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Funck-Brentano T, Vanjak A, Ostertag A, Nethander M, Fernandez S, Collet C, Hans D, van Rietbergen B, Cohen-Solal M. Evaluation of bone density and microarchitecture in adult patients with X-linked hypophosphatemic rickets: A pilot longitudinal study. Bone 2024; 187:117179. [PMID: 38960298 DOI: 10.1016/j.bone.2024.117179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024]
Abstract
X-linked Hypophosphatemia (XLH) is the most common type of inherited rickets. Although the clinical features are well characterized, bone structure, mineralization, and biomechanical properties are poorly known. Our aim was to analyze bone properties in the appendicular and axial skeleton of adults with XLH. In this observational case-control study, each affected patient (N = 14; 9 females; age 50 ± 15 years) was matched by sex, age and body mass index to a minimum of two healthy controls (N = 34). Dual-energy X-ray Absorptiometry (DXA) analyses revealed that areal bone mineral density (aBMD) was higher in XLH patients at the lumbar spine (Z score mean difference = +2.47 SD, P value = 1.4 × 10-3). Trabecular Bone Score was also higher at the lumbar spine (P value = 1.0 × 10-4). High Resolution peripheral Quantitative Computed Tomography (HRpQCT) demonstrated that bone cross-sectional area was larger at the distal radius (P value = 6 × 10-3). Total and trabecular volumetric BMD were lower at both sites. Trabecular bone volume fraction was also lower with fewer trabecular numbers at both sites. However, bone strength evaluated by micro-finite element analyzes revealed unaffected bone stiffness and maximum failure load. Evaluation of bone mineralization with aBMD by DXA at the distal radius correlated with vBMD by HRpQCT measurements at both sites. PTH levels were inversely correlated with trabecular vBMD and BV/TV at the tibia. We then followed a subset of nine patients (median follow-up of 4 years) and reassessed HRpQCT. At the tibia, we observed a greater decrease than expected from an age and sex standardized normal population in total and cortical vBMD as well as a trabecularization of the cortical compartment. In conclusion, in adult patients with XLH, bone mineral density is high at the axial skeleton but low at the appendicular skeleton. With time, microarchitectural alterations worsen. We propose that noninvasive evaluation methods of bone mineralization such as DXA including the radius should be part of the management of XLH patients. Larger studies are needed to evaluate the clinical significance of BMD changes in XLH patients under conventional or targeted therapies.
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Affiliation(s)
- Thomas Funck-Brentano
- BIOSCAR UMRS 1132, INSERM, Université Paris Cité, F-75475 Paris, France; Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, DMU Locomotion, Department of Rheumatology, F-75475 Paris, France; National Reference Center For Rare Bone Diseases, Lariboisière Hospital, APHP.Nord, Filière OSCAR, F-75475 Paris, France.
| | - Arnaud Vanjak
- BIOSCAR UMRS 1132, INSERM, Université Paris Cité, F-75475 Paris, France; Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, DMU Locomotion, Department of Rheumatology, F-75475 Paris, France; National Reference Center For Rare Bone Diseases, Lariboisière Hospital, APHP.Nord, Filière OSCAR, F-75475 Paris, France.
