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Bisazza KT, Nelson BB, Sikes KJ, Nakamura L, Easley JT. Computed Tomography Provides Improved Quantification of Trabecular Lumbar Spine Bone Loss Compared to Dual-Energy X-Ray Absorptiometry in Ovariectomized Sheep. JBMR Plus 2023; 7:e10807. [PMID: 38130759 PMCID: PMC10731101 DOI: 10.1002/jbm4.10807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 12/23/2023] Open
Abstract
Early detection of osteoporosis using advanced imaging is imperative to the successful treatment and prevention of high morbidity fractures in aging patients. In this preclinical study, we aimed to compare dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) to quantify bone mineral density (BMD) changes in the sheep lumbar spine. We also aimed to determine the relationship of BMD to microarchitecture in the same animals as an estimate of imaging modality precision. Osteoporosis was induced in 10 ewes via laparoscopic ovariectomy and administration of high-dose corticosteroids. We performed DXA and QCT imaging to measure areal BMD (aBMD) and trabecular volumetric BMD (Tb.vBMD)/cortical vBMD (Ct.vBMD), respectively, at baseline (before ovariectomy) and at 3, 6, 9, and 12 months after ovariectomy. Iliac crest bone biopsies were collected at each time point for micro-computed tomography (microCT) analysis; bone volume fraction (BV/TV), trabecular number (Tb.N), thickness (Tb.Th), and spacing (Tb.Sp) were reported. aBMD and Tb.vBMD both decreased significantly by 3 and 6 months (p < 0.05) compared with baseline, whereas no changes to Ct.vBMD were observed. Combined (Tb. and Ct.) vBMD was significantly correlated with aBMD at all time points (all p < 0.05). Additionally, greater significant correlations were found between BV/TV and Tb.vBMD at all five time points (R 2 = 0.54, 0.57, 0.66, 0.46, and 0.56, respectively) than with aBMD values (R 2 = 0.23, 0.55, 0.41, 0.20, and 0.19, respectively). The higher correlation of microCT values with QCT than with DXA indicates that QCT provides additional detailed information regarding bone mineral density changes in preclinical settings. Because trabecular bone is susceptible to rapid density loss and structural changes during osteoporosis, QCT can capture these subtle changes more precisely than DXA in a large animal preclinical model. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Katie T Bisazza
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsCOUSA
| | - Brad B Nelson
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsCOUSA
| | - Katie J Sikes
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsCOUSA
| | - Lucas Nakamura
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical EngineeringColorado State UniversityFort CollinsCOUSA
| | - Jeremiah T Easley
- Preclinical Surgical Research Laboratory, Department of Clinical SciencesColorado State UniversityFort CollinsCOUSA
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Yang Y, Kang Y, Yang Y, Ding M, Shan X, Cai Z. Feasibility analysis of bone density evaluation with Hounsfield unit value after fibula flap reconstruction of jaw defect. Maxillofac Plast Reconstr Surg 2023; 45:30. [PMID: 37644349 PMCID: PMC10465458 DOI: 10.1186/s40902-023-00397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Implant-supported dentures have become an essential means of restoring occlusal function after jaw reconstruction. Bone mineral density (BMD) may influence the success rate of implant denture restorations. This study aimed to explore whether the Hounsfield unit (HU) value can be used to monitor the changing trend of fibular BMD after jaw reconstruction. RESULTS A total of 54 patients who underwent maxillar/mandibular reconstruction with a fibula flap were included in this study. There was a significant correlation between the HU value and BMD at 1 week, 3 months, and 6 months after surgery, and both were significantly correlated with follow-up time. The difference between each pair of absorption rates (DAR) was less than 10% in 66.7% and 75.9% of patients at 3 and 6 months; however, the DAR was more than 20% in 12% and 13.8% of patients at 3 and 6 months, respectively. CONCLUSIONS There is a significant correlation between HU value and BMD. The HU value can be used to roughly reflect the fibular BMD changing trend in a group of patients as opposed to an individual, and the HU value is not equivalent to BMD. TRIAL REGISTRATION ChiCTR, ChiCTR2300069661, retrospectively registered on 22 March 2023. Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=188953 .
