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Wang L, Yang M, Liu Y, Ge Y, Zhu S, Su Y, Cheng X, Wu X, Blake GM, Engelke K. Differences in Hip Geometry Between Female Subjects With and Without Acute Hip Fracture: A Cross-Sectional Case-Control Study. Front Endocrinol (Lausanne) 2022; 13:799381. [PMID: 35282435 PMCID: PMC8907418 DOI: 10.3389/fendo.2022.799381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Although it is widely recognized that hip BMD is reduced in patients with hip fracture, the differences in geometrical parameters such as cortical volume and thickness between subjects with and without hip fracture are less well known. MATERIALS AND METHODS Five hundred and sixty two community-dwelling elderly women with hip CT scans were included in this cross-sectional study, of whom 236 had an acute hip fracture. 326 age matched women without hip fracture served as controls. MIAF-Femur software was used for the measurement of the intact contralateral femur in patients with hip fracture and the left femur of the controls. Integral and cortical volumes (Vols) of the total hip (TH), femoral head (FH), femoral neck (FN), trochanter (TR) and intertrochanter (IT) were analyzed. In the FH and FN the volumes were further subdivided into superior anterior (SA) and posterior (SP) as well as inferior anterior (IA) and posterior (IP) quadrants. Cortical thickness (CortThick) was determined for all sub volumes of interest (VOIs) listed above. RESULTS The average age of the control and fracture groups was 71.7 and 72.0 years, respectively. The fracture patients had significantly lower CortThick and Vol of all VOIs except for TRVol. In the fracture patients, cortical thickness and volume at the FN were significantly lower in all quadrants except for cortical volume of quadrant SA (p= 0.635). Hip fracture patients had smaller integral FN volume and cross-sectional area (CSA) before and after adjustment of age, height and weight. With respect to hip fracture discrimination, cortical volume performed poorer than cortical thickness across the whole proximal femur. The ratio of Cort/TrabMass (RCTM), a measure of the internal distribution of bone, performed better than cortical thickness in discriminating hip fracture risk. The highest area under curve (AUC) value of 0.805 was obtained for the model that included THCortThick, FHVol, THRCTM and FNCSA. CONCLUSION There were substantial differences in total and cortical volume as well as cortical thickness between fractured and unfractured women across the proximal femur. A combination of geometric variables resulted in similar discrimination power for hip fracture risk as aBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yufeng Ge
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Glen M. Blake
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Michalski AS, Besler BA, Burt LA, Boyd SK. Opportunistic CT screening predicts individuals at risk of major osteoporotic fracture. Osteoporos Int 2021; 32:1639-1649. [PMID: 33566138 DOI: 10.1007/s00198-021-05863-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
UNLABELLED Millions of CT scans are performed annually and could be also used to opportunistically assess musculoskeletal health; however, it is unknown how well this secondary assessment relates to osteoporotic fracture. This study demonstrates that opportunistic CT screening is a promising tool to predict individuals with previous osteoporotic fracture. INTRODUCTION Opportunistic computed tomography (oCT) screening for osteoporosis and fracture risk determination complements current dual X-ray absorptiometry (DXA) diagnosis. This study determined major osteoporotic fracture prediction by oCT at the spine and hip from abdominal CT scans. METHODS Initial 1158 clinical abdominal CT scans were identified from administrative databases and were the basis to generate a cohort of 490 men and women with suitable abdominal CT scans. Participant CT scans met the following criteria: over 50 years of age, the scan had no image artifacts, and the field-of-view included the L4 vertebra and proximal femur. A total of 123 participants were identified as having previously suffered a fracture within 5 years of CT scan date. Fracture cause was identified from clinical data and used to create a low-energy fracture sub-cohort. At each skeletal site, bone mineral density (BMD) and finite element (FE)-estimated bone strength were determined. Logistic regression predicted fracture and receiver-operator characteristic curves analyzed prediction capabilities. RESULTS In participants with a fracture, low-energy fractures occurred in 88% of women and 79% of men. Fracture prediction by combining both BMD and FE-estimated bone strength was not statistically different than using either BMD or FE-estimated bone strength alone. Predicting low-energy fractures in women determined the greatest AUC of 0.710 by using both BMD and FE-estimated bone strength. CONCLUSIONS oCT screening using abdominal CT scans is effective at predicting individuals with previous fracture at major osteoporotic sites and offers a promising screening tool for skeletal health assessment.
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Affiliation(s)
- A S Michalski
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - B A Besler
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - L A Burt
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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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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Finite element analysis informed variable selection for femoral fracture risk prediction. J Mech Behav Biomed Mater 2021; 118:104434. [PMID: 33756419 DOI: 10.1016/j.jmbbm.2021.104434] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/07/2021] [Accepted: 02/26/2021] [Indexed: 11/22/2022]
Abstract
Logistic regression classification (LRC) is widely used to develop models to predict the risk of femoral fracture. LRC models based on areal bone mineral density (aBMD) alone are poor, with area under the receiver operator curve (AUROC) scores reported to be as low as 0.63. This has led to researchers investigating methods to extract further information from the image to increase performance. Recently, the use of active shape (ASM) and appearance models (AAM) have resulted in moderate improvements, but there is a risk that inclusion of too many modes will lead to overfitting. In addition, there are concerns that the effort required to extract the additional information does not justify the modest improvement in fracture risk prediction. This raises the question, are we reaching the limits of the information that can be extracted from an image? Finite element analysis was used in combination with active shape and appearance modelling to select variables to develop LRC models of fracture risk. Active shape and active appearance models were constructed based on a previously reported cohort of 94 post-menopausal Caucasian women (47 with and 47 without a fracture). T-tests were used to identify differences between the two groups for each mode of variation. Femur strength was predicted for two load cases, stance and a fall. Stepwise multi-variate linear regression was used to identify shape and appearance modes that were predictors of strength for the femurs in the training set. Femurs were also synthetically generated to explore the influence of the first 10 modes of the shape and appearance models. Identified modes of variation were then used to generate LRC models to predict fracture risk. Only 6 modes, 4 active appearance and 2 active shape modes, were identified that had a significant influence on predicted fracture strength. Of these, only two active appearance modes were needed to substantially improve the predictive mode performance (ΔAUROC = 0.080). The addition of 3 more modes (1 AAM and two ASM) further improved the performance of the classifier (ΔAUROC = 0.123). Further addition of modes did not result in any further substantial improvements. Based on these findings, it is suggested that we are reaching the limits of the information that can be extracted from an image to predict fracture risk.
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Akhter MP, Recker RR. High resolution imaging in bone tissue research-review. Bone 2021; 143:115620. [PMID: 32866682 DOI: 10.1016/j.bone.2020.115620] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022]
Abstract
This review article focuses on imaging of bone tissue to understand skeletal health with regards to bone quality. Skeletal fragility fractures are due to bone diseases such as osteoporosis which result in low bone mass and bone mineral density (BMD) leading to high risk of fragility fractures. Recent advances in imaging and analysis technologies have highly benefitted the field of biological sciences. In particular, their application in skeletal health has been of significant importance in understanding bone mechanical behavior (structure and properties) at the tissue level. While synchrotron based microCT technique has remained the gold standard for non-destructive evaluation of structure in material and biological sciences, several lab based microCT systems have been developed to provide high resolution imaging of specimens with greater access, and ease of use in laboratory settings. Lab based microCT scanners are widely used in the bone field as a standard tool to evaluate three-dimensional (3D) morphologies of bone structure at image resolutions appropriate for bone samples from small animals to bone biopsy specimens from humans. Both synchrotron and standard lab based microCT systems provide high resolution imaging ex vivo for a small sized specimen. A few X-ray based systems are also commercially available for in vivo scanning at relatively low image resolutions. Synchrotron-based CT microscopy is being used for various ultra-high-resolution image analyses using complex 3D software. However, the synchrotron-based CT technology is in high demand, allows only limited numbers of specimens, expensive, requires complex additional instrumentation, and is not easily available to researchers as it requires access to a synchrotron source which is always limited. Therefore, desktop laboratory scanners (microXCT, Zeiss/Xradia, Scanco, SkyScan. etc.), mimicking the synchrotron based CT technology or image resolution, have been developed to solve the accessibility issues. These lab based scanners have helped both material science, and the bone field to investigate bone tissue morphologies at submicron mage resolutions. Considerable progress has been made in both in vivo and ex vivo imaging towards providing high resolution images of bone tissue. Both clinical and research imaging technologies will continue to improve and help understand osteoporosis and other related skeletal issues in order to develop targeted treatments for bone fragility. This review summarizes the high resolution imaging work in bone research.
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Affiliation(s)
- M P Akhter
- Creighton University Osteoporosis Research Center, Omaha, NE, United States of America.
| | - R R Recker
- Creighton University Osteoporosis Research Center, Omaha, NE, United States of America
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Keyak JH, Kaneko TS, Khosla S, Amin S, Atkinson EJ, Lang TF, Sibonga JD. Hip load capacity and yield load in men and women of all ages. Bone 2020; 137:115321. [PMID: 32184195 PMCID: PMC7354222 DOI: 10.1016/j.bone.2020.115321] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/13/2020] [Indexed: 02/02/2023]
Abstract
Quantitative computed tomography (QCT) based finite element (FE) models can compute subject-specific proximal femoral strengths, or fracture loads, that are associated with hip fracture risk. These fracture loads are more strongly associated with measured fracture loads than are DXA and QCT measures and are predictive of hip fracture independently of DXA bone mineral density (BMD). However, interpreting FE-computed fracture loads of younger subjects for the purpose of evaluating hip fracture risk in old age is challenging due to limited reference data. The goal of this study was to address this issue by providing reference data for male and female adult subjects of all ages. QCT-based FE models of the left proximal femur of 216 women and 181 men, age 27 to 90 years, from a cohort of Rochester, MN residents were used to compute proximal femoral load capacities, i.e. the maximum loads that can be supported, in single-limb stance and posterolateral fall loading (Stance_LC and Fall_LC, respectively) [US Patent No. 9,245,069] and yield load under fall loading (Fall_yield). To relate these measures to information about hip fracture, the CT scanner and calibration phantom were cross-calibrated with those from our previous prospective study of hip fracture in older fracture and control subjects, the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort. We then plotted Stance_LC, Fall_LC and Fall_yield versus age for the two cohorts on the same graphs. Thus, proximal femoral strengths in individuals above 70 years of age can be assessed through direct comparison with the FE data from the AGES cohort which were analyzed using identical methods. To evaluate younger individuals, reductions in Stance_LC, Fall_LC and Fall_yield from the time of evaluation to age 70 years can be cautiously estimated from the average yearly cross-sectional decreases found in this study (108 N, 19.4 N and 14.4 N, respectively, in men and 120 N, 19.4 N and 21.6 N, respectively, in women), and the projected fracture loads can be compared with data from the AGES cohort. Although we did not set specific thresholds for identifying individuals at risk of hip fracture, these data provide some guidance and may be used to help establish diagnostic criteria in future. Additionally, given that these data were nearly entirely from Caucasian subjects, future research involving subjects of other races/ethnicities is necessary.
