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Fischer CS, Ittermann T, Hannemann A, Schmidt CO, Mederake M, Schüll D, Histing T, Lange J, Haralambiev L. Are there associations between hip geometry and bone quality? An analysis on 3074 adults from a general population. Arch Orthop Trauma Surg 2024; 144:81-90. [PMID: 37646797 PMCID: PMC10774197 DOI: 10.1007/s00402-023-05031-5] [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: 04/24/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Patients with reduced bone mineral density and altered hip geometry are susceptible for hip pathologies. Knowledge on associations between bone properties and hip geometric parameters might facilitate identification of patients at risk for hip pathologies. The aim of the present study was to identify associations of bone properties assessed by quantitative ultrasound (QUS) at the heel and hip geometric parameters like center-edge angle (CE), neck-shaft angle (NSA) and alpha angle. MATERIALS AND METHODS Hip geometric parameters (CE, NSA and alpha angle) of 3074 participants from the population-based Study of Health in Pomerania were assessed on magnetic resonance imaging. QUS was performed on both calcanei providing broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness-index. Based on the stiffness-index the individual osteoporotic fracture risk (low, moderate or high) was determined. Associations between QUS-based and hip geometric parameters were calculated in linear regression models adjusted for age, sex, body height and weight. Interactions of QUS markers with age and sex on hip geometric parameters were tested. RESULTS Significant inverse associations between BUA (β = - 0.068), SOS (β = - 0.024) as well as stiffness-index (β = - 0.056) and CE were present, while fracture risk was positively associated with CE (β for high = 1.28 and moderate = 2.54 vs. low fracture risk). Interactions between BUA and sex as well as between SOS and age were detected in the models for CE. Furthermore, there was an inverse relation between fracture risk and NSA that was restricted to the moderate risk (β for moderate vs. low fracture risk = - 0.60). There were no significant associations between QUS parameters and alpha angle. CONCLUSIONS In the general population, several associations between QUS-based bone properties or fracture risk and hip geometry are present. Less dysplastic hips had a lower stiffness-index and a higher fracture risk, whereas more valgus hips had a lower fracture risk.
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Affiliation(s)
- Cornelius Sebastian Fischer
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany.
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine, Greifswald, Germany
| | | | - Moritz Mederake
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Daniel Schüll
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Tina Histing
- Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Schnarrenbergstraße 95, 72076, Tübigen, Germany
| | - Jörn Lange
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Lyubomir Haralambiev
- Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin, Berlin, Germany
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Zhang M, Gong H, Zhang M. Prediction of femoral strength of elderly men based on quantitative computed tomography images using machine learning. J Orthop Res 2023; 41:170-182. [PMID: 35393726 DOI: 10.1002/jor.25334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Hip fracture is the most common complication of osteoporosis, and its major contributor is compromised femoral strength. This study aimed to develop practical machine learning models based on clinical quantitative computed tomography (QCT) images for predicting proximal femoral strength. Eighty subjects with entire QCT data of the right hip region were randomly selected from the full MrOS cohorts, and their proximal femoral strengths were calculated by QCT-based finite element analysis (QCT/FEA). A total of 50 parameters of each femur were extracted from QCT images as the candidate predictors of femoral strength, including grayscale distribution, regional cortical bone mapping (CBM) measurements, and geometric parameters. These parameters were simplified by using feature selection and dimensionality reduction. Support vector regression (SVR) was used as the machine learning algorithm to develop the prediction models, and the performance of each SVR model was quantified by the mean squared error (MSE), the coefficient of determination (R2 ), the mean bias, and the SD of bias. For feature selection, the best prediction performance of SVR models was achieved by integrating the grayscale value of 30% percentile and specific regional CBM measurements (MSE ≤ 0.016, R2 ≥ 0.93); and for dimensionality reduction, the best prediction performance of SVR models was achieved by extracting principal components with eigenvalues greater than 1.0 (MSE ≤ 0.014, R2 ≥ 0.93). The femoral strengths predicted from the well-trained SVR models were in good agreement with those derived from QCT/FEA. This study provided effective machine learning models for femoral strength prediction, and they may have great potential in clinical bone health assessments.