| | - Agnes Ostertag
- BIOSCAR UMRS 1132, INSERM, Université Paris Cité, F-75475 Paris, France
| | - Maria Nethander
- Center for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Sylvie Fernandez
- Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, DMU Locomotion, Department of Rheumatology, F-75475 Paris, France
| | - Corinne Collet
- Imagine Institut, Necker Hospital, Université Paris Cité, F-75475 Paris, France
| | - Didier Hans
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Martine Cohen-Solal
- BIOSCAR UMRS 1132, INSERM, Université Paris Cité, F-75475 Paris, France; Assistance Publique des Hôpitaux de Paris, Lariboisière Hospital, DMU Locomotion, Department of Rheumatology, F-75475 Paris, France; National Reference Center For Rare Bone Diseases, Lariboisière Hospital, APHP.Nord, Filière OSCAR, F-75475 Paris, France
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Bevers MSAM, Harsevoort AGJ, Gooijer K, Wyers CE, Feenstra J, van Rietbergen B, Boomsma MF, van den Bergh JP, Janus GJM. Bone microarchitecture and strength assessment in adults with osteogenesis imperfecta using HR-pQCT: normative comparison and challenges. J Bone Miner Res 2024; 39:271-286. [PMID: 38477754 DOI: 10.1093/jbmr/zjae013] [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: 09/18/2023] [Revised: 12/12/2023] [Accepted: 01/12/2024] [Indexed: 03/14/2024]
Abstract
Data on bone microarchitecture in osteogenesis imperfecta (OI) are scarce. The aim of this cross-sectional study was to assess bone microarchitecture and strength in a large cohort of adults with OI using high-resolution peripheral quantitative computed tomography (HR-pQCT) and to evaluate challenges of using HR-pQCT in this cohort. Second-generation HR-pQCT scans were obtained at the distal radius and tibia in 118 men and women with Sillence OI type I, III, or IV using an extremity-length-dependent scan protocol. In total, 102 radius and 105 tibia scans of sufficient quality could be obtained, of which 11 radius scans (11%) and 14 tibia scans (13%) had a deviated axial scan angle as compared with axial angle data of 13 young women. In the scans without a deviated axial angle and compared with normative HR-pQCT data, Z-scores at the radius for trabecular bone mineral density (BMD), number, and separation were -1.6 ± 1.3, -2.5 ± 1.4, and -2.7 (IQR: 2.7), respectively. They were -1.4 ± 1.5 and -1.1 ± 1.2 for stiffness and failure load and between ±1 for trabecular thickness and cortical bone parameters. Z-scores were significantly lower for total and trabecular BMD, stiffness, failure load, and cortical area and thickness at the tibia. Additionally, local microarchitectural inhomogeneities were observed, most pronounced being trabecular void volumes. In the scans with a deviated axial angle, the proportion of Z-scores <-4 or >4 was significantly higher for trabecular BMD and separation (radius) or most total and trabecular bone parameters (tibia). To conclude, especially trabecular bone microarchitecture and bone strength were impaired in adults with OI. HR-pQCT may be used without challenges in most adults with OI, but approximately 12% of the scans may have a deviated axial angle in OI due to bone deformities or scan positioning limitations. Furthermore, standard HR-pQCT parameters may not always be reliable due to microarchitectural inhomogeneities nor fully reflect all inhomogeneities.
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Affiliation(s)
- M S A M Bevers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
| | - A G J Harsevoort
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - K Gooijer
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - C E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - J Feenstra
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - B van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Groene Loper 3, 5612 AE, Eindhoven, The Netherlands
- Department of Orthopedic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - M F Boomsma
- Department of Radiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Tegelseweg 210, 5912 BL Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research In Metabolism, Maastricht University Medical Center, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - G J M Janus
- Expert Center for adults with Osteogenesis Imperfecta, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
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Renaud G, Minonzio JG. Current Challenges in Ultrasound Imaging of Cortical Bone Thickness. Acad Radiol 2023; 30:3162-3164. [PMID: 37758583 DOI: 10.1016/j.acra.2023.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/08/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Guillaume Renaud
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands (G.R.).
| | - Jean-Gabriel Minonzio
- Escuela de Ingeniería Informática, Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile (J-G. M.)
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Ohs N, Collins CJ, Tourolle DC, Atkins PR, Schroeder BJ, Blauth M, Christen P, Müller R. Automated segmentation of fractured distal radii by 3D geodesic active contouring of in vivo HR-pQCT images. Bone 2021; 147:115930. [PMID: 33753277 DOI: 10.1016/j.bone.2021.115930] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/28/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022]
Abstract
Radius fractures are among the most common fracture types; however, there is limited consensus on the standard of care. A better understanding of the fracture healing process could help to shape future treatment protocols and thus improve functional outcomes of patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows monitoring and evaluation of the radius on the micro-structural level, which is crucial to our understanding of fracture healing. However, current radius fracture studies using HR-pQCT are limited by the lack of automated contouring routines, hence only including small number of patients due to the prohibitively time-consuming task of manually contouring HR-pQCT images. In the present study, a new method to automatically contour images of distal radius fractures based on 3D morphological geodesic active contours (3D-GAC) is presented. Contours of 60 HR-pQCT images of fractured and conservatively treated radii spanning the healing process up to one year post-fracture are compared to the current gold standard, hand-drawn 2D contours, to assess the accuracy of the algorithm. Furthermore, robustness was established by applying the algorithm to HR-pQCT images of intact radii of 73 patients and comparing the resulting morphometric indices to the gold standard patient evaluation including a threshold- and dilation-based contouring approach. Reproducibility was evaluated using repeat scans of intact radii of 19 patients. The new 3D-GAC approach offers contours within inter-operator variability for images of fractured distal radii (mean Dice score of 0.992 ± 0.005 versus median operator Dice score of 0.992 ± 0.006). The generated contours for images of intact radii yielded morphometric indices within the in vivo reproducibility limits compared to the current gold standard. Additionally, the 3D-GAC approach shows an improved robustness against failure (n = 5) when dealing with cortical interruptions, fracture fragments, etc. compared with the automatic, default manufacturer pipeline (n = 40). Using the 3D-GAC approach assures consistent results, while reducing the need for time-consuming hand-contouring.