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Affiliation(s)
- J H Keyak
- Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, CA, USA; Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA.
| | - T S Kaneko
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - S Khosla
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - S Amin
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - E J Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - T F Lang
- Department of Radiology and Biomedical Imaging and School of Dentistry, University of California, San Francisco, CA, USA
| | - J D Sibonga
- Division of Biomedical Research and Environmental Sciences, NASA Lyndon B. Johnson Space Center, Houston, TX, USA
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7
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Humbert L, Bagué A, Di Gregorio S, Winzenrieth R, Sevillano X, González Ballester MÁ, Del Rio L. DXA-Based 3D Analysis of the Cortical and Trabecular Bone of Hip Fracture Postmenopausal Women: A Case-Control Study. J Clin Densitom 2020; 23:403-410. [PMID: 30503030 DOI: 10.1016/j.jocd.2018.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
Methods using statistical shape and appearance models have been proposed to analyze bone mineral density (BMD) in 3D from dual energy X-ray absorptiometry (DXA) scans. This paper presents a retrospective case-control study assessing the association of DXA-derived 3D measurements with osteoporotic hip fracture in postmenopausal women. Patients who experienced a hip fracture between 1 and 6 years from baseline and age-matched controls were included in this study. The 3D-SHAPER software (version 2.7, Galgo Medical, Barcelona, Spain) was used to derive 3D analysis from hip DXA scans at baseline. DXA and 3D measurements were compared between groups. Total hip areal BMD of hip fracture group as measured by DXA was 10.7% lower compared to control group. Differences in volumetric BMD (total hip) as measured by 3D-SHAPER were more pronounced in the trabecular compartment (-23.3%) than in the cortex (-8.2%). The area under the receiver operating curve was 0.742 for trabecular volumetric BMD, 0.706 for cortical volumetric BMD, and 0.712 for total hip areal BMD. Differences in the cortex were locally more pronounced at the medial aspect of the shaft, the lateral aspect of the greater trochanter, and the superolateral aspect of the neck. Marked differences in volumetric BMD were observed in the greater trochanter. This case-control study showed the association of DXA-derived 3D measurements with hip fracture. Analysis of large cohorts will be performed in future work to determine if DXA-derived 3D measurements could improve fracture risk prediction in clinical practice.
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Affiliation(s)
| | - Alexis Bagué
- Musculoskeletal Unit, Galgo Medical, Barcelona, Spain; BCN Medtech, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Xavier Sevillano
- Grup de Recerca en Tecnologies Mèdia, La Salle-Universitat Ramon Llull, Barcelona, Spain
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Rhodes S, Batzdorf A, Sorci O, Peng M, Jankelovits A, Hornyak J, An J, Noël PB, Høilund-Carlsen PF, Alavi A, Rajapakse CS. Assessment of femoral neck bone metabolism using 18F-sodium fluoride PET/CT imaging. Bone 2020; 136:115351. [PMID: 32276154 PMCID: PMC7246165 DOI: 10.1016/j.bone.2020.115351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard of care metabolic bone disease assessment relies on changes to bone quantity, which can only be detected after structural changes occur. PURPOSE To investigate the usefulness of Bone Metabolism Score (BMS), derived from fluorine 18 labeled sodium fluoride (18F-NaF) PET/CT imaging as a biomarker of localized metabolic changes at the femoral neck. METHODS In this retrospective study, 139 participants (68 females and 71 males, ages 21-75 years) that had undergone 18F-NaF PET/CT were included. BMS was calculated as the ratio of standard uptake value (SUV) in the bone region to that of the total region. Correlations and linear regressions of BMS with age, CT-derived bone mineral density (BMD), body mass index (BMI), height, and weight were conducted. Differences in BMS between women younger and older than the age of 50 years were assessed. Inter- and intra-operator reproducibility was evaluated by coefficient of variation (CV) and intra-class correlation coefficient (ICC). RESULTS Among females, age was negatively correlated with left and right whole BMS (5.61% and 4.90% drop in BMS per decade of life) and left and right cortical BMS (10.50% and 10.09% drop in BMS per decade of life). BMS of women older than 50 years was lower than BMS of women younger than 50 years (P < .0001). Among males, age was negatively correlated with left and right whole BMS (4.29% and 4.25% drop in BMS per decade of life) and left and right cortical BMS (9.13% and 10.30% drop in BMS per decade of life). BMD was positively correlated with whole (r = 0.80, P < .0001) and cortical (r = 0.92, P < .0001) BMS. CONCLUSIONS BMS could provide functional insight regarding bone metabolism in the femoral neck to complement bone health status assessed through conventional structural imaging. The methodology described herein could be potentially useful for assessing hip fracture risk in individuals when BMD tests provide borderline determination of bone disease.
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Affiliation(s)
- Sylvia Rhodes
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra Batzdorf
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia Sorci
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Peng
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Jankelovits
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Hornyak
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jongyun An
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter B Noël
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Abass Alavi
- Division of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith S Rajapakse
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Departments of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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9
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Liu G, Ge J, Zheng X, Wu C, Yan Q, Yang H, Zou J. Proximal femur lag screw placement based on bone mineral density determined by quantitative computed tomography. Exp Ther Med 2020; 19:2720-2724. [PMID: 32256754 DOI: 10.3892/etm.2020.8480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 10/22/2019] [Indexed: 01/23/2023] Open
Abstract
Following internal fixations for intertrochanteric fractures in elderly patients, lag screws or screw blades frequently cut the femoral head, leading to surgical failure. The bone mineral density (BMD) at various parts of the proximal femur is significantly correlated with the holding force of the lag screw, which in turn is closely associated with the stability of the fixation. However, the appropriate placement of the lag screw has been controversial. As a novel detection method for BMD, quantitative computed tomography (QCT) may provide relatively accurate measurements of three-dimensional structures and may provide an easy way to determine the appropriate lag screw placement. A total of 50 elderly patients with intertrochanteric fractures were selected for the present study. The BMD of the proximal femur on the healthy side, including the femoral intertrochanter, neck and head, was measured using QCT. For testing, the femoral head was divided into medial, central and lateral sections. The BMD of the femoral head was determined to be the highest, while the BMD of the femoral neck was the lowest. In the femoral head, the central section had the highest BMD, while the lateral section had the lowest BMD. The present study used QCT to detect differences in the BMD at various regions of the proximal femur and provided a novel theoretical reference for the placement of lag screws. To obtain maximum holding power, the lag screw must be placed in the central section of the femoral head.
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Affiliation(s)
- Gang Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China.,Department of Emergency Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Jun Ge
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Xiaohan Zheng
- Department of Emergency Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550001, P.R. China
| | - Cenhao Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Qi Yan
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Huilin Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Jun Zou
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Liu Y, Wang L, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan C, Yan D, Cheng X. CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone. Arch Osteoporos 2020; 15:50. [PMID: 32193671 DOI: 10.1007/s11657-020-00721-8] [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: 04/24/2019] [Accepted: 02/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution. PURPOSE Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively. METHODS We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement. RESULT In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm3, 0.9 cm3, 2.5 cm3, and 4.3 cm3 respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm3). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm3, 0.8 cm3, 2.6 cm3, and 4.4 cm3 respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values. CONCLUSION The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.
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Affiliation(s)
- Y Liu
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - L Wang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Su
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - K Brown
- Mindways Software, Austin, 78704, TX, USA
| | - R Yang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Duanmu
- Department of Radiology, The First Affiliated Hospital of USTC South District, Hefei, 230036, China
| | - Z Guo
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - W Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - C Yan
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - D Yan
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - X Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China.
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11
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Lee YS, Nichols JF, Domingo A, Kim Y, Park SM, Han G, Seo H, Hovell M. Balance performance and related soft tissue components across three age groups. Health Care Women Int 2019; 42:67-81. [PMID: 31617834 DOI: 10.1080/07399332.2019.1678160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the aging process, falls and related injuries are common and unwanted events among older women. Lost balance is the last step before the frequent experience of falls. After menopause, women's bone conditions regarding health and balance performance steeply decline often resulting in serious injury. Our purpose in the study is to identify balance performance and its associations with soft tissue components among Korean-American (KA) women with three menopausal conditions. Researchers conducted a cross-sectional study with 63 KA women divided into three age groups: 25-35 years (young), 45-55 years old (middle), and 65+ years (old). Lean and fat mass on the entire body, appendicular and gynoid areas were measured by using the dual X-ray absorptiometry. Static and dynamic balance and physical performance (floor sit to stand) were tested. We found that with increased aging, lean mass, fat and body mass index were changed; balance and physical performance decreased significantly. In regression models, age and fat ratio of android/gynoid changes explain static balance and physical performance; appendicular lean mass predicted dynamic balance. With advancing age, maintaining lean mass and proportion of fat accumulation is critical for stable balance.
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Affiliation(s)
- Young-Shin Lee
- School of Nursing, San Diego State University, San Diego, California, USA
| | - Jeanne F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Antoinette Domingo
- School of Exercise and Nutritional Sciences, San Diego State University, California, USA
| | - Yeongri Kim
- Neuro/Trauma ICU at Banner Desert Medical Center, Mesa, Arizona, USA
| | - Sae Mi Park
- Los Angeles County + USC Medical Center, Los Angeles, California, USA
| | - Giyeon Han
- Paradise Valley Hospital, National City, California, USA
| | - Hyeran Seo
- San Diego State University, California, USA
| | - Mel Hovell
- Graduate School of Public Health, San Diego State University, California, USA
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12
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Next-generation imaging of the skeletal system and its blood supply. Nat Rev Rheumatol 2019; 15:533-549. [PMID: 31395974 DOI: 10.1038/s41584-019-0274-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/16/2022]
Abstract
Bone is organized in a hierarchical 3D architecture. Traditionally, analysis of the skeletal system was based on bone mass assessment by radiographic methods or on the examination of bone structure by 2D histological sections. Advanced imaging technologies and big data analysis now enable the unprecedented examination of bone and provide new insights into its 3D macrostructure and microstructure. These technologies comprise ex vivo and in vivo methods including high-resolution computed tomography (CT), synchrotron-based imaging, X-ray microscopy, ultra-high-field magnetic resonance imaging (MRI), light-sheet fluorescence microscopy, confocal and intravital two-photon imaging. In concert, these techniques have been used to detect and quantify a novel vascular system of trans-cortical vessels in bone. Furthermore, structures such as the lacunar network, which harbours and connects osteocytes, become accessible for 3D imaging and quantification using these methods. Next-generation imaging of the skeletal system and its blood supply are anticipated to contribute to an entirely new understanding of bone tissue composition and function, from macroscale to nanoscale, in health and disease. These insights could provide the basis for early detection and precision-type intervention of bone disorders in the future.
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13
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Su YB, Wang L, Wu XB, Yi C, Yang MH, Yan D, Cheng KB, Cheng XG. The spatial differences in bone mineral density and hip structure between low-energy femoral neck and trochanteric fractures in elderly Chinese using quantitative computed tomography. Bone 2019; 124:62-68. [PMID: 31004806 DOI: 10.1016/j.bone.2019.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/12/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate the differences in bone mineral density (BMD) and hip structure between femoral neck and trochanteric fractures in elderly Chinese individuals using quantitative computed tomography (QCT). A total of 625 Chinese patients (mean age 75.8 years) who sustained low-energy hip fractures (female: 293 femoral neck, 175 trochanteric; male: 82 femoral neck, 75 trochanteric) were recruited. Each patient underwent a hip QCT scan. The areal BMD (aBMD) of the contralateral normal hip was obtained using a computed tomography X-ray absorptiometry module. Using the bone investigation toolkit (BIT) module, the femoral neck was divided into four quadrants: supero-anterior (SA), infero-anterior (IA), infero-posterior (IP), and supero-posterior (SP). Estimated cortical thickness, cortical BMD, and trabecular BMD were measured in each quadrant. Using the hip structure analysis (HSA) function, several parameters were calculated. Stratified by sex, covariance analyses were applied to compare the femoral neck fractures group with trochanteric fractures group after adjustments for age, height, and weight. In women, trochanteric fractures exhibited lower trabecular BMD and estimated cortical thickness at three quadrants of the femoral neck (IA: P = 0.02, P < 0.01; IP: P < 0.01, P = 0.01; SP: P = 0.01, P < 0.01), and lower aBMD at the trochanter area (P < 0.01); femoral neck fractures exhibited lower cortical BMD and estimated cortical thickness at the SA quadrant (P = 0.04, P = 0.01). Differences in HSA parameters were not statistically significant. Among all parameters, the most valuable ones to discrimination of hip fracture type are estimated cortical thickness of the SA quadrant of femoral neck and the aBMD of the trochanter area. In men, only lower cortical BMD at the SP quadrant and aBMD at the trochanter were found in the trochanteric fractures (P = 0.02, P < 0.01). QCT outcomes indicate that spatial differences are helpful to explore the pathogenesis of different type of hip fractures. In women, trochanteric fractures are related to severer osteoporosis, whereas cortical fragility in the SA region of the femoral neck predominates in cases of femoral neck fractures. In men, trochanteric fractures are related to more bone loss of trochanter.