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Affiliation(s)
- Meng Zhang
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - He Gong
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Watanabe D, Kimura T, Yamashita A, Minowa T, Miura K, Mizushima A. The influence of androgen deprivation therapy on hip geometric properties and bone mineral density in Japanese men with prostate cancer and its relationship with the visceral fat accumulation. Aging Male 2020; 23:1158-1164. [PMID: 31959023 DOI: 10.1080/13685538.2020.1713741] [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] [Indexed: 12/21/2022] Open
Abstract
The influence of androgen deprivation therapy (ADT) for prostate cancer on the hip geometric properties evaluated by dual-energy X-ray absorptiometry (DXA) has not yet been demonstrated. This study aimed to investigate the changes in these properties after 1 year of ADT. A total of 65 Japanese men with prostate cancer who underwent ADT for the first time in our facility were included in the study. The hip geometric parameters and the bone mineral density (BMD) taken before and after 1 year of ADT were retrospectively examined. With ADT, we not only confirmed significant BMD annual changes in the lumbar spine, the femoral neck, and the total hip of -1.65%, -1.91%, and -2.20%, respectively, but we also confirmed significant annual changes in cross-sectional areas, cross-sectional moments of inertia, and section modulus in the narrow femoral neck of -2.55%, -3.50%, and -3.14%, respectively. The annual rate of decrease in the femoral neck BMD was significantly higher in patients with visceral fat obesity than in those without visceral obesity (-1.79% vs. -0.28%). One year of ADT for Japanese men with prostate cancer might decrease the strength of bending and the structural rigidity as well as BMD at the femoral neck.
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Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Koto Hospital, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Kunihisa Miura
- Department of Anesthesiology and Pain Medicine, Koto Hospital, Tokyo, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Shin YH, Gong HS, Kim KM, Lee JH, Kwon O, Baek GH. Evaluation of Hip Geometry Parameters in Patients With a Distal Radius Fracture. J Clin Densitom 2020; 23:576-581. [PMID: 31253483 DOI: 10.1016/j.jocd.2019.06.001] [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: 04/20/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with a distal radius fracture (DRF) have an increased risk of subsequent fractures including hip fractures. The purpose of this study was to evaluate whether women with a DRF have certain hip geometry parameters known to indicate susceptibility to hip fractures. METHODS We compared bone mineral density (BMD) and hip geometry parameters (hip axis length, neck shaft angle, mean cortical thickness, femur neck width, cross-sectional area [CSA], cross-sectional moment of inertia, section modulus, and buckling ratio) in 181 women with a DRF (DRF group) and 362 propensity score-matched women without a fracture (control group). We evaluated the associations between DRF and hip geometry parameters using logistic regression analysis. RESULTS The DRF group had lower hip BMD; lower cortical thickness, CSA, and section modulus; and higher buckling ratio than the control group (all p < 0.05). The occurrence of a DRF was significantly associated with decreases in neck shaft angle (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.008-1.088) and CSA (OR, 3.114; 95% CI, 1.820-5.326) after adjusting for age, BMI, and total hip BMD. CONCLUSIONS In this study, women with a DRF were more likely than women without a DRF to have hip geometry parameters known to indicate susceptibility to hip fractures. Our results suggest that not only low hip BMD but also a decreased CSA could account for the increased risk of subsequent hip fracture in patients with a DRF.
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Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea.
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Ohsang Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Hu W, He J, Qi L, Wang C, Yue H, Gu J, Zhang H, Wang Y, Zhang Z. Association of HIVEP3 Gene and Lnc RNA with Femoral Neck Bone Mineral Content and Hip Geometry by Genome-Wide Association Analysis in Chinese People. Int J Endocrinol 2020; 2020:6929073. [PMID: 33110425 PMCID: PMC7579678 DOI: 10.1155/2020/6929073] [Citation(s) in RCA: 2] [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: 04/08/2020] [Revised: 07/27/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE GWAS has successfully located and analyzed the pathogenic genes of osteoporosis. Genetic studies have found that heritability of BMD is 50%-85% while the other half is caused by hip geometric parameters and tissue horizontal characteristics. This study was designed to study the GWAS of osteoporosis in Shanghai Han population. METHODS We collected 1224 unrelated healthy young men (20-40 years old), young women (20-40 years old), and postmenopausal women (over 50 years old) who lived in Shanghai. BMD and hip geometric parameters were measured by dual-energy X-ray absorptiometry. The genomic DNA of peripheral blood was extracted and analyzed by using Illumina Human Asian Screening Array-24 + v1.0 (ASA) gene chip. Statistical analysis was carried out to evaluate the relationship between these SNPs and BMD and hip geometric parameters. RESULTS A total of 1155 subjects were included. We found that one SNP rs35282355 located in the human immunodeficiency virus type 1 enhancer-binding protein 3 gene (HIVEP3) and another 25 SNPs located in LINC RNA were significantly correlated with bone mineral content (BMC) in the femoral neck (P= 2.30 × 10-9, P < 5 × 10-8). We also found that the correlation between SNP rs35282355 and cross-sectional area (CSA) of hip geometry was a significant marginal statistical difference (P = 5.95 × 10-8). CONCLUSIONS Through this study, we found that HIVEP3 gene and LINC RNA are potentially correlated with femoral neck BMC. These results provide important information for us to further understand the etiology and genetic pathogenesis of osteoporosis. In the future, we will expand the sample size to verify these loci and carry out molecular research.
