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Sornay-Rendu E, Duboeuf F, Chapurlat RD. Postmenopausal women with normal BMD who have fractures have deteriorated bone microarchitecture: A prospective analysis from The OFELY study. Bone 2024; 182:117072. [PMID: 38492712 DOI: 10.1016/j.bone.2024.117072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/01/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024]
Abstract
Most postmenopausal women who sustain fragility fracture (Fx) have their areal bone mineral density (BMD) above the osteoporosis threshold. A sizeable proportion of them have normal aBMD. This study aimed to prospectively investigate the association of fragility Fx with bone microarchitecture (MA) assessed by high-resolution peripheral computed tomography (HR-pQCT) in postmenopausal women without low BMD. At the 14th annual follow-up of the OFELY study, we measured bone MA at the distal radius and tibia with HR-pQCT in addition to areal BMD with DXA, in 586 postmenopausal women. Among them, 166 (29 %) women, mean (SD) age 65 (8) yr, had normal BMD defined as a T score ≥ -1 at the lumbar spine, femoral neck, and total hip. During a median [IQR] 15 [14-15] yr of follow-up, 46 of those women sustained incident fragility Fx, including 19 women with a major osteoporotic Fx (clinical spine, forearm, proximal humerus, hip). Women who sustained Fx did not differ for age, BMI, tobacco and alcohol use, diabetes, falls, FRAX®, aBMD, and TBS compared with women without incident Fx. In contrast, they had significant impairment of volumetric densities, cortical area (Ct. Ar) and thickness (Ct. Th), stiffness (K), and estimated failure load (FL) at the radius compared with women without incident Fx. At the radius, each SD decrease of volumetric densities, Ct.Ar, Ct.Th, K, and estimated FL were significantly associated with an increased risk of all fragility fractures with hazard ratios (HR) from 1.44 to 1.56 and of major osteoporotic fractures (HR from 1.66 to 2.57). Lesser impairment of bone MA was seen at the tibia. We conclude that even in women with normal areal BMD fragility fractures are associated with deterioration of bone microarchitecture.
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Affiliation(s)
| | - F Duboeuf
- INSERM UMR 1033 and Université de Lyon, France.
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Simon D, Minopoulou I, Kemenes S, Bayat S, Tascilar K, Mutlu MY, Valor-Méndez L, Krönke G, Hueber AJ, Schett G, Kleyer A. Baricitinib Improves Bone Properties and Biomechanics in Patients With Rheumatoid Arthritis: Results of the Prospective Interventional BARE BONE Trial. Arthritis Rheumatol 2023; 75:1923-1934. [PMID: 37229650 DOI: 10.1002/art.42617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is characterized by erosive joint damage, deterioration of bone mass, and biomechanics. Preclinical evidence suggests a beneficial effect of Janus kinase inhibition (JAKi) on bone properties, but clinical data are scarce to date. In this study, we evaluated the effect of JAKi through baricitinib (BARI) on 1) volumetric bone mineral density (vBMD), bone microstructure, biomechanics, and erosion repair and 2) synovial inflammation in RA patients. METHODS Prospective, single-arm, interventional, open-label, single-center phase 4 study in RA patients with pathological bone status and clinical indication of JAKi (BARE BONE trial). Participants received BARI (4 mg/day) over 52 weeks. To assess bone properties and synovial inflammation, high-resolution computed tomography scans and magnetic resonance imaging were performed at baseline (BL), week 24, and week 52. Clinical response and safety were monitored. RESULTS Thirty RA patients were included. BARI significantly improved disease activity (Disease Activity Score in 28 joints using the erythrocyte sedimentation rate: 4.82 ± 0.90 to 2.71 ± 0.83) and synovial inflammation (RAMRIS synovitis score: 5.3 [4.2] to 2.7 [3.5]). We observed a significant improvement in trabecular vBMD with a mean change of 6.11 mgHA/mm3 (95% confidence interval [95% CI] 0.01-12.26). Biomechanical properties also improved with mean change from baseline in estimated stiffness of 2.28 kN/mm (95% CI 0.30-4.25) and estimated failure load of 98.8 N (95% CI 15.9-181.7). The number and size of erosions in the metacarpal joints remained stable. No new safety signals with BARI treatment were observed. CONCLUSION Bones of RA patients improve with BARI therapy, as shown by an increase in trabecular bone mass and an improvement of biomechanical properties.
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Affiliation(s)
- David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stephan Kemenes
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Sara Bayat
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melek Yalcin Mutlu
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Larissa Valor-Méndez
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander Universität (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and Deutsches Zentrum Immuntherapie, FAU Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Kuker AP, Agarwal S, Shane E, Cohen A, Nickolas TL, Stein EM, Reid TJ, Hans D, Cremers S, Bruce JN, Freda PU. Persistent Deficits in Bone Quality in Treated Acromegaly: Evidence From Assessments of Microstructure. J Endocr Soc 2023; 7:bvad121. [PMID: 37809053 PMCID: PMC10553518 DOI: 10.1210/jendso/bvad121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Fractures are increased in patients with acromegaly, both before and after successful acromegaly treatment. Abnormalities of bone microstructure, which may underlie this fragility, are present in active acromegaly but to what extent these improve with acromegaly treatment or persist despite biochemical remission remains unclear. To examine these questions, we studied the effects of acromegaly treatment and remission on bone quality. Methods Sixty-five women and men with acromegaly were studied. Subgroups underwent assessments of areal bone mineral density by dual x-ray absorptiometry, trabecular bone score (TBS), and volumetric bone mineral density, microarchitecture, stiffness and failure load of the distal radius and tibia by high-resolution peripheral quantitative tomography in a longitudinal study before and after acromegaly treatment and in a cross-sectional study in which patients were compared to sex-, age-, and body mass index-matched healthy controls. Results In the longitudinal study, significant increases in total, cortical, and trabecular densities at the radius and tibia and increased stiffness and failure load of the tibia occurred with acromegaly treatment. In the cross-sectional study, patients in biochemical remission after surgery had larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to controls. TBS did not change with acromegaly treatment but correlated with some microstructural parameters. Conclusion We show, for the first time, that volumetric bone mineral density and microarchitecture of the peripheral skeleton improve with acromegaly treatment but remain abnormal in patients in remission after surgery compared to controls. These abnormalities, known to be associated with fractures in other populations, may play a role in the pathogenesis of persistent fragility in treated acromegaly.
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Affiliation(s)
- Adriana P Kuker
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Sanchita Agarwal
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elizabeth Shane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Adi Cohen
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Thomas L Nickolas
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Diseases, Hospital for Special Surgery, New York, NY 10032, USA
| | - Tirissa J Reid
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Didier Hans
- Center for Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Serge Cremers
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Pamela U Freda
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Ramchand SK, David NL, Lee H, Bruce M, Bouxsein ML, Tsai JN, Leder BZ. The Effect of Zoledronic Acid on Bone Microarchitecture and Strength after Denosumab and Teriparatide Administration: DATA-HD Study Extension. J Bone Miner Res 2023; 38:26-34. [PMID: 36333954 PMCID: PMC10098948 DOI: 10.1002/jbmr.4737] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
The combination of denosumab and teriparatide is an effective treatment strategy in postmenopausal osteoporosis, though skeletal gains are promptly lost when these agents are discontinued. In the DATA-HD study, we reported that a single dose of zoledronic acid (ZOL) maintains the increases in areal spine and hip bone mineral density (BMD) achieved with this combination for at least 12 months. The capacity of ZOL to maintain corresponding improvements in peripheral volumetric BMD and microarchitecture, however, has not been reported. In the 15-month DATA-HD study, 76 postmenopausal osteoporotic women were randomized to receive 9 months of teriparatide (20-μg or 40-μg daily) overlapped with denosumab (60 mg at months 3 and 9). In the Extension study, 53 participants received a single dose of ZOL (5 mg intravenously) 24-35 weeks after the last denosumab dose. We measured volumetric BMD and microarchitecture at the distal radius and tibia using high-resolution peripheral quantitative computed tomography at months 27 and 42. Despite ZOL administration, total and cortical BMD gradually decreased over 27 months resulting in values similar to baseline at the radius but still significantly above baseline at the tibia. At both sites, cortical porosity decreased to values below pretreatment baseline at month 27 but then increased from month 27 to 42. There were no significant changes in trabecular parameters throughout the 27-month post-ZOL observation period. Stiffness and failure load, at both sites, decreased progressively from month 15 42 though remained above baseline at the tibia. These findings suggest that in contrast to the largely maintained gains in dual-energy X-ray absorptiometry (DXA)-derived spine and hip BMD, a single dose of ZOL was not as effective in maintaining the gains in volumetric peripheral bone density and microarchitecture produced by 15 months of overlapping treatment with denosumab and teriparatide. Alternative therapeutic approaches that can fully maintain improvements in peripheral bone parameters require further study. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabashini K Ramchand
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.,Department of Medicine, Endocrine Unit, Austin Hospital, The University of Melbourne, Victoria, Australia
| | - Natalie L David
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Bruce
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Mary L Bouxsein
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joy N Tsai
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Benjamin Z Leder
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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Alvarenga JC, Caparbo VF, Domiciano DS, Pereira RMR. Age-related reference data of bone microarchitecture, volumetric bone density, and bone strength parameters in a population of healthy Brazilian men: an HR-pQCT study. Osteoporos Int 2022; 33:1309-1321. [PMID: 35059775 DOI: 10.1007/s00198-021-06288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED In a cross-sectional cohort of 340 healthy Brazilian men aged 20 to 92 years, data on density, structure, and strength of the distal radius and tibia were obtained using high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop age- and site-specific reference curves. Age-dependent changes differed between the sites and bone compartments (trabecular and cortical). INTRODUCTION The aim of this study was to establish age-related reference curves for bone densities, microarchitectural properties, and estimated failure load measured by HR-pQCT (distal radius and tibia) in men. Also, to correlate bone stiffness with the other HR-pQCT parameters, areal bone mineral density (BMD) by DXA and trabecular bone score (TBS). METHODS Healthy Brazilian men (n = 340) between the ages of 20 and 92 years were recruited. Non-dominant radius and left tibia were scanned using HR-pQCT (Xtreme CT I). Standard and automated segmentation methods were performed, and bone strength estimated by FE analysis. Bone mineral density at lumbar spine, total hip, femoral neck, and TBS were measured using DXA (Hologic, QDR4500). RESULTS Age-related reference curves were constructed at the distal radius and tibia for volumetric bone density, morphometry, and estimated bone strength parameters. There was a linear relationship with age only for thickness measurements of distal radius (trabecular: R2 0.108, p<0.001; cortical: R2 0.062, p=0.002) and tibia (trabecular: R2 0.109, p<0.001; cortical: R2 0.063, p=0.010), and bone strength at distal radius (R2 0.157, p<0.001). The significant correlations (p <0.05) found by Pearson's correlations (r) between bone stiffness and all other variables measured by HR-pQCT and DXA showed to be stronger at the tibia site than the distal radius. CONCLUSION The current study expands the HR-pQCT worldwide database and presents an adequate methodology for the construction of reference data in other populations. Moreover, the correlation of bone strength estimated by FEA with other bone microstructural parameters provided by HR-pQCT helps to determine the contribution of each of these variables to fracture risk prediction in men.
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Affiliation(s)
- J C Alvarenga
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil.