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Affiliation(s)
- Yong-Bin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xin-Bao Wu
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Yi
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Ming-Hui Yang
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ke-Bin Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
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14
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Zhang R, Wang L, Lin Y, Yang M, Guo Z, Xia W, Wei J, Yi C, Wu X, Cheng X, Gao X. A novel method for estimating nail-tract bone density for intertrochanteric fractures. J Orthop Translat 2019; 18:40-47. [PMID: 31508306 PMCID: PMC6718973 DOI: 10.1016/j.jot.2018.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/29/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022] Open
Abstract
SUMMARY A novel method based on voxel-based morphometry was proposed to investigate the average volumetric bone mineral density (vBMD) of femoral head nail tract in patients treated with intramedullary nails-proximal femoral nail antirotation (PFNA) and gamma nail (GN). The results showed that there was no significant difference in average vBMD between the two groups. BACKGROUND For unstable intertrochanteric fractures, poor bone quality might be one of the most important causes of cut-out complications in the femoral head during surgical treatment. Bone quality is generally regarded as an equivalent of BMD. Thus, we develop a novel voxel-based morphometry-based method to quantify vBMD of the femoral head nail tract. METHODS Automatic calculation of average vBMD of nail tracts requires three main steps. First, we built a standard nail tract in a proximal femur template. Then, we mapped the proximal femur structure of each patient to the template by B-spline and Demons registration so that the anatomical positions of the proximal femur of all patients spatially corresponded to the standard template. Finally, we calculated and visualized the average vBMD distribution of the nail tract of all patients. To verify the feasibility of the method, we enrolled 75 patients (52 women and 23 men) with hip fractures to our study to compare measurements. The root mean square of the standard deviation (RMSSD) was calculated, and the coefficient of variation (CV) of the RMSSD (CV-RMSSD) was used to evaluate the reproducibility of intraoperator and interscan measurements. The Mann-Whitney U test was used to compare the average vBMD of nail tracts for the PFNA and GN. RESULTS The CV-RMSSD of intraoperator measurements ranged from 1.0% to 2.0%, and the CV-RMSSD of interscan measurements ranged from 3.6% to 4.5%. There was no significant difference in the average vBMD between patients with PFNAs and those with GNs (p > 0.05). CONCLUSIONS The proposed method is reproducible for determining the average vBMD, which may provide a reference index for selection of appropriate intramedullary nails for individual patients. The current choice of intramedullary nail based on the experience of a surgeon may be biased. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE A novel method was proposed to measure the spatial average vBMD of nail tracts, which has good potential to provide a reference index for surgeons to choose appropriate implants.
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Affiliation(s)
- Rui Zhang
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Yanyu Lin
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- College of Materials Sciences and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Minghui Yang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Wei Xia
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jie Wei
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Chen Yi
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xinbao Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Peking University Fourth School of Clinical Medicine, Beijing, China
| | - Xin Gao
- Medical Imaging Department, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
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15
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Hip load capacity cut-points for Astronaut Skeletal Health NASA Finite Element Strength Task Group Recommendations. NPJ Microgravity 2019; 5:6. [PMID: 30886891 PMCID: PMC6418107 DOI: 10.1038/s41526-019-0066-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 02/06/2019] [Indexed: 11/09/2022] Open
Abstract
Concerns raised at a 2010 Bone Summit held for National Aeronautics and Space Administration Johnson Space Center led experts in finite element (FE) modeling for hip fracture prediction to propose including hip load capacity in the standards for astronaut skeletal health. The current standards for bone are based upon areal bone mineral density (aBMD) measurements by dual X-ray absorptiometry (DXA) and an adaptation of aBMD cut-points for fragility fractures. Task Group members recommended (i) a minimum permissible outcome limit (POL) for post-mission hip bone load capacity, (ii) use of FE hip load capacity to further screen applicants to astronaut corps, (iii) a minimum pre-flight standard for a second long-duration mission, and (iv) a method for assessing which post-mission physical activities might increase an astronaut’s risk for fracture after return. QCT-FE models of eight astronaut were analyzed using nonlinear single-limb stance (NLS) and posterolateral fall (NLF) loading configurations. QCT data from the Age Gene/Environment Susceptibility (AGES) Reykjavik cohort and the Rochester Epidemiology Project were analyzed using identical modeling procedures. The 75th percentile of NLS hip load capacity for fractured elderly males of the AGES cohort (9537N) was selected as a post-mission POL. The NLF model, in combination with a Probabilistic Risk Assessment tool, was used to assess the likelihood of exceeding the hip load capacity during post-flight activities. There was no recommendation to replace the current DXA-based standards. However, FE estimation of hip load capacity appeared more meaningful for younger, physically active astronauts and was recommended to supplement aBMD cut-points.
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16
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Wang L, Museyko O, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan D, Cheng X, Engelke K. QCT of the femur: Comparison between QCTPro CTXA and MIAF Femur. Bone 2019; 120:262-270. [PMID: 30342226 DOI: 10.1016/j.bone.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
QCT is commonly employed in research studies and clinical trials to measure BMD at the proximal femur. In this study we compared two analysis software options, QCTPro CTXA and MIAF-Femur, using CT scans of the semi-anthropometric European Proximal Femur Phantom (EPFP) and in vivo data from 130 Chinese elderly men and women aged 60-80 years. Integral (Int), cortical (Cort) and trabecular (Trab) vBMD, volume, and BMC of the neck (FN), trochanter (TR), inter-trochanter (IT), and total hip (TH) VOIs were compared. Accuracy was determined in the 5 mm wide central portion of the femoral neck of the EPFP. Nominal values were: cross-sectional area (CSA) 4.9 cm2, cortical thickness (C.Th) 2 mm, CortBMD 723 mg/cm3 and TrabBMD 100 mg/cm3. In MIAF the so-called peeled trabecular VOI was analyzed, which excludes subcortical bone to avoid partial volume artefacts at the endocortical border that artificially increase TrabBMD. For CTXA uncorrected, so called raw cortical values were used for the analysis. QCTPro and MIAF phantom results were: CSA 5.9 cm2 versus 5.1 cm2; C.Th 1.68 mm versus 1.92 mm; CortBMD 578 mg/cm3 versus 569 mg/cm3; and TrabBMD 154 mg/cm3 versus 104 mg/cm3. In vivo correlations (R2) of integral and trabecular bone parameters ranged from 0.63 to 0.96. Bland-Altman analysis for TH and FN TrabBMD showed that lower mean values were associated with higher differences, which means that TrabBMD differences between MIAF and CTXA are larger for osteoporotic than for normal patients, which can be largely explained by the inclusion of subcortical BMD in the trabecular VOI analyzed by CTXA in combination with fixed thresholds used to separate cortical from trabecular bone compartments. Correlations between CTXA corrected CortBMD and MIAF were negative, whereas raw data correlated positively with MIAF measurements for all VOIs questioning the validity of the CTXA corrections. The EPFP results demonstrated higher MIAF accuracy of cortical thickness and TrabBMD. Integral and trabecular bone parameters were highly correlated between CTXA and MIAF. Partial volume artefacts at the endocortical border artificially increased trabecular BMD by CTXA, especially for osteoporosis patients. With respect to volumetric cortical measurements with CTXA, the use raw data is recommended, because corrected data cause a negative correlation with MIAF CortBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China; Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Oleg Museyko
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | | | - Ruopei Yang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangyang Duanmu
- Department of Radiology, Anhui Provincial Hospital, Anhui, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Dept of Medicine 3, University Hospital Erlangen, Germany.
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Haider IT, Lobos SM, Simonian N, Schnitzer TJ, Edwards WB. Bone fragility after spinal cord injury: reductions in stiffness and bone mineral at the distal femur and proximal tibia as a function of time. Osteoporos Int 2018; 29:2703-2715. [PMID: 30334093 PMCID: PMC6369927 DOI: 10.1007/s00198-018-4733-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/04/2018] [Indexed: 02/08/2023]
Abstract
Computed tomography and finite element modeling were used to assess bone structure at the knee as a function of time after spinal cord injury. Analyzed regions experienced degradation in stiffness, mineral density, and content. Changes were well described as an exponential decay over time, reaching a steady state 3.5 years after injury. INTRODUCTION Spinal cord injury (SCI) is associated with bone fragility and an increased risk of fracture around the knee. The purpose of this study was to investigate bone stiffness and mineral content at the distal femur and proximal tibia, using finite element (FE) and computed tomography (CT) measures. A cross-sectional design was used to compare differences between non-ambulatory individuals with SCI as a function of time after injury (0-50 years). METHODS CT scans of the knee were obtained from 101 individuals who experienced an SCI 30 days to 50 years prior to participation. Subject-specific FE models were used to estimate stiffness under axial compression and torsional loading, and CT data was analyzed to assess volumetric bone mineral density (vBMD) and bone mineral content (BMC) for integral, cortical, and trabecular compartments of the epiphyseal, metaphyseal, and diaphyseal regions of the distal femur and proximal tibia. RESULTS Bone degradation was well described as an exponential decay over time (R2 = 0.33-0.83), reaching steady-state levels within 3.6 years of SCI. Individuals at a steady state had 40 to 85% lower FE-derived bone stiffness and robust decreases in CT mineral measures, compared to individuals who were recently injured (t ≤ 47 days). Temporal and spatial patterns of bone loss were similar between the distal femur and proximal tibia. CONCLUSIONS After SCI, individuals experienced rapid and profound reductions in bone stiffness and bone mineral at the knee. FE models predicted similar reductions to axial and torsional stiffness, suggesting that both failure modes may be clinically relevant. Importantly, CT-derived measures of bone mineral alone underpredicted the impacts of SCI, compared to FE-derived measures of stiffness. TRIAL REGISTRATION ClinicalTrials.gov (NCT01225055, NCT02325414).
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Affiliation(s)
- I T Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, USA.
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, USA.
| | - S M Lobos
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, USA
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, USA
| | - N Simonian
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Northwestern University Clinical and Translational Sciences Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - T J Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago (d.b.a. Shirley Ryan AbilityLab), Chicago, IL, 60611, USA
| | - W B Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, T2N 1N4, USA
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 1N4, USA
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Clotet J, Martelli Y, Di Gregorio S, Del Río Barquero LM, Humbert L. Structural Parameters of the Proximal Femur by 3-Dimensional Dual-Energy X-ray Absorptiometry Software: Comparison With Quantitative Computed Tomography. J Clin Densitom 2018. [PMID: 28624339 DOI: 10.1016/j.jocd.2017.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Structural parameters of the proximal femur evaluate the strength of the bone and its susceptibility to fracture. These parameters are computed from dual-energy X-ray absorptiometry (DXA) or from quantitative computed tomography (QCT). The 3-dimensional (3D)-DXA software solution provides 3D models of the proximal femur shape and bone density from anteroposterior DXA scans. In this paper, we present and evaluate a new approach to compute structural parameters using 3D-DXA software. A cohort of 60 study subjects (60.9 ± 14.7 yr) with DXA and QCT examinations was collected. 3D femoral models obtained by QCT and 3D-DXA software were aligned using rigid registration techniques for comparison purposes. Geometric, cross-sectional, and volumetric structural parameters were computed at the narrow neck, intertrochanteric, and lower shaft regions for both QCT and 3D-DXA models. The accuracy of 3D-DXA structural parameters was evaluated in comparison with QCT. Correlation coefficients (r) between geometric parameters computed by QCT and 3D-DXA software were 0.86 for the femoral neck axis length and 0.71 for the femoral neck shaft angle. Correlation coefficients ranged from 0.86 to 0.96 for the cross-sectional parameters and from 0.84 to 0.97 for the volumetric structural parameters. Our study demonstrated that accurate estimates of structural parameters for the femur can be obtained from 3D-DXA models. This provides clinicians with 3D indexes related to the femoral strength from routine anteroposterior DXA scans, which could potentially improve osteoporosis management and fracture prevention.
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Affiliation(s)
- Jordi Clotet
- Musculoskeletal Unit, Galgo Medical, Barcelona, Spain
| | - Yves Martelli
- Musculoskeletal Unit, Galgo Medical, Barcelona, Spain
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Johannesdottir F, Allaire B, Bouxsein ML. Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives. Curr Osteoporos Rep 2018; 16:411-422. [PMID: 29846870 DOI: 10.1007/s11914-018-0450-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. RECENT FINDINGS CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA.