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Affiliation(s)
- Yihui Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yifan Kang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Yifan Yang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Mengkun Ding
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Xiaofeng Shan
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
| | - Zhigang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, No. 22 South Avenue, Zhongguancun, Haidian District, Beijing, 100081 People’s Republic of China
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Vadera S, Osborne T, Shah V, Stephenson JA. Opportunistic screening for osteoporosis by abdominal CT in a British population. Insights Imaging 2023; 14:57. [PMID: 37005941 PMCID: PMC10067782 DOI: 10.1186/s13244-023-01400-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND It has previously been shown that CT scans performed for other indications can be used to identify patients with osteoporosis. This has not yet been tested in a British population. We sought to evaluate the use of vertebral CT attenuation measures for predicting osteoporosis in a British cohort, using dual-energy X-ray absorptiometry (DEXA) as a reference standard. METHODS Patients who underwent abdominal CT in 2018 and concomitantly underwent DEXA within a six-month interval were retrospectively included. CT attenuation values in Hounsfield units (HU) were measured by placement of a region-of-interest at the central portion of the L1 vertebral body and then compared to their corresponding DEXA score. Receiver operating characteristic (ROC) curves were generated to evaluate the performance of a logistic regression model and to determine sensitivity and specificity thresholds. RESULTS 536 patients (394 females, mean age 65.8) were included, of which 174 had DEXA-defined osteoporosis. L1 attenuation measures were significantly different (p < 0.01) between the three DEXA-defined groups of osteoporosis (118 HU), osteopenia (143 HU) and normal bone density (178 HU). The area under the ROC curve was 0.74 (95% CI 0.69-0.78). A threshold of 169 HU was 90% sensitive, and a threshold of 104 HU was 90% specific for diagnosing osteoporosis. CONCLUSIONS Routine abdominal CT can be used to opportunistically screen for osteoporosis without additional cost or radiation exposure. The thresholds identified in this study are comparable with previous studies in other populations. We recommend radiologists engage with primary care and rheumatology providers to determine appropriate cut-off values for further investigation.
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Affiliation(s)
- Sonam Vadera
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Timothy Osborne
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - Vikas Shah
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
| | - James A Stephenson
- Gastrointestinal Imaging Group, Department of Radiology, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK.
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Amini M, Reisinger A, Synek A, Hirtler L, Pahr D. The predictive ability of a QCT-FE model of the proximal femoral stiffness under multiple load cases is strongly influenced by experimental uncertainties. J Mech Behav Biomed Mater 2023; 139:105664. [PMID: 36657193 DOI: 10.1016/j.jmbbm.2023.105664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
Despite significant improvements in terms of the predictive ability of Quantitative Computed Tomography based Finite Element (QCT-FE) models in estimating femoral strength (fracture load and stiffness), no substantial clinical adoption of this method has taken place to date. Narrowing the wide variability of FE results by standardizing the methodology and validation protocols, as well as reducing the uncertainties in the FEA process have been proposed as routes towards improved reliability. The aim of this study was to: First, validate a QCT-FE model of proximal femoral stiffness in multiple stance load cases, and second, using a parametric approach, determine the influence of select experimental and modeling parameters on the predictive ability of our model. Ten fresh frozen human femoral samples were tested in neutral stance, 15° adducted and 15° abducted load cases. Voxel-based linear-elastic QCT-FE models of the samples were generated to predict the models' stiffness values in all load cases. The base FE models were validated against the