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Johannesdottir F, Tedtsen T, Cooke LM, Mahar S, Zhang M, Nustad J, Garrahan MA, Gehman SE, Yu EW, Bouxsein ML. Microvascular disease and early diabetes onset are associated with deficits in femoral neck bone density and structure among older adults with longstanding type 1 diabetes. J Bone Miner Res 2024; 39:1454-1463. [PMID: 39151032 PMCID: PMC11425704 DOI: 10.1093/jbmr/zjae134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 07/29/2024] [Accepted: 08/04/2024] [Indexed: 08/18/2024]
Abstract
Adults with type 1 diabetes (T1D) have increased hip fracture risk, yet no studies have assessed volumetric bone density or structure at the hip in older adults with T1D. Here, we used previously collected 3D CT scans of the proximal femur from older adults with longstanding T1D and non-diabetic controls to identify bone deficits that may contribute to hip fracture in T1D. In this retrospective cohort study, we identified 101 adults with T1D and 181 age-, sex-, and race-matched non-diabetic controls (CON) who received abdominal or pelvis CT exams from 2010 to 2020. Among adults with T1D, 33 (33%) had mild-to-moderate nephropathy, 61 (60%) had neuropathy, and 71 (70%) had retinopathy. Within the whole cohort, adults with T1D tended to have lower FN density, though differences did not reach statistical significance. The subset of the T1D group who were diagnosed before age 15 had lower total BMC (-14%, TtBMC), cortical BMC (-19.5%, CtBMC), and smaller Ct cross-sectional area (-12.6, CtCSA) than their matched controls (p<.05 for all). Individuals with T1D who were diagnosed at a later age did not differ from controls in any bone outcome (p>.21). Furthermore, adults with T1D and nephropathy had lower FN aBMD (-10.6%), TtBMC (-17%), CtBMC (-24%), and smaller CtCSA (-15.4%) compared to matched controls (p<.05 for all). Adults with T1D and neuropathy had cortical bone deficits (8.4%-12%, p<.04). In summary, among older adults with T1D, those who were diagnosed before the age of 15 yr, as well as those with nephropathy and neuropathy had unfavorable bone outcomes at the FN, which may contribute to the high risk of hip fractures among patients with T1D. These novel observations highlight the longstanding detrimental impact of T1D when present during bone accrual and skeletal fragility as an additional complication of microvascular disease in individuals with T1D.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Harvard Medical School, Boston, MA 02215, United States
| | - Trinity Tedtsen
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Laura M Cooke
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarah Mahar
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Meng Zhang
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Jordan Nustad
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Margaret A Garrahan
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarah E Gehman
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Elaine W Yu
- Harvard Medical School, Boston, MA 02215, United States
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
- Harvard Medical School, Boston, MA 02215, United States
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, United States
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Park MS, Ha HI, Lim HK, Han J, Pak S. Femoral osteoporosis prediction model using autosegmentation and machine learning analysis with PyRadiomics on abdomen-pelvic computed tomography (CT). Quant Imaging Med Surg 2024; 14:3959-3969. [PMID: 38846273 PMCID: PMC11151236 DOI: 10.21037/qims-23-1751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/07/2024] [Indexed: 06/09/2024]
Abstract
Background With the advancement of artificial intelligence technology and radiomics analysis, opportunistic prediction of osteoporosis with computed tomography (CT) is a new paradigm in osteoporosis screening. This study aimed to assess the diagnostic performance of osteoporosis prediction by the combination of autosegmentation of the proximal femur and machine learning analysis with a reference standard of dual-energy X-ray absorptiometry (DXA). Methods Abdomen-pelvic CT scans were retrospectively analyzed from 1,122 patients who received both DXA and abdomen-pelvic computed tomography (APCT) scan from January 2018 to December 2020. The study cohort consisted of a training cohort and a temporal validation cohort. The left proximal femur was automatically segmented, and a prediction model was built by machine-learning analysis using a random forest (RF) analysis and 854 PyRadiomics features. The technical success rate of autosegmentation, diagnostic test, area under the receiver operator characteristics curve (AUC), and precision recall curve (AUC-PR) analysis were used to analyze the training and validation cohorts. Results The osteoporosis prevalence of the training and validation cohorts was 24.5%, and 10.3%, respectively. The technical success rate of autosegmentation of the proximal femur was 99.7%. In the diagnostic test, the training and validation cohorts showed 78.4% vs. 63.3% sensitivity, 89.4% vs. 98.1% specificity. The prediction performance to identify osteoporosis within the groups used for training and validation cohort was high and the AUC and AUC-PR to forecast the occurrence of osteoporosis within the training and validation cohorts were 90.8% [95% confidence interval (CI), 88.4-93.2%] vs. 78.0% (95% CI, 76.0-79.9%) and 94.6% (95% CI, 89.3-99.8%) vs. 88.8% (95% CI, 86.2-91.5%), respectively. Conclusions The osteoporosis prediction model using autosegmentation of proximal femur and machine-learning analysis with PyRadiomics features on APCT showed excellent diagnostic feasibility and technical success.
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Affiliation(s)
- Min Su Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Junhee Han
- Department of Statistics and Data Science Convergence Research Center, Hallym University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Seongyong Pak
- CT Research Collaboration, Siemens-Healthineers, Seoul, Republic of Korea
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Wang C, Wang X, Cheng H, Fang J. MiR-22-3p facilitates bone marrow mesenchymal stem cell osteogenesis and fracture healing through the SOSTDC1-PI3K/AKT pathway. Int J Exp Pathol 2024; 105:52-63. [PMID: 38152045 PMCID: PMC10951417 DOI: 10.1111/iep.12500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Bone fractures are the most common form of musculoskeletal trauma worldwide. Numerous microRNAs (miRNAs) have been suggested to be participants in regulating bone-related diseases. Recent studies revealed the regulatory role of miR-22-3p in osteogenic differentiation, but its role in fracture healing has not been investigated previously. Here, a rat femoral fracture model was established, Bone marrow mesenchymal stem cells (BMSCs) were isolated to detect the specific function and underlying mechanisms of miR-22-3p. MiR-22-3p and sclerostin domain-containing 1 (SOSTDC1) expression was determined by RT-qPCR and immunohistochemistry staining. The levels of proteins associated with osteogenic differentiation were assessed by western blotting. Flow cytometry was conducted to identify the isolated rat BMSCs. Alizarin red staining, alkaline phosphatase staining and Oil Red O staining were used to evaluate the osteogenic and adipogenic differentiation of rat BMSCs. The interaction between miR-22-3p and SOSTDC1 was verified using a luciferase reporter assay. Haematoxylin and Eosin (H&E) staining of the bone tissues was performed to analyse the effect of miR-22-3p on histopathological changes in vivo. MiR-22-3p was downregulated in the callus tissues of rat femoral fracture, while the expression of SOSTDC1 was upregulated. The isolated rat BMSCs had the capacity for both osteogenic and adipogenic differentiation. The differentiation capacity of BMSCs into osteoblasts was increased by miR-22-3p overexpression. MiR-22-3p activated the PI3K/AKT pathway by targeting SOSTDC1. SOSTDC1 overexpression and PI3K/AKT signalling inhibitor LY294002 abolished the enhancing effect of miR-22-3p overexpression on the osteogenesis of BMSCs. Thus MiR-22-3p facilitated the femoral fracture healing in rats. MiR-22-3p overexpression promoted fracture healing via the activation of PI3K/AKT pathway by targeting SOSTDC1.