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Affiliation(s)
- Weiwei Hu
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Jinwei He
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Luyue Qi
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Chun Wang
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Hua Yue
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Jiemei Gu
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Hao Zhang
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
| | - Yi Wang
- Ministry of Education Key Laboratory of Contemporary Anthropology, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Zhenlin Zhang
- Shanghai Clinical Research Center of Bone Diseases, Department of Osteoporosis and Bone Diseases, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai 200233, China
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Cao WT, Zeng FF, Li BL, Lin JS, Liang YY, Chen YM. Higher dietary carotenoid intake associated with lower risk of hip fracture in middle-aged and elderly Chinese: A matched case-control study. Bone 2018; 111:116-122. [PMID: 29605302 DOI: 10.1016/j.bone.2018.03.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Mechanism studies have suggested that carotenoids may benefit bone health due to their antioxidant properties, but epidemiological data on their effects on risk of hip fracture are sparse. PURPOSE To explore the relationships between dietary total and specific carotenoids and the risk of hip fracture in a middle-aged and elderly Chinese population. DESIGN A case-control study of 1070 patients with hip fractures (diagnosed within 2 weeks) aged 55-80 years and 1070 age- (within 3 years) and gender-matched controls was conducted in Guangdong, China between 2009 and 2015. Information on dietary carotenoid intake was assessed using a 79-item food frequency questionnaire administered in face-to-face interviews, and general information was collected using structured questionnaires. The univariate and multivariate conditional logistic regression models were applied to analyze the associations. MAIN RESULTS Higher intakes of both total and some specific carotenoids (including β-carotene, β-cryptoxanthin and lutein/zeaxanthin) were significantly associated with a lower risk of hip fracture (all p trends <0.01). Compared with the lowest quartile of carotenoids, the multivariate-adjusted odds ratios and 95% confidential intervals of the highest quartile were 0.44 (0.29, 0.68) (total carotenoids), 0.50 (0.29, 0.69) (β-carotene), 0.55 (0.38, 0.80) (β-cryptoxanthin) and 0.40 (0.27, 0.59) (lutein/zeaxanthin), respectively. There were no statistically significant associations between α-carotene and lycopene intakes and hip fracture risk after adjustment for various confounding variables. CONCLUSION These results suggest that the consumption of carotenoids may be protective against hip fracture in middle-aged and elderly Chinese adults.
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Affiliation(s)
- Wen-Ting Cao
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Fang-Fang Zeng
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; Department of Epidemiology, School of Basic Medical Sciences, Jinan University, Guangzhou 510632, China
| | - Bao-Lin Li
- Guangzhou Orthopaedics Trauma Hospital, Guangzhou 510045, China
| | - Jie-Sheng Lin
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya-Yong Liang
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
| | - Yu-Ming Chen
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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Fajar JK, Taufan T, Syarif M, Azharuddin A. Hip geometry and femoral neck fractures: A meta-analysis. J Orthop Translat 2018; 13:1-6. [PMID: 29662785 PMCID: PMC5892388 DOI: 10.1016/j.jot.2017.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Several studies have reported hip geometry to predict the femoral neck fractures. However, they showed inconsistency. OBJECTIVES To determine the association between hip geometry and femoral neck fractures. METHODS Published literature from PubMed and Embase databases (until May 25th, 2017) was searched for eligible publications. The information related to (1) name of first author; (2) year of publication; (3) country of origin; (4) sample size of cases and controls and (5) mean and standard deviation of cases and controls were extracted. The pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between hip geometry and femoral neck fractures were assessed using random or fixed effect model. A Comprehensive Meta-analysis software, version 2.0, was used to analyse the data. RESULTS A total of 11 studies were included in this study. Our results showed that increase in hip axis length (OR 95% CI = 1.53 [1.06-2.21], p = 0.025), femoral neck angle (OR 95% CI = 1.47 [1.01-2.15], p = 0.044) and neck width (OR 95% CI = 2.68 [1.84-3.91], p < 0.001) was associated with the risk of femoral neck fractures, whereas we could not find the correlation between femoral neck axis length and the risk of femoral neck fractures. CONCLUSION There is strong evidence that elevated hip axis length, femoral neck angle and neck width are the risk factor for femoral neck fractures.The Translational Potential of this Article: Determining the hip axis length, femoral neck angle and neck width that are most highly associated with femoral neck fracture may allow clinicians to more accurately predict which individuals are likely to experience femoral neck fractures in the future.