experimental results using linear regression. Thirty six deviated models were created using the minimum and maximum values of experiment-based "plausible range" for 18 parameters in 4 categories of embedding, loading, material, and segmentation. The predictive ability of the models were compared in terms of the coefficient of determination (R2) of the linear regression between the measured and predicted stiffness values in all load cases. Our model was capable of capturing 90% of the variation in the experimental stiffness of the samples in neutral stance position (R2 = 0.9, concordance correlation coefficient (CCC) = 0.93, percent root mean squared error (RMSE%) = 8.4%, slope and intercept not significantly different from unity and zero, respectively). Embedding and loading categories strongly affected the predictive ability of the models with an average percent difference in R2 of 4.36% ± 2.77 and 2.96% ± 1.69 for the stance-neutral load case, respectively. The performance of the models were significantly different in adducted and abducted load cases with their R2 dropping to 71% and 70%, respectively. Similarly, off-axes load cases were affected by the parameters differently compared to the neutral load case, with the loading parameter category imposing more than 10% difference on their R2, larger than all other categories. We also showed that automatically selecting the best performing plausible value for each parameter and each sample would result in a perfectly linear correlation (R2> 0.99) between the "tuned" model's predicted stiffness and experimental results. Based on our results, high sensitivity of the model performance to experimental parameters requires extra diligence in modeling the embedding geometry and the loading angles since these sources of uncertainty could dwarf the effects of material modeling and image processing parameters. The results of this study could help in improving the robustness of the QCT-FE models of proximal femur by limiting the uncertainties in the experimental and modeling steps.
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Affiliation(s)
- Morteza Amini
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.
| | - Andreas Reisinger
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria.
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria.
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Währinger Straße 13, 1090, Vienna, Austria.
| | - Dieter Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Getreidemarkt 9, 1060, Vienna, Austria; Division Biomechanics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria.
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Hammood SMA, Ali Talib M, Al-Baghdadi FA, Dehghani S. The role of Fast spin-echo T2-weighted and diffusion-weighted imaging for spine bone marrow changes evaluation in postmenopausal women with osteoporosis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To prospectively investigate the role of Fast spin-echo T2-weighted (FSE T2-w) and diffusion-weighted imaging (DWI) in magnetic resonance imaging (MRI) for detecting spine bone marrow changes in postmenopausal women with osteoporosis (OP). A total of 101 postmenopausal women, mean age of 60.97 ± 7.41 (range 52–68) years old, who underwent dual-energy X-ray absorptiometry of the spine, were invited to this study and divided into three bone density (normal, osteopenic, and osteoporotic) groups based on T-score. After that MRI scan with both FSE T2-w and DWI of the vertebral body was done to calculate the signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC). Finally, MRI findings were compared in patients, between three groups and correlated with bone marrow density.
Results
The osteoporotic group showed significantly lower mean ADC values, compared to osteopenic and normal groups (0.58 ± 0.02 vs. 0.36 ± 0.05 vs. 0.24 ± 0.06 × 10–3 mm2/s, p < 0.001). According to these results, a significant positive correlation was found between T-scores and ADC values (r = 0.652, p < 0.001). The mean SNR in FSE T2-w images for normal, osteopenic, and osteoporotic groups was calculated 5.61 ± 0.32, 5.48 ± 0.55, and 6.63 ± 0.67, respectively. No significant correlation was found between the mean SNR and T-score for all groups (r = − 0.304, p > 0.05).
Conclusions
DWI can be used as a noninvasive, quantitative, and valuable technique for OP evaluation. While, routine MRI needs more investigation to be demonstrated as a reliable diagnostic indicator for OP.