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Affiliation(s)
- Chunqiu Wang
- Department of OrthopedicsThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Xinguo Wang
- Department of OrthopedicsZhenjiang 359 HospitalZhenjiangChina
| | - Hui Cheng
- Department of OrthopedicsZhenjiang 359 HospitalZhenjiangChina
| | - Jiahu Fang
- Department of OrthopedicsThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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Bot RB, Chirla R, Hozan CT, Cavalu S. Mapping the Spatial Evolution of Proximal Femur Osteoporosis: A Retrospective Cross-Sectional Study Based on CT Scans. Int J Gen Med 2024; 17:1085-1100. [PMID: 38529101 PMCID: PMC10962364 DOI: 10.2147/ijgm.s454546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose The purpose of this study was to quantify the modifications occurring in osteoporosis at the level of the human proximal femur throughout the trabecular structure, along with the identification of certain anatomic regions preferentially affected by osteoporosis. Another goal was to map the evolution of the radiodensity of the trabecular bone as osteoporosis progresses to an advanced stage. Methods The study included CT scans (right femur) from 51 patients, out of which 40 had various degrees of osteoporosis, but no other local pathology. Ten regions of interest in two orthogonal slices have been identified and the differences in radiodensity as well as their evolution have been statistically analyzed in terms of relative and absolute changes. Results A detailed spatial map showing the evolution of osteoporosis was obtained. As osteoporosis evolved, the relative decrease in radiodensity was inversely correlated to the radiodensity of the healthy bone. In particular, the region covering the Ward triangle decreased the most, by an average 61-62% in osteopenia and 101-106% in advanced osteoporosis, while the principal compressive group was affected the least, showing a decrease by an average 14-15% in osteopenia and 29-32% in advanced osteoporosis. The absolute decrease in radiodensity was not correlated to the radiodensity of the healthy bone and was shifted to the inferior-posterior edge of the femur. Inside the femoral head, the upper region was affected the most in absolute terms, while the greater trochanter was less affected than the femoral neck. The maximum metaphyseal cortical bone density was unaffected by the progression of osteoporosis. Conclusion Significant differences were noticed in terms of the absolute and relative osteoporotic changes in radiodensity related to different anatomical regions of the human femoral bone. These differences become more pronounced as the disease progresses.
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Affiliation(s)
- Robert B Bot
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410087, Romania
- Department of Orthopedics, Emergency County Clinical Hospital Oradea, Oradea, 410169, Romania
| | - Razvan Chirla
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410087, Romania
| | - Calin Tudor Hozan
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410087, Romania
- Department of Orthopedics, Emergency County Clinical Hospital Oradea, Oradea, 410169, Romania
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, 410087, Romania
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Sano H, Whitmarsh T, Skingle L, Shimakura T, Yamamoto N, Compston JE, Takahashi HE, Poole KES. Buds of new bone formation within the Femoral Head of Hip Fracture Patients Coincide with Zones of Low Osteocyte Sclerostin. J Bone Miner Res 2023; 38:1603-1611. [PMID: 37548352 DOI: 10.1002/jbmr.4898] [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: 02/19/2023] [Revised: 06/19/2023] [Accepted: 08/04/2023] [Indexed: 08/08/2023]
Abstract
Romosozumab treatment reduces the rate of hip fractures and increases hip bone density, increasing bone formation by inhibiting sclerostin protein. We studied the normal pattern of bone formation and osteocyte expression in the human proximal femur because it is relevant to both antisclerostin treatment effects and fracture. Having visualized and quantified buds of new bone formation in trabeculae, we hypothesized that they would coincide with areas of (a) higher mechanical stress and (b) low sclerostin expression by osteocytes. In patients with hip fracture, we visualized each bud of active modeling-based formation (forming minimodeling structure [FMiS]) in trabecular cores taken from different parts of the femoral head. Trabecular bone structure was also measured with high-resolution imaging. More buds of new bone formation (by volume) were present in the higher stress superomedial zone (FMiS density, N.FMiS/T.Ar) than lower stress superolateral (p < 0.05), and inferomedial (p < 0.001) regions. There were fewer sclerostin expressing osteocytes close to or within FMiS. FMiS density correlated with greater amount, thickness, number, and connectivity of trabeculae (bone volume BV/TV, r = 0.65, p < 0.0001; bone surface BS/TV, r = 0.47, p < 0.01; trabecular thickness Tb.Th, r = 0.55, p < 0.001; trabecular number Tb.N, r = 0.47, p < 0.01; and connectivity density Conn.D, r = 0.40, p < 0.05) and lower trabecular separation (Tb.Sp, r = -0.56, p < 0.001). These results demonstrate modeling-based bone formation in femoral trabeculae from patients with hip fracture as a potential therapeutic target to enhance bone structure. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Hiroshige Sano
- Department of Medicine, University of Cambridge, Cambridge, UK
- Niigata Bone Science Institute, Niigata, Japan
- Uchino Orthopedic Clinic, Niigata, Japan
| | | | - Linda Skingle
- Department of Medicine, University of Cambridge, Cambridge, UK
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The effect of contrast media on CT measures of bone mineral density: a systematic review. Skeletal Radiol 2023; 52:687-694. [PMID: 36329255 DOI: 10.1007/s00256-022-04222-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim was to systematically assess the literature on possible effect of administration of iodinated contrast media on CT-estimated bone mineral density (BMD). MATERIALS AND METHODS The Web of Science and PubMed databases were searched. Studies that used both CT principles of BMD measurement (volumetric quantitative BMD and CT attenuation in Hounsfield Units) were included. The baseline patient data, skeletal site, contrast medium data (if reported), and change in BMD on contrast-enhanced CT scans were collected. RESULTS Sixteen studies met our review criteria, the majority of which was performed on lumbar spine, and the others on proximal femur. Almost all studies reported a significant increase in BMD values on the contrast-enhanced CT scans, ranging from 0.8 to 30.3%. The increase was most frequently reported to be about 10 to 15% for the spine and 5 to 10% for the femur. In addition to the difference in skeletal site, some authors found the contrast effect was age-, sex-, and contrast dose-dependent. BMD values in arterial phase were generally somewhat lower than in venous phase, and the effect of contrast in venous phase was more predictable. CONCLUSION The review revealed significant changes in BMD values between unenhanced and contrast-enhanced CT. The change was more pronounced in lumbar spine than in proximal femur and appeared to depend on age, sex, contrast dose, and postcontrast imaging protocol. The review suggests the understanding of all mentioned factors during the interpretation of BMD measured on contrast-enhanced CT.
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Wysocki MA, Doyle ST. Advancing Osteoporosis Evaluation Procedures: Detailed Computational Analysis of Regional Structural Vulnerabilities in Osteoporotic Bone. J Pers Med 2023; 13:jpm13020321. [PMID: 36836558 PMCID: PMC9962183 DOI: 10.3390/jpm13020321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Osteoporotic fractures of the femur are associated with poor healing, disability, reduced quality of life, and high mortality rates within 1 year. Moreover, osteoporotic fractures of the femur are still considered to be an unsolved problem in orthopedic surgery. In order to more effectively identify osteoporosis-related fracture risk and develop advanced treatment approaches for femur fractures, it is necessary to acquire a greater understanding of how osteoporosis alters the diaphyseal structure and biomechanical characteristics. The current investigation uses computational analyses to comprehensively examine how femur structure and its associated properties differ between healthy and osteoporotic bones. The results indicate statistically significant differences in multiple geometric properties between healthy femurs and osteoporotic femurs. Additionally, localized disparities in the geometric properties are evident. Overall, this approach will be beneficial in the development of new diagnostic procedures for highly detailed patient-specific detection of fracture risk, for establishing novel injury prevention treatments, and for informing advanced surgical solutions.
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Wang Y, Li J, Men Y, Wei W. Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus. Orthop Surg 2023; 15:793-800. [PMID: 36716195 PMCID: PMC9977591 DOI: 10.1111/os.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.
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Affiliation(s)
- Yeming Wang
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| | - Jian Li
- Department of RadiologyTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yutao Men
- Tianjin Key Laboratory of the Design and Intelligent Control of the Advanced Mechanical SystemTianjin University of TechnologyTianjinChina,National Demonstration Center for Experimental Mechanical and Electrical Engineering EducationTianjin University of TechnologyTianjinChina
| | - Wanfu Wei
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
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Geometry and bone mineral density determinants of femoral neck strength changes following exercise. Biomech Model Mechanobiol 2023; 22:207-216. [PMID: 36271264 PMCID: PMC9958140 DOI: 10.1007/s10237-022-01642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/20/2022] [Indexed: 11/02/2022]
Abstract
Physical exercise induces spatially heterogeneous adaptation in bone. However, it remains unclear where the changes in BMD and geometry have the greatest impact on femoral neck strength. The aim of this study was to determine the principal BMD-and-geometry changes induced by exercise that have the greatest effect on femoral neck strength. Pre- and post-exercise 3D-DXA images of the proximal femur were collected of male participants from the LIFTMOR-M exercise intervention trial. Meshes with element-by-element correspondence were generated by morphing a template mesh to each bone to calculate changes in BMD and geometry. Finite element (FE) models predicted femoral neck strength changes under single-leg stance and sideways fall load. Partial least squares regression (PLSR) models were developed with BMD-only, geometry-only, and BMD-and-geometry changes to determine the principal modes that explained the greatest variation in neck strength changes. The PLSR models explained over 90% of the strength variation with 3 PLS components using BMD-only (R2 > 0.92, RMSE < 0.06 N) and 8 PLS components with geometry-only (R2 > 0.93, RMSE < 0.06 N). Changes in the superior neck and distal cortex were most important during single-leg stance while the superior neck, medial head, and lateral trochanter were most important during a sideways fall. Local changes in femoral neck and head geometry could differentiate the exercise groups from the control group. Exercise interventions may target BMD changes in the superior neck, inferior neck, and greater trochanter for improved femoral neck strength in single-leg stance and sideways fall.
