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Abstract
PURPOSE OF REVIEW Opportunistic screening is a combination of techniques to identify subjects of high risk for osteoporotic fracture using routine clinical CT scans prescribed for diagnoses unrelated to osteoporosis. The two main components are automated detection of vertebral fractures and measurement of bone mineral density (BMD) in CT scans, in which a phantom for calibration of CT to BMD values is not used. This review describes the particular challenges of opportunistic screening and provides an overview and comparison of current techniques used for opportunistic screening. The review further outlines the performance of opportunistic screening. RECENT FINDINGS A wide range of technologies for the automatic detection of vertebral fractures have been developed and successfully validated. Most of them are based on artificial intelligence algorithms. The automated differentiation of osteoporotic from traumatic fractures and vertebral deformities unrelated to osteoporosis, the grading of vertebral fracture severity, and the detection of mild vertebral fractures is still problematic. The accuracy of automated fracture detection compared to classical radiological semi-quantitative Genant scoring is about 80%. Accuracy errors of alternative BMD calibration methods compared to simultaneous phantom-based calibration used in standard quantitative CT (QCT) range from below 5% to about 10%. The impact of contrast agents, frequently administered in clinical CT on the determination of BMD and on fracture risk determination is still controversial. Opportunistic screening, the identification of vertebral fracture and the measurement of BMD using clinical routine CT scans, is feasible but corresponding techniques still need to be integrated into the clinical workflow and further validated with respect to the prediction of fracture risk.
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Affiliation(s)
- Klaus Engelke
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany.
| | - Oliver Chaudry
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
| | - Stefan Bartenschlager
- Department of Medicine III, Friedrich-Alexander University of Erlangen-Nürnberg, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
- Institute of Medical Physics (IMP), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052, Erlangen, Germany
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Gregson CL, Armstrong DJ, Bowden J, Cooper C, Edwards J, Gittoes NJL, Harvey N, Kanis J, Leyland S, Low R, McCloskey E, Moss K, Parker J, Paskins Z, Poole K, Reid DM, Stone M, Thomson J, Vine N, Compston J. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos 2022; 17:58. [PMID: 35378630 PMCID: PMC8979902 DOI: 10.1007/s11657-022-01061-5] [Citation(s) in RCA: 163] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
The National Osteoporosis Guideline Group (NOGG) has revised the UK guideline for the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. Accredited by NICE, this guideline is relevant for all healthcare professionals involved in osteoporosis management. INTRODUCTION The UK National Osteoporosis Guideline Group (NOGG) first produced a guideline on the prevention and treatment of osteoporosis in 2008, with updates in 2013 and 2017. This paper presents a major update of the guideline, the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women, and men age 50 years and older. METHODS Where available, systematic reviews, meta-analyses and randomised controlled trials were used to provide the evidence base. Conclusions and recommendations were systematically graded according to the strength of the available evidence. RESULTS Review of the evidence and recommendations are provided for the diagnosis of osteoporosis, fracture-risk assessment and intervention thresholds, management of vertebral fractures, non-pharmacological and pharmacological treatments, including duration and monitoring of anti-resorptive therapy, glucocorticoid-induced osteoporosis, and models of care for fracture prevention. Recommendations are made for training; service leads and commissioners of healthcare; and for review criteria for audit and quality improvement. CONCLUSION The guideline, which has received accreditation from the National Institute of Health and Care Excellence (NICE), provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals involved in its management. This position paper has been endorsed by the International Osteoporosis Foundation and by the European Society for the Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases.
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK.
- Royal United Hospital NHS Foundation Trust, Bath, UK.
| | - David J Armstrong
- Western Health and Social Care Trust (NI), Nutrition Innovation Centre for Food and Health, Ulster University, and Visiting Professor, Belfast, Northern Ireland
| | - Jean Bowden
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, and Wolstanton Medical Centre, Newcastle under Lyme, UK
| | - Neil J L Gittoes
- Centre for Endocrinology, Diabetes and Metabolism, Queen Elizabeth Hospital, University Hospitals Birmingham & University of Birmingham, Birmingham, UK
| | - Nicholas Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia and Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | | | - Rebecca Low
- Abingdon and Specialty Doctor in Metabolic Bone Disease, Marcham Road Health Centre, Nuffield Orthopaedic Centre, Oxford, UK
| | - Eugene McCloskey
- Department of Oncology & Metabolism, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Katie Moss
- St George's University Hospital, London, UK
| | - Jane Parker
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Zoe Paskins
- School of Medicine, Keele University, Keele, Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Kenneth Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | | | - Mike Stone
- University Hospital Llandough, Cardiff and Vale University Health Board, Llandough, UK
| | | | - Nic Vine
- Musculoskeletal Research Unit, Bristol Medical School, Learning and Research Building, University of Bristol, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Juliet Compston
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
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Chen W, Liu X, Li K, Luo Y, Bai S, Wu J, Chen W, Dong M, Guo D. A deep-learning model for identifying fresh vertebral compression fractures on digital radiography. Eur Radiol 2021; 32:1496-1505. [PMID: 34553256 DOI: 10.1007/s00330-021-08247-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/22/2021] [Accepted: 08/05/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To develop a deep-learning (DL) model for identifying fresh VCFs from digital radiography (DR), with magnetic resonance imaging (MRI) as the reference standard. METHODS Patients with lumbar VCFs were retrospectively enrolled from January 2011 to May 2020. All patients underwent DR and MRI scanning. VCFs were categorized as fresh or old according to MRI results, and the VCF grade and type were assessed. The raw DR data were sent to InferScholar Center for annotation. A DL-based prediction model was built, and its diagnostic performance was evaluated. The DeLong test was applied to assess differences in ROC curves between different models. RESULTS A total of 1877 VCFs in 1099 patients were included in our study and randomly divided into development (n = 824 patients) and test (n = 275 patients) datasets. The ensemble model identified fresh and old VCFs, reaching an AUC of 0.80 (95% confidence interval [CI], 0.77-0.83), an accuracy of 74% (95% CI, 72-77%), a sensitivity of 80% (95% CI, 77-83%), and a specificity of 68% (95% CI, 63-72%). Lateral (AUC, 0.83) views exhibited better performance than anteroposterior views (AUC, 0.77), and the best performance among respective subgroupings was obtained for grade 3 (AUC, 0.89) and crush-type (AUC, 0.87) subgroups. CONCLUSION The proposed DL model achieved adequate performance in identifying fresh VCFs from DR. KEY POINTS • The ensemble deep-learning model identified fresh VCFs from DR, reaching an AUC of 0.80, an accuracy of 74%, a sensitivity of 80%, and a specificity of 68% with the reference standard of MRI. • The lateral views (AUC, 0.83) exhibited better performance than anteroposterior views (AUC, 0.77). • The grade 3 (AUC, 0.89) and crush-type (AUC, 0.87) subgroups showed the best performance among their respective subgroupings.