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Affiliation(s)
- Jonny Karunia Fajar
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
- Department of Emergency, Aisyiyah Hospital, Malang, Indonesia
| | - Taufan Taufan
- Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
| | - Muhammad Syarif
- Department of Emergency, Aisyiyah Hospital, Malang, Indonesia
| | - Azharuddin Azharuddin
- Consultant of Spine Surgery, Department of Orthopedic and Traumatology, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia
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Leslie WD, Lix LM, Majumdar SR, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women. J Clin Endocrinol Metab 2017; 102:4242-4249. [PMID: 29092086 DOI: 10.1210/jc.2017-01327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. OBJECTIVE To examine whether fracture prediction by FRAX® is affected by hip area. DESIGN AND SETTING Cohort study using a population-based BMD registry. PATIENTS A total of 58,108 white women aged ≥40 years. MAIN OUTCOME MEASURES Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). RESULTS Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend < 0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend < 0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. CONCLUSIONS In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Lisa M Lix
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
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Edmondson CP, Schwartz EN. Non-BMD DXA measurements of the hip. Bone 2017; 104:73-83. [PMID: 28476576 DOI: 10.1016/j.bone.2017.03.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/19/2017] [Accepted: 03/19/2017] [Indexed: 12/31/2022]
Abstract
Hip fracture is one of the most serious complications of osteoporosis. More than 50% of hip and other fractures occur in patients without densitometric osteoporosis. Therefore, areal bone mineral density (aBMD) may not be the best way to assess fracture risk. In order to improve assessment of fracture risk, many other approaches have been taken. At the present time, the Fracture Risk Algorithm (FRAX©) is one of the most notable ways to improve assessment of fracture risk. However, since early in the initiation of the dual energy x-ray absorptiometry (DXA) era, several non-BMD DXA approaches to the assessment of hip fracture risk have been proposed. This review will cover some of those methodologies, including hip-axis length (HAL), hip-structural analysis (HSA), finite element analysis (FEA) by DXA, and body composition of the thigh by DXA (BCT). These methods have been utilized in models of hip fracture occurrence and in pharmacological clinical trials. How they should be used in clinical practice or if they should be used in clinical practice is more of an issue. In addition, we will discuss the recent proposal of the use of Long Femur Scan Field in the effort to diagnose atypical femoral fractures.
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Affiliation(s)
- Clinten P Edmondson
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
| | - Elliott N Schwartz
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
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The influence of acetabular morphology on prediction of proximal femur fractures types in an elderly population. Hip Int 2017; 27:489-493. [PMID: 28574116 DOI: 10.5301/hipint.5000476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The role of proximal femur morphology to the development of certain proximal femur fracture types both femoral neck and trochanteric fractures has been observed. However, the relavance of acetabular morphology to the development of proximal femur fractures is not extensively questioned. Therefore the aim of the study was to determine whether there is a correlation between acetabular morphology and pathogenesis of 2 different hip fracture types after low energy trauma. METHODS This retrospective study includes 60 cases (41 women, 19 men) with a proximal femoral fracture after a low energy trauma between July 2012 and December 2014. Acetabular depth and acetabular index were measured on pelvic radiographs. Neck shaft angle, hip axis length and cortical index were measured on pelvic computed tomography scans. All measurements were performed on the contralateral hip. RESULTS Mean age was 77.56 ± 8.99 years (range 61-92 years). No statistically significant difference was found with regard to neck shaft angle, acetabular depth or cortical index measurements between patients with femoral neck fracture and patients with trochanteric femoral fractures (p>0.05). Acetabular index measurement was higher (p = 0.001) and hip axis length measurement was lower (p = 0.001) in trochanteric fracture group as compared to femoral neck fracture. CONCLUSIONS The rate of trochanteric femur fractures is higher in patients with high acetabular index, whereas the rate of femoral neck fractures is higher in patients with increased hip axis length.
