone structure which is important for designing new biomimetic bone substitute materials.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Zorica Vukovic
- Department of Catalysis and Chemical Engineering, Institute of Chemistry, Technology and Metallurgy, University of Belgrade, 12 Njegoseva, Belgrade, 11000, Serbia
| | - Djordje Antonijevic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, 31a Deligradska, Belgrade, 11000, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, 31a Deligradska, Belgrade, 11000, Serbia
| | - Marija Djuric
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, Belgrade, 11000, Serbia.
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21
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Modeling the Mechanical Consequences of Age-Related Trabecular Bone Loss by XFEM Simulation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:3495152. [PMID: 27403206 PMCID: PMC4925952 DOI: 10.1155/2016/3495152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022]
Abstract
The elderly are more likely to suffer from fracture because of age-related trabecular bone loss. Different bone loss locations and patterns have different effects on bone mechanical properties. Extended finite element method (XFEM) can simulate fracture process and was suited to investigate the effects of bone loss on trabecular bone. Age-related bone loss is indicated by trabecular thinning and loss and may occur at low-strain locations or other random sites. Accordingly, several ideal normal and aged trabecular bone models were created based on different bone loss locations and patterns; then, fracture processes from crack initiation to complete failure of these models were observed by XFEM; finally, the effects of different locations and patterns on trabecular bone were compared. Results indicated that bone loss occurring at low-strain locations was more detrimental to trabecular bone than that occurring at other random sites; meanwhile, the decrease in bone strength caused by trabecular loss was higher than that caused by trabecular thinning, and the effects of vertical trabecular loss on mechanical properties were more severe than horizontal trabecular loss. This study provided a numerical method to simulate trabecular bone fracture and distinguished different effects of the possible occurrence of bone loss locations and patterns on trabecular bone.
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Molecular mechanisms of osteoporotic hip fractures in elderly women. Exp Gerontol 2015; 73:49-58. [PMID: 26608808 DOI: 10.1016/j.exger.2015.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/28/2015] [Accepted: 11/19/2015] [Indexed: 11/24/2022]
Abstract
A common manifestation of age-related bone loss and resultant osteoporosis are fractures of the hip. Age-related osteoporosis is thought to be determined by a number of intrinsic factors including genetics, hormonal changes, changes in levels of oxidative stress, or an inflammatory status associated with the aging process. The aim of this study was to investigate gene expression and bone architecture in bone samples derived from elderly osteoporotic women with hip fractures (OP) in comparison to bone samples from age matched women with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 10 women with low-trauma hip fractures (mean age 83±6) and consecutive surgical hip replacement. Ten bone samples from patients undergoing hip replacement due to osteoarthritis (mean age 80±5) served as controls. One half of each bone sample was subjected to gene expression analysis. The second half of each bone sample was analyzed by microcomputed tomography. From each half, samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. We could show a significantly decreased expression of the osteoblast related genes RUNX2, Osterix, Sclerostin, WNT10B, and Osteocalcin, a significantly increased ratio of RANKL to Osteoprotegerin, and a significantly increased expression of the enzymes superoxide dismutase 2 (SOD2) and glutathione peroxidase GPX3, and of the inflammatory cytokine IL6 in bone samples from hip fracture patients compared to controls. Major microstructural changes in OP bone were seen in the neck and were characterized by a significant decrease of bone volume, trabecular number, and connectivity density and a significant increase of trabecular separation. In conclusion, our data give evidence for a decreased expression of osteoblast related genes and increased expression of osteoclast related genes. Furthermore, increased expression of SOD2 and GPX3 suggest increased antioxidative activity in bone samples from elderly osteoporotic women with hip fractures.