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Affiliation(s)
- Weijuan Chen
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Xi Liu
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Kunhua Li
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Yin Luo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Shanwei Bai
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China
| | - Jiangfen Wu
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Weidao Chen
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Mengxing Dong
- Department of Applied Clinical Medicine, Infervision, Beijing, China
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Rd, Yuzhong District, Chongqing, 400010, China.
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Aggarwal V, Maslen C, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, Ward KA, Poole KES. Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024029. [PMID: 34290831 PMCID: PMC8274099 DOI: 10.1177/1759720x211024029] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Osteoporosis causes bones to become weak, porous and fracture more easily. While a vertebral fracture is the archetypal fracture of osteoporosis, it is also the most difficult to diagnose clinically. Patients often suffer further spine or other fractures, deformity, height loss and pain before diagnosis. There were an estimated 520,000 fragility fractures in the United Kingdom (UK) in 2017 (costing £4.5 billion), a figure set to increase 30% by 2030. One way to improve both vertebral fracture identification and the diagnosis of osteoporosis is to assess a patient's spine or hips during routine computed tomography (CT) scans. Patients attend routine CT for diagnosis and monitoring of various medical conditions, but the skeleton can be overlooked as radiologists concentrate on the primary reason for scanning. More than half a million CT scans done each year in the National Health Service (NHS) could potentially be screened for osteoporosis (increasing 5% annually). If CT-based screening became embedded in practice, then the technique could have a positive clinical impact in the identification of fragility fracture and/or low bone density. Several companies have developed software methods to diagnose osteoporosis/fragile bone strength and/or identify vertebral fractures in CT datasets, using various methods that include image processing, computational modelling, artificial intelligence and biomechanical engineering concepts. Technology to evaluate Hounsfield units is used to calculate bone density, but not necessarily bone strength. In this rapid evidence review, we summarise the current literature underpinning approved technologies for opportunistic screening of routine CT images to identify fractures, bone density or strength information. We highlight how other new software technologies have become embedded in NHS clinical practice (having overcome barriers to implementation) and highlight how the novel osteoporosis technologies could follow suit. We define the key unanswered questions where further research is needed to enable the adoption of these technologies for maximal patient benefit.
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Affiliation(s)
- Veena Aggarwal
- Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, UK
| | | | | | | | | | | | | | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Jennifer S. Gregory
- University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | | | | | - Kate A. Ward
- University of Southampton, Southampton, Hampshire, UK
| | - Kenneth E. S. Poole
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
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Kelly MA, McCabe E, Bergin D, Kearns SR, McCabe JP, Armstrong C, Heaney F, Carey JJ. Osteoporotic Vertebral Fractures are Common in Hip Fracture Patients and are Under-recognized. J Clin Densitom 2021; 24:183-189. [PMID: 32546345 DOI: 10.1016/j.jocd.2020.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The vertebrae are the most common site for osteoporotic fracture. While they can result in disability and increased mortality, only one-third present clinically. People with multiple fractures are at greater risk of future fractures. Most hip fracture patients are neither diagnosed nor treated for their underlying osteoporosis. Computed tomography (CT) studies are often performed on hospitalised patients, can be used to diagnose osteoporosis and are gaining popularity for opportunistic osteoporosis screening by measuring BMD and other bone strength indices. The aim of this study was to assess the prevalence of vertebral fractures on CT pulmonary angiograms (CTPA) in a cohort of hip fracture patients and whether this increased their diagnosis and treatment rates. METHODS We retrospectively identified all hip fractures admitted to our institution between 2010 and 2017 to identify those who underwent CTPA scans. An independent, blinded consultant musculoskeletal radiologist reviewed the images for vertebral fractures and quantified severity using Genant criteria. Results were compared to the original radiology report, discharge diagnoses and treatment rates for osteoporosis. RESULTS Eleven percent (225/2122) of patients had CTPA images available. Seventy percent (158) were female with a mean age of 78 years (SD: 11). The median length of stay for all patients was 16 days (1-301). Forty percent (90) of patients had at least one vertebral fracture present and 20% (46) had more than one fracture. Only one in 5 radiology reports noted the fractures. 24% of subjects had osteoporosis treatment recorded at hospital discharge and there was no difference between those with vertebral fractures to those without. CONCLUSION Many hip fracture patients have undiagnosed spine fractures. A screening strategy which evaluates CT scans for fractures has potential to increase diagnosis and treatment rates of osteoporosis. However, more work is needed to increase awareness.