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Guha I, Zhang X, Rajapakse CS, Letuchy EM, Chang G, Janz KF, Torner JC, Levy SM, Saha PK. CT
‐based Stiffness Measures of Trabecular Bone Microstructure — Cadaveric Validation and
In Vivo
Application. JBMR Plus 2022; 6:e10627. [PMID: 35720662 PMCID: PMC9189917 DOI: 10.1002/jbm4.10627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 03/14/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Osteoporosis causes bone fragility and elevates fracture risk. Applications of finite element (FE) analysis (FEA) for assessment of trabecular bone (Tb) microstructural strength at whole‐body computed tomography (CT) imaging are limited due to challenges with Tb microstructural segmentation. We present a nonlinear FEA method for distal tibia CT scans evading binary segmentation of Tb microstructure, while accounting for bone microstructural distribution. First, the tibial axis in a CT scan was aligned with the FE loading axis. FE cubic mesh elements were modeled using image voxels, and CT intensity values were calibrated to ash density defining mechanical properties at individual elements. For FEA of an upright volume of interest (VOI), the bottom surface was fixed, and a constant displacement was applied at each vertex on the top surface simulating different loading conditions. The method was implemented and optimized using the ANSYS software. CT‐derived computational modulus values were repeat scan reproducible (intraclass correlation coefficient [ICC] ≥ 0.97) and highly correlated (r ≥ 0.86) with the micro‐CT (μCT)‐derived values. FEA‐derived von Mises stresses over the segmented Tb microregion were significantly higher (p < 1 × 10−11) than that over the marrow space. In vivo results showed that both shear and compressive modulus for males were higher (p < 0.01) than for females. Effect sizes for different modulus measures between males and females were moderate‐to‐high (≥0.55) and reduced to small‐to‐negligible (<0.40) when adjusted for pure lean mass. Among body size and composition attributes, pure lean mass and height showed highest (r ∈ [0.45 0.56]) and lowest (r ∈ [0.25 0.39]) linear correlation, respectively, with FE‐derived modulus measures. In summary, CT‐based nonlinear FEA provides an effective surrogate measure of Tb microstructural stiffness, and the relaxation of binary segmentation will extend the scope for FEA in human studies using in vivo imaging at relatively low‐resolution. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Indranil Guha
- Department of Electrical and Computer Engineering University of Iowa Iowa City IA USA
| | - Xialiou Zhang
- Department of Electrical and Computer Engineering University of Iowa Iowa City IA USA
| | - Chamith S. Rajapakse
- Departments of Radiology and Orthopedic Surgery University of Pennsylvania PA USA
| | | | - Gregory Chang
- Department of Radiology New York University Grossman School of Medicine NY USA
| | - Kathleen F. Janz
- Department of Health and Human Physiology University of Iowa Iowa City IA USA
| | - James C. Torner
- Department of Epidemiology University of Iowa Iowa City IA USA
| | - Steven M. Levy
- Department of Epidemiology University of Iowa Iowa City IA USA
- Department of Preventive and Community Dentistry University of Iowa Iowa City IA USA
| | - Punam K. Saha
- Department of Electrical and Computer Engineering University of Iowa Iowa City IA USA
- Department of Radiology University of Iowa Iowa City IA USA
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Revel M, Gardegaront M, Bermond F, Mitton D, Follet H. A credible homogenized finite element model to predict radius fracture in the case of a forward fall. J Mech Behav Biomed Mater 2022; 131:105206. [DOI: 10.1016/j.jmbbm.2022.105206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/15/2022]
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8
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Jiajue R, Ni X, Jin C, Yu W, Huo L, Wu H, Liu Y, Jin J, Lv W, Zhou L, Xia Y, Chi Y, Cui L, Pang Q, Li X, Jiang Y, Wang O, Li M, Xing X, Meng X, Xia W. Bone Volumetric Density, Microarchitecture, and Estimated Bone Strength in Tumor-Induced Rickets/Osteomalacia Versus X-linked Hypophosphatemia in Chinese Adolescents. Front Endocrinol (Lausanne) 2022; 13:883981. [PMID: 35769089 PMCID: PMC9234144 DOI: 10.3389/fendo.2022.883981] [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: 02/25/2022] [Accepted: 05/10/2022] [Indexed: 01/15/2023] Open
Abstract
Tumor-induced rickets/osteomalacia (TIR/O) severely impairs bone microarchitecture and bone strength. However, no study has described the microarchitectural quality of bone in adolescent patients with TIR/O. TIR/O affects bone quality more severely than the inherited causes of hypophosphatemia, the most common form of which is X-linked hypophosphatemia (XLH). Nevertheless, differences of the microarchitectural quality of the bone between TIR/O and XLH have never been clarified. Therefore, in this study, we used high-resolution peripheral quantitative computed tomography to assess bone microarchitecture in five Chinese adolescent TIR/O patients, and these were compared with 15 age- and gender-matched XLH patients as well as 15 age- and gender-matched healthy controls. Compared with the healthy controls, the TIR/O patients presented with significantly lower volumetric bone mineral densities (vBMDs), severely affected bone microarchitecture, and profoundly weaker bone strength. The distal tibia was more severely affected than the distal radius. Compared with the XLH patients, the TIR/O patients showed deteriorated bone quality notably at the distal tibia and in the cancellous compartment, reflected by 45.9% lower trabecular vBMD (p = 0.029), 40.2% lower trabecular fraction (p = 0.020), 40.6% weaker stiffness (p = 0.058), and 42.7% weaker failure load (p = 0.039) at the distal tibia. The correlation analysis showed that a higher level of serum FGF23 and a lower level of serum phosphate were associated with a poorer bone microarchitecture and a weaker estimated bone strength in the hypophosphatemic patients of our study. In conclusion, our study demonstrated significantly lower vBMDs, severely impaired bone microarchitecture, and profoundly weaker bone strength in Chinese adolescent patients with TIR/O, notably at the distal tibia, compared with the same parameters in age- and sex-matched healthy controls and XLH patients, which was possibly caused by excessive FGF23 production and secretion, chronically severe hypophosphatemia, and weak mechanical stimulus at the lower extremities. These findings further our understanding of the impact of different kinds of hypophosphatemic rickets/osteomalacia on bone quality.
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Affiliation(s)
- Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaolin Ni
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Chenxi Jin
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanwen Wu
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin Jin
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Lv
- Department of Ear, Nose, and Throat, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian Zhou
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Ultrasound Diagnosis, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue Chi
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Lijia Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Qianqian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiang Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xunwu Meng
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
- *Correspondence: Weibo Xia,
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9
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Revel M, Bermond F, Duboeuf F, Mitton D, Follet H. Influence of loading conditions in finite element analysis assessed by HR-pQCT on ex vivo fracture prediction. Bone 2022; 154:116206. [PMID: 34547523 DOI: 10.1016/j.bone.2021.116206] [Citation(s) in RCA: 2] [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: 04/19/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 12/17/2022]
Abstract
Many fractures occur in individuals with normal areal Bone Mineral Density (aBMD) measured by Dual X-ray Absorptiometry (DXA). High Resolution peripheral Quantitative Computed Tomography (HR-pQCT) allows for non-invasive evaluation of bone stiffness and strength through micro finite element (μFE) analysis at the tibia and radius. These μFE outcomes are strongly associated with fragility fractures but do not provide clear enhancement compared with DXA measurements. The objective of this study was to establish whether a change in loading conditions in standard μFE analysis assessed by HR-pQCT enhance the discrimination of low-trauma fractured radii (n = 11) from non-fractured radii (n = 16) obtained experimentally throughout a mechanical test reproducing a forward fall. Micro finite element models were created using HR-pQCT images, and linear analyses were performed using four different types of loading conditions (axial, non-axial with two orientations and torsion). No significant differences were found between the failure load assessed with the axial and non-axial models. The different loading conditions tested presented the same area under the receiver operating characteristic (ROC) curves of 0.79 when classifying radius fractures with an accuracy of 81.5%. In comparison, the area under the curve (AUC) is 0.77 from DXA-derived ultra-distal aBMD of the forearm with an accuracy of 85.2%. These results suggest that the restricted HR-pQCT scanned region seems not sensitive to loading conditions for the prediction of radius fracture risk based on ex vivo experiments (n = 27).
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Affiliation(s)
- M Revel
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, LYOS UMR1033, F69008 Lyon, France; Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F69622 Lyon, France
| | - F Bermond
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F69622 Lyon, France
| | - F Duboeuf
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, LYOS UMR1033, F69008 Lyon, France
| | - D Mitton
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F69622 Lyon, France
| | - H Follet
- Univ Lyon, Univ Claude Bernard Lyon 1, INSERM, LYOS UMR1033, F69008 Lyon, France.
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10
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Cheung WH, Hung VWY, Cheuk KY, Chau WW, Tsoi KKF, Wong RMY, Chow SKH, Lam TP, Yung PSH, Law SW, Qin L. Best Performance Parameters of HR-pQCT to Predict Fragility Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res 2021; 36:2381-2398. [PMID: 34585784 PMCID: PMC9298023 DOI: 10.1002/jbmr.4449] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/30/2021] [Accepted: 09/24/2021] [Indexed: 01/11/2023]
Abstract
Osteoporosis is a systemic skeletal disease characterized by low bone mass and bone structural deterioration that may result in fragility fractures. Use of bone imaging modalities to accurately predict fragility fractures is always an important issue, yet the current gold standard of dual-energy X-ray absorptiometry (DXA) for diagnosis of osteoporosis cannot fully satisfy this purpose. The latest high-resolution peripheral quantitative computed tomography (HR-pQCT) is a three-dimensional (3D) imaging device to measure not only volumetric bone density, but also the bone microarchitecture in a noninvasive manner that may provide a better fracture prediction power. This systematic review and meta-analysis was designed to investigate which HR-pQCT parameters at the distal radius and/or distal tibia could best predict fragility fractures. A systematic literature search was conducted in Embase, PubMed, and Web of Science with relevant keywords by two independent reviewers. Original clinical studies using HR-pQCT to predict fragility fractures with available full text in English were included. Information was extracted from the included studies for further review. In total, 25 articles were included for the systematic review, and 16 articles for meta-analysis. HR-pQCT was shown to significantly predict incident fractures and/or major osteoporotic fractures (MOFs). Of all the HR-pQCT parameters, our meta-analysis revealed that cortical volumetric bone mineral density (Ct.vBMD), trabecular thickness (Tb.Th), and stiffness were better predictors. Meanwhile, HR-pQCT parameters indicated better performance in predicting MOFs than incident fractures. Between the two standard measurement sites of HR-pQCT, the non-weight-bearing distal radius was a more preferable site than distal tibia for fracture prediction. Furthermore, most of the included studies were white-based, whereas very few studies were from Asia or South America. These regions should build up their densitometric databases and conduct related prediction studies. It is expected that HR-pQCT can be used widely for the diagnosis of osteoporosis and prediction of future fragility fractures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Wing-Hoi Cheung
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Vivian Wing-Yin Hung
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Yee Cheuk
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai-Wang Chau
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin Kam-Fai Tsoi
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ronald Man-Yeung Wong
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Simon Kwoon-Ho Chow
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz-Ping Lam
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patrick Shu-Hang Yung
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheung-Wai Law
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ling Qin
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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11
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Zanchetta MB, Jerkovich F, Nuñez S, Mocarbel Y, Pignatta A, Elías N, Díaz AG, Roganovich JM, Vigovich C, Balonga MC, Cohen AC, Mumbach G, Gonzalez S, Plantalech L, Fradinger E, Zanchetta JR. Impaired bone microarchitecture and strength in patients with tumor-induced osteomalacia. J Bone Miner Res 2021; 36:1502-1509. [PMID: 33950560 DOI: 10.1002/jbmr.4325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 12/29/2022]
Abstract
Some studies based on bone biopsy have demonstrated that in patients with tumor-induced osteomalacia (TIO) the mineralization process of the bone matrix is profoundly disturbed. However, the interrelationship between clinical and biochemical features and bone microarchitecture in this disease needs further analysis. With this purpose in mind, we set out three objectives: (i) to determine bone microarchitecture and estimated bone strength in a group of patients with tumor-induced osteomalacia using high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite element analysis (FEA), (ii) to investigate correlations between duration of disease, biochemical features, bone density, HR-pQCT and FEA parameters, and (iii) to compare HR-pQCT and FEA parameters with a healthy control group. Ten patients with TIO were included. All patients had non-resolved disease. At the distal radius, all bone microarchitecture parameters were significantly affected in patients with TIO in comparison with healthy controls. At the distal tibia, all parameters were significantly impaired, except for trabecular thickness. All the parameters were more affected in the distal tibia than in the distal radius. Women with TIO (n = 7) had significantly lower bone strength parameters than healthy controls. In men (n = 3), bone strength parameters were significantly lower than in the control group at the distal tibia. Alkaline phosphatase levels exhibited a negative correlation with microarchitecture parameters, failure load, and stiffness. Higher levels of parathyroid hormone correlated with poorer microarchitecture parameters. We believe that in TIO, hormonal disturbances and the lack of mechanical stimulus specially converge to generate an extremely harmful combination for bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- María Belén Zanchetta
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina
| | - Fernando Jerkovich
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina.,División Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Selva Nuñez
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina
| | - Yamile Mocarbel
- División Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Analía Pignatta
- Servicio de Endocrinología, Hospital Interzonal San Juan Bautista, San Fernando del Valle de Catamarca, Argentina
| | - Natalia Elías
- Servicio de Endocrinología, Metabolismo, Nutrición y Diabetes, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Adriana Graciela Díaz
- División Endocrinología, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - María Celeste Balonga
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina
| | | | | | | | - Luisa Plantalech
- Servicio de Endocrinología y Medicina Nuclear, Sector Osteopatías, Hospital Italiano, Buenos Aires, Buenos Aires, Argentina
| | - Erich Fradinger
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina
| | - José Rubén Zanchetta
- IDIM, Instituto de Diagnóstico e Investigaciones Metabólicas, Universidad del Salvador, LIBERTAD 836 1 PISO, BUENOS AIRES, Argentina, C1012AAR, Argentina
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12
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Narayanan N, Palui R, Merugu C, Kar SS, Kamalanathan S, Sahoo J, Selvarajan S, Naik D. The Risk of Fractures in Primary Hyperparathyroidism: A Meta-Analysis. JBMR Plus 2021; 5:e10482. [PMID: 33869997 PMCID: PMC8046118 DOI: 10.1002/jbm4.10482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/21/2020] [Accepted: 02/16/2021] [Indexed: 12/25/2022] Open
Abstract
Primary hyperparathyroidism (PHPT) is a common metabolic bone disease affecting 1% of the adult population. Patients with PHPT have reduced BMD, especially at the cortical bone. However, studies evaluating its impact on fracture risk have shown contradictory results. In an effort to further inform fracture risk for this patient population, a meta‐analysis of studies of fracture in patients with PHPT compared with a control population was undertaken. Articles were searched in PubMed/MEDLINE, Excerpta Medica, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Web of Science bibliographic databases. The meta‐analysis included 17 studies involving 3807 PHPT cases and 11,908 controls. The primary outcome was to determine the risk of vertebral fracture (VF), nonvertebral fracture, hip fracture, distal radius fracture, and total fracture (TF) among patients with PHPT in comparison with a control population. BMD (lumbar spine, femoral neck, total hip, and distal radius) and serum 25‐hydroxy vitamin D level, as well as possible predictors of VF as secondary outcomes were assessed. From this meta‐analysis, it was found that there was a significantly increased risk of VF (risk ratio [RR], 2.57; 95% CI, 1.3–5.09; p = 0.007) and TF (RR, 1.71; 95% CI, 1.48–1.97; p < 0.00001) in patients with PHPT. There was a significant decrease in BMD in patients with PHPT versus controls at all four sites. Older age, longer duration since menopause, and lower BMD at lumbar spine and distal radius were predictors for VF. To conclude, patients with PHPT had a significantly higher risk for VF and TF in comparison with controls. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Niya Narayanan
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Rajan Palui
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Chandhana Merugu
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sitanshu Sekhar Kar
- Department of Preventive and Social Medicine Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sadishkumar Kamalanathan
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Jayaprakash Sahoo
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
| | - Dukhabandhu Naik
- Department of Endocrinology Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Puducherry India
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13
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Miller T, Ying MTC, Hung VWY, Tsang CSL, Ouyang H, Chung RCK, Qin L, Pang MYC. Determinants of estimated failure load in the distal radius after stroke: An HR-pQCT study. Bone 2021; 144:115831. [PMID: 33359893 DOI: 10.1016/j.bone.2020.115831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Bone health is often compromised after stroke and the distal radius is a common site of fragility fractures. The macro- and mircoproperties of bone tissue after stroke and their clinical correlates are understudied. The objectives of the study were to use High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) to investigate the bone properties at the distal radius, and to identify the correlates of estimated failure load for the distal radius in people with chronic stroke. This was a cross-sectional study of 64 people with stroke (age: 60.8 ± 7.7 years, stroke duration: 5.7 ± 3.9 years) and 64 age- and sex-matched controls. Bilateral bone structural, densitometric, geometric and strength parameters of the distal radius were measured using HR-pQCT. The architecture, stiffness and echo intensity of the bilateral biceps brachii muscle and brachial artery blood flow were evaluated using diagnostic ultrasound. Other outcomes included the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), and Composite Spasticity Scale (CSS). The results revealed a significant side (paretic vs non-paretic for the stroke group, non-dominant vs dominant for controls) by group (stroke vs control) interaction effect for estimated failure load, cortical area, cortical thickness, trabecular number and trabecular separation, and all volumetric density parameters. Post-hoc analysis showed percent side-to-side differences in bone outcomes were greater in the stroke group than the control group, with the exception of trabecular thickness and intracortical porosity. Among the HR-pQCT variables, percent side-to-side difference in trabecular volumetric bone mineral density contributed the most to the percent side-to-side difference in estimated failure load in the stroke group (R2 change = 0.334, β = 1.106). Stroke-related impairments (FMA, MAL, CSS) were found to be significant determinants of the percent side-to-side difference in estimated failure load (R2 change = 0.233, β = -0.480). This was the first study to examine bone microstructure post-stroke. We found that the paretic distal radius had compromised bone structural properties and lower estimated failure load compared to the non-paretic side. Motor impairment was a determinant of estimated bone strength at the distal radius and may be a potential intervention target for improving bone health post-stroke.