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Lv H, Zhang L, Yang F, Zhao Z, Yao Q, Zhang L, Tang P. Comparison of microstructural and mechanical properties of trabeculae in femoral head from osteoporosis patients with and without cartilage lesions: a case-control study. BMC Musculoskelet Disord 2015; 16:72. [PMID: 25887431 PMCID: PMC4391480 DOI: 10.1186/s12891-015-0530-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/13/2015] [Indexed: 11/24/2022] Open
Abstract
Background Degeneration of cartilage will change load distribution, affecting bone remodeling progress and trabecular structure and strength. However, in human primary osteoporosis, whether cartilage lesions would also affect properties beneath trabecular bone remains unknown. In this study, we explored the differences in local trabecular properties between osteoporosis patients with and without cartilage lesions. Methods Eighteen pairs of femoral heads with and without cartilage lesions in a weight-bearing area were collected from senile femoral neck fracture patients. The Mankin score and glycosaminoglycan (GAG) content were used to evaluate the severity of the cartilage lesions. Micro-CT and compression tests were used to obtain structural and mechanical characteristics of each trabecular column. Multivariate linear regression was performed to evaluate the association between mechanical parameters and the degree of cartilage lesion. Results In osteoporosis patients with cartilage lesions, the bone volume fraction (BV/TV) and trabecular thickness (Tb.Th) of the trabecular column were significantly higher than that of osteoporotic control patients (all P < 0.05), while the Young’s modulus was lower (P = 0.024). Multivariable linear regression indicated that in both groups, bone mineral density (BMD) significantly correlated with Young’s modulus (all P < 0.05). While in patients with cartilage lesion, GAG content was also correlated with Young’s modulus (standardized coefficient 0.443, P < 0.01). Conclusions Osteoporosis patients with cartilage lesions exhibited a weaker mechanical property of trabeculae. The intimate association of cartilage lesions and impairment of trabecular mechanical properties indicate that cartilage and trabeculae belong to an interdependent functional unit. Previously proposed adaptive mechanisms in osteoarthritis might also be applicable to the progression of osteoporosis.
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Affiliation(s)
- Houchen Lv
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Licheng Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Fei Yang
- BNLMS State Key Laboratory of Polymer Physics & Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing, China.
| | - Zhe Zhao
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Qi Yao
- Department of Orthopedics, Beijing Shijitan Hospital, Beijing, China.
| | - Lihai Zhang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
| | - Peifu Tang
- Department of Orthopedics, General Hospital of Chinese PLA, No.28 Fuxing Road, Beijing, China.
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Gao J, Gong H, Zhang R, Zhu D. Age-related regional deterioration patterns and changes in nanoscale characterizations of trabeculae in the femoral head. Exp Gerontol 2015; 62:63-72. [PMID: 25582596 DOI: 10.1016/j.exger.2015.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 12/03/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the mechanical properties and features of bone materials at the nanoscale level in different regions of the femoral head in elderly patients with femoral neck fracture. Ten femoral heads from female patients with femoral neck fractures were extracted during surgery (five for the Aged group, aged 65-66 years; five for the Advanced aged group, aged 85-95 years). The femoral head was divided into three equal layers (anterior, central, and posterior) in the coronal view, and each layer was segmented into five regions (superior, central, inferior, medial, and lateral). Nanoindentation testing and atomic force microscopy imaging were used to study the mechanical properties and surface morphology of the specimens. No statistical differences in grain size were found between age groups, which suggested that the nanostructure of trabeculae in the femoral heads of postmenopausal women cannot be used to predict age-related bone loss and fracture risk. Mechanical properties in the longitudinal direction deteriorated more quickly than those in the transverse direction for the whole femoral head. Comparisons between layers showed a higher deterioration rate with aging in the anterior layer than in other layers. In different regions, mechanical properties of the medial and lateral regions deteriorated more quickly than those in the three other regions, and deterioration in the longitudinal direction was more serious than that in the transverse direction. The regional deterioration patterns and material properties with aging observed in this study contribute to an understanding of the age-related fracture mechanism and provide a basis for predicting age-related fracture risk and decreasing early fixation failure in the proximal femur.
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Affiliation(s)
- Jiazi Gao
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - He Gong
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China.