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Affiliation(s)
- Michael A Kelly
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland
| | - Eva McCabe
- Department of Rheumatology, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland.
| | - Diane Bergin
- Department of Radiology, Galway University Hospitals, Ireland
| | - Stephen R Kearns
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | - John P McCabe
- Department of Trauma and Orthopedic Surgery, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Ireland
| | - John J Carey
- Department of Rheumatology, Galway University Hospitals, Ireland; School of Medicine, National University of Ireland, Galway, Ireland
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Mazziotti G, Rodari M, Gelardi F, Tosi G, Zucali PA, Pepe G, Chiti A. Morphometric vertebral fractures in patients with castration-resistant prostate cancer undergoing treatment with radium-223: a longitudinal study in the real-life clinical practice. Endocrine 2020; 69:204-211. [PMID: 32239451 DOI: 10.1007/s12020-020-02277-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Radium-223 was associated with high incidence of non-vertebral fractures in patients with castration-resistant prostate cancer (CRPC). However, it is still unclear whether radium-223 may induce skeletal fragility regardless of other therapies for CRPC. We aimed at evaluating the prevalence, incidence, and determinants of vertebral fractures (VFs), i.e., the most frequent complication of skeletal fragility, in CRCP patients undergoing radium-223 therapy in the real-life clinical practice. METHODS We retrospectively reviewed 49 CRPC patients with symptomatic bone metastases treated with radium-223. Patients received median number of four radium-223 doses (range: 2-6) and were followed-up for a median period of 11 months (range: 6-44). VFs were assessed by a quantitative morphometry using lateral images of spine 11C-Choline PET/CT, excluding from the analysis the vertebral bodies affected by bone metastases. RESULTS Before radium-223 administration, 24 patients (49%) had VFs significantly associated with duration of androgen deprivation therapy (ADT; odds ratio 1.29) and previous abiraterone therapy (odds ratio 3.80). During radium-223 therapy, incident VFs occurred in 25% of patients, in relationship with prevalent VFs (hazard ratio 6.89) and change in serum total alkaline phosphatase values (hazard ratio 0.97), whereas the correlations with ADT and abiraterone therapy were lost. Noteworthy, the risk of VFs did not correlate with the therapeutic end points of radium-223. CONCLUSIONS This study provides a first evidence that in real-life clinical practice, radium-223 therapy may induce skeletal fragility with high risk of VFs, likely by inhibition of bone formation and independently of ADT and abiraterone therapy.
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Affiliation(s)
- Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.
| | - Marcello Rodari
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Fabrizia Gelardi
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanni Tosi
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Paolo A Zucali
- Department of Oncology, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Giovanna Pepe
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Unit of Nuclear Medicine, Humanitas Clinical and Research Center, IRCCS, Milan, Italy
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Kaiser J, Allaire B, Fein PM, Lu D, Adams A, Kiel DP, Jarraya M, Guermazi A, Demissie S, Samelson EJ, Bouxsein ML, Morgan EF. Heterogeneity and Spatial Distribution of Intravertebral Trabecular Bone Mineral Density in the Lumbar Spine Is Associated With Prevalent Vertebral Fracture. J Bone Miner Res 2020; 35:641-648. [PMID: 31886907 PMCID: PMC7145746 DOI: 10.1002/jbmr.3946] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
The spatial heterogeneity in trabecular bone density within the vertebral centrum is associated with vertebral strength and could explain why volumetric bone mineral density (vBMD) exhibits low sensitivity in identifying fracture risk. This study evaluated whether the heterogeneity and spatial distribution of trabecular vBMD are associated with prevalent vertebral fracture. We examined the volumetric quantitative computed tomography (QCT) scans of the L3 vertebra in 148 participants in the Framingham Heart Study Multidetector CT study. Of these individuals, 37 were identified as cases of prevalent fracture, and 111 were controls, matched on sex and age with three controls per case. vBMD was calculated within 5-mm contiguous cubic regions of the centrum. Two measures of heterogeneity were calculated: (i) interquartile range (IQR); and (ii) quartile coefficient of variation (QCV). Ratios in the spatial distributions of the trabecular vBMD were also calculated: anterior/posterior, central/outer, superior/mid-transverse, and inferior/mid-transverse. Heterogeneity and spatial distributions were compared between cases and controls using Wilcoxon rank sum tests and t tests and tested for association with prevalent fractures with conditional logistic regressions independent of integral vBMD. Prevalent fracture cases had lower mean ± SD integral vBMD (134 ± 38 versus165 ± 42 mg/cm3 , p < .001), higher QCV (0.22 ± 0.13 versus 0.17 ± 0.09, p = .003), and lower anterior/posterior rBMD (0.65 ± 0.13 versus 0.78 ± 0.16, p < .001) than controls. QCV was positively associated with increased odds of prevalent fracture (OR 1.61; 95% CI, 1.04 to 2.49; p = .034), but this association was not independent of integral vBMD (p = .598). Increased anterior/posterior trabecular vBMD ratio was associated with decreased odds of prevalent fracture independent of integral vBMD (OR 0.38; 95% CI, 0.20 to 0.71; p = .003). In conclusion, increased trabecular vBMD in the anterior versus posterior centrum, but not trabecular vBMD heterogeneity, was associated with decreased risk of prevalent fracture independent of integral vBMD. Regional measurements of trabecular vBMD could aid in determining the risk and underlying mechanisms of vertebral fracture. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jarred Kaiser
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Brett Allaire
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paul M Fein
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Darlene Lu
- Department of Biostatistics, Boston University, Boston, MA, USA
| | - Alexander Adams
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
| | - Mohamed Jarraya
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Elizabeth J Samelson
- Department of Biostatistics, Boston University, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA, USA
| | - Mary L Bouxsein
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Elise F Morgan
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
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Wang L, Yin L, Cheng X, Li K, Wang Y, Zhang Y, Duanmu YY, Liu X, Deng G, Wang Y, Veronese N, Li W, Tian W. The association of calcium intake with osteoporotic vertebral fractures in a large Chinese cohort. Aging (Albany NY) 2020; 12:5500-5515. [PMID: 32221046 PMCID: PMC7138559 DOI: 10.18632/aging.102974] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/19/2020] [Indexed: 12/17/2022]
Abstract