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Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
| | - Vivian W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
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14
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Cappelle SI, Moreau M, Karmali R, Iconaru L, Baleanu F, Kinnard V, Paesmans M, Rozenberg S, Rubinstein M, Surquin M, Blard PH, Chapurlat R, Body JJ, Bergmann P. Discriminating value of HR-pQCT for fractures in women with similar FRAX scores: A substudy of the FRISBEE cohort. Bone 2021; 143:115613. [PMID: 32871273 DOI: 10.1016/j.bone.2020.115613] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 11/30/2022]
Abstract
Areal bone mineral density (aBMD) has a low sensitivity to identify women at high fracture risk. The FRAX algorithm, by combining several clinical risk factors, might improve fracture prediction compared to aBMD alone. Several micro-architectural and biomechanical parameters which can be measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) are associated with fracture risk. HR-pQCT in combination or not with finite element analysis (FEA) may be used to improve bone strength prediction. Our aim was to assess whether HR-pQCT measurements (densities, cortical and trabecular microarchitecture, biomechanical proprieties assessed by FEA) had an added value in predicting fractures in a subgroup of women belonging to the Belgian FRISBEE cohort. One hundred nineteen women who sustained a fracture (aged 60 to 85 years) during the initial follow-up of our cohort had a radius and tibia examination by HR-pQCT and were compared with controls matched for their FRAX score at baseline. We found that low distal radius total (OR = 1.41 [1.07-1.86] per SD, p < 0.05) and trabecular densities (OR = 1.45 [1.10-1.90], p < 0.01), trabecular number (OR = 1.32 [1.01-1.72], p < 0.05), intra individual distribution of separation (OR = 0.73 [0.54-0.99], p < 0.05) as several FEA parameters were significantly associated with fractures. At the distal tibia, impaired cortical density (OR = 1.32 [1.03-1.70] per SD, p < 0.05) and thickness (OR = 1.29 [1.01-1.63], p < 0.05) and apparent modulus (OR = 1.30 [1.01-1.66], p < 0.05) were significantly correlated with fractures. A low ultra distal radial aBMD (UDR) measured at the time of HR-pQCT was significantly associated with fractures (OR = 1.67 [1.22-2.28], p < 0.01). Women from both groups were followed further after the realization of the HR-pQCT and 46 new fractures were registered. In this second part of the study, low UDR aBMD (OR = 1.66 [1.18-2.35], p < 0.01), total (OR = 1.48 [1.08-2.03], p < 0.05), cortical (OR = 1.40 [1.04-1.87], p < 0.05) and trabecular (OR = 1.37 [1.01-1.85], p < 0.05) densities or apparent modulus (OR = 1.49 [1.07-2.05], p < 0.05) at the radius were associated with a significant increase of fracture risk. At the tibia, only the cortical density was significantly associated with the fracture risk (OR = 1.34 [1.02-2.76], p < 0.05). These results confirm the interest of HR-pQCT measurements for the evaluation of fracture risk, also in women matched for their baseline FRAX score. They also highlight that UDR aBMD contains pertinent information.
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Affiliation(s)
- S I Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - M Moreau
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - R Karmali
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - L Iconaru
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - F Baleanu
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Bordet Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Obstetrics and gynaecology, Université Libre de Bruxelles (ULB) and Vrije Universiteit (VUB), Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P-H Blard
- CNRS, Université de Lorraine, CRPG, F-54000 Nancy, France
| | - R Chapurlat
- INSERM Research Unit 1033-Lyos, Hôpital E. Herriot, Lyon, France
| | - J J Body
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU-Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
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15
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Stipsitz M, Zysset PK, Pahr DH. Prediction of the Inelastic Behaviour of Radius Segments: Damage-based Nonlinear Micro Finite Element Simulation vs Pistoia Criterion. J Biomech 2021; 116:110205. [PMID: 33476984 DOI: 10.1016/j.jbiomech.2020.110205] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 10/22/2022]
Abstract
The Pistoia criterion (PC) is widely used to estimate the failure load of distal radius segments based on linear micro Finite Element (μFE) analyses. The advantage of the PC is that a simple strain-threshold and a tissue volume fraction can be used to predict failure properties. In this study, the PC is compared to materially nonlinear μFE analyses, where the bone tissue is modelled as an elastic, damageable material. The goal was to investigate for which outcomes the PC is sufficient and when a nonlinear (NL) simulation is required. Three types of simulation results were compared: (1) prediction of the failure load, (2) load sharing of cortical and trabecular regions, and (3) distribution of local damaged/overstrained tissue at the maximum sustainable load. The failure load obtained experimentally could be predicted well with both the PC and the NL simulations using linear regression. Although the PC strongly overestimated the failure load, it was sufficient to predict adequately normalized apparent results. An optimised PC (oPC) was proposed which uses experimental data to calibrate the individual volume of overstrained tissue. The main areas of local over-straining predicted by the oPC were the same as estimated by the NL simulation, although the oPC predicted more diffuse regions. However, the oPC relied on an individual calibration requiring the experimental failure load while the NL simulation required no a priori knowledge of the experimental failure load.
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Affiliation(s)
- Monika Stipsitz
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria
| | - Philippe K Zysset
- ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Austria; Division Biomechanics, Karl Landsteiner University, Austria
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16
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Huang M, Hung VWY, Li TK, Law SW, Wang Y, Chen S, Qin L. Performance of HR-pQCT, DXA, and FRAX in the discrimination of asymptomatic vertebral fracture in postmenopausal Chinese women. Arch Osteoporos 2021; 16:125. [PMID: 34480663 PMCID: PMC8418592 DOI: 10.1007/s11657-021-00939-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/11/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Volumetric bone density (vBMD) and trabecular microarchitecture measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) can discriminate the patients with high risk of asymptomatic vertebral fracture (VF) in postmenopausal Chinese women. These findings suggested that HR-pQCT could provide additional information on bone quality of the patients with asymptomatic VF. INTRODUCTION Although there were several studies using HR-pQCT to investigate asymptomatic VF, it remains uncertain if HR-pQCT parameters can discriminate asymptomatic VF patients, especially in Chinese population. The purpose of this study was to investigate whether bone quality measured by HR-pQCT could discriminate asymptomatic VF independent of hip areal bone mineral density (aBMD) measured by dual-energy x-ray absorptiometry (DXA) and fracture risks evaluated using built-in Fracture Risk Assessment Tool (FRAXBMD). METHODS This is a nested case-control study. One hundred seventy-five ambulatory Chinese postmenopausal women aged 60-79 years were retrieved from Normative Reference Standards (NRS) cohort in Hong Kong. DXA was used to identify VF from lateral spine images (VFA) using Genant's semi-quantitative method. Major osteoporotic fracture risk was calculated using FRAX tool. HR-pQCT was used to assess vBMD, microarchitecture, and estimated strength at both distal radius and tibia. Comparison of HR-pQCT parameters between asymptomatic VF and control was performed using covariance analysis. Logistic regression analysis was performed for calculating the adjusted odds ratio (OR) with 95% confidence intervals (CI) of fracture status as per SD decrease in HR-pQCT parameters. RESULTS Women with asymptomatic VF were older than those of the control in our NRS cohort. Nevertheless, after adjusted for covariance, asymptomatic VF showed significantly lower trabecular vBMD (Tb.vBMD) at radius but higher SMI at tibia as compared with those of the control. Tb.vBMD at radius yielded the highest value of area under the curve (AUC) as compared with total hip aBMD and FRAXBMD. However, no significant difference was found among each other. CONCLUSION Tb.vBMD at the radius and SMI at the tibia provided by HR-pQCT can discriminate asymptomatic VF independent of hip aBMD and FRAXBMD by DXA in postmenopausal women.
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Affiliation(s)
- Meiling Huang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Vivian Wing-Yin Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz Kiu Li
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Sheung Wai Law
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yulong Wang
- Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shangjie Chen
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Rehabilitation, Shenzhen Baoan Hospital Affiliated to Southern Medical University, Shenzhen, China.
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China.