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Pinto EM, Neves JR, Teixeira A, Frada R, Atilano P, Oliveira F, Veigas T, Miranda A. Efficacy of Hounsfield Units Measured by Lumbar Computer Tomography on Bone Density Assessment: A Systematic Review. Spine (Phila Pa 1976) 2022; 47:702-710. [PMID: 34468433 DOI: 10.1097/brs.0000000000004211] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE This work aimed to compare the Hounsfield units (HU) value obtained from computed tomography and the t score of dual-energy x-ray absorptiometry (DXA) in the prediction of the lumbar spine bone mineral density (BMD). SUMMARY OF BACKGROUND DATA Several reports have found a correlation between HU and BMD values based on DXA. Using HUs to infer bone quality has a thorough clinical relevance as it could triage patients at risk for osteoporotic and fragility fractures or modify surgical indications. METHODS A systematic review in Cochrane Library, Medline, Scopus and Web of Science was performed, using the following query: "hounsfield units" AND ("osteoporosis" OR "spine" OR "bone mineral density" OR "dual x-ray absorptiometry"). We included 18 cohort studies that compared HU value obtained from computed tomography and t score of DXA for predicting regional BMD. RESULTS A total of 18 studies were included, enrolling 5307 patients. The HU measurement was most frequently made at L1 (N = 3; 18.8%). The mean HU values differentiated based on BMD measured through DXA were reported in seven studies, with values from 54.7 to 130 for osteoporotic, 78.8 to 146 for osteopenic, and from 120.8 to 230 in normal patients. Eight studies identified thresholds for diagnosing osteoporosis through receiver-operating characteristic (ROC) curves, with values ranging from 0.66 to 0.96. Medium HU values reported as diagnostic of osteoporosis ranged between 110 and 150, after exclusion of the two papers presenting outlier values. We infer an HU interval value of 90.9 to 138.7 (95% CI, P < 0.001) for the diagnosis osteoporosis. CONCLUSIONS Present data evidence favorable results regarding the possibility of establishing a threshold value for osteoporosis diagnosis from CT measurements of HU. Prospective large-scale studies are needed to more robustly infer the possibility of quantifying BMD based on CT as a screening test and infer a prognostic value of the CT-based evaluation.Level of Evidence: 2.
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Affiliation(s)
- Eduardo Moreira Pinto
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Joao Rocha Neves
- Consultant of Angiology and Vascular Surgery at Centro Hospitalar São João, Porto, Portugal;Biomedicine Department-Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal
| | - Artur Teixeira
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Ricardo Frada
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Pedro Atilano
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Filipa Oliveira
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Tania Veigas
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
| | - Antonio Miranda
- Orthopedic and Traumatology Surgery, Spine Division, Entre Douro e Vouga Hospital Center, S.M.Feira, Portugal
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Lopes GAL, Mystro Neto S, Rosa AF, Lima MC, Pasqualini W, Tebet MA, Risso Neto MÍ. SPINAL DEFORMITY INDEX AND QUALITY OF LIFE OF PATIENTS WITH A DENSITOMETRIC DIAGNOSIS OF OSTEOPOROSIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212004256194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To evaluate the existence of a possible significant correlation between the quality of life of outpatients with osteoporosis and the Spinal Deformity Index (SDI), a radiographic method for semiquantitative assessment of the spine that enables the identification of prevalent and incident fractures. Methods: A cross-sectional observational study carried out with female patients, Caucasians, over 50 years of age, with a densitometric diagnosis of osteoporosis and in an outpatient follow-up, who were submitted to the Oswestry Disability Index (ODI) and SF-36 questionnaires to measure the direct and indirect damage of vertebral fragility fractures on quality of life. The scores obtained in these questionnaires were correlated with the SDI scores, calculated from the radiographs of the lumbar and thoracic spine. Results: 48 patients completed the study, with a mean age of 69.6±6.7 years, mean body mass index (BMI) of 25.4±3.4 kg/m2, mean ODI of 25.1±17.9%, mean SF- 36 of 428.7±192.4 and mean SDI of 4.3±3. For the statistical analysis, Spearman's coefficient was used (p ≤ 0.05). Conclusion: There is no statistically significant correlation between the SDI and the scores obtained on the ODI and SF-36 quality of life questionnaires. Level of evidence: III. Study of non-consecutive patients, without gold standard, applied uniformly.