The effect of calcium on prevention of osteoporosis and related fracture which are aging issues is unclear. The aim of this study is to explore the association of calcium intake with vertebral fracture. This study enrolled 3,457 participants from China Action on Spine and Hip Status (CASH) study from 2013 and 2017. Dietary calcium intake was collected using validated food frequency questionnaires (FFQ). Vertebral fracture of CT images was defined as the primary outcome. The mean calcium intake of men and women were 522.75mg/day and 507.21mg/day, respectively. 6% reduction in the odds of fracture risk was observed per 100 unit increase of calcium intake from food among females (OR, 0.94; 95% CI, 0.89-0.99), but results among males were not significant. We divided calcium intake into quintiles when modelling its associations with fracture risk, negative associations of fracture risk with calcium intake were found among females. In a population with low usual calcium intake, higher dietary calcium intake was associated with fewer vertebral fracture in women and that no such association was seen in men.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Lu Yin
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yuebo Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yang-Yang Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Xiaoyun Liu
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Guijuan Deng
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Nicola Veronese
- Aging Branch (N.V.), National Research Council, Neuroscience Institute, Padova, Italy
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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Kay FU, Oz OK, Abbara S, Mortani Barbosa EJ, Agarwal PP, Rajiah P. Translation of Quantitative Imaging Biomarkers into Clinical Chest CT. Radiographics 2019; 39:957-976. [PMID: 31199712 DOI: 10.1148/rg.2019180168] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Quantitative imaging has been proposed as the next frontier in radiology as part of an effort to improve patient care through precision medicine. In 2007, the Radiological Society of North America launched the Quantitative Imaging Biomarkers Alliance (QIBA), an initiative aimed at improving the value and practicality of quantitative imaging biomarkers by reducing variability across devices, sites, patients, and time. Chest CT occupies a strategic position in this initiative because it is one of the most frequently used imaging modalities, anatomically encompassing the leading causes of mortality worldwide. To date, QIBA has worked on profiles focused on the accurate, reproducible, and meaningful use of volumetric measurements of lung lesions in chest CT. However, other quantitative methods are on the verge of translation from research grounds into clinical practice, including (a) assessment of parenchymal and airway changes in patients with chronic obstructive pulmonary disease, (b) analysis of perfusion with dual-energy CT biomarkers, and (c) opportunistic screening for coronary atherosclerosis and low bone mass by using chest CT examinations performed for other indications. The rationale for and the key facts related to the application of these quantitative imaging biomarkers in cardiothoracic chest CT are presented. ©RSNA, 2019 See discussion on this article by Buckler (pp 977-980).
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Orhan K Oz
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Eduardo J Mortani Barbosa
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prachi P Agarwal
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
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10
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Schousboe JT. Vertebral Fracture Identification as Part of a Comprehensive Risk Assessment in Patients with Osteoporosis. Curr Osteoporos Rep 2018; 16:573-583. [PMID: 30116975 DOI: 10.1007/s11914-018-0472-6] [Citation(s) in RCA: 5] [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: 01/22/2023]
Abstract
PURPOSE OF REVIEW To review current evidence regarding the vertebral fracture prevalence, the accuracy of vertebral fracture identification on current imaging technologies, and the potential impact of vertebral fracture identification on fracture risk. RECENT FINDINGS Important new studies have clarified the features of prevalent vertebral fracture that most strongly predict incident fractures. Age- and sex-stratified estimates of vertebral fracture prevalence on densitometric lateral spine images in the US population are now available. The accuracy of densitometric vertebral fracture assessment, how computed tomography scans and other spinal images obtained for indications other than vertebral fracture assessment can be leveraged to detect prevalent vertebral fractures, and the potential impact of vertebral fracture assessment on patient and provider fracture risk management behavior have been clarified. Substantial progress has been made regarding screening strategies using lateral spine imaging to detect prevalent vertebral fracture in the older population. Further research regarding implementation of these strategies in clinical practice and their impact on clinical outcomes is needed.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Osteoporosis Center, HealthPartners Inc., Bloomington, MN, USA.
- HealthPartners Institute, Minneapolis, MN, USA.
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
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11
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Li K, Zhang Y, Wang L, Duanmu YY, Tian W, Chen H, Yin L, Bo J, Wang Y, Li W, He L, Zhao WH, Xu SQ, Zhao LF, Zhou J, Wang FZ, Liu Y, Zhu L, Chen YZ, Zhang XL, Hao XG, Shi ZW, Wang JY, Shao JM, Chen ZJ, Lei RS, Ning G, Zhao Q, Jiang YH, Zhi YH, Li BQ, Chen X, Xiang QY, Wang L, Ma YZ, Liu SW, Cheng XG. The protocol for the Prospective Urban Rural Epidemiology China Action on Spine and Hip status study. Quant Imaging Med Surg 2018; 8:667-672. [PMID: 30211034 DOI: 10.21037/qims.2018.08.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Prospective Urban Rural Epidemiology (PURE) China Action on Spine and Hip status (CASH) study focused on the prevalence of osteoporosis and spinal fracture in China. The aim of the PURE CASH study is to determine the prevalence of osteoporosis and spinal fracture, and explore the potential relationship between spinal fracture and bone mineral density (BMD). This study is a prospective large-scale population study with a community-based sampling and recruitment strategy. The aim is to determine the prevalence of osteoporosis and vertebral fracture in this population, to evaluate the association between vertebral fractures and BMD values, and to assess the prediction power of BMD for incident fractures. Participants in the PURE CASH study are all from the PURE study in China, recruited from 12 centers in 7 Chinese provinces. The inclusion criteria are that participants should be aged more than 40 years and able to give informed consent. Exclusion criteria are pregnant women, individuals with metal implants in the lumbar spine, use of medications or the existence of any disease or condition known to have a major influence on BMD, and inability to give informed consent. A total of 3,457 participants undergo a quantitative computed tomography (QCT) scan of the upper abdomen. The scanning parameters are as follows: 120 kVp at all centers, mAs between 75 and 200, FOV 40 cm×40 cm. The BMD values of L1 to L3 are measured, and the average BMD calculated. The American College of Radiology QCT criteria for the diagnosis of osteoporosis is applied to determine the presence of osteoporosis. The scout view images of T4-L4 vertebrae are reviewed by two experienced radiologists for semi-quantification of vertebral fractures according to Genant's method.