| | - Rui Zhang
- Department of Engineering Mechanics, Jilin University, Changchun 130022, People's Republic of China
| | - Dong Zhu
- Traumatic Orthopedics, The First Hospital of Jilin University, Changchun 130021, People's Republic of China
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Gracility of the modern Homo sapiens skeleton is the result of decreased biomechanical loading. Proc Natl Acad Sci U S A 2014; 112:372-7. [PMID: 25535352 DOI: 10.1073/pnas.1418646112] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The postcranial skeleton of modern Homo sapiens is relatively gracile compared with other hominoids and earlier hominins. This gracility predisposes contemporary humans to osteoporosis and increased fracture risk. Explanations for this gracility include reduced levels of physical activity, the dissipation of load through enlarged joint surfaces, and selection for systemic physiological characteristics that differentiate modern humans from other primates. This study considered the skeletal remains of four behaviorally diverse recent human populations and a large sample of extant primates to assess variation in trabecular bone structure in the human hip joint. Proximal femur trabecular bone structure was quantified from microCT data for 229 individuals from 31 extant primate taxa and 59 individuals from four distinct archaeological human populations representing sedentary agriculturalists and mobile foragers. Analyses of mass-corrected trabecular bone variables reveal that the forager populations had significantly higher bone volume fraction, thicker trabeculae, and consequently lower relative bone surface area compared with the two agriculturalist groups. There were no significant differences between the agriculturalist and forager populations for trabecular spacing, number, or degree of anisotropy. These results reveal a correspondence between human behavior and bone structure in the proximal femur, indicating that more highly mobile human populations have trabecular bone structure similar to what would be expected for wild nonhuman primates of the same body mass. These results strongly emphasize the importance of physical activity and exercise for bone health and the attenuation of age-related bone loss.
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Chen H, Kubo KY. Bone three-dimensional microstructural features of the common osteoporotic fracture sites. World J Orthop 2014; 5:486-495. [PMID: 25232524 PMCID: PMC4133454 DOI: 10.5312/wjo.v5.i4.486] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/03/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is a common metabolic skeletal disorder characterized by decreased bone mass and deteriorated bone structure, leading to increased susceptibility to fractures. With aging population, osteoporotic fractures are of global health and socioeconomic importance. The three-dimensional microstructural information of the common osteoporosis-related fracture sites, including vertebra, femoral neck and distal radius, is a key for fully understanding osteoporosis pathogenesis and predicting the fracture risk. Low vertebral bone mineral density (BMD) is correlated with increased fracture of the spine. Vertebral BMD decreases from cervical to lumbar spine, with the lowest BMD at the third lumbar vertebra. Trabecular bone mass of the vertebrae is much lower than that of the peripheral bone. Cancellous bone of the vertebral body has a complex heterogeneous three-dimensional microstructure, with lower bone volume in the central and anterior superior regions. Trabecular bone quality is a key element to maintain the vertebral strength. The increased fragility of osteoporotic femoral neck is attributed to low cancellous bone volume and high compact porosity. Compared with age-matched controls, increased cortical porosity is observed at the femoral neck in osteoporotic fracture patients. Distal radius demonstrates spatial inhomogeneous characteristic in cortical microstructure. The medial region of the distal radius displays the highest cortical porosity compared with the lateral, anterior and posterior regions. Bone strength of the distal radius is mainly determined by cortical porosity, which deteriorates with advancing age.
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Föger-Samwald U, Patsch JM, Schamall D, Alaghebandan A, Deutschmann J, Salem S, Mousavi M, Pietschmann P. Molecular evidence of osteoblast dysfunction in elderly men with osteoporotic hip fractures. Exp Gerontol 2014; 57:114-21. [PMID: 24862290 DOI: 10.1016/j.exger.2014.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 04/28/2014] [Accepted: 05/20/2014] [Indexed: 10/25/2022]
Abstract
Osteoporosis is extremely frequent in post-menopausal women; nevertheless, osteoporosis in men is also a severe and frequently occurring but often underestimated disease. Increasing evidence links bone loss in male idiopathic osteoporosis and age related osteoporosis to osteoblast dysfunction rather than increased osteoclast activity as seen in postmenopausal osteoporosis. The aim of this study was to investigate gene expression of osteoblast related genes and of bone architecture in bone samples derived from elderly osteoporotic men with hip fractures (OP) in comparison to bone samples from age matched men with osteoarthritis of the hip (OA). Femoral heads and adjacent neck tissue were collected from 12 men with low-trauma hip fractures and consecutive surgical hip replacement. Bone samples of age matched patients undergoing hip replacement due to osteoarthritis served as controls. One half of the bone samples was subjected to RNA extraction, reverse transcription, and real-time polymerase chain reactions. The second half of the bone samples was analyzed by static histomorphometry. From each half samples from four different regions, the central and subcortical region of the femoral head and neck, were analyzed. OP patients displayed a significantly decreased RUNX2, Osterix and SOST expression compared to OA patients. Major microstructural changes in OP bone were seen in the subcortical region of the neck and were characterized by a significant decrease of bone volume, and a significant increase of trabecular separation. In conclusion, decreased local gene expression of RUNX2 and Osterix in men with hip fractures strongly supports the concept of osteoblast dysfunction in male osteoporosis. Major microstructural changes in the trabecular structure associated with osteoporotic hip fractures in men are localized in the subcortical region of the femoral neck.
