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Muellner M, Haffer H, Chiapparelli E, Dodo Y, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP. Abdominal aortic calcification assessed on standard lateral lumbar radiographs as a screening tool for impaired bone status in spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3030-3038. [PMID: 37450043 PMCID: PMC10601426 DOI: 10.1007/s00586-023-07846-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/24/2023] [Accepted: 06/24/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The aim of this study was to determine whether the presence of abdominal aortic calcification (AAC) can predict patient bone status, represented by volumetric bone mineral density (vBMD) assessed with quantitative computed tomography (QCT). METHODS Patients undergoing lumbar fusion surgery at a tertiary care center between 2014 and 2021, with a preoperative lumbar CT-scan and lateral lumbar radiographs were retrospectively reviewed. A semi-quantitative measurement method for AAC (AAC 4, 8 and 24) was performed. QCT measurements were made for L1 and L2. Patients were divided into two groups depending on whether AAC was present. A one-way analysis of covariance was conducted to adjust for age. A multiple linear regression model was used to test if age, sex, BMI, diabetes, hypertension, smoking and presence of AAC could predict the vBMD. A receiver operating characteristic (ROC) analysis was conducted for predicting impaired bone status. RESULTS 267 patients with a median age of 65.1 years and BMI of 29.8 kg/m2 were analyzed, 59.6% of patients had AAC. The group comparison showed that vBMD was significantly lower in patients with the presence of AAC (97.8 mg/cm3 vs. 121.5 mg/cm3). Age (β = - 0.360; p < 0.001) and presence of AAC (β = -0.206; p = 0.005) significantly predict vBMD as independent variables. Impaired bone status could be discriminated using AAC 4, 8 and 24 (cut off value 0.5) with a sensitivity of 70.1% and a specificity of 60.2%. CONCLUSION The presence of AAC may identify patients at risk for impaired bone status. Preoperative evaluation of standard lumbar radiographs could be used as a potential diagnostic tool in assessing bone status.
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Affiliation(s)
- Maximilian Muellner
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Henryk Haffer
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Erika Chiapparelli
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Yusuke Dodo
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Federico P Girardi
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA
| | - Alexander P Hughes
- Spine Care Institute, Hospital for Special Surgery, 535 East 70th Street, New York City, NY, 10021, USA.
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Grassi L, Väänänen SP, Isaksson H. Statistical Shape and Appearance Models: Development Towards Improved Osteoporosis Care. Curr Osteoporos Rep 2021; 19:676-687. [PMID: 34773211 PMCID: PMC8716351 DOI: 10.1007/s11914-021-00711-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Statistical models of shape and appearance have increased their popularity since the 1990s and are today highly prevalent in the field of medical image analysis. In this article, we review the recent literature about how statistical models have been applied in the context of osteoporosis and fracture risk estimation. RECENT FINDINGS Recent developments have increased their ability to accurately segment bones, as well as to perform 3D reconstruction and classify bone anatomies, all features of high interest in the field of osteoporosis and fragility fractures diagnosis, prevention, and treatment. An increasing number of studies used statistical models to estimate fracture risk in retrospective case-control cohorts, which is a promising step towards future clinical application. All the reviewed application areas made considerable steps forward in the past 5-6 years. Heterogeneities in validation hinder a thorough comparison between the different methods and represent one of the future challenges to be addressed to reach clinical implementation.
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Affiliation(s)
- Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, Box 118, 221 00, Lund, Sweden.
| | - Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 118, 221 00, Lund, Sweden
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Valero C, Olmos JM, Humbert L, Castillo J, Hernández JL, Martínez J, Macías JG. 3D analysis of bone mineral density in a cohort: age- and sex-related differences. Arch Osteoporos 2021; 16:80. [PMID: 34076788 DOI: 10.1007/s11657-021-00921-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women have lower areal BMD (g/cm2) than men; however, the women have smaller-size bones. Our study showed that women ≤ 59 years have a hip volumetric BMD by DXA 3D similar to that of men of the same age. This makes us think about the importance of taking into account bone size at the time of analyzing the sex-related differences in bone mass. PURPOSE Women have lower areal BMD (g/cm2) than men; however, these studies do not take into account that women have smaller-size bones. Recently, three-dimensional (3D) modeling methods were proposed to analyze volumetric BMD (vBMD). We want to determine the values of vBMD at the hip by DXA-based 3D modeling in a cohort of people in order to know the age- and sex-related differences. METHODS A total of 2647 people of both sexes (65% women) were recruited from a large cohort (Camargo cohort, Santander, Spain). 3D-SHAPER® software (version 2.8, Galgo Medical, Barcelona, Spain) was used to derive 3D analysis from the hip DXA scans at baseline RESULTS: The differences were less pronounced for vBMD (cortical sBMD 9.3%, trabecular vBMD 6.4%, integral vBMD 2.2%) compared to aBMD (FN aBMD 11.4% and TH aBMD 13.3%). After stratifying by age (≤ 59 years, 60-69 years, 70-79 years, and ≥ 80 years), we observed in ≤ 59 years that aBMD was lower in women compared to men, at FN (0.758 [0.114] g/cm2 vs. 0.833 [0.117] g/cm2; p = 1.4 × 10-20) and TH (0.878 [0.117] g/cm2 vs. 0.990 [0.119] g/cm2; p = 4.1 × 10-40). Nevertheless, no statistically significant difference was observed for integral vBMD (331 [58] mg/cm3 in women and 326 [51] mg/cm3 in men; p = 0.19) and trabecular vBMD (190 [41] mg/cm3 in women and 195 [39] mg/cm3 in men; p = 0.20). CONCLUSION Our results make us think about the importance of taking into account bone size at the time of analyzing the sex-related differences in bone mass.
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Affiliation(s)
- Carmen Valero
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain. .,University of Cantabria, IDIVAL, Santander, Spain.
| | - José Manuel Olmos
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | | | - Jesús Castillo
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - José Luis Hernández
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - Josefina Martínez
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - Jesús González Macías
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
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