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Shen Y, Tang ML, Wu XP, Yuan LQ, Dai RC, Zhang H, Sheng ZF, Peng YQ, Luo XH, Wu XY, Liao EY. Gender differences in a reference database of age-related femoral neck geometric parameters for Chinese population and their association with femoral neck fractures. Bone 2016; 93:64-70. [PMID: 27641474 DOI: 10.1016/j.bone.2016.09.014] [Citation(s) in RCA: 2] [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: 05/31/2016] [Revised: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Femoral neck geometric parameters (FNGPs) are closely related to the strength of the femoral neck and the risk of fragility fractures. No reference database is available for FNGPs for Chinese population, and gender-related differences in FNGPs as well as their association with the risk of femoral neck fractures are unknown. This investigation aimed to set up reference databases for FNGPs, understand gender-related differences in FNGPs, and examine the association between FNGPs and the risk of osteoporotic fractures of the femoral neck. This study included 5268 females and 2156 males (aged 15-91years) from Chinese population. A total of 384 patients (282 females and 102 males) had sustained femoral neck fractures; 384 age- and sex-matched individuals without any fractures served as controls. Femoral neck DXA images were used to measure bone mineral density (BMD) and eight FNGPs. Our results showed that the age-related trends of FNGPs were fitted with the best goodness-of-fit by applying the cubic regression model. The trends shown by FNGPs were significantly different between male and female subjects, and the fitting curves were significantly higher in male subjects. After adjustments were made for age, height, weight, and body mass index, Cox regression analysis showed that changes in all FNGPs were related to increased hazard ratios (HRs) of femoral neck fractures. After further adjustment was made for BMD of the femoral neck, the HRs related to a cortical thickness (CT) decrease and buckling ratio (BR) increase in females went up by 3.35-folds (95% CI: 2.75-4.07) and 1.86-folds (95% CI: 1.33-2.60), respectively. In males, the HRs related to the decrease in CT and cross-sectional area (CSA) increased by 3.21-folds (95% CI: 2.32-4.45) and 1.88-folds (95% CI: 1.03-3.44), respectively. In conclusions, the reference databases of FNGPs established in this study will assist in the evaluation and prediction of femoral neck fracture risk in the clinic. The decrease in CT and increase in BR of the femoral neck were independent risk factors for osteoporotic fractures of the femoral neck in females from mainland China, while a decrease in CT and CSA were risk factors in male.
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Affiliation(s)
- Yi Shen
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Orthopedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Meng-Lu Tang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Heze Hospital of Traditional Chinese Medicine, Shandong Province, No.1036 Danyang Road, Heze, Shandong 274000, PR China
| | - Xian-Ping Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ling-Qing Yuan
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ru-Chun Dai
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Hong Zhang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Yi-Qun Peng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xiang-Hang Luo
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xi-Yu Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China.
| | - Er-Yuan Liao
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
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12
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Hernandez-de Sosa N, Athanasiadis G, Malouf J, Laiz A, Marin A, Herrera S, Farrerons J, Soria JM, Casademont J. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study. PLoS One 2016; 11:e0154833. [PMID: 27163365 PMCID: PMC4862643 DOI: 10.1371/journal.pone.0154833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Femoral neck geometry parameters are believed to be as good as bone mineral density as independent factors in predicting hip fracture risk. This study was conducted to analyze the roles of genetic and environmental factors in femoral properties measured in a sample of Spanish families with osteoporotic fractures and extended genealogy. The "Genetic Analysis of Osteoporosis (GAO) Project" involved 11 extended families with a total number of 376 individuals. We studied three categorical phenotypes of particular clinical interest and we used a Hip structural analysis based on DXA to analyze 17 strength and geometrical phenotypes of the hip. All the femoral properties had highly significant heritability, ranging from 0.252 to 0.586. The most significant correlations were observed at the genetic level (ρG). Osteoporotic fracture status (Affected 2) and, particularly, low bone mass and osteoporotic condition (Affected 3) had the highest number of significant genetic correlations with diverse femoral properties. In conclusion, our findings suggest that a relatively simple and easy to use method based on DXA studies can provide useful data on properties of the Hip in clinical practice. Furthermore, our results provide a strong motivation for further studies in order to improve the understanding of the pathophysiological mechanism underlying bone architecture and the genetics of osteoporosis.