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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20
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Kim JJ, Nam J, Jang IG. Fully automated segmentation of a hip joint using the patient-specific optimal thresholding and watershed algorithm. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 154:161-171. [PMID: 29249340 DOI: 10.1016/j.cmpb.2017.11.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/07/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND AND OBJECTIVE Automated segmentation with high accuracy and speed is a prerequisite for FEA-based quantitative assessment with a large population. However, hip joint segmentation has remained challenging due to a narrow articular cartilage and thin cortical bone with a marked interindividual variance. To overcome this challenge, this paper proposes a fully automated segmentation method for a hip joint that uses the complementary characteristics between the thresholding technique and the watershed algorithm. METHODS Using the golden section method and load path algorithm, the proposed method first determines the patient-specific optimal threshold value that enables reliably separating a femur from a pelvis while removing cortical and trabecular bone in the femur at the minimum. This provides regional information on the femur. The watershed algorithm is then used to obtain boundary information on the femur. The proximal femur can be extracted by merging the complementary information on a target image. RESULTS For eight CT images, compared with the manual segmentation and other segmentation methods, the proposed method offers a high accuracy in terms of the dice overlap coefficient (97.24 ± 0.44%) and average surface distance (0.36 ± 0.07 mm) within a fast timeframe in terms of processing time per slice (1.25 ± 0.27 s). The proposed method also delivers structural behavior which is close to that of the manual segmentation with a small mean of average relative errors of the risk factor (4.99%). CONCLUSION The segmentation results show that, without the aid of a prerequisite dataset and users' manual intervention, the proposed method can segment a hip joint as fast as the simplified Kang (SK)-based automated segmentation, while maintaining the segmentation accuracy at a similar level of the snake-based semi-automated segmentation.
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Affiliation(s)
- Jung Jin Kim
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
| | - Jimin Nam
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
| | - In Gwun Jang
- The Cho Chun Shik Graduate School of Green Transportation, 373-1, Guseong-dong, Yuseong-gu, Daejeon 305-701, Korea Advanced Institute of Science and Technology, Republic of Korea.
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21
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Cortical and trabecular morphology is altered in the limb bones of mice artificially selected for faster skeletal growth. Sci Rep 2017; 7:10527. [PMID: 28874773 PMCID: PMC5585176 DOI: 10.1038/s41598-017-10317-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/07/2017] [Indexed: 12/26/2022] Open
Abstract
Bone strength is influenced by mineral density and macro- and microstructure. Research into factors that contribute to bone morphology and strength has focused on genetic, environmental and morphological factors (e.g., body mass index), but little is known regarding the impact of rates of skeletal elongation on adult skeletal morphology and strength. Using micro-CT, we examined the impact of rates of skeletal elongation on bone cortical and trabecular morphology, and on rates of estrogen-dependent bone loss in the tibia in CD-1 mice, and in mice with accelerated skeletal growth (Longshanks). Groups of adult mice (n = 7/group) were subjected to ovariectomy or sham surgeries, scanned for 6 weeks, and indices of bone morphology were collected. Results show that Longshanks mice had significantly less trabecular bone at skeletal maturity, characterized by fewer, thinner trabeculae, and furthermore lost trabecular bone more slowly in response to ovariectomy. Artificial selection for rapid skeletal growth relative to somatic growth thus had a significant impact on trabecular bone morphology in Longshanks. Our data do not unequivocally demonstrate a causal relationship between rapid bone growth and reduced trabecular bone quality, but suggest that rapid linear bone growth may influence the risk of cancellous bone fragility.
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22
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Yu A, Carballido-Gamio J, Wang L, Lang TF, Su Y, Wu X, Wang M, Wei J, Yi C, Cheng X. Spatial Differences in the Distribution of Bone Between Femoral Neck and Trochanteric Fractures. J Bone Miner Res 2017; 32:1672-1680. [PMID: 28407298 PMCID: PMC5550343 DOI: 10.1002/jbmr.3150] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/21/2017] [Accepted: 04/10/2017] [Indexed: 01/08/2023]
Abstract
There is little knowledge about the spatial distribution differences in volumetric bone mineral density and cortical bone structure at the proximal femur between femoral neck fractures and trochanteric fractures. In this case-control study, a total of 93 women with fragility hip fractures, 72 with femoral neck fractures (mean ± SD age: 70.6 ± 12.7 years) and 21 with trochanteric fractures (75.6 ± 9.3 years), and 50 control subjects (63.7 ± 7.0 years) were included for the comparisons. Differences in the spatial distributions of volumetric bone mineral density, cortical bone thickness, cortical volumetric bone mineral density, and volumetric bone mineral density in a layer adjacent to the endosteal surface were investigated using voxel-based morphometry (VBM) and surface-based statistical parametric mapping (SPM). We compared these spatial distributions between controls and both types of fracture, and between the two types of fracture. Using VBM, we found spatially heterogeneous volumetric bone mineral density differences between control subjects and subjects with hip fracture that varied by fracture type. Interestingly, femoral neck fracture subjects, but not subjects with trochanteric fracture, showed significantly lower volumetric bone mineral density in the superior aspect of the femoral neck compared with controls. Using surface-based SPM, we found that compared with controls, both fracture types showed thinner cortices in regions in agreement with the type of fracture. Most outcomes of cortical and endocortical volumetric bone mineral density comparisons were consistent with VBM results. Our results suggest: 1) that the spatial distribution of trabecular volumetric bone mineral density might play a significant role in hip fracture; 2) that focal cortical bone thinning might be more relevant in femoral neck fractures; and 3) that areas of reduced cortical and endocortical volumetric bone mineral density might be more relevant for trochanteric fractures in Chinese women. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | | | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Xinbao Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Manyi Wang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Jie Wei
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Chen Yi
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 4th Medical College of Peking University, Beijing, China
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23
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Manhard MK, Nyman JS, Does MD. Advances in imaging approaches to fracture risk evaluation. Transl Res 2017; 181:1-14. [PMID: 27816505 PMCID: PMC5357194 DOI: 10.1016/j.trsl.2016.09.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/19/2016] [Accepted: 09/27/2016] [Indexed: 01/23/2023]
Abstract
Fragility fractures are a growing problem worldwide, and current methods for diagnosing osteoporosis do not always identify individuals who require treatment to prevent a fracture and may misidentify those not a risk. Traditionally, fracture risk is assessed using dual-energy X-ray absorptiometry, which provides measurements of areal bone mineral density at sites prone to fracture. Recent advances in imaging show promise in adding new information that could improve the prediction of fracture risk in the clinic. As reviewed herein, advances in quantitative computed tomography (QCT) predict hip and vertebral body strength; high-resolution HR-peripheral QCT (HR-pQCT) and micromagnetic resonance imaging assess the microarchitecture of trabecular bone; quantitative ultrasound measures the modulus or tissue stiffness of cortical bone; and quantitative ultrashort echo-time MRI methods quantify the concentrations of bound water and pore water in cortical bone, which reflect a variety of mechanical properties of bone. Each of these technologies provides unique characteristics of bone and may improve fracture risk diagnoses and reduce prevalence of fractures by helping to guide treatment decisions.
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Affiliation(s)
- Mary Kate Manhard
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN
| | - Jeffry S Nyman
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Orthopaedic Surgery and Rehabilitation, Vanderbilt University, Nashville, TN; Tennessee Valley Healthcare System, Department of Veterans Affairs, Nashville, TN; Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN
| | - Mark D Does
- Biomedical Engineering, Vanderbilt University, Nashville, TN; Vanderbilt University Institute of Imaging Science, Nashville, TN; Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN; Electrical Engineering, Vanderbilt University, Nashville, TN.
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24
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Humbert L, Hazrati Marangalou J, Del Río Barquero LM, van Lenthe GH, van Rietbergen B. Technical Note: Cortical thickness and density estimation from clinical CT using a prior thickness-density relationship. Med Phys 2016; 43:1945. [PMID: 27036590 DOI: 10.1118/1.4944501] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Cortical thickness and density are critical components in determining the strength of bony structures. Computed tomography (CT) is one possible modality for analyzing the cortex in 3D. In this paper, a model-based approach for measuring the cortical bone thickness and density from clinical CT images is proposed. METHODS Density variations across the cortex were modeled as a function of the cortical thickness and density, location of the cortex, density of surrounding tissues, and imaging blur. High resolution micro-CT data of cadaver proximal femurs were analyzed to determine a relationship between cortical thickness and density. This thickness-density relationship was used as prior information to be incorporated in the model to obtain accurate measurements of cortical thickness and density from clinical CT volumes. The method was validated using micro-CT scans of 23 cadaver proximal femurs. Simulated clinical CT images with different voxel sizes were generated from the micro-CT data. Cortical thickness and density were estimated from the simulated images using the proposed method and compared with measurements obtained using the micro-CT images to evaluate the effect of voxel size on the accuracy of the method. Then, 19 of the 23 specimens were imaged using a clinical CT scanner. Cortical thickness and density were estimated from the clinical CT images using the proposed method and compared with the micro-CT measurements. Finally, a case-control study including 20 patients with osteoporosis and 20 age-matched controls with normal bone density was performed to evaluate the proposed method in a clinical context. RESULTS Cortical thickness (density) estimation errors were 0.07 ± 0.19 mm (-18 ± 92 mg/cm(3)) using the simulated clinical CT volumes with the smallest voxel size (0.33 × 0.33 × 0.5 mm(3)), and 0.10 ± 0.24 mm (-10 ± 115 mg/cm(3)) using the volumes with the largest voxel size (1.0 × 1.0 × 3.0 mm(3)). A trend for the cortical thickness and density estimation errors to increase with voxel size was observed and was more pronounced for thin cortices. Using clinical CT data for 19 of the 23 samples, mean errors of 0.18 ± 0.24 mm for the cortical thickness and 15 ± 106 mg/cm(3) for the density were found. The case-control study showed that osteoporotic patients had a thinner cortex and a lower cortical density, with average differences of -0.8 mm and -58.6 mg/cm(3) at the proximal femur in comparison with age-matched controls (p-value < 0.001). CONCLUSIONS This method might be a promising approach for the quantification of cortical bone thickness and density using clinical routine imaging techniques. Future work will concentrate on investigating how this approach can improve the estimation of mechanical strength of bony structures, the prevention of fracture, and the management of osteoporosis.