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17
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Ramchand SK, David NL, Lee H, Bruce M, Bouxsein ML, Leder BZ, Tsai JN. Effects of Combination Denosumab and High-Dose Teriparatide Administration on Bone Microarchitecture and Estimated Strength: The DATA-HD HR-pQCT Study. J Bone Miner Res 2021; 36:41-51. [PMID: 32790196 DOI: 10.1002/jbmr.4161] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 11/11/2022]
Abstract
In postmenopausal women at high risk of fracture, we previously reported that combined denosumab and high-dose (HD; 40 μg) teriparatide increased spine and hip bone mineral density (BMD) more than combination with standard-dose teriparatide (SD; 20 μg). To assess the effects of these combinations on bone microarchitecture and estimated bone strength, we performed high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius and distal tibia in these women, who were randomized to receive either teriparatide 20 μg (n = 39) or 40 μg (n = 37) during months 0 to 9 overlapped with denosumab 60 mg s.c. given at months 3 and 9, for a 15-month study duration. The 69 women who completed at least one study visit after baseline are included in this analysis. Over 15 months, increases in total BMD were higher in the HD-group than the SD-group at the distal tibia (5.3% versus 3.4%, p = 0.01) with a similar trend at the distal radius (2.6% versus 1.0%, p = 0.06). At 15 months, cortical porosity remained similar to baseline, with absolute differences of -0.1% and -0.7% at the distal tibia and -0.4% and -0.1% at the distal radius in the HD-group and SD-group, respectively; p = NS for all comparisons. Tibial cortical tissue mineral density increased similarly in both treatment groups (1.3% [p < 0.0001 versus baseline] and 1.5% [p < 0.0001 versus baseline] in the HD-group and SD-group, respectively; p = 0.75 for overall group difference). Improvements in trabecular microarchitecture at the distal tibia and estimated strength by micro-finite element analysis at both sites were numerically greater in the HD-group compared with SD-group but not significantly so. Together, these findings suggest that short-term treatment combining denosumab with either high- or standard-dose teriparatide improves HR-pQCT measures of bone density, microstructure, and estimated strength, with greater gains in total bone density observed in the HD-group, which may be of benefit in postmenopausal women with severe osteoporosis. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabashini K Ramchand
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA.,Department of Medicine, Endocrine Unit, Austin Hospital, The University of Melbourne, Melbourne, Australia
| | - Natalie L David
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Bruce
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Mary L Bouxsein
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin Z Leder
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Joy N Tsai
- Department of Medicine, Endocrine Unit, Massachusetts General Hospital, Harvard University, Boston, MA, USA
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18
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Shiraishi K, Burghardt AJ, Osaki M, Khosla S, Carballido-Gamio J. Global and Spatial Compartmental Interrelationships of Bone Density, Microstructure, Geometry and Biomechanics in the Distal Radius in a Colles' Fracture Study Using HR-pQCT. Front Endocrinol (Lausanne) 2021; 12:568454. [PMID: 34122326 PMCID: PMC8187761 DOI: 10.3389/fendo.2021.568454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bone parameters derived from HR-pQCT have been investigated on a parameter-by-parameter basis for different clinical conditions. However, little is known regarding the interrelationships of bone parameters and the spatial distribution of these interrelationships. In this work: 1) we investigate compartmental interrelationships of bone parameters; 2) assess the spatial distribution of interrelationships of bone parameters; and 3) compare interrelationships of bone parameters between postmenopausal women with and without a recent Colles' fracture. METHODS Images from the unaffected radius in fracture cases (n=84), and from the non-dominant radius of controls (n=98) were obtained using HR-pQCT. Trabecular voxel-based maps of local bone volume fraction (L.Tb.BV/TV), homogenized volumetric bone mineral density (H.Tb.BMD), homogenized μFEA-derived strain energy density (H.Tb.SED), and homogenized inter-trabecular distances (H.Tb.1/N) were generated; as well as surface-based maps of apparent cortical bone thickness (Surf.app.Ct.Th), porosity-weighted cortical bone thickness (Surf.Ct.SIT), mean cortical BMD (Surf.Ct.BMD), and mean cortical SED (Surf.Ct.SED). Anatomical correspondences across the parametric maps in the study were established via spatial normalization to a common template. Mean values of the parametric maps before spatial normalization were used to assess compartmental Spearman's rank partial correlations of bone parameters (e.g., between H.Tb.BMD and L.Tb.BV/TV or between Surf.Ct.BMD and Surf.app.Ct.Th). Spearman's rank partial correlations were also assessed for each voxel and vertex of the spatially normalized parametric maps, thus generating maps of Spearman's rank partial correlation coefficients. Correlations were performed independently within each group, and compared between groups using the Fisher's Z transformation. RESULTS All within-group global trabecular and cortical Spearman's rank partial correlations were significant; and the correlations of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, Surf.Ct.BMD-Surf.Ct.SED and Surf.Ct.SIT-Surf.Ct.SED were significantly different between controls and fracture cases. The spatial analyses revealed significant heterogeneous voxel- and surface-based correlation coefficient maps across the distal radius for both groups; and the correlation maps of H.Tb.BMD-L.Tb.BV/TV, H.Tb.BMD-H.Tb.1/N, L.Tb.BV/TV-H.Tb.1/N, H.Tb.1/N-H.Tb.SED and Surf.app.Ct.Th - Surf.Ct.SIT yielded small clusters of significant correlation differences between groups. DISCUSSION The heterogeneous spatial distribution of interrelationships of bone parameters assessing density, microstructure, geometry and biomechanics, along with their global and local differences between controls and fracture cases, may help us further understand different bone mechanisms of bone fracture.
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Affiliation(s)
- Kazuteru Shiraishi
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrew J. Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Julio Carballido-Gamio,
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19
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Guha I, Klintström B, Klintström E, Zhang X, Smedby Ö, Moreno R, Saha PK. A comparative study of trabecular bone micro-structural measurements using different CT modalities. Phys Med Biol 2020; 65:10.1088/1361-6560/abc367. [PMID: 33086213 PMCID: PMC8058110 DOI: 10.1088/1361-6560/abc367] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 10/21/2020] [Indexed: 01/23/2023]
Abstract
Osteoporosis, characterized by reduced bone mineral density and micro-architectural degeneration, significantly enhances fracture-risk. There are several viable methods for trabecular bone micro-imaging, which widely vary in terms of technology, reconstruction principle, spatial resolution, and acquisition time. We have performed an excised cadaveric bone specimen study to evaluate different computed tomography (CT)-imaging modalities for trabecular bone micro-structural analysis. Excised cadaveric bone specimens from the distal radius were scanned using micro-CT and fourin vivoCT imaging modalities: high-resolution peripheral quantitative computed tomography (HR-pQCT), dental cone beam CT (CBCT), whole-body multi-row detector CT (MDCT), and extremity CBCT. A new algorithm was developed to optimize soft thresholding parameters for individualin vivoCT modalities for computing quantitative bone volume fraction maps. Finally, agreement of trabecular bone micro-structural measures, derived from differentin vivoCT imaging, with reference measures from micro-CT imaging was examined. Observed values of most trabecular measures, including trabecular bone volume, network area, transverse and plate-rod micro-structure, thickness, and spacing, forin vivoCT modalities were higher than their micro-CT-based reference values. In general, HR-pQCT-based trabecular bone measures were closer to their reference values as compared to otherin vivoCT modalities. Despite large differences in observed values of measures among modalities, high linear correlation (rε [0.94 0.99]) was found between micro-CT andin vivoCT-derived measures of trabecular bone volume, transverse and plate micro-structural volume, and network area. All HR-pQCT-derived trabecular measures, except the erosion index, showed high correlation (rε [0.91 0.99]). The plate-width measure showed a higher correlation (rε [0.72 0.91]) amongin vivoand micro-CT modalities than its counterpart binary plate-rod characterization-based measure erosion index (rε [0.65 0.81]). Although a strong correlation was observed between micro-structural measures fromin vivoand micro-CT imaging, large shifts in their values forin vivomodalities warrant proper scanner calibration prior to adopting in multi-site and longitudinal studies.
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Affiliation(s)
- Indranil Guha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, United States of America
| | - Benjamin Klintström
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Eva Klintström
- Department of Medical and Health Sciences and Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Xiaoliu Zhang
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, United States of America
| | - Örjan Smedby
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Rodrigo Moreno
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Punam K Saha
- Department of Electrical and Computer Engineering, College of Engineering, University of Iowa, Iowa City, IA, United States of America
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States of America
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20
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Ouhsousou S, Revel M, Bacchetta J, Follet H. Finite element analysis for prediction of adolescent bone strength: micro vs continuum models. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1813431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- S. Ouhsousou
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, Lyon, France
| | - M. Revel
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, Lyon, France
| | - J. Bacchetta
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, Lyon, France
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - H. Follet
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, LYOS UMR 1033, Lyon, France
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21
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Sidhu K, Ali B, Burt LA, Boyd SK, Khan A. Spectrum of microarchitectural bone disease in inborn errors of metabolism: a cross-sectional, observational study. Orphanet J Rare Dis 2020; 15:251. [PMID: 32938479 PMCID: PMC7493311 DOI: 10.1186/s13023-020-01521-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/24/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Patients diagnosed with inborn errors of metabolism (IBEM) often present with compromised bone health leading to low bone density, bone pain, fractures, and short stature. Dual-energy X-ray absorptiometry (DXA) is the current gold standard for clinical assessment of bone in the general population and has been adopted for monitoring bone density in IBEM patients. However, IBEM patients are at greater risk for scoliosis, short stature and often have orthopedic hardware at standard DXA scan sites, limiting its use in these patients. Furthermore, DXA is limited to measuring areal bone mineral density (BMD), and does not provide information on microarchitecture. METHODS In this study, microarchitecture was investigated in IBEM patients (n = 101) using a new three-dimensional imaging technology high-resolution peripheral quantitative computed tomography (HR-pQCT) which scans at the distal radius and distal tibia. Volumetric BMD and bone microarchitecture were computed and compared amongst the different IBEMs. For IBEM patients over 16 years-old (n = 67), HR-pQCT reference data was available and Z-scores were calculated. RESULTS Cortical bone density was significantly lower in IBEMs associated with decreased bone mass when compared to lysosomal storage disorders (LSD) with no primary skeletal pathology at both the radius and tibia. Cortical thickness was also significantly lower in these disorders when compared to LSD with no primary skeletal pathology at the radius. Cortical porosity was significantly greater in hypophosphatasia when compared to all other IBEM subtypes. CONCLUSION We demonstrated compromised bone microarchitecture in IBEMs where there is primary involvement of the skeleton, as well as IBEMs where skeletal complications are a secondary outcome. In conclusion, our findings suggest HR-pQCT may serve as a valuable tool to monitor skeletal disease in the IBEM population, and provides insight to the greatly varying bone phenotype for this cohort that can be used for clinical monitoring and the assessment of response to therapeutic interventions.
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Affiliation(s)
- Karamjot Sidhu
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.,Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada
| | - Bilal Ali
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Aneal Khan
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada. .,Medical Genetics and Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, 28 Oki Drive NW, Calgary, Alberta, T3B 6A8, Canada.
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22
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Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:1607-1627. [PMID: 32458029 PMCID: PMC7429313 DOI: 10.1007/s00198-020-05438-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems. METHODS A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document. RESULTS An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems. CONCLUSION This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.
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Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J Paccou
- Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - A Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Bioclinica, Inc., Hamburg, Germany
| | - M L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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23
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Fuusager G, Milandt N, Shanbhogue VV, Hermann AP, Schou AJ, Christesen HT. Lower estimated bone strength and impaired bone microarchitecture in children with type 1 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001384. [PMID: 32816873 PMCID: PMC7437694 DOI: 10.1136/bmjdrc-2020-001384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/30/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Patients with type 1 diabetes has an increased risk of fracture. We wished to evaluate estimated bone strength in children and adolescents with type 1 diabetes and assess peripheral bone geometry, volumetric bone mineral density (vBMD) and microarchitecture. RESEARCH DESIGN AND METHODS In a cross-sectional study, high-resolution peripheral quantitative CT (HR-pQCT) was performed of the radius and tibia in 84 children with type 1 diabetes and 55 healthy sibling controls. Estimated bone strength was assessed using a microfinite element analysis solver. Multivariate regression analyses were performed adjusting for age, sex, height and body mass index. RESULTS The median age was 13.0 years in the diabetes group vs 11.5 years in healthy sibling controls. The median (range) diabetes duration was 4.2 (0.4-15.9) years; median (range) latest year Hb1Ac was 7.8 (5.9-11.8) % (61.8 (41-106) mmol/mol). In adjusted analyses, patients with type 1 diabetes had reduced estimated bone strength in both radius, β -390.6 (-621.2 to -159.9) N, p=0.001, and tibia, β -891.9 (-1321 to -462.9) N, p<0.001. In the radius and tibia, children with type 1 diabetes had reduced cortical area, trabecular vBMD, trabecular number and trabecular bone volume fraction and increased trabecular inhomogeneity, adjusted p<0.05 for all. Latest year HbA1c was negatively correlated with bone microarchitecture (radius and tibia), trabecular vBMD and estimated bone strength (tibia). CONCLUSION Children with type 1 diabetes had reduced estimated bone strength. This reduced bone strength could partly be explained by reduced trabecular bone mineral density, adverse microarchitecture and reduced cortical area. We also found increasing latest year HbA1c to be associated with several adverse changes in bone parameters. HR-pQCT holds potential to identify early adverse bone changes and to explain the increased fracture risk in young patients with type 1 diabetes.
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Affiliation(s)
- Gitte Fuusager
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Department of Internal Medicine, Hospitalsenheden Vest, Herning, Denmark
- OPEN - Odense Patient data Explorative Network, Odense Universitets Hospital, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
| | - Nikolaj Milandt
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- The Orthopedic Research Unit, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Jørgen Schou
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
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24
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Daniels AM, Wyers CE, Janzing HMJ, Sassen S, Loeffen D, Kaarsemaker S, van Rietbergen B, Hannemann PFW, Poeze M, van den Bergh JP. The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT. Bone Joint J 2020; 102-B:478-484. [DOI: 10.1302/0301-620x.102b4.bjj-2019-0632.r3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.
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Affiliation(s)
- Anne M. Daniels
- Department of Surgery, ViCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sander Sassen
- Department of Radiology, ViCuri Medical Centre, Venlo, The Netherlands
| | - Daan Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, ViCuri Medical Centre, Venlo, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
BACKGROUND This is a cross-sectional study aiming to understand the early characteristics and background of bone health impairment in clinically well children with Fontan circulation. METHODS We enrolled 10 clinically well children with Fontan palliation (operated >5 years before study entrance, Tanner stage ≤3, age 12.1 ± 1.77 years, 7 males) and 11 healthy controls (age 12.0 ± 1.45 years, 9 males) at two children's hospitals. All patients underwent peripheral quantitative CT. For the Fontan group, we obtained clinical characteristics, NYHA class, cardiac index by MRI, dual x-ray absorptiometry, and biochemical studies. Linear regression was used to compare radius and tibia peripheral quantitative CT measures between Fontan patients and controls. RESULTS All Fontan patients were clinically well (NYHA class 1 or 2, cardiac index 4.85 ± 1.51 L/min/m2) and without significant comorbidities. Adjusted trabecular bone mineral density, cortical thickness, and bone strength index at the radius were significantly decreased in Fontan patients compared to controls with mean differences -30.13 mg/cm3 (p = 0.041), -0.31 mm (p = 0.043), and -6.65 mg2/mm4 (p = 0.036), respectively. No differences were found for tibial measures. In Fontan patients, the mean height-adjusted lumbar bone mineral density and total body less head z scores were -0.46 ± 1.1 and -0.63 ± 1.1, respectively, which are below the average, but within normal range for age and sex. CONCLUSIONS In a clinically well Fontan cohort, we found significant bone deficits by peripheral quantitative CT in the radius but not the tibia, suggesting non-weight-bearing bones may be more vulnerable to the unique haemodynamics of the Fontan circulation.