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Affiliation(s)
- Nerea Hernandez-de Sosa
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Georgios Athanasiadis
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Jorge Malouf
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Laiz
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Marin
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Herrera
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Farrerons
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Manuel Soria
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Moon JH, Jung KY, Kim KM, Choi SH, Lim S, Park YJ, Park DJ, Jang HC. The effect of thyroid stimulating hormone suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma. Bone 2016; 83:104-110. [PMID: 26518742 DOI: 10.1016/j.bone.2015.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/24/2015] [Accepted: 10/25/2015] [Indexed: 11/22/2022]
Abstract
Subclinical hyperthyroidism has been reported to increase the fracture risk. However, the effect of thyroid stimulating hormone (TSH) suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma (DTC) is still unclear. The aim of this study was to investigate the effect of TSH suppression on bone geometry in the hip area of pre- and postmenopausal women with DTC. We conducted a retrospective cohort study including 99 women with DTC (25 pre- and 74 postmenopausal) who had received TSH suppressive therapy for at least 3years and 297 control subjects (75 and 222, respectively) matched for sex and age. Bone mineral density (BMD) in the spine and hip area and bone geometry at the femoral neck measured by dual energy X-ray absorptiometry (DXA) were compared between patients and controls. The association between thyroid hormone and bone parameters was investigated. All analyses of bone parameters were adjusted for age, body mass index, and serum calcium levels. In premenopausal subjects, TSH suppressive therapy was not associated with poor bone parameters. In postmenopausal subjects, patients with DTC undergoing TSH suppression showed lower cross-sectional moment of inertia (CSMI), cross-sectional area, and section modulus and thinner cortical thickness at the femoral neck than those of control subjects, whereas their femoral neck BMD was comparable with controls. Total hip BMD was lower in postmenopausal patients than in controls. CSMI and section modulus at the femoral neck were independently associated with serum free T4 levels in postmenopausal patients. The difference in femoral neck bone geometry between patients and controls was only apparent in postmenopausal DTC patients with free T4 >1.79ng/dL (23.04pmol/l), and not in those with free T4 levels ≤1.79ng/dL (23.04pmol/l). TSH suppression in postmenopausal DTC patients was associated with decreased bone strength by altering bone geometry rather than BMD in the hip area, especially the femoral neck. This alteration in bone quality was observed only in patients with free T4 levels above the upper normal limit.
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Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
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14
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Kang H, Chen YM, Han G, Huang H, Chen WQ, Wang X, Zhu YY, Xiao SM. Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:157. [PMID: 26805871 PMCID: PMC4772177 DOI: 10.3390/ijerph13020157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022]
Abstract
This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD) and geometric parameters, including cross-sectional area (CSA), outer diameter (OD), cortical thickness (CT), section modulus (SM), buckling ratio (BR) at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS). Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p < 0.05), which indicated a weaker bone strength at the proximal femur. BMI and years of menstruation had the positive relationships with proximal femur strength (p < 0.05). Further analyses showed that the ranges of absolute value of change slope per year, per BMI or per year of menstruation were 0.14%-1.34%, 0.20%-2.70%, and 0.16%-0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.
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Affiliation(s)
- Huili Kang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Yu-Ming Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Guiyuan Han
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Hua Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Xidan Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Ying-Ying Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Su-Mei Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
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15
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Wheeler RL, Hampton AD, Langley NR. The effects of body mass index and age on cross-sectional properties of the femoral neck. Clin Anat 2015; 28:1048-57. [DOI: 10.1002/ca.22632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
Affiliation(s)
- Rachel L. Wheeler
- Department of Anatomy; Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate; Tennessee
| | - Aaron D. Hampton
- Department of Anatomy; Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate; Tennessee
| | - Natalie R. Langley
- Department of Anatomy; Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate; Tennessee
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16
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Broy SB, Cauley JA, Lewiecki ME, Schousboe JT, Shepherd JA, Leslie WD. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 1: Hip Geometry. J Clin Densitom 2015; 18:287-308. [PMID: 26277848 DOI: 10.1016/j.jocd.2015.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/19/2023]
Abstract
Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry is the current imaging procedure of choice to assess fracture risk. However, BMD is only one of the factors that explain bone strength or resistance to fracture. Other factors include bone microarchitecture and macroarchitecture. We now have the ability to assess some of these non-BMD parameters from a dual-energy X-ray absorptiometry image. Available measurements include various measurements of hip geometry including hip structural analysis, hip axis length, and neck-shaft angle. At the 2015 Position Development Conference, the International Society of Clinical Densitometry established official positions for the clinical utility of measurements of hip geometry. We present the official positions approved by an expert panel after careful review of the recommendations and evidence prepared by an independent task force. Each question addressed by the task force is presented followed by the official position with the associated medical evidence and rationale.
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Affiliation(s)
- Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael E Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - John T Schousboe
- Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, USA
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
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Mitra A, Khadijeh B, Vida AP, Ali RN, Farzaneh M, Maryam VF, Vahid Y. Sexing based on measurements of the femoral head parameters on pelvic radiographs. J Forensic Leg Med 2014; 23:70-5. [DOI: 10.1016/j.jflm.2014.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 12/12/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
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18
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Ripamonti C, Lisi L, Avella M. Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 2014; 87:20130358. [PMID: 24678889 DOI: 10.1259/bjr.20130358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. METHODS We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. RESULTS Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. CONCLUSION NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. ADVANCES IN KNOWLEDGE The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.