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Foessl I, Bassett JHD, Bjørnerem Å, Busse B, Calado Â, Chavassieux P, Christou M, Douni E, Fiedler IAK, Fonseca JE, Hassler E, Högler W, Kague E, Karasik D, Khashayar P, Langdahl BL, Leitch VD, Lopes P, Markozannes G, McGuigan FEA, Medina-Gomez C, Ntzani E, Oei L, Ohlsson C, Szulc P, Tobias JH, Trajanoska K, Tuzun Ş, Valjevac A, van Rietbergen B, Williams GR, Zekic T, Rivadeneira F, Obermayer-Pietsch B. Bone Phenotyping Approaches in Human, Mice and Zebrafish - Expert Overview of the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal traits TranslatiOnal NEtwork"). Front Endocrinol (Lausanne) 2021; 12:720728. [PMID: 34925226 PMCID: PMC8672201 DOI: 10.3389/fendo.2021.720728] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/21/2021] [Indexed: 12/16/2022] Open
Abstract
A synoptic overview of scientific methods applied in bone and associated research fields across species has yet to be published. Experts from the EU Cost Action GEMSTONE ("GEnomics of MusculoSkeletal Traits translational Network") Working Group 2 present an overview of the routine techniques as well as clinical and research approaches employed to characterize bone phenotypes in humans and selected animal models (mice and zebrafish) of health and disease. The goal is consolidation of knowledge and a map for future research. This expert paper provides a comprehensive overview of state-of-the-art technologies to investigate bone properties in humans and animals - including their strengths and weaknesses. New research methodologies are outlined and future strategies are discussed to combine phenotypic with rapidly developing -omics data in order to advance musculoskeletal research and move towards "personalised medicine".
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Affiliation(s)
- Ines Foessl
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrine Lab Platform, Medical University of Graz, Graz, Austria
| | - J. H. Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Åshild Bjørnerem
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Research Centre for Women’s Health, Oslo University Hospital, Oslo, Norway
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Ângelo Calado
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | | | - Maria Christou
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Douni
- Institute for Bioinnovation, Biomedical Sciences Research Center “Alexander Fleming”, Vari, Greece
- Department of Biotechnology, Agricultural University of Athens, Athens, Greece
| | - Imke A. K. Fiedler
- Department of Osteology and Biomechanics, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - João Eurico Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Eva Hassler
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University Graz, Graz, Austria
| | - Wolfgang Högler
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Erika Kague
- The School of Physiology, Pharmacology and Neuroscience, Biomedical Sciences, University of Bristol, Bristol, United Kingdom
| | - David Karasik
- Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Patricia Khashayar
- Center for Microsystems Technology, Imec and Ghent University, Ghent, Belgium
| | - Bente L. Langdahl
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Victoria D. Leitch
- Innovative Manufacturing Cooperative Research Centre, Royal Melbourne Institute of Technology, School of Engineering, Carlton, VIC, Australia
| | - Philippe Lopes
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, Medical School, University of Ioannina, Ioannina, Greece
- Department of Health Services, Policy and Practice, Center for Research Synthesis in Health, School of Public Health, Brown University, Providence, RI, United States
| | - Ling Oei
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Lyon, France
| | - Jonathan H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit, Bristol Medical School, Bristol, University of Bristol, Bristol, United Kingdom
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, Netherlands
| | - Şansın Tuzun
- Physical Medicine & Rehabilitation Department, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Amina Valjevac
- Department of Human Physiology, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Graham R. Williams
- Molecular Endocrinology Laboratory, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Tatjana Zekic
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Clinical Hospital Center Rijeka, Rijeka, Croatia
| | | | - Barbara Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Endocrine Lab Platform, Medical University of Graz, Graz, Austria