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Affiliation(s)
- Nicholas Ohs
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | | | - Penny R Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Michael Blauth
- Department for Trauma Surgery, Innsbruck University Hospital, Innsbruck, Austria
| | - Patrik Christen
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Institute for Information Systems, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
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Chiba K, Okazaki N, Isobe Y, Miyazaki S, Yonekura A, Tomita M, Osaki M. Precision of 3D Registration Analysis for Longitudinal Study of Second-Generation HR-pQCT. J Clin Densitom 2021; 24:319-329. [PMID: 33172803 DOI: 10.1016/j.jocd.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this research was to develop 3D registration analysis method in longitudinal studies of high-resolution peripheral quantitative computed tomography (HR-pQCT), to analyze ranges of bone microstructure parameters in addition to standard parameters, and to test the precision of these measurements. METHODS Scans of HR-pQCT and analysis of bone microstructure were performed at 3 times in 15 subjects. The 3 images were matched 3-dimensionally, and bone microstructures were analyzed in the common region. In addition to standard measurement parameters of geometry, bone mineral density (BMD), trabecular bone, and cortical bone, parameters showing plate to rod-like structure, connectivity, cavity formation of trabecular bone, and bending stability of cortical bone were also measured. Precision was evaluated with the root mean square percent coefficient variance (RMS%CV). RESULTS RMS%CV was 0.1%-1.3% for geometry, 0.6%-1.9% for BMD, 0.8%-3.3% for trabecular bone, 2.1%-9.8% for additionally measured trabecular bone, 1.0%-3.4% for cortical bone excluding Ct.Po, 6.0%-6.1% for Ct.Po, and 0.8%-1.5% for additionally measured cortical bone. Precision was higher for 3D registration than for 2D registration in geometry, BV/TV, and Ct.Po. CONCLUSIONS 3D registration analysis of a range of bone microstructural parameters in longitudinal analysis of HR-pQCT showed good precision, offering potential for contributing to future research on osteoporosis and bone metabolic diseases.
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Affiliation(s)
- Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan.
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | | | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masato Tomita
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:1607-1627. [PMID: 32458029 PMCID: PMC7429313 DOI: 10.1007/s00198-020-05438-5] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems. METHODS A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document. RESULTS An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems. CONCLUSION This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.
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Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J Paccou
- Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - A Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Bioclinica, Inc., Hamburg, Germany
| | - M L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Bevers MSAM, Daniels AM, Wyers CE, van Rietbergen B, Geusens PPMM, Kaarsemaker S, Janzing HMJ, Hannemann PFW, Poeze M, van den Bergh JPW. The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures. J Clin Densitom 2020; 23:432-442. [PMID: 31495579 DOI: 10.1016/j.jocd.2019.08.003] [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: 04/26/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Diagnosing scaphoid fractures remains challenging. High-resolution peripheral quantitative computed tomography (HR-pQCT) might be a potential imaging technique, but no data are available on its feasibility to scan the scaphoid bone in vivo. METHODOLOGY Patients (≥18 years) with a clinically suspected scaphoid fracture received an HR-pQCT scan of the scaphoid bone (three 10.2-mm stacks, 61-μm voxel size) with their wrist immobilized with a cast. Scan quality assessment and bone contouring were performed using methods originally developed for HR-pQCT scans of radius and tibia. The contouring algorithm was applied on coarse hand-drawn pre-contours of the scaphoid bone, and the resulting contours (AUTO) were manually corrected (sAUTO) when visually deviating from bone margins. Standard morphologic analyses were performed on the AUTO- and sAUTO-contoured bones. RESULTS Ninety-one patients were scanned. Two out of the first five scans were repeated due to poor scan quality (40%) based on standard quality assessment during scanning, which decreased to three out of the next 86 scans (3.5%) when using an additional thumb cast. Nevertheless, after excluding one scan with an incompletely scanned scaphoid bone, post hoc grading revealed a poor quality in 14.9% of the stacks and 32.9% of the scans in the remaining 85 patients. After excluding two scans with contouring problems due to scan quality, bone indices obtained by AUTO- and sAUTO-contouring were compared in 83 scans. All AUTO-contours were manually corrected, resulting in significant but small differences in densitometric and trabecular indices (<1.0%). CONCLUSIONS In vivo HR-pQCT scanning of the scaphoid bone is feasible in patients with a clinically suspected scaphoid fracture when using a cast with thumb part. The proportion of poor-quality stacks is similar to radius scans, and AUTO-contouring appears appropriate in good- and poor-quality scans . Thus, HR-pQCT may be promising for diagnosis of and microarchitectural evaluations in suspected scaphoid fractures.