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Affiliation(s)
- C Ripamonti
- Struttura Semplice Dipartimentale di Medicina Generale, Istituto Ortopedico Rizzoli, Bologna, Italy
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19
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Zhang ZQ, Ho SC, Chen ZQ, Zhang CX, Chen YM. Reference values of bone mineral density and prevalence of osteoporosis in Chinese adults. Osteoporos Int 2014; 25:497-507. [PMID: 23800746 DOI: 10.1007/s00198-013-2418-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 06/10/2013] [Indexed: 12/24/2022]
Abstract
UNLABELLED We pooled bone mineral density (BMD) data published in 91 articles including 139,912 Chinese adults and then established a national-wide BMD reference database at the lumbar spine and femur neck for Chinese adults. The prevalence of osteoporosis in the middle-aged and elderly Chinese population was also estimated. INTRODUCTION Well-accepted reference value of BMD is lacking in Chinese. We established the reference database and assessed osteoporosis prevalence based on published literature conducted in the Mainland China, Taiwan, and Hong Kong Chinese. METHODS We searched for all published articles indexed in MEDLINE, PubMed, CNKI, and SinoMed up to January 2013. We included cross-sectional studies that examined BMD using a dual-energy X-ray absorptiometry at the femur neck (FN) and/or lumbar spine (LS) in healthy adults. Overall age-specific mean (SD) BMD were pooled after standardization. RESULTS Ninety-one studies including 51,906 males and 88,006 females (≥ 20 years) in 38 cities in China were included in this pooling study. Gender- and age-specific reference curves of standardized BMD (sBMD) at the LS and FN were constructed. The sBMD cutoffs for osteoporosis classification were 0.746 and 0.549 in women, and 0.680 and 0.568 g/cm(2) in men; age-standardized prevalence of osteoporosis was 23.9 % and 12.5 % in women and 3.2 % and 5.3 % in men aged ≥ 50 years at the LS and FN, respectively. Meta-regression analysis showed that greater age and altitude, lower latitude, smaller city size, earlier detection time, and random sample were correlated to lower sBMD in at least one gender-specific bone sites; the Hologic DXA produced a higher value of FN sBMD than the other two devices (Lunar and Norland). CONCLUSION We have established a national-wide BMD reference database at the LS and FN for Chinese adults and estimated the prevalence of osteoporosis in the middle-aged and elderly Chinese population.
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Affiliation(s)
- Z-Q Zhang
- Guangdong Provincial Key Laboratory of Food, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
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20
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Li GW, Chang SX, Xu Z, Chen Y, Bao H, Shi X. Prediction of hip osteoporotic fractures from composite indices of femoral neck strength. Skeletal Radiol 2013; 42:195-201. [PMID: 22714125 DOI: 10.1007/s00256-012-1473-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/30/2012] [Accepted: 06/04/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To clarify whether composite hip strength indices improve predictive ability for hip osteoporotic fractures independent of conventional bone mineral density (BMD). SUBJECTS AND METHODS Three hundred and eighty-two health controls and 43 women with hip fractures (aged 28.2-87.7 years, mean age 59.5 ± 9.2 years) were measured by dual energy X-ray absorptiometry for femoral neck bone mineral density (FN_BMD) and proximal femur geometry parameters of hip, and composite hip strength indices (Compression strength index, Bending strength index, and Impact strength index). The association between the studied parameters and the fractures was modelled using multiple logistic regression, including age, height, weight, and menopausal status. Fracture-predicted probability was calculated for each predictor tested. ROC curve areas (AUCs) were calculated for the fracture status, having the calculated fracture-predicted probability as a test variable. AUCs were compared by the Hanley-McNeil test. RESULTS Women with hip fractures had lower FN_BMD, composite hip strength indices, and longer hip axis length than controls, and no significant difference in femoral neck width. Logistic regression showed composite hip strength indices could predict hip fractures risk. To the same extent as FN BMD, Compression Strength Index (CSI) best predicted the risk for each fracture (AUC = 0.787 ± 0.028). When CSI was added to FN_BMD, there was a small but not statistically significant increase in AUC to 0.796 ± 0.027 (P = 0.9018). CONCLUSION Composite indices of femoral neck strength may be valuable in the assessment of the biomechanics of bone fragility; however, they do not appear to add diagnostic value to the simple measurement of BMD.
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Affiliation(s)
- Guan-Wu Li
- Department of Radiology, Yueyang Hospital affiliated to ShangHai University of Traditional Chinese Medicine, Shanghai, China.