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Affiliation(s)
| | - Javad Hazrati Marangalou
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, The Netherlands
| | | | - G Harry van Lenthe
- Biomechanics Section, KU Leuven-University of Leuven, Leuven 3001, Belgium
| | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven 5600 MB, The Netherlands
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Walker MD, Saeed I, Lee JA, Zhang C, Hans D, Lang T, Silverberg SJ. Effect of concomitant vitamin D deficiency or insufficiency on lumbar spine volumetric bone mineral density and trabecular bone score in primary hyperparathyroidism. Osteoporos Int 2016; 27:3063-71. [PMID: 27198233 PMCID: PMC5555733 DOI: 10.1007/s00198-016-3637-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/12/2016] [Indexed: 01/31/2023]
Abstract
UNLABELLED Lower vitamin D and higher parathyroid hormone (PTH) levels are associated with higher volumetric BMD and bone strength at the lumbar spine as measured by central quantitative computed tomography in primary hyperparathyroidism (PHPT), but there are no differences in bone microarchitecture as measured by trabecular bone score (TBS). INTRODUCTION The purpose of this study was to evaluate the association between 25-hydroxyvitamin D (25OHD) and volumetric bone mineral density (vBMD) and the TBS at the lumbar spine (LS) in PHPT. METHODS This is a cross-sectional analysis of PHPT patients with and without low 25OHD. We measured vBMD with quantitative computed tomography (cQCT) and TBS by dual-energy X-ray absorptiometry (DXA) at the LS in 52 and 88 participants, respectively. RESULTS In the cQCT cohort, those with lower vitamin D (<20 vs. 20-29 vs. ≥30 ng/ml) tended to be younger (p = 0.05), were less likely to use vitamin D supplementation (p < 0.01), and had better renal function (p = 0.03). Those with 25OHD <20 ng/ml had 80 and 126 % higher serum PTH levels respectively vs. those with 25OHD 20-29 ng/ml (p = 0.002) and 25OHD ≥30 ng/ml (p < 0.0001). Covariate-adjusted integral and trabecular vBMD were higher in those with 25OHD 20-29 vs. those with 25OHD ≥30 ng/ml, but those with 25OHD <20 did not differ. Because there were few participants with 25OHD deficiency, we also compared those with vitamin D <30 vs. ≥30 ng/ml. Covariate-adjusted integral and trabecular vBMD were 23 and 30 % higher respectively (both p < 0.05) in those with vitamin D <30 vs. ≥30 ng/ml. TBS was in the partially degraded range but did not differ by vitamin D status. CONCLUSION In mild PHPT, lower 25OHD is associated with higher PTH, but vitamin D deficiency and insufficiency using current clinical thresholds did not adversely affect lumbar spine skeletal health in PHPT. Further work is needed to determine if higher vBMD in those with lower vitamin D is due to an anabolic effect of PTH.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - I Saeed
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - J A Lee
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - C Zhang
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - D Hans
- Center of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - T Lang
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA
| | - S J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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26
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Lespessailles E, Hambli R, Ferrari S. Osteoporosis drug effects on cortical and trabecular bone microstructure: a review of HR-pQCT analyses. BONEKEY REPORTS 2016; 5:836. [PMID: 27617082 DOI: 10.1038/bonekey.2016.59] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 06/27/2016] [Indexed: 12/14/2022]
Abstract
With the development of new non-invasive analytical techniques and particularly the advent of high-resolution peripheral quantitative computed tomography (HRpQCT) it is possible to assess cortical and trabecular bone changes under the effects of ageing, diseases and treatments. In the present study, we reviewed the treatment-related effects on bone parameters assessed by HRpQCT imaging. We identified 12 full-length articles published in peer-reviewed journals describing treatment-induced changes assessed by HRpQCT. The design of these studies varied a lot in terms of duration and methodology: some of them were open-labelled, others were double-blind, placebo-controlled or double-blind, double-dummy, active controlled. In addition, the sample size in these studies ranged from 11 to 324 patients. Motion artifacts occurring during data acquisition were sometimes a real challenge particularly at the radius leading sometimes to exclude the analysis at the radius due to the uninterpretability of microstructural parameters. Responses to therapies were treatment-specific and divergent effects in cortical and trabecular bone with antiresorptive or anabolic agents were observed. Standardization of bone microarchitecture parameters (including porosity) and bone strength estimates by finite element analysis (FEA) are mandatory. The additional value of microarchitecture and FEA estimates changes with therapies in terms of improvement in fracture outcomes which have to be adequately assessed in clinical trials with fracture end point. Data from these reviewed studies advance our understanding of the microstructural consequences of osteoporosis and highlight potential differences in bone quality outcomes within therapies.
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Affiliation(s)
- Eric Lespessailles
- University Orleans, Orleans, France; Rheumatology Department, Orleans Hospital, Orleans, France
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27
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Li C, Jin D, Chen C, Letuchy EM, Janz KF, Burns TL, Torner JC, Levy SM, Saha PK. Automated cortical bone segmentation for multirow-detector CT imaging with validation and application to human studies. Med Phys 2016; 42:4553-65. [PMID: 26233184 DOI: 10.1118/1.4923753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Cortical bone supports and protects human skeletal functions and plays an important role in determining bone strength and fracture risk. Cortical bone segmentation at a peripheral site using multirow-detector CT (MD-CT) imaging is useful for in vivo assessment of bone strength and fracture risk. Major challenges for the task emerge from limited spatial resolution, low signal-to-noise ratio, presence of cortical pores, and structural complexity over the transition between trabecular and cortical bones. An automated algorithm for cortical bone segmentation at the distal tibia from in vivo MD-CT imaging is presented and its performance and application are examined. METHODS The algorithm is completed in two major steps-(1) bone filling, alignment, and region-of-interest computation and (2) segmentation of cortical bone. After the first step, the following sequence of tasks is performed to accomplish cortical bone segmentation-(1) detection of marrow space and possible pores, (2) computation of cortical bone thickness, detection of recession points, and confirmation and filling of true pores, and (3) detection of endosteal boundary and delineation of cortical bone. Effective generalizations of several digital topologic and geometric techniques are introduced and a fully automated algorithm is presented for cortical bone segmentation. RESULTS An accuracy of 95.1% in terms of volume of agreement with manual outlining of cortical bone was observed in human MD-CT scans, while an accuracy of 88.5% was achieved when compared with manual outlining on postregistered high resolution micro-CT imaging. An intraclass correlation coefficient of 0.98 was obtained in cadaveric repeat scans. A pilot study was conducted to describe gender differences in cortical bone properties. This study involved 51 female and 46 male participants (age: 19-20 yr) from the Iowa Bone Development Study. Results from this pilot study suggest that, on average after adjustment for height and weight differences, males have thicker cortex (mean difference 0.33 mm and effect size 0.92 at the anterior region) with lower bone mineral density (mean difference -28.73 mg/cm(3) and effect size 1.35 at the posterior region) as compared to females. CONCLUSIONS The algorithm presented is suitable for fully automated segmentation of cortical bone in MD-CT imaging of the distal tibia with high accuracy and reproducibility. Analysis of data from a pilot study demonstrated that the cortical bone indices allow quantification of gender differences in cortical bone from MD-CT imaging. Application to larger population groups, including those with compromised bone, is needed.
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Affiliation(s)
- Cheng Li
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Dakai Jin
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Cheng Chen
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242
| | - Elena M Letuchy
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Kathleen F Janz
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, Iowa City, Iowa 52242
| | - Trudy L Burns
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - James C Torner
- Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Steven M Levy
- Department of Preventive and Community Dentistry, College of Dentistry, Iowa City, Iowa 52242 and Department of Epidemiology, College of Public Health, Iowa City, Iowa 52242
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, Iowa City, Iowa 52242 and Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242
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Pottecher P, Engelke K, Duchemin L, Museyko O, Moser T, Mitton D, Vicaut E, Adams J, Skalli W, Laredo JD, Bousson V. Prediction of Hip Failure Load: In Vitro Study of 80 Femurs Using Three Imaging Methods and Finite Element Models-The European Fracture Study (EFFECT). Radiology 2016; 280:837-47. [PMID: 27077380 DOI: 10.1148/radiol.2016142796] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Purpose To evaluate the performance of three imaging methods (radiography, dual-energy x-ray absorptiometry [DXA], and quantitative computed tomography [CT]) and that of a numerical analysis with finite element modeling (FEM) in the prediction of failure load of the proximal femur and to identify the best densitometric or geometric predictors of hip failure load. Materials and Methods Institutional review board approval was obtained. A total of 40 pairs of excised cadaver femurs (mean patient age at time of death, 82 years ± 12 [standard deviation]) were examined with (a) radiography to measure geometric parameters (lengths, angles, and cortical thicknesses), (b) DXA (reference standard) to determine areal bone mineral densities (BMDs), and (c) quantitative CT with dedicated three-dimensional analysis software to determine volumetric BMDs and geometric parameters (neck axis length, cortical thicknesses, volumes, and moments of inertia), and (d) quantitative CT-based FEM to calculate a numerical value of failure load. The 80 femurs were fractured via mechanical testing, with random assignment of one femur from each pair to the single-limb stance configuration (hereafter, stance configuration) and assignment of the paired femur to the sideways fall configuration (hereafter, side configuration). Descriptive statistics, univariate correlations, and stepwise regression models were obtained for each imaging method and for FEM to enable us to predict failure load in both configurations. Results Statistics reported are for stance and side configurations, respectively. For radiography, the strongest correlation with mechanical failure load was obtained by using a geometric parameter combined with a cortical thickness (r(2) = 0.66, P < .001; r(2) = 0.65, P < .001). For DXA, the strongest correlation with mechanical failure load was obtained by using total BMD (r(2) = 0.73, P < .001) and trochanteric BMD (r(2) = 0.80, P < .001). For quantitative CT, in both configurations, the best model combined volumetric BMD and a moment of inertia (r(2) = 0.78, P < .001; r(2) = 0.85, P < .001). FEM explained 87% (P < .001) and 83% (P < .001) of bone strength, respectively. By combining (a) radiography and DXA and (b) quantitative CT and DXA, correlations with mechanical failure load increased to 0.82 (P < .001) and 0.84 (P < .001), respectively, for radiography and DXA and to 0.80 (P < .001) and 0.86 (P < .001) , respectively, for quantitative CT and DXA. Conclusion Quantitative CT-based FEM was the best method with which to predict the experimental failure load; however, combining quantitative CT and DXA yielded a performance as good as that attained with FEM. The quantitative CT DXA combination may be easier to use in fracture prediction, provided standardized software is developed. These findings also highlight the major influence on femoral failure load, particularly in the trochanteric region, of a densitometric parameter combined with a geometric parameter. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Pierre Pottecher
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Klaus Engelke
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Laure Duchemin
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Oleg Museyko
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Thomas Moser
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - David Mitton
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Eric Vicaut
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Judith Adams
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Wafa Skalli
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Jean Denis Laredo
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
| | - Valérie Bousson
- From the Laboratoire de Radiologie Expérimentale, CNRS UMR 7052, UFR Lariboisière-Saint-Louis, 2 rue Ambroise Paré, 75010 Paris, France (P.P., J.D.L., V.B.); Institute of Medical Physics, University of Erlangen, Erlangen, Germany (K.E., O.M.); LBM/Institut de Biomecanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France (L.D., W.S.); Department of Radiology, Hôpital Notre-Dame, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada (T.M.); Laboratoire de Biomécanique et Mécanique des Chocs-Université Lyon 1-IFSTTAR, Lyon, France (D.M.); Unité de Recherché Clinique Saint-Louis Lariboisère Fernand Widal, Paris, France (E.V.); and Department of Clinical Radiology, The Royal Infirmary, Imaging Science and Biomedical Engineering, University of Manchester, Manchester, England (J.A.)
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Museyko O, Bousson V, Adams J, Laredo JD, Engelke K. QCT of the proximal femur--which parameters should be measured to discriminate hip fracture? Osteoporos Int 2016; 27:1137-1147. [PMID: 26415934 DOI: 10.1007/s00198-015-3324-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 09/11/2015] [Indexed: 02/04/2023]
Abstract
SUMMARY For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with "cortical" thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination. INTRODUCTION For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures. METHODS The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.2 ± 9.3 years) were compared with 46 female patients (age 80.9 ± 11.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups. RESULTS For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC) = 0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only "cortical" cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry parameter, "cortical" thickness of the neck discriminated hip fracture with an AUC value of 0.83 which was significantly better than 0.77 for total femur BMD alone. A comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination. CONCLUSIONS If QCT of the hip is performed, the analysis should include neck and trochanter. In particular, for fractures of any type, a comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination nor did the inclusion of strength-related parameters other than "cortical" area or thickness. One BMD and one geometry parameter, in this study, the combination of trabecular BMD of the trochanter and of "cortical" thickness of the neck resulted in significant hip fracture discrimination.
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Affiliation(s)
- O Museyko
- Institute of Medical Physics (IMP), University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany.
| | - V Bousson
- Service de Radiologie OstéoArticulaire, Hôpital Lariboisière, Paris, France
| | - J Adams
- Clinical Radiology, The Royal Infirmary, University of Manchester, Manchester, UK
| | - J -D Laredo
- Service de Radiologie OstéoArticulaire, Hôpital Lariboisière, Paris, France
| | - K Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany
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Morphometric Evaluation of Korean Femurs by Geometric Computation: Comparisons of the Sex and the Population. BIOMED RESEARCH INTERNATIONAL 2015; 2015:730538. [PMID: 26413540 PMCID: PMC4564606 DOI: 10.1155/2015/730538] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/14/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
We measured 28 parameters of 202 femurs from Koreans by an automated geometric computation program using 3D models generated from computed tomography images. The measurement parameters were selected with reference to physical and forensic anthropology studies as well as orthopedic implant design studies. All measurements were calculated using 3D reconstructions on a computer using scientific computation language. We also analyzed sex and population differences by comparison with data from previous studies. Most parameters were larger in males than in females. The height, head diameter, head center offset, and chord length of the diaphysis, most parameters in the distal femur, and the isthmic width of the medullary canal were smaller in Koreans than in other populations. However, the neck-shaft angle, subtense, and width of the intercondylar notch in the distal femur were larger than those in other populations. The results of this study will be useful as a reference for physical and forensic anthropology as well as the design of medical devices suitable for Koreans.