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Affiliation(s)
- Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Janina M Patsch
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiodiagnostics, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Doris Schamall
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Afarin Alaghebandan
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Julia Deutschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
| | - Sylvia Salem
- Department of Orthopaedics, St. Vincent Hospital Vienna, Stumpergasse 13, A-1060 Vienna, Austria.
| | - Mehdi Mousavi
- Department of Trauma Surgery, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria.
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Immunology and Infectiology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Hazrati Marangalou J, Ito K, Taddei F, van Rietbergen B. Inter-individual variability of bone density and morphology distribution in the proximal femur and T12 vertebra. Bone 2014; 60:213-20. [PMID: 24370733 DOI: 10.1016/j.bone.2013.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 01/16/2023]
Abstract
Bone geometry, density and microstructure can vary widely between subjects. Knowledge about this variation in a population is of interest in particular for the design of orthopedic implants and interventions. The goal of this study is to investigate the local variability of bone density and microstructural parameters between subjects using a novel inter-subject image registration approach. Human proximal femora of 29 and T12 vertebrae of 20 individuals were scanned using a HR-pQCT and a micro-CT system, respectively. A pre-defined iso-anatomic mesh template was morphed to each micro-CT scan. For each element bone volume fraction and other morphological parameters (Tb.Th, Tb.N, Tb.Sp, SMI, DA) were determined and assigned to the element. A coefficient of variation (CV) was calculated for each parameter at each element location of the 29 femora and 20 T12 vertebrae. Contour plots of the CV distribution revealed very detailed information about the inter-individual variation in bone density and morphology. It is also shown that analyzing large sub-volumes, as commonly done in previous studies, would miss much of this variation. Detailed quantitative information of bone morphological parameters for each sample in the femur and the T12 database and their inter-individual variability are available from the mesh templates as supplementary data (http://w3.bmt.tue.nl/nl/fe_database/). We expect that these results can help to optimize implants and orthopedic procedures by taking local bone morphological parameter variations into account.
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Affiliation(s)
- Javad Hazrati Marangalou
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Keita Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Fulvia Taddei
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, Bologna, Italy
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Wang J, Zhou B, Parkinson I, Thomas CDL, Clement JG, Fazzalari N, Guo XE. Trabecular Plate Loss and Deteriorating Elastic Modulus of Femoral Trabecular Bone in Intertrochanteric Hip Fractures. Bone Res 2013; 1:346-54. [PMID: 26273512 DOI: 10.4248/br201304005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/21/2013] [Indexed: 11/10/2022] Open
Abstract
Osteoporotic hip fracture is associated with significant trabecular bone loss, which is typically characterized as low bone density by dual-energy X-ray absorptiometry (DXA) and altered microstructure by micro-computed tomography (μCT). Emerging morphological analysis techniques, e.g. individual trabecula segmentation (ITS), can provide additional insights into changes in plate-like and rod-like trabeculae, two major microstructural types serving different roles in determining bone strength. Using ITS, we evaluated trabecular microstructure of intertrochanteric bone cores obtained from 23 patients undergoing hip replacement surgery for intertrochanteric fracture and 22 cadaveric controls. Micro-finite element (μFE) analyses were performed to further understand how the abnormalities seen by ITS might translate into effects on bone strength. ITS analyses revealed that, near fracture site, plate-like trabeculae were seriously depleted in fracture patients, but trabecular rod volume was maintained. Besides, decreased plate area and rod length were observed in fracture patients. Fracture patients also showed decreased elastic moduli and shear moduli of trabecular bone. These results provided evidence that in intertrochanteric hip fracture, preferential loss of plate-like trabeculae led to more rod-like microstructure and deteriorated mechanical competence adjacent to the fracture site, which increased our understanding of the biomechanical pathogenesis of hip fracture in osteoporosis.