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Affiliation(s)
- M S A M Bevers
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - A M Daniels
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - C E Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - P P M M Geusens
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Faculty of Medicine, Hasselt University, Belgium
| | - S Kaarsemaker
- Department of Orthopaedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - H M J Janzing
- Department of Surgery, VieCuri Medical Centre, Venlo, the Netherlands
| | - P F W Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - M Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands; Faculty of Medicine, Hasselt University, Belgium.
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8
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Whittier DE, Mudryk AN, Vandergaag ID, Burt LA, Boyd SK. Optimizing HR-pQCT workflow: a comparison of bias and precision error for quantitative bone analysis. Osteoporos Int 2020; 31:567-576. [PMID: 31784787 DOI: 10.1007/s00198-019-05214-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/28/2019] [Indexed: 11/28/2022]
Abstract
UNLABELLED Manual correction of automatically generated contours for high-resolution peripheral quantitative computed tomography can be time consuming and introduces precision error. However, bias related to the automated protocol is unknown. This study provides insight into error bias that is present when using uncorrected contours and inter-operator precision error based on operator training. INTRODUCTION High-resolution peripheral quantitative computed tomography workflow includes manually correcting contours generated by the manufacturer's automated protocol. There is interest in minimizing corrections to save time and reduce precision error; however, bias related to the automated protocol is unknown. This study quantifies error bias when contours are uncorrected and identifies the impact of operator training on bias and precision error. METHODS Forty-five radii and tibiae scans across a representative range of bone density were analyzed using the automated and manually corrected contours of three operators, with training ranging from beginner to expert, and compared with a "ground truth" to estimate bias. Inter-operator precision was measured across operators. RESULTS The tibia had greater error bias than the radius when contours were uncorrected, with compartmental bone mineral densities and cortical microarchitecture having greatest biases, which could have significant implications for interpretation of studies using this skeletal site. Bias and precision error were greatest when contours were corrected by the beginner operator; however, when this operator was removed, bias was no longer present and inter-operator precision was between 0.01 and 3.74% for all parameters except cortical porosity. CONCLUSION These findings establish the need for manual correction and provide guidance on operator training needed to maximize workflow efficiency.