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Zhang M, Gong H, Zhang M. Prediction of femoral strength of elderly men based on quantitative computed tomography images using machine learning. J Orthop Res 2023; 41:170-182. [PMID: 35393726 DOI: 10.1002/jor.25334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Hip fracture is the most common complication of osteoporosis, and its major contributor is compromised femoral strength. This study aimed to develop practical machine learning models based on clinical quantitative computed tomography (QCT) images for predicting proximal femoral strength. Eighty subjects with entire QCT data of the right hip region were randomly selected from the full MrOS cohorts, and their proximal femoral strengths were calculated by QCT-based finite element analysis (QCT/FEA). A total of 50 parameters of each femur were extracted from QCT images as the candidate predictors of femoral strength, including grayscale distribution, regional cortical bone mapping (CBM) measurements, and geometric parameters. These parameters were simplified by using feature selection and dimensionality reduction. Support vector regression (SVR) was used as the machine learning algorithm to develop the prediction models, and the performance of each SVR model was quantified by the mean squared error (MSE), the coefficient of determination (R2 ), the mean bias, and the SD of bias. For feature selection, the best prediction performance of SVR models was achieved by integrating the grayscale value of 30% percentile and specific regional CBM measurements (MSE ≤ 0.016, R2 ≥ 0.93); and for dimensionality reduction, the best prediction performance of SVR models was achieved by extracting principal components with eigenvalues greater than 1.0 (MSE ≤ 0.014, R2 ≥ 0.93). The femoral strengths predicted from the well-trained SVR models were in good agreement with those derived from QCT/FEA. This study provided effective machine learning models for femoral strength prediction, and they may have great potential in clinical bone health assessments.
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Affiliation(s)
- Meng Zhang
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - He Gong
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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11
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Li Y, Samant P, Cochran C, zhao Y, Keyak JH, Hu X, Yu A, Xiang L. The feasibility study of XACT imaging for characterizing osteoporosis. Med Phys 2022; 49:7694-7702. [PMID: 35962866 PMCID: PMC10567061 DOI: 10.1002/mp.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/08/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Osteoporosis is a progressive bone disease that is characterized by a decrease in bone mass and the deterioration in bone microarchitecture, which might be related to age and space travel. An unmet need exists for the development of novel imaging technologies to characterize osteoporosis. PURPOSE The purpose of our study is to investigate the feasibility of X-ray-induced acoustic computed tomography (XACT) imaging for osteoporosis detection. METHODS An in-house simulation workflow was developed to assess the ability of XACT for osteoporosis detection. To evaluate this simulation workflow, a three-dimensional digital bone phantom for XACT imaging was created by a series of two-dimensional micro-computed tomography (micro-CT) slices of normal and osteoporotic bones in mice. In XACT imaging, the initial acoustic pressure rise caused by the X-ray induce acoustic (XA) effect is proportional to bone density. First, region growing was deployed for image segmentation of different materials inside the bone. Then k-wave simulations were deployed to model XA wave propagation, attenuation, and detection. Finally, the time-varying pressure signals detected at each transducer location were used to reconstruct the XACT image with a time-reversal reconstruction algorithm. RESULTS Through the simulated XACT images, cortical porosity has been calculated, and XA signal spectra slopes have been analyzed for the detection of osteoporosis. The results have demonstrated that osteoporotic bones have lower bone mineral density and higher spectra slopes. These findings from XACT images were in good agreement with porosity calculation from micro-CT images. CONCLUSION This work explores the feasibility of using XACT imaging as a new imaging tool for Osteoporosis detection. Considering that acoustic signals are generated by X-ray absorption, XACT imaging can be combined with traditional X-ray imaging that holds potential for clinical management of osteoporosis and other bone diseases.
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Affiliation(s)
- Yizhou Li
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Pratik Samant
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Department of Oncology, University of Oxford, Oxford, UK
| | - Christian Cochran
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, Oklahoma, USA
| | - Yue zhao
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, Oklahoma, USA
| | - Joyce H. Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, California, USA
| | - Xiang Hu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Aixi Yu
- Department of Orthopedics Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liangzhong Xiang
- School of Electrical and Computer Engineering, The University of Oklahoma, Norman, Oklahoma, USA
- Department of Radiological Sciences, University of California, Irvine, Irvine, California, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California, USA
- Beckman Laser Institute & Medical Clinic, University of California, Irvine, Irvine, California, USA
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Rikitake H, Horiuchi K, Miyai K, Susa M, Inoue M, Taguchi E, Ishizaka T, Chiba K. Risk assessment of femoral pathological fracture in prostate cancer patients by computed tomography analysis. J Bone Miner Metab 2022; 40:704-711. [PMID: 35637395 DOI: 10.1007/s00774-022-01338-2] [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: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Prostate cancer often forms osteoblastic lesions that appear as a high-dense shadow upon X-ray. Although the lesions may seem to increase bone strength, pathological fracture occurs in one in four patients with prostate cancer. The aim of this study is to elucidate the factors that may increase the risk of pathological fracture in patients with prostate cancer metastases in the proximal femur by analyzing computed tomography data. MATERIALS AND METHODS Computed tomography data of the femur of 62 prostate cancer patients were retrospectively analyzed. The patients were divided into three groups based on the presence or absence of femoral metastatic lesions and pathological fracture. Surgical specimens of the proximal femur collected from patients who had a pathological fracture were histologically analyzed. RESULTS Bone density in the marrow area was increased in all cases with metastases compared with those with no metastases. Contrarily, the cortical bone density at the medial trochanter region was significantly lower in patients who had pathological fractures in the proximal femur than those who did not. Accordingly, histological analysis of the surgical specimens revealed that the affected cortical bone was osteopenic without any apparent new bone formation. CONCLUSION These results indicate that prostate cancer is less effective in inducing bone formation in the cortex than in the marrow and that the decrease in the cortical bone density at the medial trochanter region leads to an increased risk of pathological fracture. Therefore, a previously undocumented risk factor for pathological fracture in prostate cancer patients is presented.
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Affiliation(s)
- Hajime Rikitake
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Keisuke Horiuchi
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
- Department of Orthopedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Kosuke Miyai
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, 154-0001, Japan
| | - Michiro Susa
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masahiro Inoue
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Eiko Taguchi
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Takahiro Ishizaka
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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Guo J, Zhou Y, Shang M, Chen W, Hou Z, Zhang Y, Dong W. Morphological characteristics of the surgical neck region in the proximal humerus at different ages. Eur J Med Res 2022; 27:102. [PMID: 35773745 PMCID: PMC9245283 DOI: 10.1186/s40001-022-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to demonstrate the cortical thickness character in the humeral surgical neck region using 3D cortical bone mapping technique and try to illustrate its morphological changes with age. MATERIAL AND METHODS Normal individuals, including 11 volunteers younger than 18 years, 87 adult men and 46 adult women, were enrolled. The cortical thickness and height of the surgical neck region was measured with Mimic and 3 Matic software. The height of the region was compared and measured. People with an age of 18-30 years was identified as Group I, people in 31-40 years as Group II, people in 41-50 years as Group III, people in 51-60 years as Group IV, and Group V including people ≥ 61 years. RESULTS Compared with the baseline Group I, cortical thickness was significantly decreased by 0.52 mm (P = 0.006) in Group III, by 0.76 mm (P < 0.001) in Group IV, and by 0.77 mm (P < 0.001) in Group V. Age moderately predicted cortical thickness with r = -0.5481. The height of the cortical change region was significantly decreased by 2.25 mm (P = 0.007) in Group II, by 2.98 mm (P < 0.001) in Group III, and by 2.07 mm (P = 0.02) in Group IV. However, no significant decrease was illustrated in Group V (0.57 mm) (P = 0.891). The relation between age and the height of the cortical thickness change region was nonlinear. CONCLUSIONS This study identified an obvious decrease in cortical thickness with aging, and the height was curve fitted with aging in surgical neck region.