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Affiliation(s)
- Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, New York 10027, USA
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, New York 10027, USA
| | - Ian Parkinson
- Bone and Joint Research Lab, SA Pathology and Discipline of Anatomy and Pathology, University of Adelaide , Adelaide, Australia
| | - C David L Thomas
- Section of Oral Anatomy and Surgery, The Melbourne Dental School, University of Melbourne , Victoria 3010, Australia
| | - John G Clement
- Section of Oral Anatomy and Surgery, The Melbourne Dental School, University of Melbourne , Victoria 3010, Australia
| | - Nick Fazzalari
- Bone and Joint Research Lab, SA Pathology and Discipline of Anatomy and Pathology, University of Adelaide , Adelaide, Australia
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University , New York, New York 10027, USA
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Räth C, Baum T, Monetti R, Sidorenko I, Wolf P, Eckstein F, Matsuura M, Lochmüller EM, Zysset PK, Rummeny EJ, Link TM, Bauer JS. Scaling relations between trabecular bone volume fraction and microstructure at different skeletal sites. Bone 2013; 57:377-83. [PMID: 24056252 DOI: 10.1016/j.bone.2013.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 09/03/2013] [Accepted: 09/05/2013] [Indexed: 11/23/2022]
Abstract
In this study, we investigated the scaling relations between trabecular bone volume fraction (BV/TV) and parameters of the trabecular microstructure at different skeletal sites. Cylindrical bone samples with a diameter of 8mm were harvested from different skeletal sites of 154 human donors in vitro: 87 from the distal radius, 59/69 from the thoracic/lumbar spine, 51 from the femoral neck, and 83 from the greater trochanter. μCT images were obtained with an isotropic spatial resolution of 26μm. BV/TV and trabecular microstructure parameters (TbN, TbTh, TbSp, scaling indices (< > and σ of α and αz), and Minkowski Functionals (Surface, Curvature, Euler)) were computed for each sample. The regression coefficient β was determined for each skeletal site as the slope of a linear fit in the double-logarithmic representations of the correlations of BV/TV versus the respective microstructure parameter. Statistically significant correlation coefficients ranging from r=0.36 to r=0.97 were observed for BV/TV versus microstructure parameters, except for Curvature and Euler. The regression coefficients β were 0.19 to 0.23 (TbN), 0.21 to 0.30 (TbTh), -0.28 to -0.24 (TbSp), 0.58 to 0.71 (Surface) and 0.12 to 0.16 (<α>), 0.07 to 0.11 (<αz>), -0.44 to -0.30 (σ(α)), and -0.39 to -0.14 (σ(αz)) at the different skeletal sites. The 95% confidence intervals of β overlapped for almost all microstructure parameters at the different skeletal sites. The scaling relations were independent of vertebral fracture status and similar for subjects aged 60-69, 70-79, and >79years. In conclusion, the bone volume fraction-microstructure scaling relations showed a rather universal character.
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Affiliation(s)
- Christoph Räth
- Max-Planck-Institut für extraterrestrische Physik, Giessenbachstr. 1, 85748 Garching, Germany
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31
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Vale AC, Aleixo IP, Lúcio M, Saraiva A, Caetano-Lopes J, Rodrigues A, Amaral PM, Rosa LG, Monteiro J, Fonseca JE, Vaz MF, Canhão H. At the moment of occurrence of a fragility hip fracture, men have higher mechanical properties values in comparison with women. BMC Musculoskelet Disord 2013; 14:295. [PMID: 24131745 PMCID: PMC4015558 DOI: 10.1186/1471-2474-14-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/01/2013] [Indexed: 02/04/2023] Open
Abstract
Background It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture. Methods Femoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed. Results Seventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis. Conclusions Our observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João E Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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Chang G, Deniz CM, Honig S, Egol K, Regatte RR, Zhu Y, Sodickson DK, Brown R. MRI of the hip at 7T: feasibility of bone microarchitecture, high-resolution cartilage, and clinical imaging. J Magn Reson Imaging 2013; 39:1384-93. [PMID: 24115554 DOI: 10.1002/jmri.24305] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 06/18/2013] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of performing bone microarchitecture, high-resolution cartilage, and clinical imaging of the hip at 7T. MATERIALS AND METHODS This study had Institutional Review Board approval. Using an 8-channel coil constructed in-house, we imaged the hips of 15 subjects on a 7T magnetic resonance imaging (MRI) scanner. We applied: 1) a T1-weighted 3D fast low angle shot (3D FLASH) sequence (0.23 × 0.23 × 1-1.5 mm(3) ) for bone microarchitecture imaging; 2) T1-weighted 3D FLASH (water excitation) and volumetric interpolated breath-hold examination (VIBE) sequences (0.23 × 0.23 × 1.5 mm(3) ) with saturation or inversion recovery-based fat suppression for cartilage imaging; 3) 2D intermediate-weighted fast spin-echo (FSE) sequences without and with fat saturation (0.27 × 0.27 × 2 mm) for clinical imaging. RESULTS Bone microarchitecture images allowed visualization of individual trabeculae within the proximal femur. Cartilage was well visualized and fat was well suppressed on FLASH and VIBE sequences. FSE sequences allowed visualization of cartilage, the labrum (including cartilage and labral pathology), joint capsule, and tendons. CONCLUSION This is the first study to demonstrate the feasibility of performing a clinically comprehensive hip MRI protocol at 7T, including high-resolution imaging of bone microarchitecture and cartilage, as well as clinical imaging.