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Malekzadeh M, Abbasi-Rad S, Keyak JH, Nabil M, Asadi M, Mobini N, Naghdi P, Emadi H, Saligheh Rad H, Shiran MB. Liquid Calibration Phantoms in Ultra-Low-Dose QCT for the Assessment of Bone Mineral Density. J Clin Densitom 2020; 23:108-116. [PMID: 30902572 DOI: 10.1016/j.jocd.2019.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Cortical bone is affected by metabolic diseases. Some studies have shown that lower cortical bone mineral density (BMD) is related to increases in fracture risk which could be diagnosed by quantitative computed tomography (QCT). Nowadays, hybrid iterative reconstruction-based (HIR) computed tomography (CT) could be helpful to quantify the peripheral bone tissue. A key focus of this paper is to evaluate liquid calibration phantoms for BMD quantification in the tibia and under hybrid iterative reconstruction-based-CT with the different hydrogen dipotassium phosphate (K2HPO4) concentrations phantoms. METHODOLOGY Four ranges of concentrations of K2HPO4 were made and tested with 2 exposure settings. Accuracy of the phantoms with ash gravimetry and intermediate K2HPO4 concentration as hypothetical patients were evaluated. The correlations and mean differences between measured equivalent QCT BMD and ash density as a gold standard were calculated. Relative percentage error (RPE) in CT numbers of each concentration over a 6-mo period was reported. RESULTS The correlation values (R2 was close to 1.0), suggested that the precision of QCT-BMD measurements using standard and ultra-low dose settings were similar for all phantoms. The mean differences between QCT-BMD and the ash density for low concentrations (about 93 mg/cm3) were lower than high concentration phantoms with 135 and 234 mg/cm3 biases. In regard to accuracy test for hypothetical patient, RPE was up to 16.1% for the low concentration (LC) phantom for the case of high mineral content. However, the lowest RPE (0.4 to 1.8%) was obtained for the high concentration (HC) phantom, particularly for the high mineral content case. In addition, over 6 months, the K2HPO4 concentrations increased 25% for 50 mg/cm3 solution and 0.7 % for 1300 mg/cm3 solution in phantoms. CONCLUSION The excellent linear correlations between the QCT equivalent density and the ash density gold standard indicate that QCT can be used with submilisivert radiation dose. We conclude that using liquid calibration phantoms with a range of mineral content similar to that being measured will minimize bias. Finally, we suggest performing BMD measurements with ultra-low dose scan concurrent with iterative-based reconstruction to reduce radiation exposure.
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Affiliation(s)
- Malakeh Malekzadeh
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Abbasi-Rad
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Joyce H Keyak
- Department of Radiological Sciences, Department of Biomedical Engineering and Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA
| | - Mahnaz Nabil
- Department of Mathematics, Islamic Azad University, Qazvin Branch, Qazvin, Iran
| | - Mojgan Asadi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Mobini
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Naghdi
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Emadi
- Department of Applied Chemistry, Faculty of Chemistry, University of Mazandaran, Babolsar, Iran
| | - Hamidreza Saligheh Rad
- Quantitative Medical Imaging Systems Group, Research Center for Molecular and Cellular Imaging, Tehran University of Medical Sciences, Tehran, Iran; Medical Physics and Biomedical Engineering Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagher Shiran
- Medical Physics Department, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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Mata-Mbemba D, Rohringer T, Ibrahim A, Adams-Webberc T, Moineddin R, Doria AS, Vali R. HR-pQCT imaging in children, adolescents and young adults: Systematic review and subgroup meta-analysis of normative data. PLoS One 2019; 14:e0225663. [PMID: 31834887 PMCID: PMC6910691 DOI: 10.1371/journal.pone.0225663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the methodologies on image acquisition of normative data of high-resolution peripheral quantitative computed tomography (HR-pQCT) in children, adolescents and/or young adults (up to 25 years) and to determine their normative data based on available literature. A literature search was conducted in MEDLINE, EMBASE and Web of Science from 1947 to July 2019. Quality of articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and Modified Newcastle-Ottawa scale (NOS). Articles which fitted the following criteria were combined to meta-analysis: age range (15 to 22.6 years), references at tibia (22.5mm) and/or radius (9.0 to 9.5mm). Eight articles were ultimately included in the systematic review and 4 of them that filled the criteria were summarised in meta-analysis. The results of random effects model of HR-pQCT parameters of the 4 articles were as follows: 1)Radius: bone volume fraction (BT/BV) [estimate 0.17:0.1229(lower)-0.2115 (upper); trabecular number (Tb_N):2.08(2.03–2.12); trabecular thickness (Tb.Th):0.07 (0.07–0.0.08); trabecular separation (Tb.Sp):0.41 (0.38–0.42); cortical thickness (Ct.Th):0.85 (0.76–0.94); cortical porosity (Ct.Po):1.53 (0.63–2.44); total area (Tt.Ar):263.66(-385.3–912.6); total bone density (Tt-vBMD):280.5 (73.1–487.7); Trabecular density (Tb-vBMD):223.6 (47.1–400.09), and cortical density (CT.vBMD):765.9 (389.1–1142.8). 2)Tibia: BT/BV:0.18 (0.17–0.19); Tb_N:2.02 (1.83–2.2); Tb.Th:0.08 (0.80–0.09); Tb.Sp:0.40(0.36–0.44); Ct.Th:1.32(1.26–1.38); Ct.Po:3.15 (1.1–5.2); Tt.Ar:693.1(150.2–1235.8); Tt-vBMD:343.76 (335.5–352.1); Tb-vBMD:223.6 (213.37 (193.5–233.2), and CT.vBMD:894.3 (857.6–931.1). There is overall ‘fair’ evidence on reporting of results of normative data of HR-pQCT parameters in children, adolescents and/or young adults. However, data are scarce pointing out to the urgent need for standardization of acquisition parameters and guidelines on the use of HR-PQCT in these populations.
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Affiliation(s)
- Daddy Mata-Mbemba
- Department of Diagnostic Imaging, IWK Health Centre, and Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
- * E-mail:
| | | | - Ala Ibrahim
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Rahim Moineddin
- Departments of Family and Community Medicine (R.M.), University of Toronto, Toronto, Canada
| | - Andrea S. Doria
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
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Westbury LD, Shere C, Edwards MH, Cooper C, Dennison EM, Ward KA. Cluster Analysis of Finite Element Analysis and Bone Microarchitectural Parameters Identifies Phenotypes with High Fracture Risk. Calcif Tissue Int 2019; 105:252-262. [PMID: 31187198 PMCID: PMC6694037 DOI: 10.1007/s00223-019-00564-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/10/2019] [Indexed: 12/02/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HRpQCT) is increasingly used for exploring associations between bone microarchitectural and finite element analysis (FEA) parameters and fracture. We hypothesised that combining bone microarchitectural parameters, geometry, BMD and FEA estimates of bone strength from HRpQCT may improve discrimination of fragility fractures. The analysis sample comprised of 359 participants (aged 72-81 years) from the Hertfordshire Cohort Study. Fracture history was determined by self-report and vertebral fracture assessment. Participants underwent HRpQCT scans of the distal radius and DXA scans of the proximal femur and lateral spine. Poisson regression with robust variance estimation was used to derive relative risks for the relationship between individual bone microarchitectural and FEA parameters and previous fracture. Cluster analysis of these parameters was then performed to identify phenotypes associated with fracture prevalence. Receiver operating characteristic analysis suggested that bone microarchitectural parameters improved fracture discrimination compared to aBMD alone, whereas further inclusion of FEA parameters resulted in minimal improvements. Cluster analysis (k-means) identified four clusters. The first had lower Young modulus, cortical thickness, cortical volumetric density and Von Mises stresses compared to the wider sample; fracture rates were only significantly greater among women (relative risk [95%CI] compared to lowest risk cluster: 2.55 [1.28, 5.07], p = 0.008). The second cluster in women had greater trabecular separation, lower trabecular volumetric density and lower trabecular load with an increase in fracture rate compared to lowest risk cluster (1.93 [0.98, 3.78], p = 0.057). These findings may help inform intervention strategies for the prevention and management of osteoporosis.
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Affiliation(s)
- Leo D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Clare Shere
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Mark H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Queen Alexandra Hospital, Portsmouth, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
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Wang J, Zhou B, Hu Y, Zhang Z, Yu YE, Nawathe S, Nishiyama KK, Keaveny TM, Shane E, Guo XE. Accurate and Efficient Plate and Rod Micro Finite Element Whole Bone Models Based on High-Resolution Peripheral Computed Tomography. J Biomech Eng 2019; 141:2723756. [PMID: 30703208 DOI: 10.1115/1.4042680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Indexed: 12/29/2022]
Abstract
The high-resolution peripheral quantitative computed tomography (HRpQCT) provides unprecedented visualization of bone microstructure and the basis for constructing patient-specific micro-finite element (µFE) models. Based on HRpQCT images, we have developed a plate rod µFE (PRµFE) method for whole bone segments using individual trabecula segmentation (ITS) and an adaptive cortical meshing technique. In contrast to the conventional voxel approach, the complex microarchitecture of the trabecular compartment is simplified into shell and beam elements based on the trabecular plate-and-rod configuration. Compared to voxel-based µFE models of µCT and mechanical testing, nonlinear analyses of stiffness and yield strength using the HRpQCT-based PRµFE models demonstrated high correlation and accuracy, indicating that the combination of segmented trabecular plate-rod morphology and adjusted cortical mesh adequately captures mechanics of the whole bone segment. Meanwhile, the PRµFE approach reduced model size by nearly 300-fold and shortened computation time for nonlinear analysis from days to within hours, permitting broader clinical application of HRpQCT-based nonlinear µFE modeling. Furthermore, the presented approach was tested using a subset of radius and tibia HRpQCT scans of patients with prior vertebral fracture from a previous study. Results indicated that yield strength for radius and tibia predicted by the PRµFE model was effective in discriminating vertebral fracture subjects from non-fractured controls. In conclusion, the PR µFE model of HRpQCT images accurately predicted mechanics for whole bone segments and can serve as a valuable clinical tool to evaluate musculoskeletal diseases.
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Affiliation(s)
- Ji Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A
| | - Zhendong Zhang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A; Department of Orthopedic Surgery, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Y Eric Yu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A
| | - Shashank Nawathe
- Orthopaedic Biomechanics Laboratory, Department of Mechanical Engineering, University of California, Berkeley, California, U.S.A
| | - Kyle K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University, New York, New York, U.S.A
| | - Tony M Keaveny
- Orthopaedic Biomechanics Laboratory, Department of Mechanical Engineering, University of California, Berkeley, California, U.S.A
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, New York, U.S.A
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York, U.S.A
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Shimizu S, Matsushita H, Minami A, Kanazawa H, Suzuki T, Watanabe K, Wakatsuki A. Royal jelly does not prevent bone loss but improves bone strength in ovariectomized rats. Climacteric 2018; 21:601-606. [PMID: 30296854 DOI: 10.1080/13697137.2018.1517739] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Royal jelly (RJ) has been used for medical and nutritional purposes, and previous studies have indicated that it may have estrogenic activity. The present study investigated the effects of RJ on bone metabolism in ovariectomized (OVX) rats. METHODS Rats (12 weeks old) were randomly divided into four groups, namely Baseline, Sham, OVX, and OVX + RJ groups. Rats in the Baseline group were killed immediately, whereas rats in the OVX and OVX + RJ groups underwent bilateral ovariectomy and those in the Sham group underwent sham operation. RJ was administered to rats in the OVX + RJ group daily for 12 weeks. At the end of the 12-week period, bone mass, bone histomorphometry, and bone mechanics were analyzed. RESULTS Femur bone mineral density (BMD) was significantly lower in the OVX group than in the Sham group, and this decrease in BMD was not ameliorated by RJ administration. However, femur stiffness, as evaluated by a three-point bending test, was significantly higher in the OVX + RJ group than in the OVX group. CONCLUSION The findings of the present study suggest that RJ does not prevent bone loss, but does improve bone strength in OVX rats.