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Affiliation(s)
- Jialiang Guo
- The School of Medicine, Nankai University, Tianjin, People's Republic of China.,Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yali Zhou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Meishuang Shang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China. .,Chinese Academy of Engineering, Beijing, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
| | - Weichong Dong
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
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14
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Auger JD, Naik AJ, Murakami AM, Gerstenfeld LC, Morgan EF. Spatial assessment of femoral neck bone density and microstructure in hip osteoarthritis. Bone Rep 2022; 16:101155. [PMID: 34984214 PMCID: PMC8693349 DOI: 10.1016/j.bonr.2021.101155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022] Open
Abstract
Osteoarthritis (OA) is known to involve profound changes in bone density and microstructure near to, and even distal to, the joint. Critically, however, a full, spatial picture of these abnormalities has not been well documented in a quantitative fashion in hip OA. Here, micro-computed tomography (44.8 μm/voxel) and data-driven computational anatomy were used to generate 3-D maps of the distribution of bone density and microstructure in human femoral neck samples with early (6F/4M, mean age = 51.3 years), moderate (14F/8M, mean age = 60 years), and severe (16F/6M, mean age = 63.3 years) radiographic OA. With increasing severity of radiographic OA, there was decreased cortical bone mineral density (BMD) (p=0.003), increased cortical thickness (p=0.001), increased cortical porosity (p=0.0028), and increased cortical cross-sectional area (p=0.0012, due to an increase in periosteal radius (p=0.018)), with no differences detected in the total femoral neck or trabecular compartment measures. No OA-related region-specific differences were detected through Statistical Parametric Mapping, but there were trends towards decreased tissue mineral density (TMD) in the inferior femoral neck with increasing OA severity (0.050 < p ≤ 0.091), possibly due to osteophytes. Overall, the lack of differences in cortical TMD among radiographic OA groups indicated that the decrease in cortical BMD with increasing OA severity was largely due to the increased cortical porosity rather than decreased tissue mineralization. As porosity is inversely associated with stiffness and strength in cortical bone, increased porosity may offset the effect that increased cortical cross-sectional area would be expected to have on reducing stresses within the femoral neck. The use of high-resolution imaging and quantitative spatial assessment in this study provide insight into the heterogeneous and multi-faceted changes in density and microstructure in hip OA, which have implications for OA progression and fracture risk.
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Affiliation(s)
| | | | - Akira M. Murakami
- Boston University School of Medicine, Boston, MA, United States of America
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15
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Li C, Ma C, Zhuo X, Li L, Li B, Li S, Lu WW. Focal osteoporosis defect is associated with vertebral compression fracture prevalence in a bone mineral density-independent manner. JOR Spine 2022; 5:e1195. [PMID: 35386753 PMCID: PMC8966878 DOI: 10.1002/jsp2.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Focal osteoporosis defect has shown a high association with the bone fragility and osteoporotic fracture prevalence. However, no routine computed tomography (CT)-based vertebral focal osteoporosis defect measurement and its association with vertebral compression fracture (VCF) were discussed yet. This study aimed to develop a routine CT-based measurement method for focal osteoporosis defect quantification, and to assess its association with the VCF prevalence. Materials and Methods A total of 205 cases who underwent routine CT scanning, were retrospectively reviewed and enrolled into either the VCF or the control group. The focal bone mineral content loss (focal BMC loss), measured as the cumulated demineralization within bone void space, was proposed for focal osteoporosis defect quantification. Its scan-rescan reproducibility and its correlation with trabecular bone mineral density (BMD) and apparent microarchitecture parameters were evaluated. The association between focal BMC loss and the prevalence of VCF was studied by logistic regression. Results The measurement of focal BMC loss showed high reproducibility (RMSSD = 0.011 mm, LSC = 0.030 mm, ICC = 0.97), and good correlation with focal bone volume fraction (r = 0.79, P < 0.001), trabecular bone separation (r = 0.76, P < 0.001), but poor correlation with trabecular BMD (r = 0.37, P < 0.001). The focal BMC loss was significantly higher in the fracture group than the control (1.03 ± 0.13 vs. 0.93 ± 0.11 mm; P < 0.001), and was associated with prevalent VCF (1.87, 95% CI = 1.31-2.65, P < 0.001) independent of trabecular BMD level. Discussion As a surrogate measure of focal osteoporosis defect, focal BMC Loss independently associated with the VCF prevalence. It suggests that focal osteoporosis defect is a common manifestation that positively contributed to compression fracture risk and can be quantified with routine CT using focal BMC Loss.
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Affiliation(s)
- Chentian Li
- Department of Orthopedics and TaumatologyZhujiang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Chi Ma
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
| | - Xianglong Zhuo
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Li Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Bing Li
- Department of OrthopaedicsLiuzhou Worker's Hospital, Guangxi Medical UniversityLiuzhouGuangxiChina
| | - Songjian Li
- Department of Orthopedics and TaumatologyZhujiang Hospital, Southern Medical UniversityGuangzhouGuangdongChina
| | - William W. Lu
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of MedicineThe University of Hong KongHong Kong SARChina
- SIAT & Shenzhen Institutes of Advanced TechnologyChinese Academy of ScienceShenzhenGuangdongChina
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16
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Poole KES, Treece GM, Pearson RA, Gee AH, Bolognese MA, Brown JP, Goemaere S, Grauer A, Hanley DA, Mautalen C, Recknor C, Yang Y, Rojeski M, Libanati C, Whitmarsh T. Romosozumab Enhances Vertebral Bone Structure in Women With Low Bone Density. J Bone Miner Res 2022; 37:256-264. [PMID: 34738660 PMCID: PMC9299688 DOI: 10.1002/jbmr.4465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 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)
- Kenneth ES Poole
- Department of MedicineUniversity of Cambridge and Addenbrooke's HospitalCambridgeUK
| | | | - Rose A Pearson
- Department of EngineeringUniversity of CambridgeCambridgeUK
| | - Andrew H Gee
- Department of EngineeringUniversity of CambridgeCambridgeUK
| | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval UniversityQuebec CityCanada
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17
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Improving the Hip Fracture Risk Prediction with a Statistical Shape-and-Intensity Model of the Proximal Femur. Ann Biomed Eng 2022; 50:211-221. [PMID: 35044572 PMCID: PMC8803671 DOI: 10.1007/s10439-022-02918-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/02/2022] [Indexed: 11/21/2022]
Abstract
Severe predictions have been made regarding osteoporotic fracture incidence for the next years, with major economic and social impacts in a worldwide greying society. However, the performance of the currently adopted gold standard for fracture risk prediction, the areal Bone Mineral Density (aBMD), remains moderate. To overcome current limitations, the construction of statistical models of the proximal femur, based on three-dimensional shape and intensity (a hallmark of bone density), is here proposed for predicting hip fracture in a Caucasian postmenopausal cohort. Partial Least Square (PLS)-based statistical models of the shape, intensity and their combination were developed, and the corresponding modes and components were identified. Logistic regression models using the first two shape, intensity and shape-intensity PLS components were implemented and tested within a 10-fold cross-validation procedure as predictors of hip fracture. It emerged that (1) intensity components were superior to shape components in stratifying patients according to their fracture status, and that (2) a combination of intensity and shape improved patients risk stratification. The area under the ROC curve was 0.64, 0.85 and 0.92 for the models based on shape, intensity and shape-intensity combination respectively, against a 0.72 value for the aBMD standard approach. Based on these findings, the presented methodology turns out to be promising in tackling the need for an enhanced fracture risk assessment.
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18
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Hong N, Burm SW, Treece G, Ye Kim J, Hwan Kim M, Lee S, Shin S, Rhee Y. Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study. J Bone Oncol 2022; 32:100409. [PMID: 35024328 PMCID: PMC8728402 DOI: 10.1016/j.jbo.2021.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Aromatase inhibitor use was associated with cortical bone loss in the hip. Bisphosphonate protected hip cortical bone against aromatase inhibitor use. The effect was prominent at the superior femoral neck and greater trochanter.
Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seung Won Burm
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Graham Treece
- Department of Engineering, University of Cambridge, Trumpington St, Cambridge CB2 1PZ, UK
| | - Jee Ye Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Min Hwan Kim
- Division of Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Sungjae Shin
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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19
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Park SY, Ha HI, Lee SM, Lee IJ, Lim HK. Comparison of diagnostic accuracy of 2D and 3D measurements to determine opportunistic screening of osteoporosis using the proximal femur on abdomen-pelvic CT. PLoS One 2022; 17:e0262025. [PMID: 34982780 PMCID: PMC8726491 DOI: 10.1371/journal.pone.0262025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To compare the osteoporosis-predicting ability of computed tomography (CT) indexes in abdomen-pelvic CT using the proximal femur and the reliability of measurements in two- and three-dimensional analyses. METHODS Four hundred thirty female patients (age range, 50-96 years) who underwent dual-energy X-ray absorptiometry and abdominal-pelvic CT within 1 month were retrospectively selected. The volumes of interest (VOIs) from the femoral head to the lesser trochanter and the femoral neck were expressed as 3DFemur. Round regions of interest (ROIs) of image plane drawn over the femoral neck touching the outer cortex were determined as 2Dcoronal. In HU histogram analysis (HUHA), the percentages of HU histogram ranges related to the ROI or VOI were classified as HUHAFat (<0 HU) and HUHABone (126 HU≤). Diagnostic performance, correlation analysis and measurement reliability were analyzed by receiver operating characteristic curves, correlation coefficient and interobserver correlation coefficient (ICC), respectively. RESULTS AUCs of each HUHA and mean-HU measurement on 2D-ROI and 3D-VOI were 0.94 or higher (P < 0.001). Both 3DFemur-Mean-HU and 3DFemur-HUHABone showed the highest AUC (0.96). The cut-off value of 3DFemur-Mean-HU was 231HU or less, (sensitivity: 94.8%; specificity: 85.0%; correlation coefficient: -0.65; P <0.001) for diagnosis of osteoporosis. There was no superiority between AUCs in 2D-ROI and 3D-VOI measurements (P > 0.05). Reliability of the 3D-VOI measurement showed perfect agreement (ICC ≥ 0.94), and 2D-ROI showed moderate to good agreement (ICC range: 0.63~0.84). CONCLUSIONS CT indexes on 3D-VOI for predicting femoral osteoporosis showed similar diagnostic accuracy with better reproducibility of measurement, compared with 2D-ROI.
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Affiliation(s)
- Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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Wang Y, Li J, Men Y, Wei W. Menopause-related cortical loss of the humeral head region mainly occurred in the greater tuberosity. Front Endocrinol (Lausanne) 2022; 13:942803. [PMID: 36093094 PMCID: PMC9449578 DOI: 10.3389/fendo.2022.942803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Proximal humerus fractures are commonly observed in postmenopausal women. The goal of this study was to investigate menopause-related changes in cortical structure of the humeral head. MATERIALS AND METHODS Clinical computed tomography (CT) scans of 75 healthy women spanning a wide range of ages (20-72 years) were analyzed. For each subject, cortical bone mapping (CBM) was applied to create a color three-dimensional (3D) thickness map for the proximal humerus. Nine regions of interest (ROIs) were defined in three walls of the humeral head. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD), were measured. RESULTS Compared to premenopausal women, postmenopausal women were characterized by a significantly lower CTh and CM value in the lateral part of the greater tuberosity. Similar changes were only found in ROI 4, but not in ROIs 5-6 in the lesser tuberosity. Linear regression analysis revealed that the CTh and CM value of ROIs 1, 3, and 4 were negatively associated with age. These results showed that menopause-related loss in CTh and CM was mainly in the greater tuberosity besides the proximal part of the lesser tuberosity. Trabecular bone variable measured as ECTD showed a notably lower value in ROIs 1-9 in postmenopausal vs. premenopausal group. Inverse linear associations for ECTD and age were found in ROIs 2, 3, 5, 6, 7, and 9, indicating no site-specific differences of endocortical trabecular bone loss between the greater and lesser tuberosity. CONCLUSIONS Menopause-related cortical loss of the humeral head mainly occurred in the lateral part of the greater tuberosity. The increased rate of humeral bone loss in the greater tuberosity may contribute materially to complex proximal humerus fractures.
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Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
- *Correspondence: Yeming Wang, ; Wanfu Wei,
| | - Jian Li
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
| | - Yutao Men
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Wanfu Wei
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
- *Correspondence: Yeming Wang, ; Wanfu Wei,
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21
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Wang L, Yang M, Liu Y, Ge Y, Zhu S, Su Y, Cheng X, Wu X, Blake GM, Engelke K. Differences in Hip Geometry Between Female Subjects With and Without Acute Hip Fracture: A Cross-Sectional Case-Control Study. Front Endocrinol (Lausanne) 2022; 13:799381. [PMID: 35282435 PMCID: PMC8907418 DOI: 10.3389/fendo.2022.799381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Although it is widely recognized that hip BMD is reduced in patients with hip fracture, the differences in geometrical parameters such as cortical volume and thickness between subjects with and without hip fracture are less well known. MATERIALS AND METHODS Five hundred and sixty two community-dwelling elderly women with hip CT scans were included in this cross-sectional study, of whom 236 had an acute hip fracture. 326 age matched women without hip fracture served as controls. MIAF-Femur software was used for the measurement of the intact contralateral femur in patients with hip fracture and the left femur of the controls. Integral and cortical volumes (Vols) of the total hip (TH), femoral head (FH), femoral neck (FN), trochanter (TR) and intertrochanter (IT) were analyzed. In the FH and FN the volumes were further subdivided into superior anterior (SA) and posterior (SP) as well as inferior anterior (IA) and posterior (IP) quadrants. Cortical thickness (CortThick) was determined for all sub volumes of interest (VOIs) listed above. RESULTS The average age of the control and fracture groups was 71.7 and 72.0 years, respectively. The fracture patients had significantly lower CortThick and Vol of all VOIs except for TRVol. In the fracture patients, cortical thickness and volume at the FN were significantly lower in all quadrants except for cortical volume of quadrant SA (p= 0.635). Hip fracture patients had smaller integral FN volume and cross-sectional area (CSA) before and after adjustment of age, height and weight. With respect to hip fracture discrimination, cortical volume performed poorer than cortical thickness across the whole proximal femur. The ratio of Cort/TrabMass (RCTM), a measure of the internal distribution of bone, performed better than cortical thickness in discriminating hip fracture risk. The highest area under curve (AUC) value of 0.805 was obtained for the model that included THCortThick, FHVol, THRCTM and FNCSA. CONCLUSION There were substantial differences in total and cortical volume as well as cortical thickness between fractured and unfractured women across the proximal femur. A combination of geometric variables resulted in similar discrimination power for hip fracture risk as aBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yufeng Ge
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Shiwen Zhu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
- *Correspondence: Xinbao Wu, ; Xiaoguang Cheng,
| | - Glen M. Blake
- School of Biomedical Engineering & Imaging Sciences, King’s College London, St Thomas’ Hospital, London, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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22
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Ling M, Li X, Xu Y, Fan Y. Spatial distribution of hip cortical thickness in postmenopausal women with different osteoporotic fractures. Arch Osteoporos 2021; 16:172. [PMID: 34779934 DOI: 10.1007/s11657-021-01039-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Few studies h ave discussed the association between cortical bone outside the fracture site and the fracture itself. Focusing on hip cortical thickness, this study revealed distinct distributions of the parameters for hip (trochanteric or femoral neck), vertebral, and peripheral osteoporotic fractures and suggested that the spatial distribution of hip cortical thickness was fracture-specific. PURPOSE Cortical bone is critical for bone strength. Hip cortical thickness is reported to be closely associated with the incidence of hip fractures, but its relationship with nonhip fractures is rarely studied. As the hip is a major site for fracture risk assessment, it would be of great benefit to investigate the association between hip cortical thickness and different osteoporotic fractures. METHODS One hundred age-matched postmenopausal women were equally assigned to 4 osteoporotic fracture groups (trochanteric, femoral neck, vertebral, and peripheral fractures) and a nonfracture group. Each subject had a clinical quantitative computed tomography scan of the bilateral hips and the lumbar spine. A cortical bone mapping algorithm was adopted to calculate hip cortical thickness. Hip and lumbar trabecular density and the hip cortical thickness distribution were compared among the groups. RESULTS All the fracture groups presented lower lumbar trabecular density. Compared with nonfracture controls, patients with hip or vertebral fractures but not peripheral fractures showed decreased cortical thickness and trabecular density of the hip. Fracture-specific distributions of cortical thickness were revealed, including zonal defects on the neck-intertrochanter junction, greater trochanter, and the periphery of the lesser trochanter for trochanteric fractures, a focal defect on the anterosuperior neck for femoral neck fractures, a moderate and average distribution for vertebral fractures, and focally thicker cortices on the anterosuperior greater trochanter and the periphery of the lesser trochanter for peripheral fractures. CONCLUSION The spatial distribution of hip cortical thickness was different for each type of osteoporotic fracture, and patients with centrally located fractures demonstrated more severe cortical deterioration. This finding needs to be validated in a larger sample.