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Huang M, Hung VWY, Li TK, Law SW, Wang Y, Chen S, Qin L. Performance of HR-pQCT, DXA, and FRAX in the discrimination of asymptomatic vertebral fracture in postmenopausal Chinese women. Arch Osteoporos 2021; 16:125. [PMID: 34480663 PMCID: PMC8418592 DOI: 10.1007/s11657-021-00939-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Volumetric bone density (vBMD) and trabecular microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) can discriminate the patients with high risk of asymptomatic vertebral fracture (VF) in postmenopausal Chinese women. These findings suggested that HR-pQCT could provide additional information on bone quality of the patients with asymptomatic VF. INTRODUCTION Although there were several studies using HR-pQCT to investigate asymptomatic VF, it remains uncertain if HR-pQCT parameters can discriminate asymptomatic VF patients, especially in Chinese population. The purpose of this study was to investigate whether bone quality measured by HR-pQCT could discriminate asymptomatic VF independent of hip areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry (DXA) and fracture risks evaluated using built-in Fracture Risk Assessment Tool (FRAXBMD). METHODS This is a nested case-control study. One hundred seventy-five ambulatory Chinese postmenopausal women aged 60-79 years were retrieved from Normative Reference Standards (NRS) cohort in Hong Kong. DXA was used to identify VF from lateral spine images (VFA) using Genant's semi-quantitative method. Major osteoporotic fracture risk was calculated using FRAX tool. HR-pQCT was used to assess vBMD, microarchitecture, and estimated strength at both distal radius and tibia. Comparison of HR-pQCT parameters between asymptomatic VF and control was performed using covariance analysis. Logistic regression analysis was performed for calculating the adjusted odds ratio (OR) with 95% confidence intervals (CI) of fracture status as per SD decrease in HR-pQCT parameters. RESULTS Women with asymptomatic VF were older than those of the control in our NRS cohort. Nevertheless, after adjusted for covariance, asymptomatic VF showed significantly lower trabecular vBMD (Tb.vBMD) at radius but higher SMI at tibia as compared with those of the control. Tb.vBMD at radius yielded the highest value of area under the curve (AUC) as compared with total hip aBMD and FRAXBMD. However, no significant difference was found among each other. CONCLUSION Tb.vBMD at the radius and SMI at the tibia provided by HR-pQCT can discriminate asymptomatic VF independent of hip aBMD and FRAXBMD by DXA in postmenopausal women.
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Affiliation(s)
- Meiling Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Vivian Wing-Yin Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Kiu Li
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheung Wai Law
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shangjie Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Rehabilitation, Shenzhen Baoan Hospital Affiliated to Southern Medical University, Shenzhen, China.
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
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Patel B, Aqil A, Riaz O, Jeffers R, Dickson D. The 2nd Metacarpal Cortical Index as a Simple Screening Tool for Osteopenia. J Bone Metab 2020; 27:261-266. [PMID: 33317229 PMCID: PMC7746479 DOI: 10.11005/jbm.2020.27.4.261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/01/2020] [Indexed: 11/11/2022] Open
Abstract
Background Osteopenia is a known risk factor for sustaining skeletal fractures. Prevention of fragility fractures has obvious clinical and economic advantages, however screening all patients using a dual energy X-ray absorptiometry (DXA) is controversial not only because of the cost implications but also because it would potentially involve exposing a percentage of normal patients to unnecessary radiation. We wished to assess whether a simple hand X-ray measuring the 2nd metacarpal cortical index (2MCI) could be used as a simple screening tool for identifying patients with osteopenia. Methods We retrospectively collected the radiographic data of 206 patients who had a simple radiograph of the hand and a DXA scan within one year of each other from our picture archiving and communication system database. The 2MCI was calculated for all patients. As data was parametric, a Pearson’s correlation was performed to assess association between T-scores and 2MCI. Further analysis involved the construction of receiver operating characteristic (ROC) curves to identify a 2MCI index, which would give the most appropriate sensitivity and specificity values for identifying the presence of osteopenia. Results A statistically significant and moderate correlation between DXA T-scores and 2MCI values was found (r=0.54, n=206, P<0.001). Further ROC curve analysis of normal and osteopenic subjects identified that a 2MCI of 41.5 had a sensitivity of 100% and specificity of 53% for detecting osteopenia. Conclusions Our results support the use of the 2MCI as a simple screening tool for identifying patients with osteopenia.