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Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A N Mudryk
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - I D Vandergaag
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - L A Burt
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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9
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Draghici AE, Taylor JA, Bouxsein ML, Shefelbine SJ. Effects of FES-Rowing Exercise on the Time-Dependent Changes in Bone Microarchitecture After Spinal Cord Injury: A Cross-Sectional Investigation. JBMR Plus 2019; 3:e10200. [PMID: 31667456 PMCID: PMC6808228 DOI: 10.1002/jbm4.10200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/22/2019] [Indexed: 01/21/2023] Open
Abstract
Disuse osteoporosis is a serious, secondary consequence of spinal cord injury (SCI). Numerous pharmacological and exercise therapies have been implemented to mitigate bone loss after SCI. However, these therapies have not been shown to improve bone density, potentially because of insufficient duration and magnitude of loading and/or inability of imaging modalities to capture changes in bone microarchitecture. In this cross‐sectional study, we evaluated bone microstructure of the distal tibia and radius using HR‐pQCT in men with SCI (N = 13) who regularly trained with functional electrical stimulation‐ (FES‐) rowing. We aimed to determine whether the amount of FES‐rowing (total distance rowed and peak foot force) and/or time since injury (TSI) predict bone loss after SCI. We assessed volumetric density of the total, cortical, and trabecular compartments, cortical thickness, and trabecular thickness. Using linear regression analysis, we found that TSI was not associated with any of the tibial bone metrics. In fact, none of the variables (TSI, total distance rowed, and peak foot force) independently predicted bone loss. Using stepwise regression, when all three variables were considered together, we found a strong prediction for trabecular microstructure (trabecular vBMD: R2 = 0.53; p = 0.06; trabecular thickness: R2 = 0.72; p < 0.01), but not cortical bone metrics. In particular, trabecular vBMD and thickness were negatively associated with TSI and positively associated with distance rowed. Foot force contributed markedly less to trabecular bone than distance rowed or TSI. Our results suggest that regular FES‐rowing may have the capacity to alter the time‐dependent bone negative effects of SCI on trabecular bone density and microstructure. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Adina E Draghici
- Department of Bioengineering Northeastern University Boston MA USA.,Cardiovascular Research Laboratory Spaulding Rehabilitation Hospital Boston MA USA.,Department of Physical Medicine and Rehabilitation Harvard Medical School Boston MA USA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory Spaulding Rehabilitation Hospital Boston MA USA.,Department of Physical Medicine and Rehabilitation Harvard Medical School Boston MA USA
| | - Mary L Bouxsein
- Endocrine Unit Massachusetts General Hospital and Harvard Medical School Boston MA USA.,Center for Advanced Orthopaedic Studies Beth Israel Deaconess Medical Center Boston MA USA
| | - Sandra J Shefelbine
- Department of Bioengineering Northeastern University Boston MA USA.,Department of Mechanical and Industrial Engineering Northeastern University Boston MA USA
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10
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Iori G, Schneider J, Reisinger A, Heyer F, Peralta L, Wyers C, Gräsel M, Barkmann R, Glüer CC, van den Bergh JP, Pahr D, Raum K. Large cortical bone pores in the tibia are associated with proximal femur strength. PLoS One 2019; 14:e0215405. [PMID: 30995279 PMCID: PMC6469812 DOI: 10.1371/journal.pone.0215405] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 11/23/2022] Open
Abstract
Alterations of structure and density of cortical bone are associated with fragility fractures and can be assessed in vivo in humans at the tibia. Bone remodeling deficits in aging women have been recently linked to an increase in size of cortical pores. In this ex vivo study, we characterized the cortical microarchitecture of 19 tibiae from human donors (aged 69 to 94 years) to address, whether this can reflect impairments of the mechanical competence of the proximal femur, i.e., a major fracture site in osteoporosis. Scanning acoustic microscopy (12 μm pixel size) provided reference microstructural measurements at the left tibia, while the bone vBMD at this site was obtained using microcomputed tomography (microCT). The areal bone mineral density of both left and right femoral necks (aBMDneck) was measured by dual‐energy X‐ray absorptiometry (DXA), while homogenized nonlinear finite element models based on high-resolution peripheral quantitative computed tomography provided hip stiffness and strength for one-legged standing and sideways falling loads. Hip strength was associated with aBMDneck (r = 0.74 to 0.78), with tibial cortical thickness (r = 0.81) and with measurements of the tibial cross-sectional geometry (r = 0.48 to 0.73) of the same leg. Tibial vBMD was associated with hip strength only for standing loads (r = 0.59 to 0.65). Cortical porosity (Ct.Po) of the tibia was not associated with any of the femoral parameters. However, the proportion of Ct.Po attributable to large pores (diameter > 100 μm) was associated with hip strength in both standing (r = -0.61) and falling (r = 0.48) conditions. When added to aBMDneck, the prevalence of large pores could explain up to 17% of the femur ultimate force. In conclusion, microstructural characteristics of the tibia reflect hip strength as well as femoral DXA, but it remains to be tested whether such properties can be measured in vivo.