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Affiliation(s)
- Kai Li
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Yang-Yang Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei Tian
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Hui Chen
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Lu Yin
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Jian Bo
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Yang Wang
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Wei Li
- Medical Research & Biometrics Center, National Center for Cardiovascular Disease, Beijing 102300, China
| | - Li He
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Wen-Hua Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Shao-Qi Xu
- Department of Radiology, Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine, Changzhou 213161, China
| | - Lin-Fen Zhao
- Department of Radiology, Nanjing University of Chinese Medicine Affiliated Wujin Hospital of Traditional Chinese Medicine, Changzhou 213161, China
| | - Jun Zhou
- Department of Radiology, the 4th People's Hospital of Shenyang, Shenyang 110031, China
| | - Feng-Zhe Wang
- Department of Radiology, the 4th People's Hospital of Shenyang, Shenyang 110031, China
| | - Yu Liu
- Department of Prevention and Healthcare, Shenyang No. 242 Hospital, Shenyang 110034, China
| | - Lei Zhu
- Department of Radiology, the People's Hospital of Dayi County, Chengdu 611330, China
| | - Yi-Zhong Chen
- Department of Radiology, the People's Hospital of Dayi County, Chengdu 611330, China
| | - Xiao-Lin Zhang
- Department of Prevention and Healthcare, Dayi County Public Health Hospital, Chengdu 611330, China
| | - Xiao-Guang Hao
- Department of Radiology, Taiyuan Central Hospital, Taiyuan 030009, China
| | - Zhi-Wei Shi
- Department of Radiology, Taiyuan Central Hospital, Taiyuan 030009, China
| | - Jun-Ying Wang
- Balingqiao Community Health Service Center, Taiyuan 030013, China
| | - Ji-Man Shao
- Department of Radiology, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - Zhi-Jian Chen
- Department of Radiology, the Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang 330006, China
| | - Ren-Sheng Lei
- Nanchang County Center for Disease Control & Prevention, Nanchang 330200, China
| | - Gang Ning
- Department of Radiology, West China Second University Hospital of Sichuan University, Chengdu 610041, China
| | - Qian Zhao
- General Practice Department, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yong-Hong Jiang
- Department of Radiology, Xi'an Honghui Hospital, Xi'an 710054, China
| | - Ya-Hong Zhi
- Department of Prevention and Healthcare, Hospital of Xidian University, Xi'an 710071, China
| | - Bao-Qing Li
- Department of Radiology, Beijing Shijingshan Hospital, Beijing 100043, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Quan-Yong Xiang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210019, China
| | - Liang Wang
- Center of Orthopedics, the 309th Hospital of People's Liberation Army, Beijing 100091, China
| | - Yuan-Zheng Ma
- Center of Orthopedics, the 309th Hospital of People's Liberation Army, Beijing 100091, China
| | - Shi-Wei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing 100035, China
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12
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Oei L, Koromani F, Breda SJ, Schousboe JT, Clark EM, van Meurs JB, Ikram MA, Waarsing JH, van Rooij FJ, Zillikens MC, Krestin GP, Oei EH, Rivadeneira F. Osteoporotic Vertebral Fracture Prevalence Varies Widely Between Qualitative and Quantitative Radiological Assessment Methods: The Rotterdam Study. J Bone Miner Res 2018; 33:560-568. [PMID: 28719143 DOI: 10.1002/jbmr.3220] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 12/29/2022]
Abstract
Accurate diagnosis of vertebral osteoporotic fractures is crucial for the identification of individuals at high risk of future fractures. Different methods for radiological assessment of vertebral fractures exist, but a gold standard is lacking. The aim of our study was to estimate statistical measures of agreement and prevalence of osteoporotic vertebral fractures in the population-based Rotterdam Study, across two assessment methods. The quantitative morphometry assisted by SpineAnalyzer® (QM SA) method evaluates vertebral height loss that affects vertebral shape whereas the algorithm-based qualitative (ABQ) method judges endplate integrity and includes guidelines for the differentiation of vertebral fracture and nonfracture deformities. Cross-sectional radiographs were assessed for 7582 participants aged 45 to 95 years. With QM SA, the prevalence was 14.2% (95% CI, 13.4% to 15.0%), compared to 4.0% (95% CI, 3.6% to 4.5%) with ABQ. Inter-method agreement according to kappa (κ) was 0.24. The highest agreement between methods was among females (κ = 0.31), participants age >80 years (κ = 0.40), and at the L1 level (κ = 0.40). With ABQ, most fractures were found at the thoracolumbar junction (T12 -L1 ) followed by the T7 -T8 level, whereas with QM SA, most deformities were in the mid thoracic (T7 -T8 ) and lower thoracic spine (T11 -T12 ), with similar number of fractures in both peaks. Excluding mild QM SA deformities (grade 1 with QM) from the analysis increased, the agreement between the methods from κ = 0.24 to 0.40, whereas reexamining mild deformities based on endplate depression increased agreement from κ = 0.24 to 0.50 (p <0.001). Vertebral fracture prevalence differs significantly between QM SA and ABQ; reexamining QM mild deformities based on endplate depression would increase the agreement between methods. More widespread and consistent application of an optimal method may improve clinical care. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Stephan J Breda
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Inc., Minneapolis, MN, USA
| | - Emma M Clark
- Musculoskeletal Research Unit, School of Clinical Science, University of Bristol, Southmead Hospital, Bristol, UK
| | | | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jan H Waarsing
- Department of Orthopedics, Erasmus MC, Rotterdam, The Netherlands
| | | | - Maria C Zillikens
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Edwin Hg Oei
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
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13