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Ahmed LA, Shigdel R, Joakimsen RM, Eldevik OP, Eriksen EF, Ghasem-Zadeh A, Bala Y, Zebaze R, Seeman E, Bjørnerem Å. Measurement of cortical porosity of the proximal femur improves identification of women with nonvertebral fragility fractures. Osteoporos Int 2015; 26:2137-46. [PMID: 25876879 PMCID: PMC4503860 DOI: 10.1007/s00198-015-3118-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/23/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED We tested whether cortical porosity of the proximal femur measured using StrAx1.0 software provides additional information to areal bone mineral density (aBMD) or Fracture Risk Assessment Tool (FRAX) in differentiating women with and without fracture. Porosity was associated with fracture independent of aBMD and FRAX and identified additional women with fractures than by osteoporosis or FRAX thresholds. INTRODUCTION Neither aBMD nor the FRAX captures cortical porosity, a major determinant of bone strength. We therefore tested whether combining porosity with aBMD or FRAX improves identification of women with fractures. METHODS We quantified femoral neck (FN) aBMD using dual-energy X-ray absorptiometry, FRAX score, and femoral subtrochanteric cortical porosity using StrAx1.0 software in 211 postmenopausal women aged 54-94 years with nonvertebral fractures and 232 controls in Tromsø, Norway. Odds ratios (ORs) were calculated using logistic regression analysis. RESULTS Women with fractures had lower FN aBMD, higher FRAX score, and higher cortical porosity than controls (all p < 0.001). Each standard deviation higher porosity was associated with fracture independent of FN aBMD (OR 1.39; 95% confidence interval 1.11-1.74) and FRAX score (OR 1.58; 1.27-1.97) in all women combined. Porosity was also associated with fracture independent of FRAX score in subgroups with normal FN aBMD (OR 1.88; 1.21-2.94), osteopenia (OR 1.40; 1.06-1.85), but not significantly in those with osteoporosis (OR 1.48; 0.68-3.23). Of the 211 fracture cases, only 18 women (9%) were identified using FN aBMD T-score < -2.5, 45 women (21%) using FRAX threshold >20%, whereas porosity >80th percentile identified 61 women (29%). Porosity identified 26% additional women with fractures than identified by the osteoporosis threshold and 21% additional women with fractures than by this FRAX threshold. CONCLUSIONS Cortical porosity is a risk factor for fracture independent of aBMD and FRAX and improves identification of women with fracture.
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Affiliation(s)
- L. A. Ahmed
- Department of Health and Care Sciences, UiT–The Arctic University of Norway, Tromsø, Norway
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R. Shigdel
- Department of Health and Care Sciences, UiT–The Arctic University of Norway, Tromsø, Norway
| | - R. M. Joakimsen
- Department of Clinical Medicine, UiT–The Arctic University of Norway, Tromsø, Norway
- Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - O. P. Eldevik
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - E. F. Eriksen
- Department of Clinical Endocrinology, Oslo University Hospital, Oslo, Norway
| | - A. Ghasem-Zadeh
- Endocrine Centre, Austin Health, University of Melbourne, Melbourne, Australia
| | - Y. Bala
- Endocrine Centre, Austin Health, University of Melbourne, Melbourne, Australia
| | - R. Zebaze
- Endocrine Centre, Austin Health, University of Melbourne, Melbourne, Australia
| | - E. Seeman
- Endocrine Centre, Austin Health, University of Melbourne, Melbourne, Australia
| | - Å. Bjørnerem
- Department of Health and Care Sciences, UiT–The Arctic University of Norway, Tromsø, Norway
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Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, Shepherd JA, Schousboe JT. Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part I. J Clin Densitom 2015; 18:338-58. [PMID: 26277851 DOI: 10.1016/j.jocd.2015.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/21/2022]
Abstract
The International Society for Clinical Densitometry (ISCD) has developed new official positions for the clinical use of quantitative computed tomography of the hip. The ISCD task force for quantitative computed tomography reviewed the evidence for clinical applications and presented a report with recommendations at the 2015 ISCD Position Development Conference. Here, we discuss the agreed on ISCD official positions with supporting medical evidence, rationale, controversy, and suggestions for further study. Parts II and III address the advanced techniques of finite element analysis applied to computed tomography scans and the clinical feasibility of existing techniques for opportunistic screening of osteoporosis using computed tomography scans obtained for other diagnosis such as colonography was addressed.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Germany; Bioclinica, Hamburg, Germany.
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - Sundeep Khosla
- Center for Clinical and Translational Science, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, China
| | - Philippe Zysset
- Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - John T Schousboe
- Park Nicollet Clinic/HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Ishikawa K, Fukui T, Nagai T, Kuroda T, Hara N, Yamamoto T, Inagaki K, Hirano T. Type 1 diabetes patients have lower strength in femoral bone determined by quantitative computed tomography: A cross-sectional study. J Diabetes Investig 2015; 6:726-33. [PMID: 26543548 PMCID: PMC4627551 DOI: 10.1111/jdi.12372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/16/2023] Open
Abstract
AIMS/INTRODUCTION Previous studies have reported osteoporosis measured by dual-energy X-ray absorptiometry in younger patients with type 1 diabetes. Limitations of 2-D imaging, however, limit the precision of dual-energy X-ray absorptiometry for the measurement of bone mineral density and bone strength. MATERIALS AND METHODS Three-dimensional quantitative computed tomography was used to calculate volumetric-bone mineral density (vBMD) and strength in femoral bone subfractions. A total of 17 male type 1 diabetes patients and 18 sex-matched healthy controls aged from 18 to 49 years were investigated in the present cross-sectional study. Patients with overt nephropathy were excluded. RESULTS Type 1 diabetes patients had significantly lower cortical vBMD in the femoral neck, and significantly lower total vBMD, cortical thickness and cortical cross-sectional area (cortical CSA) in the intertrochanter. Bone strength estimated by the buckling ratio (an index of cortical instability) of the intertrochanter was significantly higher in type 1 diabetes patients. The following serum bone markers were comparable between the two groups: bone-specific alkaline phosphatase, N-terminal propeptide of type 1 procollagen, osteocalcin, pentosidine and homocysteine. Serum insulin-like growth factor-1 values were significantly lower in the type 1 diabetes patients than in controls. Serum insulin-like growth factor-1values were positively correlated with serum bone formation markers, and the total vBMD of the femoral neck and lumbar spine in type 1 diabetes patients. CONCLUSIONS The present study is the first investigation by quantitative computed tomography measurement to show cortical instability and lower vBMD in the intertrochanter of young and middle-aged type 1 diabetes patients. Low insulin-like growth factor-1 might be a causative factor for osteoporosis in type 1 diabetes.
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Affiliation(s)
- Koji Ishikawa
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Tomoyasu Fukui
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Takashi Nagai
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Takuma Kuroda
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Noriko Hara
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Takeshi Yamamoto
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Katsunori Inagaki
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
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Link TM, Lang TF. Axial QCT: clinical applications and new developments. J Clin Densitom 2014; 17:438-48. [PMID: 24880494 DOI: 10.1016/j.jocd.2014.04.119] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 01/22/2023]
Abstract
Quantitative computed tomography (QCT) is currently undergoing a renaissance, with an increasing number of studies being published and the definition of both QCT-specific osteoporosis thresholds and treatment criteria. Compared with dual-energy X-ray absorptiometry, the current standard bone mineral density technique, QCT has a number of pertinent advantages, including volumetric measurements, less susceptibility to degenerative spine changes, and higher sensitivity to changes in bone mass. Disadvantages include the higher radiation doses and less experience with fracture prediction and therapy monitoring. Over the last 10 yr, a number of novel applications have been described allowing assessment of bone mineral density and bone quality in larger patient populations, developments that may substantially improve patient care.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Johannesdottir F, Turmezei T, Poole KES. Cortical bone assessed with clinical computed tomography at the proximal femur. J Bone Miner Res 2014; 29:771-83. [PMID: 24677244 DOI: 10.1002/jbmr.2199] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 01/30/2014] [Accepted: 02/01/2014] [Indexed: 11/10/2022]
Abstract
Hip fractures are the most serious of all fragility fractures in older people of both sexes. Trips, stumbles, and falls result in fractures of the femoral neck or trochanter, and the incidence of these two common fractures is increasing worldwide as populations age. Although clinical risk factors and chance are important in causation, the ability of a femur to resist fracture also depends on the size and spatial distribution of the bone, its intrinsic material properties, and the loads applied. Over the past two decades, clinical quantitative computed tomography (QCT) studies of living volunteers have provided insight into how the femur changes with advancing age to leave older men and women at increased risk of hip fractures. In this review, we focus on patterns of cortical bone loss associated with hip fracture, age-related changes in cortical bone, and the effects of drugs used to treat osteoporosis. There are several methodologies available to measure cortical bone in vivo using QCT. Most techniques quantify bone density (g/cm(3)), mass (g), and thickness (mm) in selected, predefined or “traditional” regions of interest such as the “femoral neck” or “total hip” region. A recent alternative approach termed “computational anatomy,” uses parametric methods to identify systematic differences, before displaying statistically significant regions as color-scaled maps of density, mass, or thickness on or within a representative femur model. This review will highlight discoveries made using both traditional and computational anatomy methods, focusing on cortical bone of the proximal femur.
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Affiliation(s)
| | - Tom Turmezei
- Department of Medicine; University of Cambridge; Cambridge UK
- Department of Radiology; Addenbrooke's Hospital; Cambridge UK
- Department of Engineering; University of Cambridge; Cambridge UK
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A local reference frame for describing the proximal human femur: application in clinical settings. Skeletal Radiol 2014; 43:323-9. [PMID: 24346337 DOI: 10.1007/s00256-013-1782-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/01/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The conventional reference frame for the femur has limited relevance for the planning of hip surgery as the femoral neck axis, a crucial reference for surgeons, has to be independently derived. The purpose of this study is to develop and validate a reliable frame of reference for the proximal femur that can be applied in clinical settings. MATERIALS AND METHODS Ten three-dimensional models of femurs were obtained. An iterative method was developed to find the femoral neck axis (X-axis). A second axis was also created from the lesser trochanter to the piriformis fossa (LTPF). The origin was defined as the femoral head centre. The cross product of the neck and LTPF axes provided the Z-axis and the third axis (Y-axis) was perpendicular to the other two. Intra-/inter-investigator reliability was assessed on the ten femur models; ten times by one investigator and twice by three investigators respectively. The results were then compared with the conventional reference frame using landmarks on the distal femur. RESULTS The femoral neck and LTPF axes had mean intra-/inter-investigator angle differences of 0.5° (SD 0.4°) and 0.7° (SD 0.5°), and 0.8° (SD 0.5°) and 0.9° (SD 0.6°) respectively while the variations of the X-, Y- and Z- axes were SD 0.6°, 0.7° and 0.5°. CONCLUSIONS A reliable method of obtaining the three-dimensional proximal femoral frame was developed, using the femoral neck axis, with greater relevance to clinical settings, preoperative planning and accurate assessment of procedures post-operatively.