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Affiliation(s)
- Ming Ling
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xianlong Li
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yueyang Xu
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yongqian Fan
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
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23
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Fuchs RK, Carballido-Gamio J, Keyak JH, Kersh ME, Warden SJ. Physical activity induced adaptation can increase proximal femur strength under loading from a fall onto the greater trochanter. Bone 2021; 152:116090. [PMID: 34175500 PMCID: PMC8316435 DOI: 10.1016/j.bone.2021.116090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
Physical activity enhances proximal femur bone mass, but it remains unclear whether the benefits translate into an enhanced ability to resist fracture related loading. We recently used baseball pitchers as a within-subject controlled model to demonstrate physical activity induced proximal femur adaptation in regions associated with weight bearing and increased strength under single-leg stance loading. However, there was no measurable benefit to resisting common injurious loading (e.g. a fall onto the greater trochanter). A lack of power and a small physical activity effect size may have contributed to the latter null finding. Softball pitchers represent an alternative within-subject controlled model to explore adaptation of the proximal femur to physical activity, exhibiting greater dominant-to-nondominant (D-to-ND) leg differences than baseball pitchers. The current study used quantitative computed tomography, statistical parametric mapping, and subject-specific finite element (FE) modeling to explore adaptation of the proximal femur to physical activity in female softball pitchers (n = 25). Female cross-country runners (n = 15) were included as symmetrically loaded controls, showing very limited D-to-ND leg differences. Softball pitchers had D-to-ND leg differences in proximal femur, femoral neck, and trochanteric volumetric bone mineral density and content, and femoral neck volume. Voxel-based morphometry analyses and cortical bone mapping showed D-to-ND leg differences within a large region connecting the superior femoral head, inferior femoral neck and medial intertrochanteric region, and within the greater trochanter. FE modeling revealed pitchers had 19.4% (95%CI, 15.0 to 23.9%) and 4.9% (95%CI, 1.7 to 8.2%) D-to-ND leg differences in predicted ultimate strength under single-leg stance loading and a fall onto the greater trochanter, respectively. These data affirm the spatial and strength adaptation of the proximal femur to weight bearing directed loading and demonstrate that the changes can also have benefits, albeit smaller, on resisting loads associated with a sideways fall onto the greater trochanter.
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Affiliation(s)
- Robyn K Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Joyce H Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States of America; Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States of America; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States of America.
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States of America.
| | - Stuart J Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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24
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Comparison of HU histogram analysis and BMD for proximal femoral fragility fracture assessment: a retrospective single-center case-control study. Eur Radiol 2021; 32:1448-1455. [PMID: 34647175 DOI: 10.1007/s00330-021-08281-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/03/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the feasibility of HU histogram analysis (HUHA) to assess proximal femoral fragility fractures with respect to BMD. METHODS This retrospective study included 137 patients with femoral fragility fractures who underwent hip CT and 137 control patients without fractures who underwent abdominal CT between January 2018 and February 2019. HUHA was calculated with the 3D volume of interest from the femoral head to the lesser trochanter. HUHAfat (percentage of negative HU values) and HUHAbone (percentage of HU values ≥ 125 HU) were assumed to be fat and bone components, respectively. Statistical significance was assessed using the area under the receiver operating characteristic curve (AUC), Spearman correlation (ρ), and odds ratio. RESULTS HUHAfat was strongly positively correlated (ρ = 0.56) and BMD was moderately negatively correlated with fragility fractures (ρ = - 0.37). AUC of HUHAfat (0.82, 95% CI [0.77, 0.87]) significantly differed from that of BMD (0.69, 95% CI [0.63, 0.75]) (p < .001). The cutoff value was 15.8% for HUHAfat (sensitivity: 90.4%; specificity: 67.7%) and 0.709 g/cm2 for BMD (sensitivity: 87.5%; specificity: 51.5%), with higher HUHAfat and lower BMD values indicating fragility fractures. The odds ratio of HUHAfat was 19.5 (95% CI [9.9, 38.2], p < .001), which was higher than that of BMD, 7.4 (95% CI [4.0, 13.6], p < .001). CONCLUSION HUHAfat revealed better performance than BMD and demonstrated feasibility in assessing proximal femoral fragility fractures. KEY POINTS • HUHAfat showed a strong positive correlation (Spearman ρ = 0.56, p < .001), and BMD showed a moderate negative correlation (Spearman ρ = - 0.37, p < .001) with proximal femoral fragility fractures. • HUHAfat (AUC = 0.82) performed significantly better than BMD in assessing proximal femoral fragility fractures (AUC = 0.69) (p < .001). • The odds ratio of HUHAfat for proximal femoral fragility fractures was higher than that of BMD (19.5 and 7.4, respectively; p < .001).
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25
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Loundagin LL, Bredbenner TL, Jepsen KJ, Edwards WB. Bringing Mechanical Context to Image-Based Measurements of Bone Integrity. Curr Osteoporos Rep 2021; 19:542-552. [PMID: 34269975 DOI: 10.1007/s11914-021-00700-z] [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] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Image-based measurements of bone integrity are used to estimate failure properties and clinical fracture risk. This paper (1) reviews recent imaging studies that have enhanced our understanding of the mechanical pathways to bone fracture and (2) discusses the influence that inter-individual differences in image-based measurements may have on the clinical assessment of fracture risk RECENT FINDINGS: Increased tissue mineralization is associated with improved bone strength but reduced fracture toughness. Trabecular architecture that is important for fatigue resistance is less important for bone strength. The influence of porosity on bone failure properties is heavily dependent on pore location and size. The interaction of various characteristics, such as bone area and mineral content, can further complicate their influence on bone failure properties. What is beneficial for bone strength is not always beneficial for bone toughness or fatigue resistance. Additionally, given the large amount of imaging data that is clinically available, there is a need to develop effective translational strategies to better interpret non-invasive measurements of bone integrity.
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Affiliation(s)
- Lindsay L Loundagin
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, 105 Administration Place, Saskatoon, SK, S7N 5A2, Canada
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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26
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Ryoo CH, Chai JW, Hong SH, Choi JY, Yoo HJ, Chae HD. CT Hounsfield unit and histogram analysis for differentiation of recent versus remote vertebral compression fractures. Br J Radiol 2021; 94:20210941. [PMID: 34538076 DOI: 10.1259/bjr.20210941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyze the intraosseous tissue changes in recent vertebral compression fractures (VCFs) and to differentiate recent from remote VCFs using CT Hounsfield unit histogram analysis (HUHA). METHODS 65 patients with T11 to L3 VCFs were included. HUHA of 2 vertebral bodies (VBs)- a fractured VB and the closest lower-level unaffected VB-was done. The mean Hounsfield unit (HU) value and HU proportions of 5 ranges (HU ≤ 0, 0 < HU ≤ 50, 50 < HU ≤ 100, 100 < HU ≤ 150, and HU > 150) were obtained. Then, ΔHU value and ΔHU proportion were calculated by subtracting the values from the two vertebrae. Finally, the obtained values were compared between the recent and remote VCF groups and subjected to ROC curve analysis. RESULTS In recent VCF group, the ΔHU proportion (HU ≤ 0) corresponding to normal fatty marrow was lower (-0.17 vs 0.01) and the ΔHU proportion (HU > 150) representing trabecular bone was higher (0.23 vs 0.04) than in remote VCF group (p < 0.001). In the differentiation of recent from remote VCF, the ΔHU value and ΔHU proportion (HU > 150) showed high area under the curve (AUC, 0.939 and 0.912, respectively). CONCLUSION CT HUHA demonstrated both trabecular bone and bone marrow changes in recent VCFs, and showed high diagnostic performance in differentiating between recent and remote VCFs. ADVANCES IN KNOWLEDGE With its vendor neutral applicability, CT HUHA can be used for the differentiation of recent and remote VCFs.