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Li H, Yong Z, Chen Z, Huang Y, Lin Z, Wu D. Anterior cervical distraction and screw elevating-pulling reduction for traumatic cervical spine fractures and dislocations: A retrospective analysis of 86 cases. Medicine (Baltimore) 2017; 96:e7287. [PMID: 28658125 PMCID: PMC5500047 DOI: 10.1097/md.0000000000007287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Treatment of cervical fracture and dislocation by improving the anterior cervical technique.Anterior cervical approach has been extensively used in treating cervical spine fractures and dislocations. However, when this approach is used in the treatment of locked facet joints, an unsatisfactory intraoperative reduction and prying reduction increases the risk of secondary spinal cord injury. Thus, herein, the cervical anterior approach was improved. With distractor and screw elevation therapy during surgery, the restoration rate is increased, and secondary injury to the spinal cord is avoided.To discuss the feasibility of the surgical method of treating traumatic cervical spine fractures and dislocations and the clinical application.This retrospective study included the duration of patients' hospitalization from January 2005 to June 2015. The potential risks of surgery (including death and other surgical complications) were explained clearly, and written consents were obtained from all patients before surgery.The study was conducted on 86 patients (54 males and 32 females, average age of 40.1 ± 5.6 years) with traumatic cervical spine fractures and dislocations, who underwent one-stage anterior approach treatment. The effective methods were evaluated by postoperative follow-up.The healing of the surgical incision was monitored in 86 patients. The follow-up duration was 18 to 36 (average 26.4 ± 7.1) months. The patients achieved bones grafted fusion and restored spine stability in 3 to 9 (average 6) months after the surgery. Statistically, significant improvement was observed by Frankel score, visual analog scale score, Japanese Orthopedic Association score, and correction rate of the cervical spine dislocation pre- and postoperative (P < .01).The modified anterior cervical approach is simple with a low risk but a good effect in reduction. In addition, it can reduce the risk of iatrogenic secondary spinal cord injury and maintain optimal cervical spine stability as observed during follow-ups. Therefore, it is suitable for clinical promotion and application.
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Affiliation(s)
- Haoxi Li
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Zhiyao Yong
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Zhaoxiong Chen
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Yufeng Huang
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Zhoudan Lin
- Department of Orthopaedic Surgery, 303th Hospital of PLA, Nanning, China
| | - Desheng Wu
- Department of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
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14
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Choi YJ, Chung YS. Type 2 diabetes mellitus and bone fragility: Special focus on bone imaging. Osteoporos Sarcopenia 2016; 2:20-24. [PMID: 30775463 PMCID: PMC6372751 DOI: 10.1016/j.afos.2016.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 01/28/2016] [Accepted: 02/04/2016] [Indexed: 12/05/2022] Open
Abstract
Fragility fracture rate is increased in type 2 diabetes patients despite of higher bone mineral density than non-diabetes control subjects. Vertebral fractures are usually asymptomatic; therefore, morphometric radiologic evaluation should be considered especially for diabetes patients. Bone quality may more contribute to the increased risk of osteoporotic fractures in patients with type 2 diabetes than bone mass. Hip geometry, cortical porosity, and trabecular bone score have been studied as bone quality parameters by imaging in type 2 diabetes mellitus.
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Affiliation(s)
- Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea
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15
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Precision and Accuracy of Measurements on CT Scout View. J Med Imaging Radiat Sci 2015; 46:309-316. [PMID: 31052138 DOI: 10.1016/j.jmir.2015.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/12/2015] [Accepted: 06/19/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy. METHODS For the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data. RESULTS Scout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from -13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance. CONCLUSIONS Measurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.
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16
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Buckens CF, de Jong PA, Mali WP, Verhaar HJ, van der Graaf Y, Verkooijen HM. Prevalent vertebral fractures on chest CT: higher risk for future hip fracture. J Bone Miner Res 2014; 29:392-8. [PMID: 23821454 DOI: 10.1002/jbmr.2028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/16/2013] [Accepted: 06/24/2013] [Indexed: 11/05/2022]
Abstract
Subclinical or undiagnosed vertebral fractures on routine chest computed tomography (CT) may be useful for detecting patients at increased risk of future hip fractures who might benefit from preventive interventions. We investigated whether prevalent vertebral fractures on routine chest CT are associated with future hip fractures. From a source population of 5679 patients ≥40 years old undergoing chest CT in one of three Dutch hospitals between 2002 and 2005, patients hospitalized for hip fractures (n = 149) during a median follow-up of 4.4 years were identified. Following a case-cohort design, a random sample of 576 patients was drawn from the source population and added to the cases. In this group, the presence and severity of vertebral fractures was determined using semiquantitative vertebral fracture assessment and multivariate case-cohort appropriate Cox modeling. We found that cases were older (69 versus 63 years) and more often female (48% versus 38%) than the source population. Compared with those with no fracture, patients with any vertebral fracture had triple the risk of future hip fracture (age- and gender-adjusted hazard ratio [HR] = 3.1, 95% confidence interval [CI] 2.1-4.7). This HR rose to 3.8 (CI 2.6-5.6) if mild fractures were discounted. Future fracture risk increased significantly with increasing severity of vertebral fracture status: from mild (HR = 2.4, CI 1.5-3.7) and moderate (HR = 4.8, CI 2.5-9.2) to severe (HR = 6.7, CI 2.9-15.5). The same was true for having higher cumulative fracture grades: 1 to 3 (HR = 2.7, CI 1.8-4.1), 4 to 6 (HR = 4.8, CI 2.2-10.5), or ≥7 (HR = 11.2, CI 3.7-34.6). In conclusion, prevalent vertebral fractures on routine clinical chest CT are associated with future hip fracture risk.