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Affiliation(s)
- Gregory Chang
- Department of Radiology, NYU Langone Medical Center, Center for Musculoskeletal Care, New York, New York, USA
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33
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Chiba K, Burghardt AJ, Osaki M, Majumdar S. Heterogeneity of bone microstructure in the femoral head in patients with osteoporosis: an ex vivo HR-pQCT study. Bone 2013; 56:139-46. [PMID: 23748104 PMCID: PMC3740186 DOI: 10.1016/j.bone.2013.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Trabecular bone in the femoral head has a complicated and heterogeneous structure with few studies having analyzed heterogeneity in this structure quantitatively. We analyze trabecular bone microstructure in the femoral head with osteoporosis (OP) using high resolution peripheral quantitative CT (HR-pQCT) to investigate its regional characteristics. METHODS Fifteen femoral heads extracted from female OP patients with femoral neck fracture (85 ± 7, 67-94 years) were scanned by HR-pQCT at 41 μm voxel size. The femoral head was segmented into 15 regions (3 longitudinal regions: superior, center, and inferior, and 5 axial subregions: center, medial, lateral, anterior, posterior). Of these 15 regions, five were excluded due to overlap with the fracture site, leaving a total of 10 regions of cancellous bone microstructures to be quantitatively assessed using the following parameters: bone volume fraction, trabecular thickness, number, separation, connectivity density, structure model index, and degree and orientation of anisotropy. These parameters were compared among each region. RESULTS Trabecular bone at the center, superior, and supero-posterior regions of the femoral head had higher bone volume, trabecular number, thickness, narrower bone marrow spaces, higher connectivity and anisotropy, and more plate-like structure. This plate-like structure ran supero-inferiorly and antero-posteriorly at the superior and center regions. Bone volume at the anterior, posterior, and medial regions was almost half of the central and superior regions. CONCLUSION Significant heterogeneity of the trabecular bone microstructure in the OP femoral head was showed quantitatively in this study. These data offer new insight into bone microstructural anatomy and may prove to provide useful information on clinical medicine such as hip surgeries.
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Affiliation(s)
- Ko Chiba
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Chen H, Zhou X, Fujita H, Onozuka M, Kubo KY. Age-related changes in trabecular and cortical bone microstructure. Int J Endocrinol 2013; 2013:213234. [PMID: 23573086 PMCID: PMC3614119 DOI: 10.1155/2013/213234] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 02/14/2013] [Indexed: 12/20/2022] Open
Abstract
The elderly population has substantially increased worldwide. Aging is a complex process, and the effects of aging are myriad and insidious, leading to progressive deterioration of various organs, including the skeleton. Age-related bone loss and resultant osteoporosis in the elderly population increase the risk for fractures and morbidity. Osteoporosis is one of the most common conditions associated with aging, and age is an independent risk factor for osteoporotic fractures. With the development of noninvasive imaging techniques such as computed tomography (CT), micro-CT, and high resolution peripheral quantitative CT (HR-pQCT), imaging of the bone architecture provides important information about age-related changes in bone microstructure and estimates of bone strength. In the past two decades, studies of human specimens using imaging techniques have revealed decreased bone strength in older adults compared with younger adults. The present paper addresses recently studied age-related changes in trabecular and cortical bone microstructure based primarily on HR-pQCT and micro-CT. We specifically focus on the three-dimensional microstructure of the vertebrae, femoral neck, and distal radius, which are common osteoporotic fracture sites.