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Affiliation(s)
- Chang Hyun Ryoo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee Won Chai
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Ja-Young Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hye Jin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hee Dong Chae
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
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27
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Yang Q, Zhou Y, Wang T, Cai P, Fu W, Wang J, Li X. MiRNA-1271-5p regulates osteogenic differentiation of human bone marrow-derived mesenchymal stem cells by targeting forkhead box O1 (FOXO1). Cell Biol Int 2021; 45:1468-1476. [PMID: 33675274 DOI: 10.1002/cbin.11585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 12/13/2022]
Abstract
Forkhead box O1 (FOXO1) is a key regulator of osteogenesis. The aim of this study was to identify the mechanisms of microRNAs (miRNAs) targeting FOXO1 in osteogenic differentiation of human bone marrow mesenchymal stem cells (hMSCs). Three miRNA target prediction programs were used to search for potential miRNAs that target FOXO1. Quantitative real-time polymerase chain reaction was conducted to detect the expression of miR-1271-5p and FOXO1 during osteogenic differentiation. Target gene prediction and screening, luciferase reporter assay was used to verify the downstream target gene of miR-1271-5p. The expression levels of FOXO1 and Runx2 were detected by RT-qPCR and Western blot analysis. Alkaline phosphatase (ALP) activity and matrix mineralization were detected by biochemical methods. The expression levels of Runx2, ALP, and osteocalcin were detected by RT-qPCR. Our results showed that miR-1271-5p was downregulated during osteogenic induction. And the expression levels of miR-1271-5p were higher in osteoporotic tissues than that in adjacent nonosteoporotic tissues. The expression levels of FOXO1 were lower in osteoporotic tissues than that in adjacent nonosteoporotic tissues. And a negative correlation was found between miR-1271-5p and FOXO1 in osteoporotic tissues. Overexpression of miR-1271-5p downregulated FOXO1 and inhibited osteogenic differentiation in hMSCs. Overexpression of miR-1271-5p downregulated the expression of osteogenic markers and reduced ALP activity. In addition, ectopic expression of FOXO1 reversed the effect of miR-1271-5p on osteogenic differentiation. In conclusion, miR-1271-5p functioned as a therapeutic target of osteogenic differentiation in hMSCs by inhibiting FOXO1, which provides valuable insights into the use of miR-1271-5p as a target in the treatment of osteoporosis and other bone metabolic diseases.
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Affiliation(s)
- Qining Yang
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Yongwei Zhou
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Tianbao Wang
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Pengfei Cai
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Weicong Fu
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Jinhua Wang
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
| | - Xiaofei Li
- Department of Joint surgery, The affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua City, Zhejiang Province, China
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Three-Dimensional Quantification of Bone Mineral Density in the Distal Femur and Proximal Tibia Based on Computed Tomography: In Vitro Evaluation of an Extended Standardization Method. J Clin Med 2021; 10:jcm10010160. [PMID: 33466413 PMCID: PMC7796434 DOI: 10.3390/jcm10010160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
While alterations in bone mineral density (BMD) are of interest in a number of musculoskeletal conditions affecting the knee, their analysis is limited by a lack of tools able to take full advantage of modern imaging modalities. This study introduced a new method, combining computed tomography (CT) and computational anatomy algorithms, to produce standardized three-dimensional BMD quantification in the distal femur and proximal tibia. The method was evaluated on ten cadaveric knees CT-scanned twice and processed following three different experimental settings to assess the influence of different scans and operators. The median reliability (intraclass correlation coefficient (ICC)) ranged from 0.96 to 0.99 and the median reproducibility (precision error (RMSSD)) ranged from 3.97 to 10.75 mg/cc for the different experimental settings. In conclusion, this paper presented a method to standardize three-dimensional knee BMD with excellent reliability and adequate reproducibility to be used in research and clinical applications. The perspectives offered by this novel method are further reinforced by the fact it relies on conventional CT scan of the knee. The standardization method introduced in this work is not limited to BMD and could be adapted to quantify other bone parameters in three dimension based on CT images or images acquired using different modalities.
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29
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Lee HW, Ha HI, Park SY, Lim HK. Reliability of 3D image analysis and influence of contrast medium administration on measurement of Hounsfield unit values of the proximal femur. PLoS One 2020; 15:e0241012. [PMID: 33085702 PMCID: PMC7577441 DOI: 10.1371/journal.pone.0241012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the reliability of 3D image analysis and the effect of an iodine contrast agent on the computed tomography (CT) Hounsfield unit (HU) values of the proximal femur. MATERIALS AND METHODS Fifty female patients (mean age, 61.3 years; age range, 50-79 years) who underwent both pre- and post-enhancement abdominopelvic CT scans were included in this retrospective study. Whole 3D volumes of the left proximal femur from the head to the lesser trochanter were extracted using the regional growth technique with commercial 3D software. Total volume, mean HU, and HU histogram analysis (HUHA) values of the extracted femur were calculated. HUHA distribution was classified into HUHAfat for the assumed fatty marrow (percentage of negative HU values) and HUHAdense-bone (percentage of HU values ≥ 126 HU). Reliability was assessed by calculating intra- and interobserver correlation coefficients (ICCs) and by drawing Bland-Altman plots. The effect of contrast medium administration was evaluated by the paired t-test. RESULTS All intra- and interobserver ICCs of 3D volume measurements showed excellent reproducibility (all ICCs > 0.90). On Bland-Altman analysis of two observers' 3D volume measurements, the differences in the mean total volume, HUHAfat, HUHAdense-bone, and mean HU were 2.4 cm3, 0.17%, 0.6%, and 1.9 HU, respectively. The mean difference in HU after contrast agent administration (-2.2 HU) was not significant (P = 0.27). The mean difference in HUHAfat and HUHAdense-bone after contrast agent administration were -1.1% and -2.2%, respectively, on the Bland-Altman plot. HUHAfat and HUHAdense-bone showed significant differences (P < 0.05). The 95% limits of agreement for HUHAfat, HUHAdense-bone, and mean HU were -3.6% to 1.3%, -6.5% to 2.1%, and -30.0 to 25.5 HU, respectively. CONCLUSION Image analysis based on 3D volume measurement of the proximal femur showed excellent reliability, with the contrast agent administration showing negligible influence on the mean HU.
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Affiliation(s)
- Hye-Won Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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30
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Schileo E, Pitocchi J, Falcinelli C, Taddei F. Cortical bone mapping improves finite element strain prediction accuracy at the proximal femur. Bone 2020; 136:115348. [PMID: 32240847 DOI: 10.1016/j.bone.2020.115348] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/17/2020] [Accepted: 03/27/2020] [Indexed: 11/28/2022]
Abstract
Despite evidence of the biomechanical role of cortical bone, current state of the art finite element models of the proximal femur built from clinical CT data lack a subject-specific representation of the bone cortex. Our main research hypothesis is that the subject-specific modelling of cortical bone layer from CT images, through a deconvolution procedure known as Cortical Bone Mapping (CBM, validated for cortical thickness and density estimates) can improve the accuracy of CT-based FE models of the proximal femur, currently limited by partial volume artefacts. Our secondary hypothesis is that a careful choice of cortical-specific density-elasticity relationship may improve model accuracy. We therefore: (i) implemented a procedure to include subject-specific CBM estimates of both cortical thickness and density in CT-based FE models. (ii) defined alternative models that included CBM estimates and featured a cortical-specific or an independently optimised density-elasticity relationship. (iii) tested our hypotheses in terms of elastic strain estimates and failure load and location prediction, by comparing with a published cohort of 14 femurs, where strain and strength in stance and fall loading configuration were experimentally measured, and estimated through reference FE models that did not explicitly model the cortical compartment. Our findings support the main hypothesis: an explicit modelling of the proximal femur cortical bone layer including CBM estimates of cortical bone thickness and density increased the FE strains prediction, mostly by reducing peak errors (average error reduced by 30%, maximum error and 95th percentile of error distribution halved) and especially when focusing on the femoral neck locations (all error metrics at least halved). We instead rejected the secondary hypothesis: changes in cortical density-elasticity relationship could not improve validation performances. From these improved baseline strain estimates, further work is needed to achieve accurate strength predictions, as models incorporating cortical thickness and density produced worse estimates of failure load and equivalent estimates of failure location when compared to reference models. In summary, we recommend including local estimates of cortical thickness and density in FE models to estimate bone strains in physiological conditions, and especially when designing exercise studies to promote bone strength.