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Affiliation(s)
- Bhavika Patel
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, United Kingdom
| | - Adeel Aqil
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, United Kingdom
| | - Osman Riaz
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, United Kingdom
| | - Russ Jeffers
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, United Kingdom
| | - David Dickson
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, United Kingdom
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11
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ERSOY C. Current Approaches to the Basic Aspects of Osteoporosis. TURKISH JOURNAL OF INTERNAL MEDICINE 2020. [DOI: 10.46310/tjim.732932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Berger-Groch J, Thiesen DM, Ntalos D, Hennes F, Hartel MJ. Assessment of bone quality at the lumbar and sacral spine using CT scans: a retrospective feasibility study in 50 comparing CT and DXA data. 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 2020; 29:1098-1104. [PMID: 31955257 DOI: 10.1007/s00586-020-06292-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 10/14/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Computed tomography (CT) is a standard diagnostic tool for preoperative screening for many indications in spinal and pelvic surgery. The gold standard for diagnosing osteoporosis is standard dual-energy X-ray absorptiometry (DXA). The aim of the present study was to compare the accuracy of Hounsfield unit (HU) measurements not only at the lower lumbar, but also at the sacral spine using standard CT scans. PATIENTS AND METHODS Main inclusion criterion for this retrospective analysis in 50 patients was the availability of both a CT scan of the lumbar and sacral spines and a DXA scan. HUs were measured in intact vertebral bodies L4, L5 and S1. Results of the HU in CT scan were compared to the T-score and bone mineral density in DXA. A group with normal bone density (T-score higher - 1, n = 26) was compared with a group with impaired bone density (T-score lower - 1, n = 24). RESULTS A multivariant binary logistic regression analysis showed significant results for HU measurement in L4 (p = 0.009), L5 (p = 0.005) and S1 (p = 0.046) with respect to differentiation between normal and impaired bone quality. Cutoffs between normal and impaired bone density values for trabecular region of interest attenuation for L4, L5 and S1 are presented. In L4 100% sensitivity to detect normal bone was reached when HU was higher than 161, HU higher than 157 in L5 and HU higher than 207 in S1. CONCLUSIONS HU measurements in CT scans have proven to be a feasible tool to additionally assess bone quality at the lumbar and sacral spine with good sensitivity, when compared with the gold standard DXA. LEVEL OF EVIDENCE III. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- J Berger-Groch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - D M Thiesen
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - D Ntalos
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - F Hennes
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - M J Hartel
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Yang XW, Wang F, Qin RZ, Zhou QL, Huang HX. Elevated serum CCL4/MIP-1β levels in postmenopausal osteoporosis patients are linked with disease severity. Biomark Med 2018; 13:17-25. [PMID: 30561228 DOI: 10.2217/bmm-2018-0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To investigate if the serum CC motif ligand 4 (CCL4) levels are linked to disease severity in patients with postmenopausal osteoporosis (PMOP). PATIENTS & METHODS We enrolled 66 PMOP females, 68 postmenopausal nonosteoporotic women and 67 healthy women of childbearing age. Bone mineral densities were assessed with dual x-ray absorptiometry scans. The Oswestry disability index and the visual analog scale were employed to quantify functional ability and severity of symptoms. Serum CCL4 levels were examined with a quantitative sandwich enzyme-linked immunosorbent assay. RESULTS We observed a significant negative correlation of CCL4 serum levels with bone mineral density. Furthermore, serum CCL4 concentrations were significantly related to the visual analog scale and Oswestry Disability Index scores. CONCLUSION Serum CCL4 is a potential biomarker to evaluate disease severity in PMOP females.