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Affiliation(s)
- Gianluca Iori
- Berlin-Brandenburg Center for Regenerative Therapies, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Schneider
- Berlin-Brandenburg Center for Regenerative Therapies, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Reisinger
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Frans Heyer
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Laura Peralta
- Laboratoire d’Imagerie Biomédicale, Sorbonne Universités, INSERM UMR S 1146, CNRS UMR 7371, Paris, France
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King’s College London, London, United Kingdom
| | - Caroline Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Melanie Gräsel
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Reinhard Barkmann
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Claus C. Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - J. P. van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
| | - Dieter Pahr
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
- Institute for Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Kay Raum
- Berlin-Brandenburg Center for Regenerative Therapies, Charité –Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- * E-mail:
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11
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de Waard EAC, de Jong JJA, Koster A, Savelberg HHCM, van Geel TA, Houben AJHM, Schram MT, Dagnelie PC, van der Kallen CJ, Sep SJS, Stehouwer CDA, Schaper NC, Berendschot TTJM, Schouten JSAG, Geusens PPMM, van den Bergh JPW. The association between diabetes status, HbA1c, diabetes duration, microvascular disease, and bone quality of the distal radius and tibia as measured with high-resolution peripheral quantitative computed tomography-The Maastricht Study. Osteoporos Int 2018; 29:2725-2738. [PMID: 30209523 PMCID: PMC6267131 DOI: 10.1007/s00198-018-4678-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/19/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED In this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites. INTRODUCTION To examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally-in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters. METHODS Cross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history. RESULTS After full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (- 4%) in prediabetes and smaller cross-sectional area of the tibia (- 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (- 5%), cortical thickness (- 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (- 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters. CONCLUSIONS In this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.
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Affiliation(s)
- E A C de Waard
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University, Maastricht, the Netherlands.
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
| | - J J A de Jong
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - A Koster
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Social Medicine, Maastricht University, Maastricht, the Netherlands
| | - H H C M Savelberg
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Human Movement Science, Maastricht University, Maastricht, the Netherlands
| | - T A van Geel
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - A J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - M T Schram
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - P C Dagnelie
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands
| | - C J van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - S J S Sep
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands
| | - C D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | - N C Schaper
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- CARIM School for Cardiovascular diseases, Maastricht University, Maastricht, the Netherlands
| | | | | | - P P M M Geusens
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Biomedical Research Institute, University of Hasselt, Hasselt, Belgium
| | - J P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Universiteitssingel 40, room C5.535, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, the Netherlands
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12
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Neumann A, Haschka J, Kleyer A, Schuster L, Englbrecht M, Berlin A, Figueiredo CP, Simon D, Muschitz C, Kocijan R, Resch H, Rech J, Schett G. Cortical bone loss is an early feature of nonradiographic axial spondyloarthritis. Arthritis Res Ther 2018; 20:202. [PMID: 30165891 PMCID: PMC6117894 DOI: 10.1186/s13075-018-1620-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/09/2018] [Indexed: 01/09/2023] Open
Abstract
Background In the present study, we investigated bone geometry, microstructure, and volumetric bone mineral density (vBMD) in a cohort of patients with nonradiographic axial spondyloarthritis (nr-axSpA) in order to define the early bone changes occurring in axial spondyloarthritis (axSpA) and to define potential factors for deterioration of bone microstructure. Methods Patients with axSpA (n = 107) and healthy control subjects (n = 50) of similar age and sex were assessed for geometric, volumetric, and microstructural parameters of bone using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius. Additionally, demographic and disease-specific characteristics of patients with axSpA were recorded. Results Patients with nr-axSpA and control subjects were comparable in age, sex, and body mass index. Geometric and microstructural analysis by HR-pQCT revealed a significantly reduced cortical area (p = 0.022) and cortical thickness (p = 0.006) in patients with nr-axSpA compared with control subjects. Total and cortical vBMD were significantly reduced in patients with nr-axSpA (p = 0.042 and p = 0.007, respectively), whereas there was no difference in trabecular vBMD. Patients with a short disease duration (< 2 years; n = 46) also showed significant reduction of cortical thickness and cortical area compared with control subjects. Patients with disease duration > 2 years (n = 55) additionally developed a decrease of cortical and total vBMD. Multiple regression models identified male sex to be associated with lower cortical vBMD and female sex to be associated with lower trabecular vBMD. Conclusions Bone microstructure in patients with nr-axSpA is characterized primarily by deterioration of cortical bone. Cortical bone loss starts early and is evident within the first 2 years of the disease. Electronic supplementary material The online version of this article (10.1186/s13075-018-1620-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Neumann
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Louis Schuster
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Andreas Berlin
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Camille P Figueiredo
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.,Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - David Simon
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Christian Muschitz
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Roland Kocijan
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Heinrich Resch
- St. Vincent Hospital, VINFORCE Study Group, Medical University of Vienna, Vienna, Austria
| | - Jürgen Rech
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich Alexander University Erlangen-Nurnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
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