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Affiliation(s)
- S Shimizu
- a Department of Obstetrics and Gynecology, School of Medicine , Aichi Medical University , Nagakute , Japan
| | - H Matsushita
- a Department of Obstetrics and Gynecology, School of Medicine , Aichi Medical University , Nagakute , Japan
| | - A Minami
- b Department of Biochemistry, School of Pharmaceutical Sciences , University of Shizuoka , Shizuoka , Japan
| | - H Kanazawa
- c Department of Functional Anatomy, School of Nursing , University of Shizuoka , Shizuoka , Japan
| | - T Suzuki
- b Department of Biochemistry, School of Pharmaceutical Sciences , University of Shizuoka , Shizuoka , Japan
| | - K Watanabe
- a Department of Obstetrics and Gynecology, School of Medicine , Aichi Medical University , Nagakute , Japan
| | - A Wakatsuki
- a Department of Obstetrics and Gynecology, School of Medicine , Aichi Medical University , Nagakute , Japan
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Mys K, Stockmans F, Vereecke E, van Lenthe GH. Quantification of bone microstructure in the wrist using cone-beam computed tomography. Bone 2018; 114:206-214. [PMID: 29909060 DOI: 10.1016/j.bone.2018.06.006] [Citation(s) in RCA: 22] [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: 03/08/2018] [Revised: 05/15/2018] [Accepted: 06/10/2018] [Indexed: 11/19/2022]
Abstract
Due to the rising life expectancy, bone diseases (e.g. osteoporosis, osteoarthritis) and trauma (e.g. fracture) have become an important socio-economic burden. Accurate visualization and quantification of the bone microstructure in vivo is seen as an important step to enhance diagnosis and treatment. Micro-computed tomography (microCT) has become the gold standard in three-dimensional (3D) imaging of trabecular bone structure. Yet, usage is limited to ex vivo analyses, hence, it cannot be used to evaluate bone and bone adaptive responses in a patient. High-resolution peripheral computed tomography (HR-pQCT) is considered the best technique to measure the bone microarchitecture in vivo. By design HR-pQCT is limited to scanning extremities, such as the distal radius and distal tibia with a limited field of view and long scanning time (~2 à 3 min. for a stack of 0.9 cm). Cone-beam computed tomography (CBCT) is a promising alternative with a much larger field of view. Yet, CBCT is challenged by artefacts that reduce image contrast, such that it is currently being used for qualitative evaluation only. Therefore, the aims of this work were first to enhance image contrast and second to determine the accuracy of high-resolution CBCT for bone microarchitectural assessment. Trapezia of nineteen female arthritic patients were scanned twice ex vivo; once using CBCT (NewTom 5G, Cefla, Verona, Italy) at a nominal voxel size of 75 μm and once using microCT (SkyScan 1172, Bruker, Kontich, Belgium) at a voxel size of 19.84 μm. The CBCT-scans were reconstructed following 2 protocols: (1) using the commercial software delivered with the scanner and (2) using in-house developed software. After reconstruction and image processing, the images were segmented using adaptive thresholding. Bone morphometric parameters including bone volume (BV), total tissue volume (TV), bone volume fraction (BV/TV), bone surface density (BS/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp) and trabecular number (Tb.N) were calculated. Statistical evaluations were made at a significance level of 5%. Significant correlations were found between the CBCT-based bone parameters and the microCT-based parameters with R2 > 0.68 The in-house reconstructed software outperformed the commercial software. Smaller bias (overestimation of Tb.Th decreased from 114.24% to 59.96%) as well as higher correlations were observed for the in-house processed images. Still, a significant overestimation was observed for BV/TV and Tb. Th and an underestimation for Tb.N. We conclude that our CBCT image reconstruction improved image contrast which allowed for an accurate quantification of trabecular bone microarchitecture.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium.
| | - Filip Stockmans
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie Vereecke
- Muscles & Movement, Department of development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical engineering, KU Leuven, Leuven, Belgium
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Comparison of HR-pQCT- and microCT-based finite element models for the estimation of the mechanical properties of the calcaneus trabecular bone. Biomech Model Mechanobiol 2018; 17:1715-1730. [DOI: 10.1007/s10237-018-1051-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
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Stemmler F, Simon D, Liphardt AM, Englbrecht M, Rech J, Hueber AJ, Engelke K, Schett G, Kleyer A. Biomechanical properties of bone are impaired in patients with ACPA-positive rheumatoid arthritis and associated with the occurrence of fractures. Ann Rheum Dis 2018; 77:973-980. [PMID: 29475856 PMCID: PMC6029639 DOI: 10.1136/annrheumdis-2017-212404] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/26/2018] [Accepted: 01/30/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Bone loss is a well-established consequence of rheumatoid arthritis (RA). To date, bone disease in RA is exclusively characterised by bone density measurements, while the functional properties of bone in RA are undefined. This study aimed to define the impact of RA on the functional properties of bone, such as failure load and stiffness. METHODS Micro-finite element analysis (µFEA) was carried out to measure failure load and stiffness of bone based on high-resolution peripheral quantitative CT data from the distal radius of anti-citrullinated protein antibody (ACPA)-positive RA (RA+), ACPA-negative RA (RA-) and healthy controls (HC). In addition, total, trabecular and cortical bone densities as well as microstructural parameters of bone were recorded. Correlations and multivariate models were used to determine the role of demographic, disease-specific and structural data of bone strength as well as its relation to prevalent fractures. RESULTS 276 individuals were analysed. Failure load and stiffness (both P<0.001) of bone were decreased in RA+, but not RA-, compared with HC. Lower bone strength affected both female and male patients with RA+, was related to longer disease duration and significantly (stiffness P=0.020; failure load P=0.012) associated with the occurrence of osteoporotic fractures. Impaired bone strength was correlated with altered bone density and microstructural parameters, which were all decreased in RA+. Multivariate models showed that ACPA status (P=0.007) and sex (P<0.001) were independently associated with reduced biomechanical properties of bone in RA. CONCLUSION In summary, µFEA showed that bone strength is significantly decreased in RA+ and associated with fractures.
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Affiliation(s)
- Fabian Stemmler
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Anna-Maria Liphardt
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Englbrecht
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Juergen Rech
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Axel J Hueber
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Klaus Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Erlangen, Germany
| | - Georg Schett
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Friedrich Alexander University Erlangen-Nürnberg, Department of Internal Medicine 3, Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
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Rozental TD, Johannesdottir F, Kempland KC, Bouxsein ML. Characterization of trabecular bone microstructure in premenopausal women with distal radius fractures. Osteoporos Int 2018; 29:409-419. [PMID: 29101409 DOI: 10.1007/s00198-017-4293-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/27/2017] [Indexed: 11/30/2022]
Abstract
UNLABELLED Individual trabecular segmentation was utilized to identify differences in trabecular bone structure in premenopausal women with wrist fractures and non-fracture controls. Fracture subjects had reduced trabecular plate volume, number, thickness, and connectivity. Identifying altered trabecular microarchitecture in young women offers opportunities for counseling and lifestyle modifications to reduce fracture risk. INTRODUCTION Premenopausal women with distal radius fractures (DRF) have worse trabecular bone microarchitecture than non-fracture controls (CONT), yet the characteristics of their trabecular bone structure are unknown. METHODS Premenopausal women with DRF (n = 40) and CONT (n = 80) were recruited. Primary outcome variables included trabecular structure at the distal radius and tibia, assessed by volumetric decomposition of individual trabecular plates and rods from high-resolution peripheral quantitative CT images. Trabecular morphology included plate and rod number, volume, thickness, and connectivity. Areal bone mineral density (aBMD) of the femoral neck (FN aBMD), and ultradistal radius (UDR aBMD) were measured by DXA. RESULTS Trabecular morphology differed between DRF and CONT at the radius and tibia (OR per SD decline 1.58-2.7). At the radius, associations remained significant when adjusting for age and FN aBMD (ORs = 1.76-3.26) and age and UDR aBMD (ORs = 1.72-3.97). Plate volume fraction, number and axially aligned trabeculae remained associated with DRF after adjustment for trabecular density (ORs = 2.55-2.85). Area under the curve (AUC) for discriminating DRF was 0.74 for the proportion of axially aligned trabeculae, compared with 0.60 for FN aBMD, 0.65 for UDR aBMD, and 0.69 for trabecular density. Plate number, plate-plate junction, and axial bone volume fraction remained associated with DRF at the tibia (ORs = 2.14-2.77) after adjusting for age, FN aBMD, or UDR aBMD. AUCP.P.Junc.D was 0.72 versus 0.61 for FNaBMD, 0.66 for UDRaBMD, and 0.70 for trabecular density. CONCLUSION Premenopausal women with DRF have lower trabecular plate volume, number, thickness, and connectivity than CONT. Identification of young women with altered microarchitecture offers opportunities for lifestyle modifications to reduce fracture risk.
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Affiliation(s)
- T D Rozental
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, 330 Brookline Avenue - Stoneman 10, Boston, MA, 02215, USA.
| | - F Johannesdottir
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Orthopedic Biomechanics Laboratory, RN 119, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - K C Kempland
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, 330 Brookline Avenue - Stoneman 10, Boston, MA, 02215, USA
| | - M L Bouxsein
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Orthopedic Biomechanics Laboratory, RN 119, 330 Brookline Avenue, Boston, MA, 02215, USA
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Biver E, Durosier-Izart C, Chevalley T, van Rietbergen B, Rizzoli R, Ferrari S. Evaluation of Radius Microstructure and Areal Bone Mineral Density Improves Fracture Prediction in Postmenopausal Women. J Bone Miner Res 2018; 33:328-337. [PMID: 28960489 DOI: 10.1002/jbmr.3299] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022]
Abstract
A majority of low-trauma fractures occur in subjects with only moderate decrease of areal bone mineral density (aBMD), ie, osteopenia, assessed by dual-energy X-ray absorptiometry (DXA) or low fracture probability assessed by FRAX. We investigated whether peripheral bone microstructure and estimated strength improve the prediction of incident fractures beyond central DXA and FRAX. In this population-based study of 740 postmenopausal women (aged 65.0 ± 1.4 years) from the Geneva Retirees Cohort (ISRCTN registry 11865958), we assessed at baseline cortical (Ct) and trabecular (Tb) volumetric bone mineral density (vBMD) and microstructure by peripheral quantitative computed tomography (HR-pQCT); bone strength by micro-finite element analysis; aBMD and trabecular bone score (TBS) by DXA; and FRAX fracture probability. Eighty-five low-trauma fractures occurred in 68 women over a follow-up of 5.0 ± 1.8 years. Tb and Ct vBMD and microstructure predicted incident fractures, independently of each other and of femoral neck (FN) aBMD and FRAX (with BMD ± TBS). However, the associations were markedly attenuated after adjustment for ultra-distal radius aBMD (same bone site). The best discrimination between women with and without fracture was obtained at the radius with total vBMD, the combination of a Tb with a Ct parameter, or with failure load, which improved the area under the curve (AUC) for major osteoporotic fracture when added to FN aBMD (0.760 versus 0.695, p = 0.022) or to FRAX-BMD (0.759 versus 0.714, p = 0.015). The replacement of failure load by ultra-distal aBMD did not significantly decrease the AUC (0.753, p = 0.747 and 0.750, p = 0.509, respectively). In conclusion, peripheral bone microstructure and strength improve the prediction of fractures beyond central DXA and FRAX but are partially captured in aBMD measured by DXA at the radius. Because HR-pQCT is not widely available for clinical purposes, assessment of ultra-distal radius aBMD by DXA may meanwhile improve fracture risk estimation. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claire Durosier-Izart
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Fan R, Liu J, Jia Z, Deng Y, Liu J. Determination of a tissue-level failure evaluation standard for rat femoral cortical bone utilizing a hybrid computational-experimental method. Proc Inst Mech Eng H 2017; 232:80-89. [PMID: 29165039 DOI: 10.1177/0954411917743275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Macro-level failure in bone structure could be diagnosed by pain or physical examination. However, diagnosing tissue-level failure in a timely manner is challenging due to the difficulty in observing the interior mechanical environment of bone tissue. Because most fractures begin with tissue-level failure in bone tissue caused by continually applied loading, people attempt to monitor the tissue-level failure of bone and provide corresponding measures to prevent fracture. Many tissue-level mechanical parameters of bone could be predicted or measured; however, the value of the parameter may vary among different specimens belonging to a kind of bone structure even at the same age and anatomical site. These variations cause difficulty in representing tissue-level bone failure. Therefore, determining an appropriate tissue-level failure evaluation standard is necessary to represent tissue-level bone failure. In this study, the yield and failure processes of rat femoral cortical bones were primarily simulated through a hybrid computational-experimental method. Subsequently, the tissue-level strains and the ratio between tissue-level failure and yield strains in cortical bones were predicted. The results indicated that certain differences existed in tissue-level strains; however, slight variations in the ratio were observed among different cortical bones. Therefore, the ratio between tissue-level failure and yield strains for a kind of bone structure could be determined. This ratio may then be regarded as an appropriate tissue-level failure evaluation standard to represent the mechanical status of bone tissue.