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Affiliation(s)
- Constantinus F Buckens
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
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Comprehensive vertebral deformity and vertebral fracture assessment in clinical practice: intra- and inter-reader agreement of a clinical workflow tool. Spine (Phila Pa 1976) 2013; 38:E1676-83. [PMID: 24108294 DOI: 10.1097/brs.0000000000000048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Study design randomized intra- and inter-reader reproducibility study. OBJECTIVE To evaluate reproducibility of quantitative morphometry (QM) and agreement of dichotomous fracture/no-fracture status on lateral spinal radiographs acquired during routine clinical practice using a clinical workflow tool. SUMMARY OF BACKGROUND DATA Several recent guidelines have underlined the importance of Genant semi-quantitative scoring and selective QM to confirm and grade suspected vertebral fractures in clinical practice. METHODS Thoracic and lumbar spine radiographs were acquired from 98 consecutive subjects (mean age, 60.1 ± 11.7 yr) attending the clinic for osteoporosis evaluation. For each subject, QM and Genant semi-quantitative scoring were performed on all evaluable vertebrae from L4 to T4 using a software workflow tool. A radiologist and an experienced radiographical technician performed 2 repeat reading sessions of the radiographs 12 months apart, blinded to each other's results; for the second read, the cases were anonymized and the order was randomized. RESULTS Inter-reader reproducibility results were 3.1% and 3.2% coefficient of variation (%) for heights, 0.030 and 0.031 root mean square standard deviation for height ratios. For intrareader reproducibility, these values were 2.2% and 3.5% coefficient of variation %; 0.023 and 0.034 root mean square standard deviation. Kappa score results for agreement of dichotomous fracture/no-fracture status were 0.67 and 0.72 (inter-rater) and 0.50 and 0.67 (intrarater). CONCLUSION The software assessed in this study is a reliable clinical tool that facilitates QM and Genant semi-quantitative scoring of the spine in routine clinical practice. LEVEL OF EVIDENCE 3.
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18
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Bazzocchi A, Fuzzi F, Garzillo G, Diano D, Rimondi E, Merlino B, Moio A, Albisinni U, Battista G, Guglielmi G. Reliability and accuracy of scout CT in the detection of vertebral fractures. Br J Radiol 2013; 86:20130373. [PMID: 24100019 DOI: 10.1259/bjr.20130373] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The aim of the present study was to evaluate the reliability of scout CT (sCT) lateral radiograph, in terms of diagnostic accuracy and intra- and interobserver agreement in the detection of vertebral fractures (VFs). METHODS 300 CT examinations of the thoracic and/or lumbar spine were collected and independently analysed by 3 musculoskeletal radiologists in 2 different sessions. A semi-quantitative approach was used for VF assessment on sCT, and morphometric analysis was performed when a VF was suspected. Results of multiplanar sagittal CT reconstructions interpreted by the most expert radiologist were considered as gold standard. Arthrosis was also scored. Only vertebral bodies assessable by both sCT and gold standard were considered for the analysis. Area under the receiver operating characteristic curve (AUROC), Cohen's kappa statistic and linear-by-linear association were used for statistical analysis. RESULTS 1522 vertebrae were considered (130 males and 170 females; ages, 73.0±2.8 years). 73 of 1522 (4.8%) VFs were identified in 34/300 patients (11.3%). In the detection of VFs, the sensitivity and specificity of sCT were 98.7% and 99.7%, respectively. Accuracy (AUROC=0.992±0.008), as well as interobserver agreement (k=0.968±0.008), was excellent. Intra-observer agreement was perfect (k=1.000). Performance of this method was independent of arthrosis, vertebral level and type and grade of VFs. CONCLUSION sCT is a simple but very accurate method for the detection of VFs. It should be introduced as a spine evaluation tool for the detection of VFs in examinations that are performed for other diagnostic purposes. ADVANCES IN KNOWLEDGE sCT lateral radiograph is an accurate tool for the detection of VFs. This technique may be used with several advantages in clinical practice.
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Affiliation(s)
- A Bazzocchi
- Department of Specialized, Diagnostic, and Experimental Medicine, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
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19
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Stern D, Njagulj V, Likar B, Pernuš F, Vrtovec T. Quantitative vertebral morphometry based on parametric modeling of vertebral bodies in 3D. Osteoporos Int 2013; 24:1357-68. [PMID: 22825483 DOI: 10.1007/s00198-012-2089-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED Quantitative vertebral morphometry (QVM) was performed by parametric modeling of vertebral bodies in three dimensions (3D). INTRODUCTION Identification of vertebral fractures in two dimensions is a challenging task due to the projective nature of radiographic images and variability in the vertebral shape. By generating detailed 3D anatomical images, computed tomography (CT) enables accurate measurement of vertebral deformations and fractures. METHODS A detailed 3D representation of the vertebral body shape is obtained by automatically aligning a parametric 3D model to vertebral bodies in CT images. The parameters of the 3D model describe clinically meaningful morphometric vertebral body features, and QVM in 3D is performed by comparing the parameters to their statistical values. Thresholds and parameters that best discriminate between normal and fractured vertebral bodies are determined by applying statistical classification analysis. RESULTS The proposed QVM in 3D was applied to 454 normal and 228 fractured vertebral bodies, yielding classification sensitivity of 92.5% at 7.5% specificity, with corresponding accuracy of 92.5% and precision of 86.1%. The 3D shape parameters that provided the best separation between normal and fractured vertebral bodies were the vertebral body height and the inclination and concavity of both vertebral endplates. CONCLUSION The described QVM in 3D is able to efficiently and objectively discriminate between normal and fractured vertebral bodies and identify morphological cases (wedge, (bi)concavity, or crush) and grades (1, 2, or 3) of vertebral body fractures. It may be therefore valuable for diagnosing and predicting vertebral fractures in patients who are at risk of osteoporosis.