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Affiliation(s)
- Huayue Chen
- Department of Anatomy, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
- *Huayue Chen:
| | - Xiangrong Zhou
- Department of Intelligent Image Information, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroshi Fujita
- Department of Intelligent Image Information, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Minoru Onozuka
- Nittai Jusei Medical College for Judo Therapeutics, 2-2-7 Yoga, Setagaya-ku, Tokyo 158-0097, Japan
| | - Kin-Ya Kubo
- Seijoh University Graduate School of Health Care Studies, 2-172 Fukinodai, Tokai, Aichi 476-8588, Japan
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Milovanovic P, Djonic D, Marshall RP, Hahn M, Nikolic S, Zivkovic V, Amling M, Djuric M. Micro-structural basis for particular vulnerability of the superolateral neck trabecular bone in the postmenopausal women with hip fractures. Bone 2012; 50:63-8. [PMID: 21964412 DOI: 10.1016/j.bone.2011.09.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 08/29/2011] [Accepted: 09/15/2011] [Indexed: 10/17/2022]
Abstract
In this study we analyzed the trabecular bone micro-architecture in the inferomedial and superolateral subregions of the femoral neck in a group with hip fractures and a control group of elderly women, with aim to clarify the micro-structural basis of bone fragility. Proximal femora from 29 Caucasian female cadavers were collected at Institute of Forensic Medicine in Belgrade (15 women with hip fracture: age 79.5±8.5 yrs.; and 14 women without hip fractures: age 74.1±9.3 yrs.). The femoral neck section was scanned in dry conditions using a micro-computed tomography (Scanco μCT 40), at 70 kV, 114 μA, 300 ms integration time, 36 μm resolution, isotropic, 1024×1024 pixels per slice, automatically evaluating trabecular micro-architecture using the built-in program of the micro-CT with direct 3D morphometry. The samples were foam padded to avoid any movement artifacts during scanning. Analysis of the neck section in the fracture group compared to the control cases demonstrated significantly lower bone volume fraction (mean: 6.3% vs. 11.2%, p=0.002), lower connectivity density (0.33/mm(3) vs. 0.74/mm(3), p=0.019) and higher trabecular separation (0.87 mm vs. 0.83 mm, p=0.030). Division into the superolateral and inferomedial regions of interest revealed that the superolateral neck displayed even more differences in micro-architectural properties between the fracture and non-fracture groups. Namely, while in the inferomedial neck only bone volume fraction and degree of anisotropy displayed significant inter-group variability (lower BV/TV with higher degree of anisotropy in the fracture group), in the superolateral neck almost all parameters were different between the fracture cases and the controls, where the fracture group showed a lower trabecular bone volume fraction (3.6% vs. 8.2%, p=0.001), lower connectivity (0.21 vs. 0.63/mm(3), p=0.008), more rod like trabecular structure (SMI: 2.94 vs. 2.62, p=0.049), higher separation and the thinned trabeculae (Tb.Sp: 0.89 vs. 0.85 mm, p=0.013; Tb.Th: 0.17 vs. 0.20 mm, p=0.05). In addition, after adjusting for the effects of BV/TV, the majority of differences disappeared, demonstrating that the bone loss manifests itself via the changes in micro-architectural parameters: trabecular thinning, rising the spacing between individual trabeculae, reducing trabecular connectivity and accentuating trabecular perforations leading to predominance of rod-like trabecular elements. Preferential impairment of the superolateral neck trabecular structure and organization in women with hip fracture reveals the region-dependent micro-structural basis of bone fragility in elderly women.