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21
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Hu WW, Zhang H, Wang C, Gu JM, Yue H, Ke YH, Hu YQ, Fu WZ, Li M, Zhang ZL. Lean mass predicts hip geometry and bone mineral density in chinese men and women and age comparisons of body composition. J Clin Densitom 2012; 15:434-442. [PMID: 22521541 DOI: 10.1016/j.jocd.2012.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 02/03/2012] [Accepted: 02/13/2012] [Indexed: 01/05/2023]
Abstract
Previous studies have suggested that changes in hip geometry increase the risk of hip fracture. The aim of this study was to identify whether body composition were associated with hip geometry or bone mineral density (BMD) in a large sample of Chinese people. A total of 2072 subjects aged 20-79 yr (including 700 males and 1372 females) were selected. The following measurements were taken: lumbar spine (L1-4); proximal femur BMD; lean mass (LM); fat mass (FM); and hip geometric parameters, including hip axis length (HAL), cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), neck-shaft angle, and femur strength index (SI) by dual-energy X-ray absorptiometry. FM and LM were positively correlated with HAL, CSMI, and CSA, and negatively correlated with SI in both men and women. Multiple regression analysis showed that leg LM contributions to HAL, CSMI, and CSA variance were 12.6-37.6%. Compared with FM, LM was generally more strongly related to hip geometry and BMD in young and old men and women. Body composition was a good predictor for hip geometry parameter variation and BMD variation.
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Affiliation(s)
- Wei-Wei Hu
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hao Zhang
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chun Wang
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jie-Mei Gu
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Yue
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yao-Hua Ke
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yun-Qiu Hu
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wen-Zhen Fu
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Miao Li
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhen-Lin Zhang
- Department of Osteoporosis and Bone Disease, Metabolic Bone Disease and Genetic Research Unit, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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22
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Alwis G, Karlsson C, Stenevi-Lundgren S, Rosengren BE, Karlsson MK. Femoral neck bone strength estimated by hip structural analysis (HSA) in Swedish Caucasians aged 6-90 years. Calcif Tissue Int 2012; 90:174-85. [PMID: 22271247 DOI: 10.1007/s00223-011-9566-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/23/2011] [Indexed: 11/26/2022]
Abstract
Dual-energy X-ray absorptiometry hip scans of 1,760 population-based Caucasians, 599 girls and 642 boys aged 6-19 years and 270 women and 249 men aged 20-90 years, were analyzed with the hip structural analysis (HSA) software to present age- and sex-specific normative HSA data of the femoral neck (FN). Measured traits included bone mineral density (BMD), cross-sectional area (CSA), section modulus (Z), periosteal diameter (PD), endosteal diameter (ED), cortical thickness (CT), and cross-sectional moment of inertia (CSMI). When plotting the measured traits versus age, the curves increased with higher ages until statistically significant break points were reached, for all traits at age 17 in girls and age 19 in boys. After the break points, PD and ED increased with higher ages but, as ED increased more than PD, BMD and CT decreased significantly with higher ages. The decline in BMD was counteracted by the increase in bone size so that there was only a nonstatistically significant decrease in bone strength, estimated as Z and CSMI, from break point to age 90. The partial preservation of bone strength was more obvious in men than in women as the decline in BMD was higher in women than in men, while the expansion in PD was larger in men than in women. The sex difference in the normative FN bone strength data seems to be related to sex discrepancies in the development of both bone mass and geometrical parameters during both growth and adulthood.
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Affiliation(s)
- Gayani Alwis
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
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23
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Tuck SP, Rawlings DJ, Scane AC, Pande I, Summers GD, Woolf AD, Francis RM. Femoral neck shaft angle in men with fragility fractures. J Osteoporos 2011; 2011:903726. [PMID: 22013546 PMCID: PMC3195776 DOI: 10.4061/2011/903726] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 04/09/2011] [Accepted: 08/10/2011] [Indexed: 11/24/2022] Open
Abstract
Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm(2): lumbar spine, femoral neck, and total femur) measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P = 0.001), but larger in those with distal forearm fractures (129.8° versus 128.5°: P = 0.01). Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.
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Affiliation(s)
- S. P. Tuck
- Department of Rheumatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK,*S. P. Tuck:
| | - D. J. Rawlings
- Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK
| | - A. C. Scane
- Hunter Rural Aged Care Assessment Team, Lang Street, Kurri Kurri, NSW 2327, Australia
| | - I. Pande
- Rheumatology Department, Nottingham University Hospital, Nottingham NG7 2UH, UK
| | - G. D. Summers
- Medical Specialities OPD, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3NE, UK
| | - A. D. Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro TR1 3LJ, UK
| | - R. M. Francis
- Institute for Ageing and Health, The Medical School, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
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