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Rianon NJ, Lang TF, Siggeirsdottir K, Sigurdsson G, Eiriksdottir G, Sigurdsson S, Jonsson BY, Garcia M, Yu B, Kapadia AS, Taylor WC, Selwyn BJ, Gudnason V, Launer LJ, Harris TB. Fracture risk assessment in older adults using a combination of selected quantitative computed tomography bone measures: a subanalysis of the Age, Gene/Environment Susceptibility-Reykjavik Study. J Clin Densitom 2014; 17:25-31. [PMID: 23562129 PMCID: PMC4948945 DOI: 10.1016/j.jocd.2013.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 03/05/2013] [Indexed: 11/23/2022]
Abstract
Bone mineral density (BMD) and geometric bone measures are individually associated with prevalent osteoporotic fractures. Whether an aggregate of these measures would better associate with fractures has not been examined. We examined relationships between self-reported fractures and selected bone measures acquired by quantitative computerized tomography (QCT), a composite bone score, and QCT-acquired dual-energy X-ray absorptiometry-like total femur BMD in 2110 men and 2682 women in the Age, Gene/Environment Susceptibility-Reykjavik Study. The combined bone score was generated by summing gender-specific Z-scores for 4 QCT measures: vertebral trabecular BMD, femur neck cortical thickness, femur neck trabecular BMD, and femur neck minimal cross-sectional area. Except for the latter measure, lower scores for QCT measures, singly and combined, showed positive (p < 0.05) associations with fractures. Results remained the same in stratified models for participants not taking bone-promoting medication. In women on bone-promoting medication, greater femur neck cortical thickness and trabecular BMD were significantly associated with fracture status. However, the association between fracture and combined bone score was not stronger than the associations between fracture and individual measures or total femur BMD. Thus, the selected measures did not all similarly associate with fracture status and did not appear to have an additive effect on fracture status.
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Affiliation(s)
- Nahid J Rianon
- Division of Geriatrics & Palliative Medicine, Department of Internal Medicine, UT Medical School at Houston, TX, USA.
| | - Thomas F Lang
- Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | | | - Gunnar Sigurdsson
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Landspitali-University Hospital, Reykjavik, Iceland
| | | | | | | | | | - Binbing Yu
- LEDB, National Institute on Aging, Bethesda, MD, USA
| | | | | | | | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; Cardiovascular Genetics, University of Iceland, Reykjavik, Iceland
| | - Lenore J Launer
- Neuroepidemiology Section, National Institute on Aging, Bethesda, MD, USA
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Yang L, Udall WJM, McCloskey EV, Eastell R. Distribution of bone density and cortical thickness in the proximal femur and their association with hip fracture in postmenopausal women: a quantitative computed tomography study. Osteoporos Int 2014; 25:251-63. [PMID: 23719860 DOI: 10.1007/s00198-013-2401-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 05/13/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED The quantitative computed tomography (QCT) scans in an individually matched case-control study of women with hip fracture were analysed. There were widespread deficits in the femoral volumetric bone mineral density (vBMD) and cortical thickness of cases, and cortical vBMD and thickness discriminated hip fracture independently of BMD by dual-energy X-ray absorptiometry (DXA). INTRODUCTION Acknowledging the limitations of QCT associated with partial volume effects, we used QCT in an individually matched case-control study of women with hip fracture to better understand its structural basis. METHODS Fifty postmenopausal women (55-89 years) who had sustained hip fractures due to low-energy trauma underwent QCT scans of the contralateral hip within 3 months of the fracture. For each case, postmenopausal women, matched by age (±5 years), weight (±5 kg) and height (±5 cm), were recruited as controls. We quantified cortical, trabecular and integral vBMD and apparent cortical thickness (AppCtTh) in four quadrants of cross-sections along the length of the femoral head (FH), femoral neck (FN), intertrochanter and trochanter and examined their association with hip fracture. RESULTS Women with hip or intracapsular (IC) fracture had significantly (p < 0.05) lower vBMD and AppCtTh than the controls in the majority of cross-sections and quadrants of the proximal femur, and both cortical and trabecular compartments are involved. Cortical vBMD and AppCtTh in the FH and FN were associated with hip and IC fractures independent of hip areal BMD (aBMD). The combination of AppCtTh and trabecular or integral vBMD discriminated hip fracture, whereas the combination of FH and FN AppCtTh discriminated IC fracture significantly (p < 0.05) better than the hip aBMD. CONCLUSION Deficits in vBMD and AppCtTh in cases were widespread in the proximal femur, and cortical vBMD and AppCtTh discriminated hip fracture independently of aBMD by DXA.
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Affiliation(s)
- L Yang
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, School of Medicine, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK,
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Thevenot J, Hirvasniemi J, Finnilä M, Pulkkinen P, Kuhn V, Link T, Eckstein F, Jämsä T, Saarakkala S. Trabecular homogeneity index derived from plain radiograph to evaluate bone quality. J Bone Miner Res 2013; 28:2584-91. [PMID: 23677814 DOI: 10.1002/jbmr.1987] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 05/02/2013] [Accepted: 05/06/2013] [Indexed: 11/06/2022]
Abstract
Radiographic texture analysis has been developed lately to improve the assessment of bone architecture as a determinant of bone quality. We validate here an algorithm for the evaluation of trabecular homogeneity index (HI) in the proximal femur from hip radiographs, with a focus on the impact of the principal compressive system of the trabecular bone, and evaluate its correlation with femoral strength, bone mineral density (BMD), and volumetric trabecular structure parameters. A semiautomatic custom-made algorithm was applied to calculate the HI in the femoral neck and trochanteric areas from radiographs of 178 femoral bone specimens (mean age 79.3 ± 10.4 years). Corresponding neck region was selected in CT scans to calculate volumetric parameters of trabecular structure. The site-specific BMDs were assessed from dual-energy X-ray absorptiometry (DXA), and the femoral strength was experimentally tested in side-impact configuration. Regression analysis was performed between the HI and biomechanical femoral strength, BMD, and volumetric parameters. The correlation between HI and failure load was R(2) = 0.50; this result was improved to R(2) = 0.58 for cervical fractures alone. The discrimination of bones with high risk of fractures (load <3000 N) was similar for HI and BMD (AUC = 0.87). Regression analysis between the HIs versus site-specific BMDs yielded R(2) = 0.66 in neck area, R(2) = 0.60 in trochanteric area, and an overall of R(2) = 0.66 for the total hip. Neck HI and BMD correlated significantly with volumetric structure parameters. We present here a method to assess HI that can explain 50% of an experimental failure load and determines bones with high fracture risk with similar accuracy as BMD. The HI also had good correlation with DXA and computed tomography-derived data.
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Affiliation(s)
- Jérôme Thevenot
- Department of Medical Technology, University of Oulu, Oulu, Finland
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Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, Atkinson EJ, Therneau TM, Siggeirsdottir K, Cheng X, Melton LJ, Keyak J, Gudnason V, Khosla S, Harris TB, Lang TF. Structural patterns of the proximal femur in relation to age and hip fracture risk in women. Bone 2013; 57:290-9. [PMID: 23981658 PMCID: PMC3809121 DOI: 10.1016/j.bone.2013.08.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 08/09/2013] [Accepted: 08/13/2013] [Indexed: 11/21/2022]
Abstract
Fractures of the proximal femur are the most devastating outcome of osteoporosis. It is generally understood that age-related changes in hip structure confer increased risk, but there have been few explicit comparisons of such changes in healthy subjects to those with hip fracture. In this study, we used quantitative computed tomography and tensor-based morphometry (TBM) to identify three-dimensional internal structural patterns of the proximal femur associated with age and with incident hip fracture. A population-based cohort of 349 women representing a broad age range (21-97years) was included in this study, along with a cohort of 222 older women (mean age 79±7years) with (n=74) and without (n=148) incident hip fracture. Images were spatially normalized to a standardized space, and age- and fracture-specific morphometric features were identified based on statistical maps of shape features described as local changes of bone volume. Morphometric features were visualized as maps of local contractions and expansions, and significance was displayed as Student's t-test statistical maps. Significant age-related changes included local expansions of regions low in volumetric bone mineral density (vBMD) and local contractions of regions high in vBMD. Some significant fracture-related features resembled an accentuated aging process, including local expansion of the superior aspect of the trabecular bone compartment in the femoral neck, with contraction of the adjoining cortical bone. However, other features were observed only in the comparison of hip fracture subjects with age-matched controls including focal contractions of the cortical bone at the superior aspect of the femoral neck, the lateral cortical bone just inferior to the greater trochanter, and the anterior intertrochanteric region. Results of this study support the idea that the spatial distribution of morphometric features is relevant to age-related changes in bone and independent to fracture risk. In women, the identification by TBM of fracture-specific morphometric alterations of the proximal femur, in conjunction with vBMD and clinical risk factors, may improve hip fracture prediction.
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Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Roy Harnish
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Isra Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Timothy Streeper
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Shreyasee Amin
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Terry M. Therneau
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoguang Cheng
- Department of Radiology, Beijing Ji Shui Tan Hospital, Beijing, China
| | - L. Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joyce Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamara B. Harris
- Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Dall’Ara E, Luisier B, Schmidt R, Pretterklieber M, Kainberger F, Zysset P, Pahr D. DXA predictions of human femoral mechanical properties depend on the load configuration. Med Eng Phys 2013; 35:1564-72; discussion 1564. [DOI: 10.1016/j.medengphy.2013.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 04/16/2013] [Accepted: 04/21/2013] [Indexed: 10/26/2022]
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Silva BC, Walker MD, Abraham A, Boutroy S, Zhang C, McMahon DJ, Liu G, Hans D, Bilezikian JP. Trabecular bone score is associated with volumetric bone density and microarchitecture as assessed by central QCT and HRpQCT in Chinese American and white women. J Clin Densitom 2013; 16:554-61. [PMID: 24080513 PMCID: PMC3818347 DOI: 10.1016/j.jocd.2013.07.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
Abstract
Although high-resolution peripheral quantitative computed tomography (HRpQCT) and central quantitative computed tomography (QCT) studies have shown bone structural differences between Chinese American (CH) and white (WH) women, these techniques are not readily available in the clinical setting. The trabecular bone score (TBS) estimates trabecular microarchitecture from dual-energy X-ray absorptiometry spine images. We assessed TBS in CH and WH women and investigated whether TBS is associated with QCT and HRpQCT indices. Areal bone mineral density (aBMD) by dual-energy X-ray absorptiometry, lumbar spine (LS) TBS, QCT of the LS and hip, and HRpQCT of the radius and tibia were performed in 71 pre- (37 WH and 34 CH) and 44 postmenopausal (21 WH and 23 CH) women. TBS did not differ by race in either pre- or postmenopausal women. In the entire cohort, TBS positively correlated with LS trabecular volumetric bone mineral density (vBMD) (r = 0.664), femoral neck integral (r = 0.651), trabecular (r = 0.641) and cortical vBMD (r = 0.346), and cortical thickness (C/I; r = 0.540) by QCT (p < 0.001 for all). TBS also correlated with integral (r = 0.643), trabecular (r = 0.574) and cortical vBMD (r = 0.491), and C/I (r = 0.541) at the total hip (p < 0.001 for all). The combination of TBS and LS aBMD predicted more of the variance in QCT measures than aBMD alone. TBS was associated with all HRpQCT indices (r = 0.20-0.52) except radial cortical thickness and tibial trabecular thickness. Significant associations between TBS and measures of HRpQCT and QCT in WH and CH pre- and postmenopausal women demonstrated here suggest that TBS may be a useful adjunct to aBMD for assessing bone quality.
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Affiliation(s)
- Barbara C Silva
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Engelke K, Libanati C, Fuerst T, Zysset P, Genant HK. Advanced CT based in vivo methods for the assessment of bone density, structure, and strength. Curr Osteoporos Rep 2013; 11:246-55. [PMID: 23712690 DOI: 10.1007/s11914-013-0147-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Based on spiral 3D tomography a large variety of applications have been developed during the last decade to asses bone mineral density, bone macro and micro structure, and bone strength. Quantitative computed tomography (QCT) using clinical whole body scanners provides separate assessment of trabecular, cortical, and subcortical bone mineral density (BMD) and content (BMC) principally in the spine and hip, although the distal forearm can also be assessed. Further bone macrostructure, for example bone geometry or cortical thickness can be quantified. Special high resolution peripheral CT (hr-pQCT) devices have been introduced to measure bone microstructure for example the trabecular architecture or cortical porosity at the distal forearm or tibia. 3D CT is also the basis for finite element analysis (FEA) to determine bone strength. QCT, hr-pQCT, and FEM are increasingly used in research as well as in clinical trials to complement areal BMD measurements obtained by the standard densitometric technique of dual x-ray absorptiometry (DXA). This review explains technical developments and demonstrates how QCT based techniques advanced our understanding of bone biology.