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Affiliation(s)
- Petar Milovanovic
- Laboratory for Anthropology, Institute of Anatomy, Faculty of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
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Chen H, Zhou X, Shoumura S, Emura S, Bunai Y. Age- and gender-dependent changes in three-dimensional microstructure of cortical and trabecular bone at the human femoral neck. Osteoporos Int 2010; 21:627-36. [PMID: 19543764 DOI: 10.1007/s00198-009-0993-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
UNLABELLED We investigated age- and gender-related variation of both cortical and trabecular microstructure in human femoral neck. We found that age-related change of cortical porosity is more noticeable than that of trabecular parameter. Our data may help to gain more insight into the potential mechanism of osteoporotic femoral neck fractures. INTRODUCTION Variations in the microstructure of cortical and trabecular bone contribute to decreased bone strength. Age- and gender-related changes in cortical and trabecular microstructure of femoral neck is unclear. The aim of this study was to identify three-dimensional (3D) microstructural changes of both cortical and trabecular bone simultaneously in human femoral neck with age and gender, using micro-computed tomography (micro-CT). We hypothesized that there would be differences in age-related changes of cortical and trabecular bone for both women and men. METHODS We used 56 femoral necks of 28 women and men (57-98 years of age) from a Japanese population. The subjects were chosen to give an even age and gender distribution. Both women and men were divided into three age groups: middle (57-68 years), old (72-82 years), and elderly (87-98 years) groups. We examined cortical bone specimen from the inferior sector of femoral neck and trabecular bone specimen from the middle of femoral neck using micro-CT and 3D bone analysis software. RESULTS Cortical thickness (Ct.Th) decreased by 10-15%, cortical porosity (Ca.V/TV) almost doubled, and canal diameter (Ca.Dm) increased by 65-77% between the middle-aged and elderly groups for both women and men. The trabecular bone volume fraction (BV/TV) decreased by around 20%; trabecular thickness (Tb.Th), trabecular number (Tb.N), and connectivity density (Conn.D) decreased; and trabecular separation (Tb.Sp) and structure model index (SMI) increased with age for both women and men. As compared with women, men had higher Ct.Th and BV/TV and lower Ca.V/TV and Ca.Dm among three age groups. There was a significant inverse correlation between Ca.V.TV and BV/TV for both women and men. CONCLUSION Our findings indicate that Ct.Th and BV/TV decreased, and Ca.V/TV and Ca.Dm increased in femoral neck with age for both women and men. The most obvious age-related change is the increase of Ca.V/TV. The decrease of BV/TV with age is more noticeable than that of Ct.Th. This is the first study that has provided both cortical and trabecular microstructural data simultaneously in a Japanese sample. These data may help us to gain more insight into the potential mechanism of osteoporotic femoral neck fractures.
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Affiliation(s)
- H Chen
- Department of Anatomy, Gifu University Graduate School of Medicine, Gifu, Japan.
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Djuric M, Djonic D, Milovanovic P, Nikolic S, Marshall R, Marinkovic J, Hahn M. Region-specific sex-dependent pattern of age-related changes of proximal femoral cancellous bone and its implications on differential bone fragility. Calcif Tissue Int 2010; 86:192-201. [PMID: 20012269 DOI: 10.1007/s00223-009-9325-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Accepted: 11/13/2009] [Indexed: 11/26/2022]
Abstract
Despite evident interest in age-related bone changes, data on regional differences within the proximal femur are scarce. To date, there has been no comprehensive study on site-specific age-related changes in the trabecular architecture of three biomechanically important femoral subregions (medial neck, lateral neck, and intertrochanteric region) for both genders. In this study we investigated age-related deterioration in the trabecular architecture of those three subregions of the femoral neck for both genders. The research sample included 52 proximal femora (26 males, 26 females; age range, 26-96 years) from Forensic Department at University of Belgrade. Bone sections from the three regions of interest were scanned by micro-CT at University of Hamburg. The study revealed that proximal femoral microarchitecture cannot be perceived as homogeneous and, more importantly, that the aging process is not uniform. Besides the initial intersite differences, microarchitecture changed differently with increasing age, maintaining significant differences between the regions. In addition, we observed a different aging pattern between genders: deterioration was most significant in the intertrochanteric region in women, while the lateral neck was most affected in men. This finding supports epidemiological data about the differential occurrence of cervical vs. trochanteric fractures in aging males and females. In conclusion, the aging process in the proximal femur cannot be regarded as a simple function of quantitative bone loss but, rather, as an alteration of specific architecture that may degrade bone strength.
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Affiliation(s)
- Marija Djuric
- Laboratory for Anthropology, Department of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia.
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