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Affiliation(s)
- Ruoxun Fan
- 1 Department of Automotive Engineering, Jilin Institute of Chemical Technology, Jilin, P.R. China
| | - Jie Liu
- 1 Department of Automotive Engineering, Jilin Institute of Chemical Technology, Jilin, P.R. China
| | - Zhengbin Jia
- 2 Department of Engineering Mechanics, Jilin University, Changchun, P.R. China
| | - Ying Deng
- 3 School of Public Health, Jilin University, Changchun, P.R. China
| | - Jun Liu
- 4 Hand & Foot Surgery and Reparative & Reconstructive Surgery Center, No. 2 Hospital of Jilin University, Changchun, P.R. China
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Johnson JE, Troy KL. Simplified boundary conditions alter cortical-trabecular load sharing at the distal radius; A multiscale finite element analysis. J Biomech 2017; 66:180-185. [PMID: 29137724 DOI: 10.1016/j.jbiomech.2017.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/27/2017] [Accepted: 10/28/2017] [Indexed: 10/18/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) derived micro-finite element (FE) modeling is used to evaluate mechanical behavior at the distal radius microstructure. However, these analyses typically simulate non-physiologic simplified platen-compression boundary conditions on a small section of the distal radius. Cortical and trabecular regions contribute uniquely to distal radius mechanical behavior, and various factors affect these regions distinctly. Generalized strength predictions from standardized platen-compression analyses may not adequately capture region specific responses in bone. Our goal was to compare load sharing within the cortical-trabecular compartments between the standardized platen-compression BC simulations, and physiologic BC simulations using a validated multiscale approach. Clinical- and high-resolution images were acquired from nine cadaveric forearm specimens using an HR-pQCT scanner. Multiscale FE models simulating physiologic BCs, and micro-FE only models simulating platen-compression BCs were created for each specimen. Cortical and trabecular loads (N) along the length of the distal radius micro-FE section were compared between BCs using correlations. Principal strain distributions were also compared quantitatively. Cortical and trabecular loads from the platen-compression BC simulations were strongly correlated to the physiologic BC simulations. However, a 30% difference in cortical loads distally, and a 53% difference in trabecular loads proximally was observed under platen BC simulations. Also, distribution of principal strains was clearly different. Our data indicated that platen-compression BC simulations alter cortical-trabecular load sharing. Therefore, results from these analyses should be interpreted in the appropriate mechanical context for clinical evaluations of normal and pathologic mechanical behavior at the distal radius.
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Affiliation(s)
- Joshua E Johnson
- Worcester Polytechnic Institute, Department of Biomedical Engineering, 100 Institute Road, Worcester, MA 01609, United States.
| | - Karen L Troy
- Worcester Polytechnic Institute, Department of Biomedical Engineering, 100 Institute Road, Worcester, MA 01609, United States.
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Chevalley T, Bonjour JP, Audet MC, Merminod F, van Rietbergen B, Rizzoli R, Ferrari S. Fracture Prospectively Recorded From Prepuberty to Young Adulthood: Are They Markers of Peak Bone Mass and Strength in Males? J Bone Miner Res 2017; 32:1963-1969. [PMID: 28543781 DOI: 10.1002/jbmr.3174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 11/05/2022]
Abstract
Fractures are common in otherwise healthy children and adolescents. They result from trauma of varying severity. Some reflect a greater skeletal fragility. A long-term implication of these fractures is their potentiality to predict adult bone fragility and increased risk of osteoporosis in later life. Using dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and micro-finite element analysis (μFEA) measurements, we previously found in 124 healthy females, followed from the age of 7.9 to 20.4 years, substantial deficits in both structural and strength components of the radius in the 42 girls who sustained a fracture during skeletal development. The objective of the current study was to assess in healthy males the relationship between fracture during development and expression of bone fragility in adulthood. A cohort of 152 boys was followed from age 7.4 ± 04 (mean ± SD) to 22.6 ± 0.7 years, ie, when peak bone mass is attained. Ninety participants (59.2%) sustained at least one fracture during growth, with highest incidence within the 10- to 13-year age range. Forearm was the most frequent site of fractures. At 7.4 years, several bone DXA-measured variables (areal bone mineral density [aBMD], bone mineral content [BMC]) were lower in the group with a positive fracture history during skeletal development compared with the non-fractured group. In contrast, at 22.6 years, no DXA-measured sites, including forearm, indicated a deficit in the fractured group compared with the non-fractured group. Likewise, at 22.6 years, neither HR-pQCT nor μFEA measurements, including distal radius, showed a structural or strength deficit in the fractured group. These results markedly contrast with a similar prospective study using the same technical and clinical design in 124 healthy girls. In conclusion, our prospective studies suggest a sex difference in the predictability of bone fragility in young adults who sustained fractures during childhood and adolescence. This difference might be related to the degree of trauma severity, usually lower in girls than in boys. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Thierry Chevalley
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Philippe Bonjour
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Claude Audet
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fanny Merminod
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Rene Rizzoli
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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de Jong JJA, Arts JJC, Willems PC, Bours SPG, Bons JPA, Menheere PPCA, van Rietbergen B, Geusens PP, van den Bergh JPW. Contra-lateral bone loss at the distal radius in postmenopausal women after a distal radius fracture: A two-year follow-up HRpQCT study. Bone 2017; 101:245-251. [PMID: 28502885 DOI: 10.1016/j.bone.2017.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/21/2017] [Accepted: 05/10/2017] [Indexed: 11/24/2022]
Abstract
Opposite to the fracture side, bone mineral density (BMD) measured by DXA at the contra-lateral side does not change after a distal radius fracture. However, it is unknown if also bone micro-architecture and strength at the contralateral side are unaffected. Therefore, the aim of this study was to assess BMD, micro-architecture and bone mechanical properties at the contra-lateral side during two years follow-up after a distal radius fracture using high resolution peripheral quantitative computed tomography (HRpQCT). The contra-lateral distal radius of 15 postmenopausal women (mean age 64±8years) with a distal radius fracture treated by cast immobilization was scanned by HRpQCT at baseline, 3months and 2years post-fracture. BMD and cortical and trabecular micro-architecture were measured and biomechanical parameters were estimated using micro finite element analysis (μFEA). Additionally, markers of bone resorption and formation were measured at each visit. Bone parameters and turnover markers across the three visits were analysed using a linear mixed-effect model with Bonferroni correction. Two years post-fracture, a significant decrease from baseline was found in cortical BMD (-4.2%, p<0.001), failure load (-6.1%, p=0.001), stiffness in compression (-5.7%, p=0.003) and bending (-6.4%, p=0.008), and bone formation (-47.6%, p=0.010). No significant changes from baseline were observed in total and trabecular BMD, nor in cortical or trabecular micro-architecture and neither in bone resorption. Results were similar between patients with or without adequate anti-osteoporosis drug treatment. We found a significant decline in BMD in the cortical but not the trabecular region, and a reduction in bone strength and stiffness at the contra-lateral side two years after a distal radius fracture. These changes exceeded the changes that may be expected due to aging, even in the presence of adequate anti-osteoporosis treatment.
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Affiliation(s)
- Joost J A de Jong
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, The Netherlands; Department of Rheumatology, Maastricht University Medical Center, The Netherlands.
| | - Jacobus J C Arts
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, The Netherlands; Department of Orthopaedic Surgery, Maastricht University Medical Center, The Netherlands; Faculty of Biomedical Engineering, Section Orthopaedic Biomechanics, Eindhoven University of Technology, The Netherlands
| | - Paul C Willems
- CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, The Netherlands; Department of Orthopaedic Surgery, Maastricht University Medical Center, The Netherlands
| | - Sandrine P G Bours
- Department of Rheumatology, Maastricht University Medical Center, The Netherlands
| | - Judith P A Bons
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul P C A Menheere
- Central Diagnostic Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bert van Rietbergen
- Faculty of Biomedical Engineering, Section Orthopaedic Biomechanics, Eindhoven University of Technology, The Netherlands
| | - Piet P Geusens
- Department of Rheumatology, Maastricht University Medical Center, The Netherlands; CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, The Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium
| | - Joop P W van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, The Netherlands; Department of Rheumatology, Maastricht University Medical Center, The Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium; Department of Internal Medicine, VieCuri Medical Center Venlo, The Netherlands
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Sornay-Rendu E, Boutroy S, Duboeuf F, Chapurlat RD. Bone Microarchitecture Assessed by HR-pQCT as Predictor of Fracture Risk in Postmenopausal Women: The OFELY Study. J Bone Miner Res 2017; 32:1243-1251. [PMID: 28276092 DOI: 10.1002/jbmr.3105] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/19/2017] [Accepted: 02/04/2017] [Indexed: 11/11/2022]
Abstract
Several cross-sectional studies have shown that impairment of bone microarchitecture contributes to skeletal fragility. The aim of this study was to prospectively investigate the prediction of fracture (Fx) by bone microarchitecture assessed by high-resolution peripheral computed tomography (HR- pQCT) in postmenopausal women. We measured microarchitecture at the distal radius and tibia with HR-pQCT in the OFELY study, in addition to areal BMD with dual-energy X-ray absorptiometry (DXA) in 589 women, mean ± SD age 68 ± 9 years. During a median [IQ] 9.4 [1.0] years of follow-up, 135 women sustained an incident fragility Fx, including 81 women with a major osteoporotic Fx (MOP Fx). After adjustment for age, women who sustained Fx had significantly lower total and trabecular volumetric densities (vBMD) at both sites, cortical parameters (area and thickness at the radius, vBMD at the tibia), trabecular number (Tb.N), connectivity density (Conn.D), stiffness, and estimated failure load at both sites, compared with control women. After adjustment for age, current smoking, falls, prior Fx, use of osteoporosis-related drugs, and total hip BMD, each quartile decrease of several baseline values of bone microarchitecture at the radius was associated with significant change of the risk of Fx (HR of 1.39 for Tb.BMD [p = 0.001], 1.32 for Tb.N [p = 0.01], 0.76 for Tb.Sp.SD [p = 0.01], 1.49 [p = 0.01] for Conn.D, and 1.27 for stiffness [p = 0.02]). At the tibia, the association remained significant for stiffness and failure load in the multivariate model for all fragility Fx and for Tt.BMD, stiffness, and failure load for MOP Fx. We conclude that impairment of bone microarchitecture-essentially in the trabecular compartment of the radius-predict the occurrence of incident fracture in postmenopausal women. This assessment may play an important role in identifying women at high risk of fracture who could not be adequately detected by BMD measurement alone, to benefit from a therapeutic intervention. © 2017 American Society for Bone and Mineral Research.
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Contribution of high resolution peripheral quantitative CT to the management of bone and joint diseases. Joint Bone Spine 2017; 85:301-306. [PMID: 28512004 DOI: 10.1016/j.jbspin.2017.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/26/2017] [Indexed: 01/08/2023]
Abstract
Many imaging modalities have been described to diagnose and monitor osteoporosis (OP), osteoarthritis and inflammatory rheumatic diseases. Over the last ten years, High Resolution peripheral Quantitative Computerized Tomography (HR-pQCT) was shown to be a precise and non invasive technique to study bone and joint diseases in clinical research. It allows the study of both cortical and trabecular bone microarchitecture at the distal tibia and radius, and further applications have been developed such as the study of mechanical properties by the finite element analysis. Thus, in case-control and cross-sectional studies, microarchitecture parameters discriminated fractured individuals independently of areal BMD. Also, microstructure parameters can predict incident fracture in postmenopausal women. In metabolic diseases associated with bone fragility, HR-pQCT may also be used to explore bone changes. In joint disease studies, HR-pQCT was a remarkable tool to assess bone erosion and joint space narrowing at the hand. This article gives an overview of this imaging technique.
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Neumeyer AM, Cano Sokoloff N, McDonnell E, Macklin EA, McDougle CJ, Misra M. Bone microarchitecture in adolescent boys with autism spectrum disorder. Bone 2017; 97:139-146. [PMID: 28088646 PMCID: PMC6309443 DOI: 10.1016/j.bone.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/07/2017] [Accepted: 01/10/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Boys with autism spectrum disorder (ASD) have lower areal bone mineral density (aBMD) than typically developing controls (TDC). Studies of volumetric BMD (vBMD) and bone microarchitecture provide information about fracture risk beyond that provided by aBMD but are currently lacking in ASD. OBJECTIVES To assess ultradistal radius and distal tibia vBMD, bone microarchitecture and strength estimates in adolescent boys with ASD compared to TDC. DESIGN/METHODS Cross-sectional study of 34 boys (16 ASD, 18 TDC) that assessed (i) aBMD at the whole body (WB), WB less head (WBLH), hip and spine using dual X-ray absorptiometry (DXA), (ii) vBMD and bone microarchitecture at the ultradistal radius and distal tibia using high-resolution peripheral quantitative CT (HRpQCT), and (iii) bone strength estimates (stiffness and failure load) using micro-finite element analysis (FEA). We controlled for age in all groupwise comparisons of HRpQCT and FEA measures. Activity questionnaires, food records, physical exam, and fasting levels of 25(OH) vitamin D and bone markers (C-terminal collagen crosslinks and N-terminal telopeptide (CTX and NTX) for bone resorption, N-terminal propeptide of Type 1 procollagen (P1NP) for bone formation) were obtained. RESULTS ASD participants were slightly younger than TDC participants (13.6 vs. 14.2years, p=0.44). Tanner stage, height Z-scores and fasting serum bone marker levels did not differ between groups. ASD participants had higher BMI Z-scores, percent body fat, IGF-1 Z-scores, and lower lean mass and aBMD Z-scores than TDC at the WB, WBLH, and femoral neck (P<0.1). At the radius, ASD participants had lower trabecular thickness (0.063 vs. 0.070mm, p=0.004), compressive stiffness (56.7 vs. 69.7kN/mm, p=0.030) and failure load (3.0 vs. 3.7kN, p=0.031) than TDC. ASD participants also had 61% smaller cortical area (6.6 vs. 16.4mm2, p=0.051) and thickness (0.08 vs. 0.22mm, p=0.054) compared to TDC. At the tibia, ASD participants had lower compressive stiffness (183 vs. 210kN/mm, p=0.048) and failure load (9.4 vs. 10.8kN, p=0.043) and 23% smaller cortical area (60.3 vs. 81.5mm2, p=0.078) compared to TDC. A lower proportion of ASD participants were categorized as "very physically active" (20% vs. 72%, p=0.005). Differences in physical activity, calcium intake and IGF-1 responsiveness may contribute to group differences in stiffness and failure load. CONCLUSION Bone microarchitectural parameters are impaired in ASD, with reductions in bone strength estimates (stiffness and failure load) at the ultradistal radius and distal tibia. This may result from lower physical activity and calcium intake, and decreased IGF-1 responsiveness.