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Affiliation(s)
- K Engelke
- Institute of Medical Physics, University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany,
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Edwards WB, Schnitzer TJ, Troy KL. Bone mineral loss at the proximal femur in acute spinal cord injury. Osteoporos Int 2013; 24:2461-9. [PMID: 23468075 DOI: 10.1007/s00198-013-2323-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/12/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study used quantitative computed tomography to assess changes in bone mineral at the proximal femur after acute spinal cord injury (SCI). Individuals with acute SCI experienced a marked loss of bone mineral from a combination of trabecular and endocortical resorption. Targeted therapeutic interventions are thus warranted in this population. INTRODUCTION SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. Some 10 to 20% of these fractures occur at the proximal femur. The purpose of this study was to quantify changes to bone mineral, geometry, and measures of strength at the proximal femur in acute SCI. METHODS Quantitative computed tomography analysis was performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range, 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at the femoral neck, trochanteric, and total proximal femur regions. Changes in bone volumes, cross-sectional areas, and surrogate measures of compressive and bending strength were also determined. RESULTS During the acute period of SCI, subjects experienced a 2.7-3.3%/month reduction in integral BMC (p < 0.001) and a 2.5-3.1 %/month reduction in integral vBMD (p < 0.001). Trabecular BMC decreased by 3.1-4.7 %/month (p < 0.001) and trabecular vBMD by 2.8-4.4 %/month (p < 0.001). A 3.9-4.0 %/month reduction was observed for cortical BMC (p < 0.001), while the reduction in cortical vBMD was noticeably lower (0.8-1.0 %/month; p ≤ 0.01). Changes in bone volume and cross-sectional area suggested that cortical bone loss occurred primarily through endosteal resorption. Declines in bone mineral were associated with a 4.9-5.9 %/month reduction in surrogate measures of strength. CONCLUSIONS These data highlight the need for therapeutic interventions in this population that target both trabecular and endocortical bone mineral preservation.
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Affiliation(s)
- W B Edwards
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor Street, 650 AHSB, M/C 517, Chicago, IL 60612, USA.
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Del Rio LM, Winzenrieth R, Cormier C, Di Gregorio S. Is bone microarchitecture status of the lumbar spine assessed by TBS related to femoral neck fracture? A Spanish case-control study. Osteoporos Int 2013; 24:991-8. [PMID: 22581295 DOI: 10.1007/s00198-012-2008-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 04/05/2012] [Indexed: 11/29/2022]
Abstract
UNLABELLED Bone mineral density (BMD) as assessed by dual energy X-ray absorptiometry (DXA) constitutes the gold standard for osteoporosis diagnosis. However, DXA does not take into account bone microarchitecture alterations. INTRODUCTION The aim of our study was to evaluate the ability of trabecular bone score (TBS) at lumbar spine to discriminate subjects with hip fracture. METHODS We presented a case-control study of 191 Spanish women aged 50 years and older. Women presented transcervical fractures only. BMD was measured at lumbar spine (LS-BMD) using a Prodigy densitometer. TBS was calculated directly on the same spine image. Descriptive statistics, tests of difference and univariate and multivariate backward regressions were used. Odds ratio (OR) and the ROC curve area of discriminating parameters were calculated. RESULTS The study population consisted of 83 subjects with a fracture and 108 control subjects. Significant lower spine and hip BMD and TBS values were found for subjects with fractures (p < 0.0001). Correlation between LS-BMD and spine TBS was modest (r = 0.41, p < 0.05). LS-BMD and TBS independently discriminate fractures equally well (OR = 2.21 [1.56-3.13] and 2.05 [1.45-2.89], respectively) but remain lower than BMD at neck or at total femur (OR = 5.86 [3.39-10.14] and 6.06 [3.55-10.34], respectively). After adjusting for age, LS-BMD and TBS remain significant for transcervical fracture discrimination (OR = 1.94 [1.35-2.79] and 1.71 [1.15-2.55], respectively). TBS and LS-BMD combination (OR = 2.39[1.70-3.37]) improved fracture risk prediction by 25 %. CONCLUSION This study shows the potential of TBS to discriminate subjects with and without hip fracture. TBS and LS-BMD combination improves fracture risk prediction. Nevertheless, BMD at hip remains the best predictor of hip fracture.
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Carballido-Gamio J, Harnish R, Saeed I, Streeper T, Sigurdsson S, Amin S, Atkinson EJ, Therneau TM, Siggeirsdottir K, Cheng X, Melton LJ, Keyak J, Gudnason V, Khosla S, Harris TB, Lang TF. Proximal femoral density distribution and structure in relation to age and hip fracture risk in women. J Bone Miner Res 2013; 28:537-46. [PMID: 23109068 PMCID: PMC3578081 DOI: 10.1002/jbmr.1802] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 10/02/2012] [Accepted: 10/10/2012] [Indexed: 01/23/2023]
Abstract
Hip fracture risk rises exponentially with age, but there is little knowledge about how fracture-related alterations in hip structure differ from those of aging. We employed computed tomography (CT) imaging to visualize the three-dimensional (3D) spatial distribution of bone mineral density (BMD) in the hip in relation to age and incident hip fracture. We used intersubject image registration to integrate 3D hip CT images into a statistical atlas comprising women aged 21 to 97 years (n = 349) and a group of women with (n = 74) and without (n = 148) incident hip fracture 4 to 7 years after their imaging session. Voxel-based morphometry was used to generate Student's t test statistical maps from the atlas, which indicated regions that were significantly associated with age or with incident hip fracture. Scaling factors derived from intersubject image registration were employed as measures of bone size. BMD comparisons of young, middle-aged, and older American women showed preservation of load-bearing cortical and trabecular structures with aging, whereas extensive bone loss was observed in other trabecular and cortical regions. In contrast, comparisons of older Icelandic fracture women with age-matched controls showed that hip fracture was associated with a global cortical bone deficit, including both the superior cortical margin and the load-bearing inferior cortex. Bone size comparisons showed larger dimensions in older compared to younger American women and in older Icelandic fracture women compared to controls. The results indicate that older Icelandic women who sustain incident hip fracture have a structural phenotype that cannot be described as an accelerated pattern of normal age-related loss. The fracture-related cortical deficit noted in this study may provide a biomarker of increased hip fracture risk that may be translatable to dual-energy X-ray absorptiometry (DXA) and other clinical images.
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Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Roy Harnish
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Isra Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Timothy Streeper
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | - Shreyasee Amin
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Terry M. Therneau
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Xiaoguang Cheng
- Department of Radiology, Beijing Ji Shui Tan Hospital, Beijing, China
| | - L. Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joyce Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamara B. Harris
- Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Yang L, Sycheva AV, Black DM, Eastell R. Site-specific differential effects of once-yearly zoledronic acid on the hip assessed with quantitative computed tomography: results from the HORIZON Pivotal Fracture Trial. Osteoporos Int 2013; 24:329-38. [PMID: 23128664 DOI: 10.1007/s00198-012-2200-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED We used new approaches to the analysis of diagnostic scans to detect changes in bone density in different regions of the hip after 3 years of treatment with the zoledronic acid. We showed that the drug significantly increases hip bone density compared to placebo at regions where hip fractures usually occur. INTRODUCTION This study aims to identify whether treatment with zoledronic acid exerts site-specific differential effects on volumetric bone mineral density (vBMD) at the hip. METHODS We analysed quantitative computed tomography scans of the hip obtained at baseline and 36 months in 179 women participating in the HORIZON Pivotal Fracture Trial. Cortical, trabecular and integral BMDs were determined at three main regions of interest-the femoral neck (FN), trochanter (TR) and total hip (TH)-and several sub-regions of interest, namely the proximal, middle, distal, anterior, posterior, inferomedial and superolateral FN, and the middle and distal TR. RESULTS Volumetric BMD increased significantly (p < 0.05) from baseline with zoledronic acid compared to placebo. Trabecular vBMD increased as follows: FN, 5.4 %; FN sub-regions, 6.0 % (proximal), 4.4 % (middle), 5.6 % (distal), 7.5 % (anterior), 7.0 % (superolateral) and 5.4 % (posterior); TR, 6.5 % and TH, 5.7 %. Cortical vBMD increased as follows: FN sub-regions, 5.0 % (proximal FN) and 2.3 % (anterior); TR, 4.6 %; middle TR, 2.7 % and TH, 3.8 %. CONCLUSIONS The effects on vBMD of annual infusion of 5 mg of zoledronic acid are site-specific and dominated by trabecular changes.
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Affiliation(s)
- L Yang
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, S10 2RX, UK.
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Abstract
PURPOSE OF REVIEW To give an overview of advanced in-vivo imaging techniques for assessing bone quality beyond bone mineral density that have considerably advanced in recent years. RECENT FINDINGS Quantitative computed tomography and finite element analysis improve fracture risk prediction at the spine, and help to better understand the pathophysiology of skeletal diseases and response to therapy by quantifying bone mineral density in different bone compartments, determining bone strength, and assessing bone geometry. With new high-resolution techniques, trabecular structure at the spine, forearm, and tibia, and cortical porosity at the forearm and tibia can be measured. Hip structure analysis and trabecular bone score have extended the usefulness of dual X-ray absorptiometry. SUMMARY New advanced three-dimensional imaging techniques to quantify bone quality are mature and have proven to be complimentary methods to dual X-ray absorptiometry enhancing our understanding of bone metabolism and treatment.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany.
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A quasi-brittle continuum damage finite element model of the human proximal femur based on element deletion. Med Biol Eng Comput 2012. [DOI: 10.1007/s11517-012-0986-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cohen A, Lang TF, McMahon DJ, Liu XS, Guo XE, Zhang C, Stein EM, Dempster DW, Young P, Saeed I, Lappe JM, Recker RR, Shane E. Central QCT reveals lower volumetric BMD and stiffness in premenopausal women with idiopathic osteoporosis, regardless of fracture history. J Clin Endocrinol Metab 2012; 97:4244-52. [PMID: 22962425 PMCID: PMC3485589 DOI: 10.1210/jc.2012-2099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Idiopathic osteoporosis (IOP) affects otherwise healthy young individuals with intact gonadal function and no secondary cause of bone fragility. In premenopausal women with IOP, a low trauma fracture is evidence of impaired bone quality and strength. The extent to which low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA) reflects low volumetric BMD, bone microstructure, and strength is uncertain in the absence of low trauma fracture. OBJECTIVE The objective of the study was to compare three-dimensional volumetric BMD and bone stiffness in premenopausal women with IOP based on fracture history, those with idiopathic low BMD (Z score ≤ -2.0) and no low trauma fracture, and normal age-matched controls. DESIGN We measured volumetric BMD and bone geometry by central quantitative computed tomography (cQCT) scans of the spine and hip and estimated bone stiffness by finite element analysis of cQCT data sets in 32 premenopausal women with IOP, 12 with idiopathic low BMD, and 34 controls. RESULTS Subjects had comparable decreases in total and trabecular volumetric BMD, cortical thickness, and whole-bone stiffness compared with controls, regardless of fracture history. These differences remained significant after controlling for age, body mass index, and bone size. The positive predictive values of a DXA Z score of -2.0 or less for a cQCT volumetric BMD Z score of -2.0 or less were 95% at the lumbar spine, 90% at the total hip, and 86% at the femoral neck. CONCLUSION Women with idiopathic low BMD alone and those with low trauma fractures had comparable deficits in bone mass, structure, and stiffness. Low areal BMD by DXA is fairly accurate for predicting low volumetric BMD by cQCT. These results are consistent with three-dimensional bone imaging at the iliac crest, radius, and tibia in premenopausal IOP and suggest that the term osteoporosis may be appropriate in women with Z scores below -2.0, whether or not there is a history of fracture.
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Affiliation(s)
- Adi Cohen
- Department of Medicine, PH8-864, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032, USA.
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