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Affiliation(s)
- Xian-Wen Yang
- Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, GuangZhou, GuangDong Province, 510006, PR China
| | - Fei Wang
- Air Force General Hospital, Beijing 100142, PR China
| | - Ru-Zi Qin
- Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, GuangZhou, GuangDong Province, 510006, PR China
| | - Qin-Lin Zhou
- Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, GuangZhou, GuangDong Province, 510006, PR China
| | - Hong-Xing Huang
- The Third Affiliated Hospital of GuangZhou University of Chinese Medicine, GuangZhou, GuangDong Province, 510170, PR China
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Di Iorgi N, Maruca K, Patti G, Mora S. Update on bone density measurements and their interpretation in children and adolescents. Best Pract Res Clin Endocrinol Metab 2018; 32:477-498. [PMID: 30086870 DOI: 10.1016/j.beem.2018.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Following the increased awareness about the central role of the pediatric age in building bone for life, clinicians face more than ever the necessity of assessing bone health in pediatric subjects at risk for early bone mass derangements or in healthy children, in order to optimize their bone mass accrual and prevent osteoporosis. Although the diagnosis of osteoporosis is not made solely upon bone mineral density measurements during growth, such determination can be very useful in the follow-up of pediatric patients with primary and secondary osteoporosis. The ideal instrument would give information on the mineral content and density of the bone, and on its architecture. It should be able to perform the measurements on the skeletal sites where fractures are more frequent, and it should be minimally invasive, accurate, precise and rapid. Unfortunately, none of the techniques currently utilized fulfills all requirements. In the present review, we focus on the pediatric use of dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), and magnetic resonance imaging (MRI), highlighting advantages and limits for their use and providing indications for bone densitometry interpretation and of vertebral fractures diagnosis in pediatric subjects.
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Affiliation(s)
- Natascia Di Iorgi
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy.
| | - Katia Maruca
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy
| | - Giuseppa Patti
- Department of Pediatrics, Istituto Giannina Gaslini, University of Genova, Genova, Italy
| | - Stefano Mora
- Pediatric Bone Densitormetry Service and Laboratory of Pediatric Endocrinology, IRCCS San Raffaele Institute, Milano, Italy.
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Bos D, Leening MJG. Leveraging the coronary calcium scan beyond the coronary calcium score. Eur Radiol 2018; 28:3082-3087. [PMID: 29383526 PMCID: PMC5986828 DOI: 10.1007/s00330-017-5264-3] [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: 09/27/2017] [Revised: 11/28/2017] [Accepted: 12/20/2017] [Indexed: 12/21/2022]
Abstract
Non-contrast cardiac computed tomography in order to obtain the coronary artery calcium score has become an established diagnostic procedure in the clinical setting, and is commonly employed in clinical and population-based research. This state-of-the-art review paper highlights the potential gain in information that can be obtained from the non-contrast coronary calcium scans without any necessary modifications to the scan protocol. This includes markers of cardio-metabolic health, such as the amount of epicardial fat and liver fat, but also markers of general health including bone density and lung density. Finally, this paper addresses the importance of incidental findings and of radiation exposure accompanying imaging with non-contrast cardiac computed tomography. Despite the fact that coronary calcium scan protocols have been optimized for the visualization of coronary calcification in terms image quality and radiation exposure, it is important for radiologists, cardiologists and medical specialists in the field of preventive medicine to acknowledge that numerous additional markers of cardio-metabolic health and general health can be readily identified on a coronary calcium scan. KEY POINTS • The coronary artery calcium score substantially increased the use of cardiac CT. • Cardio-metabolic and general health markers may be derived without changes to the scan protocol. • Those include epicardial fat, aortic valve calcifications, liver fat, bone density, and lung density. • Clinicians must be aware of this potential additional yield from non-contrast cardiac CT.
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Affiliation(s)
- Daniel Bos
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Cardiology, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, The Netherlands
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