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Affiliation(s)
- D Stern
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, 1000, Ljubljana, Slovenia,
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Oei L, Rivadeneira F, Ly F, Breda SJ, Zillikens MC, Hofman A, Uitterlinden AG, Krestin GP, Oei EHG. Review of radiological scoring methods of osteoporotic vertebral fractures for clinical and research settings. Eur Radiol 2012; 23:476-86. [DOI: 10.1007/s00330-012-2622-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 01/23/2023]
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Bazzocchi A, Spinnato P, Garzillo G, Ciccarese F, Albisinni U, Mignani S, Battista G, Rossi C. Detection of incidental vertebral fractures in breast imaging: the potential role of MR localisers. Eur Radiol 2012; 22:2617-23. [PMID: 22688128 DOI: 10.1007/s00330-012-2521-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/07/2012] [Accepted: 04/21/2012] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Incidental diagnosis of vertebral fractures (VFs) may represent a key point in the assessment of bone health status. Our purpose was to retrospectively evaluate localisation sequences (MR-loc) of breast MRI as a potential tool to detect osteoporotic VFs. METHODS MR-loc sagittal images of 856 breast MRIs were reviewed by three expert musculoskeletal radiologists with a semiquantitative approach to detecting VFs. Anamnesis and data of patients were investigated. Official breast MRI and previous imaging reports were checked to understand if VFs or other relevant bone findings were known in patients' clinical history. RESULTS A total of 780/856 female patients (91.1 %) undergoing MRI for oncological reasons and 76/856 (8.9 %) with non-oncological aims were recruited into the study (54.7 ± 12.2 years old, 21-89 years); 57/856 MR-loc images (6.7 %) were considered inadequate for diagnostic purposes and were excluded from the analysis. MR-loc detected VFs in 71/799 patients (8.9 %). VFs were neither reported nor previously known in the clinical history of 63/71 patients (88.7 %; P < 0.001). No mention of VFs was found in any breast MR reports. In four patients MR-loc identified vertebral metastases. CONCLUSIONS A systematic evaluation of MR-loc may offer additional clinical information to prevent unrecognised VFs. MR-loc may screen for VFs in other imaging settings. KEY POINTS Vertebral fractures are usually a hallmark of osteoporosis. Localisation sequences before breast MR examinations can identify vertebral fractures. MR localisers should be inspected for vertebral fractures in other clinical settings.
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Affiliation(s)
- Alberto Bazzocchi
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy.
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Kim YM, Demissie S, Genant HK, Cheng X, Yu W, Samelson EJ, Kiel DP, Bouxsein ML. Identification of prevalent vertebral fractures using CT lateral scout views: a comparison of semi-automated quantitative vertebral morphometry and radiologist semi-quantitative grading. Osteoporos Int 2012; 23:1007-16. [PMID: 21927924 PMCID: PMC3584446 DOI: 10.1007/s00198-011-1774-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 08/11/2011] [Indexed: 11/27/2022]
Abstract
UNLABELLED We compared vertebral fracture assessment by semi-automated quantitative vertebral morphometry measurements with the conventional semi-quantitative (SQ) grading using lateral CT scout views. The semi-automated morphometry method showed good to excellent agreement with the visual SQ grading by radiologists for identification of vertebral fractures. INTRODUCTION Semi-automated quantitative vertebral morphometry (QM) measurements may enhance management of osteoporosis patients by providing an efficient means to identify vertebral fractures (VFx). We compared identification of prevalent VFx by semi-automated QM to SQ grading. METHODS A non-radiologist performed semi-automated QM from CT lateral scout views in 200 subjects (102 men, 98 women, 65.8 ± 8.9 years) selected from the Framingham Heart Study Multidetector CT Study. VFx were classified in the QM approach based on using Genant's criteria for deformities, and compared with conventional SQ grading performed by experienced radiologists as the gold standard. The kappa (k) statistics, percent agreement (% Agree), sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) were computed. RESULTS Among 200 subjects, 57 had mild and 41 had moderate or severe VFx by visual SQ grading. Per-person analyses showed excellent agreement between the two methods, with k = 0.780. The % Agree ranged from 86.7% to 91.2%, the SE was 81.3%-96%, and the SP was 86.5%-92%. Among 2,588 vertebrae analyzed, 107 had mild and 49 had moderate or severe VFx by visual SQ grading. Per-vertebra analyses revealed good agreement, with k = 0.580. Agreement between the methods tended to be highest in L1-L4 region. Agreement and validity measures were higher when only moderate and severe fractures were included. CONCLUSION The semi-automated quantitative vertebral morphometry measurements from CT lateral scout views provided good to excellent agreement with the standard SQ grading for assessment of prevalent vertebral fractures.
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Affiliation(s)
- Y. M. Kim
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA. Department of Internal Medicine, Mizmedi Hospital, Seoul, South Korea
| | - S. Demissie
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - H. K. Genant
- Synarc and University of California San Francisco, San Francisco, CA, USA
| | - X. Cheng
- Department of Radiology, Peking University, Jishuitan Hospital, Beijing, China
| | - W. Yu
- Department of Radiology, Peking Union Medical College Hospital, Beijing, China
| | - E. J. Samelson
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - D. P. Kiel
- Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA. Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - M. L. Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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