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Affiliation(s)
- Ann M Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States.
| | - Natalia Cano Sokoloff
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States
| | - Erin McDonnell
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Eric A Macklin
- Harvard Medical School, Boston, MA 02115, United States; Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA 02421, United States; Harvard Medical School, Boston, MA 02115, United States
| | - Madhusmita Misra
- Harvard Medical School, Boston, MA 02115, United States; Pediatric Endocrine and Neuroendocrine Units, Massachusetts General Hospital, Boston, MA 02114, United States
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Johnson JE, Troy KL. Validation of a new multiscale finite element analysis approach at the distal radius. Med Eng Phys 2017; 44:16-24. [PMID: 28373011 DOI: 10.1016/j.medengphy.2017.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 03/02/2017] [Accepted: 03/12/2017] [Indexed: 12/15/2022]
Abstract
High-resolution peripheral computed tomography is commonly used to evaluate mechanical behavior of the distal radius microstructure using micro-finite element (FE) modeling. However, only a 9mm section is considered and boundary conditions (BCs) are usually simplified (platen-compression), and may not represent physiologic loading. Regardless, these methods are increasingly being used for clinical evaluations. Our goal was to develop and validate a novel multiscale solution that allows for physiologically relevant loading simulations (such as bracing during a fall), and show that mechanical behavior in the distal radius is different under platen BCs. Our approach incorporated bone microstructure together with organ-level radius geometry, by replacing matching continuum regions with micro-FE sections in user-defined regions of interest. Multiscale model predicted strains showed a strong correlation and a significant relationship with measured strains (r=0.836, p<0.001; slope=0.881, intercept=-12.17 µε, p<0.001). Interestingly, platen BC simulated strains were almost 50% lower than measured strains (r=0.835, p<0.001), and strain distributions were clearly different. Our multiscale method demonstrated excellent potential as a computationally efficient alternative for observing true mechanical environment within distal radius microstructure under physiologically accurate loading.
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Affiliation(s)
- Joshua E Johnson
- Worcester Polytechnic Institute, Department of Biomedical Engineering, 100 Institute Road, Worcester, MA 01609, Unites States of America.
| | - Karen L Troy
- Worcester Polytechnic Institute, Department of Biomedical Engineering, 100 Institute Road, Worcester, MA 01609, Unites States of America.
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Abstract
PURPOSE OF REVIEW This paper seeks to evaluate and compare recent advances in the clinical assessment of the changes in bone mechanical properties that take place as a result of osteoporosis and other metabolic bone diseases and their treatments. RECENT FINDINGS In addition to the standard of DXA-based areal bone mineral density (aBMD), a variety of methods, including imaging-based structural measurements, finite element analysis (FEA)-based techniques, and alternate methods including ultrasound, bone biopsy, reference point indentation, and statistical shape and density modeling, have been developed which allow for reliable prediction of bone strength and fracture risk. These methods have also shown promise in the evaluation of treatment-induced changes in bone mechanical properties. Continued technological advances allowing for increasingly high-resolution imaging with low radiation dose, together with the expanding adoption of DXA-based predictions of bone structure and mechanics, as well as the increasing awareness of the importance of bone material properties in determining whole-bone mechanics, lead us to anticipate substantial future advances in this field.
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Affiliation(s)
- Chantal M J de Bakker
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Wei-Ju Tseng
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Yihan Li
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA
| | - Hongbo Zhao
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA
| | - X Sherry Liu
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, 426C Stemmler Hall, 36th Street and Hamilton Walk, Philadelphia, PA, 19104, USA.
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45
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Abstract
Beyond bone mineral density (BMD), bone quality designates the mechanical integrity of bone tissue. In vivo images based on X-ray attenuation, such as CT reconstructions, provide size, shape, and local BMD distribution and may be exploited as input for finite element analysis (FEA) to assess bone fragility. Further key input parameters of FEA are the material properties of bone tissue. This review discusses the main determinants of bone mechanical properties and emphasizes the added value, as well as the important assumptions underlying finite element analysis. Bone tissue is a sophisticated, multiscale composite material that undergoes remodeling but exhibits a rather narrow band of tissue mineralization. Mechanically, bone tissue behaves elastically under physiologic loads and yields by cracking beyond critical strain levels. Through adequate cell-orchestrated modeling, trabecular bone tunes its mechanical properties by volume fraction and fabric. With proper calibration, these mechanical properties may be incorporated in quantitative CT-based finite element analysis that has been validated extensively with ex vivo experiments and has been applied increasingly in clinical trials to assess treatment efficacy against osteoporosis.
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Affiliation(s)
- Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - Philippe K Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland.
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46
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Burt LA, Liang Z, Sajobi TT, Hanley DA, Boyd SK. Sex- and Site-Specific Normative Data Curves for HR-pQCT. J Bone Miner Res 2016; 31:2041-2047. [PMID: 27192388 DOI: 10.1002/jbmr.2873] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/05/2016] [Accepted: 05/15/2016] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to develop age-, site-, and sex-specific centile curves for common high-resolution peripheral quantitative computed tomography (HR-pQCT) and finite-element (FE) parameters for males and females older than 16 years. Participants (n = 866) from the Calgary cohort of the Canadian Multicentre Osteoporosis Study (CaMos) between the ages of 16 and 98 years were included in this study. Participants' nondominant radius and left tibia were scanned using HR-pQCT. Standard and automated segmentation methods were performed and FE analysis estimated apparent bone strength. Centile curves were generated for males and females at the tibia and radius using the generalized additive models for location, scale, and shape (GAMLSS) package in R. After GAMLSS analysis, age-, sex-, and site-specific centiles (10th, 25th, 50th, 75th, 90th) for total bone mineral density and trabecular number as well as failure load have been calculated. Clinicians and researchers can use these reference curves as a tool to assess bone health and changes in bone quality. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Lauren A Burt
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Zhiying Liang
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - David A Hanley
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
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47
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Christen P, Schulte FA, Zwahlen A, van Rietbergen B, Boutroy S, Melton LJ, Amin S, Khosla S, Goldhahn J, Müller R. Voxel size dependency, reproducibility and sensitivity of an in vivo bone loading estimation algorithm. J R Soc Interface 2016; 13:20150991. [PMID: 26790999 DOI: 10.1098/rsif.2015.0991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A bone loading estimation algorithm was previously developed that provides in vivo loading conditions required for in vivo bone remodelling simulations. The algorithm derives a bone's loading history from its microstructure as assessed by high-resolution (HR) computed tomography (CT). This reverse engineering approach showed accurate and realistic results based on micro-CT and HR-peripheral quantitative CT images. However, its voxel size dependency, reproducibility and sensitivity still need to be investigated, which is the purpose of this study. Voxel size dependency was tested on cadaveric distal radii with micro-CT images scanned at 25 µm and downscaled to 50, 61, 75, 82, 100, 125 and 150 µm. Reproducibility was calculated with repeated in vitro as well as in vivo HR-pQCT measurements at 82 µm. Sensitivity was defined using HR-pQCT images from women with fracture versus non-fracture, and low versus high bone volume fraction, expecting similar and different loading histories, respectively. Our results indicate that the algorithm is voxel size independent within an average (maximum) error of 8.2% (32.9%) at 61 µm, but that the dependency increases considerably at voxel sizes bigger than 82 µm. In vitro and in vivo reproducibility are up to 4.5% and 10.2%, respectively, which is comparable to other in vitro studies and slightly higher than in other in vivo studies. Subjects with different bone volume fraction were clearly distinguished but not subjects with and without fracture. This is in agreement with bone adapting to customary loading but not to fall loads. We conclude that the in vivo bone loading estimation algorithm provides reproducible, sensitive and fairly voxel size independent results at up to 82 µm, but that smaller voxel sizes would be advantageous.
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Affiliation(s)
| | | | | | - Bert van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Stephanie Boutroy
- INSERM UMR 1033, Hôpital Edouard Herriot, Université de Lyon, Lyon, France
| | - L Joseph Melton
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Shreyasee Amin
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jörg Goldhahn
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland Novartis, Institutes for BioMedical Research (NIBR), Basel, Switzerland
| | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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48
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Value of Measuring Bone Microarchitecture in Fracture Discrimination in Older Women with Recent Hip Fracture: A Case-control Study with HR-pQCT. Sci Rep 2016; 6:34185. [PMID: 27670149 PMCID: PMC5037450 DOI: 10.1038/srep34185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/09/2016] [Indexed: 11/09/2022] Open
Abstract
We aimed to determine whether loss of volumetric bone mineral density (vBMD) and deterioration of microarchitecture imaged by high-resolution peripheral quantitative computed tomography at the distal radius/tibia provided additional information in fracture discrimination in postmenopausal women with recent hip fracture. This case-control study involved 24 postmenopausal Chinese women with unilateral femoral neck fracture (average [SD] age: 79.6[5.6]) and 24 age-matched women without any history of fracture. Each SD decrease in T-score at femoral neck (FN) was associated with a higher fracture risk (odds ratio: 6.905, p = 0.001). At the distal radius, fracture women had significantly lower total vBMD (−17.5%), fewer (−20.3%) and more unevenly spaced (81.4%) trabeculae, and thinner cortices (−14.0%) (all p < 0.05). At the distal tibia, vBMD was on average −4.7% (cortical) to −25.4% (total) lower, trabecular microarchitecture was on average −19.8% (number) to 102% (inhomogeneity) inferior, cortices were thinner (−21.1%) and more porous (18.2%) (all p < 0.05). Adding parameters of vBMD and microarchitecture in multivariate models did not offer additional discriminative capacity of fracture status compared with using T-score at FN. In old postmenopausal women with already excessive loss of bone mass, measuring bone microarchitecture may provide limited added value to improve identification of risk of femoral neck fracture.
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49
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Kawalilak CE, Kontulainen SA, Amini MA, Lanovaz JL, Olszynski WP, Johnston JD. In vivo precision of three HR-pQCT-derived finite element models of the distal radius and tibia in postmenopausal women. BMC Musculoskelet Disord 2016; 17:389. [PMID: 27619649 PMCID: PMC5020521 DOI: 10.1186/s12891-016-1238-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 08/31/2016] [Indexed: 01/09/2023] Open
Abstract
Background The distal radius is the most common osteoporotic fracture site occurring in postmenopausal women. Finite element (FE) modeling is a non-invasive mathematical technique that can estimate bone strength using inputted geometry/micro-architecture and tissue material properties from computed tomographic images. Our first objective was to define and compare in vivo precision errors for three high-resolution peripheral quantitative computed tomography (HR-pQCT, XtremeCT; Scanco) based FE models of the distal radius and tibia in postmenopausal women. Our second objective was to assess the role of scan interval, scan quality, and common region on precision errors of outcomes for each FE model. Methods Models included: single-tissue model (STM), cortical-trabecular dual-tissue model (DTM), and one scaled model using imaged bone mineral density (E-BMD). Using HR-pQCT, we scanned the distal radius and tibia of 34 postmenopausal women (74 ± 7 years), at two time points. Primary outcomes included: tissue stiffness, apparent modulus, average von Mises stress, and failure load. Precision errors (root-mean-squared coefficient of variation, CV%RMS) were calculated. Multivariate ANOVA was used to compare the mean of individual CV% among the 3 HR-pQCT-based FE models. Spearman correlations were used to characterize the associations between precision errors of all FE model outcomes and scan/time interval, scan quality, and common region. Significance was accepted at P < 0.05. Results At the distal radius, CV%RMS precision errors were <9 % (Range STM: 2.8–5.3 %; DTM: 2.9–5.4 %; E-BMD: 4.4–8.7 %). At the distal tibia, CV%RMS precision errors were <6 % (Range STM: 2.7–4.8 %; DTM: 2.9–3.8 %; E-BMD: 1.8–2.5 %). At the radius, Spearman correlations indicated associations between the common region and associated precision errors of the E-BMD-derived apparent modulus (ρ = −0.392; P < 0.001) and von Mises stress (ρ = −0.297; P = 0.007). Conclusion Results suggest that the STM and DTM are more precise for modeling apparent modulus, average von Mises stress, and failure load at the distal radius. Precision errors were comparable for all three models at the distal tibia. Results indicate that the noted differences in precision error at the distal radius were associated with the common scan region, illustrating the importance of participant repositioning within the cast and reference line placement in the scout view during the scanning process.
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Affiliation(s)
- C E Kawalilak
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada.
| | - S A Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - M A Amini
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
| | - J L Lanovaz
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - W P Olszynski
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - J D Johnston
- Department of Mechanical Engineering, College of Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK, S7N 5A9, Canada
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50
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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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