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Affiliation(s)
- Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Jonathan Pitocchi
- Materialise N.V., Heverlee, Belgium; Multiscale in Mechanical and Biological Engineering (M2BE), University of Zaragoza, Zaragoza, Spain; Biomechanics Section, KU Leuven, Leuven, Belgium
| | | | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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31
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Keaveny TM, Clarke BL, Cosman F, Orwoll ES, Siris ES, Khosla S, Bouxsein ML. Biomechanical Computed Tomography analysis (BCT) for clinical assessment of osteoporosis. Osteoporos Int 2020; 31:1025-1048. [PMID: 32335687 PMCID: PMC7237403 DOI: 10.1007/s00198-020-05384-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Abstract
The surgeon general of the USA defines osteoporosis as "a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk of fracture." Measuring bone strength, Biomechanical Computed Tomography analysis (BCT), namely, finite element analysis of a patient's clinical-resolution computed tomography (CT) scan, is now available in the USA as a Medicare screening benefit for osteoporosis diagnostic testing. Helping to address under-diagnosis of osteoporosis, BCT can be applied "opportunistically" to most existing CT scans that include the spine or hip regions and were previously obtained for an unrelated medical indication. For the BCT test, no modifications are required to standard clinical CT imaging protocols. The analysis provides measurements of bone strength as well as a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) T-score at the hip and a volumetric BMD of trabecular bone at the spine. Based on both the bone strength and BMD measurements, a physician can identify osteoporosis and assess fracture risk (high, increased, not increased), without needing confirmation by DXA. To help introduce BCT to clinicians and health care professionals, we describe in this review the currently available clinical implementation of the test (VirtuOst), its application for managing patients, and the underlying supporting evidence; we also discuss its main limitations and how its results can be interpreted clinically. Together, this body of evidence supports BCT as an accurate and convenient diagnostic test for osteoporosis in both sexes, particularly when used opportunistically for patients already with CT. Biomechanical Computed Tomography analysis (BCT) uses a patient's CT scan to measure both bone strength and bone mineral density at the hip or spine. Performing at least as well as DXA for both diagnosing osteoporosis and assessing fracture risk, BCT is particularly well-suited to "opportunistic" use for the patient without a recent DXA who is undergoing or has previously undergone CT testing (including hip or spine regions) for an unrelated medical condition.
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Affiliation(s)
- T M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, USA.
| | - B L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - F Cosman
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - E S Siris
- Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - S Khosla
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - M L Bouxsein
- Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Oh TK, Song IA. Metformin therapy and hip fracture risk among patients with type II diabetes mellitus: A population-based cohort study. Bone 2020; 135:115325. [PMID: 32201359 DOI: 10.1016/j.bone.2020.115325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study aimed to investigate the potential association of exposure to metformin therapy with the risk of hip fracture in adult patients with type II diabetes. We included patients with diabetes who were registered in the 2010 sample cohort database of the National Health Insurance Service in South Korea. METHODS The patients who had been prescribed continuous oral metformin therapy for a 1-year period in 2010 were defined as the metformin group, while those who were not prescribed metformin during the same period were classified as the control group. The primary endpoint of this study was the development of hip fracture between January 2011 and December 2015. RESULTS A total of 64,878 patients (31,300 patients in the metformin group and 32,439 patients in the control group) were included in this study. Among those, 1655 patients (2.6%) had experienced a hip fracture. After a propensity score matching, a total of 37,378 patients (18,689 patients in each group) were included in the analysis. Using a time-dependent Cox regression analysis on the propensity score-matched cohort, the exposure to metformin was not significantly associated with the development of hip fracture compared to the control group (hazard ratio: 1.00, 95% confidence interval: 0.86 to 1.16; P = 0.985). Similar results were observed using sensitivity analysis of a multivariable time-dependent Cox regression model of the entire cohort (hazard ratio: 0.78, 95% confidence interval: 0.36 to 1.69; P = 0.525). CONCLUSIONS This population-based cohort study in South Korea showed that there was no significant association between the exposure to metformin therapy and hip fracture in patients with type II diabetes mellitus.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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Warden SJ, Carballido-Gamio J, Weatherholt AM, Keyak JH, Yan C, Kersh ME, Lang TF, Fuchs RK. Heterogeneous Spatial and Strength Adaptation of the Proximal Femur to Physical Activity: A Within-Subject Controlled Cross-Sectional Study. J Bone Miner Res 2020; 35:681-690. [PMID: 31826314 PMCID: PMC7145739 DOI: 10.1002/jbmr.3939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
Physical activity (PA) enhances proximal femur bone mass, as assessed using projectional imaging techniques. However, these techniques average data over large volumes, obscuring spatially heterogeneous adaptations. The current study used quantitative computed tomography, statistical parameter mapping, and subject-specific finite element (FE) modeling to explore spatial adaptation of the proximal femur to PA. In particular, we were interested in adaptation occurring at the superior femoral neck and improving strength under loading from a fall onto the greater trochanter. High/long jump athletes (n = 16) and baseball pitchers (n = 16) were utilized as within-subject controlled models as they preferentially load their take-off leg and leg contralateral to their throwing arm, respectively. Controls (n = 15) were included but did not show any dominant-to-nondominant (D-to-ND) leg differences. Jumping athletes showed some D-to-ND leg differences but less than pitchers. Pitchers had 5.8% (95% confidence interval [CI] 3.9%-7.6%) D-to-ND leg differences in total hip volumetric bone mineral density (vBMD), with increased vBMD in the cortical compartment of the femoral neck and trochanteric cortical and trabecular compartments. Voxel-based morphometry analyses and cortical bone mapping showed pitchers had D-to-ND leg differences within the regions of the primary compressive trabeculae, inferior femoral neck, and greater trochanter but not the superior femoral neck. FE modeling revealed pitchers had 4.1% (95% CI 1.4%-6.7%) D-to-ND leg differences in ultimate strength under single-leg stance loading but no differences in ultimate strength to a fall onto the greater trochanter. These data indicate the asymmetrical loading associated with baseball pitching induces proximal femur adaptation in regions associated with weight bearing and muscle contractile forces and increases strength under single-leg stance loading. However, there were no benefits evident at the superior femoral neck and no measurable improvement in ultimate strength to common injurious loading during aging (ie, fall onto the greater trochanter), raising questions as to how to better target these variables with PA. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Stuart J. Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alyssa M. Weatherholt
- Department of Kinesiology and Sport, Pott College of Science, Engineering, and Education, University of Southern Indiana, Evansville, IN
| | - Joyce H. Keyak
- Departments of Radiological Sciences, Mechanical and Aerospace Engineering, and Biomedical Engineering, University of California Irvine, Irvine CA
| | - Chenxi Yan
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Mariana E. Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Robyn K. Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
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Turmezei TD, Treece GM, Gee AH, Sigurdsson S, Jonsson H, Aspelund T, Gudnason V, Poole KES. Quantitative 3D imaging parameters improve prediction of hip osteoarthritis outcome. Sci Rep 2020; 10:4127. [PMID: 32139721 PMCID: PMC7058047 DOI: 10.1038/s41598-020-59977-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Abstract
Osteoarthritis is an increasingly important health problem for which the main treatment remains joint replacement. Therapy developments have been hampered by a lack of biomarkers that can reliably predict disease, while 2D radiographs interpreted by human observers are still the gold standard for clinical trial imaging assessment. We propose a 3D approach using computed tomography—a fast, readily available clinical technique—that can be applied in the assessment of osteoarthritis using a new quantitative 3D analysis technique called joint space mapping (JSM). We demonstrate the application of JSM at the hip in 263 healthy older adults from the AGES-Reykjavík cohort, examining relationships between 3D joint space width, 3D joint shape, and future joint replacement. Using JSM, statistical shape modelling, and statistical parametric mapping, we show an 18% improvement in prediction of joint replacement using 3D metrics combined with radiographic Kellgren & Lawrence grade (AUC 0.86) over the existing 2D FDA-approved gold standard of minimum 2D joint space width (AUC 0.73). We also show that assessment of joint asymmetry can reveal significant differences between individuals destined for joint replacement versus controls at regions of the joint that are not captured by radiographs. This technique is immediately implementable with standard imaging technologies.
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Affiliation(s)
- T D Turmezei
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, UK.
| | - G M Treece
- Cambridge University Engineering Department, Cambridge, UK
| | - A H Gee
- Cambridge University Engineering Department, Cambridge, UK
| | | | - H Jonsson
- Department of Rheumatology, Landspitalinn University Hospital, Reykjavik, Iceland
| | - T Aspelund
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - V Gudnason
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - K E S Poole
- Department of Medicine, University of Cambridge, Cambridge, UK
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35
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Acciaioli A, Falco L, Baleani M. Measurement of apparent mechanical properties of trabecular bone tissue: Accuracy and limitation of digital image correlation technique. J Mech Behav Biomed Mater 2020; 103:103542. [DOI: 10.1016/j.jmbbm.2019.103542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/21/2019] [Accepted: 11/15/2019] [Indexed: 01/02/2023]
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Baptista F, Lopes E, Matute-Llorente Á, Teles J, Zymbal V. Adaptation of Proximal Femur to Mechanical Loading in Young Adults: Standard Vs Localized Regions Evaluated by DXA. J Clin Densitom 2020; 23:73-81. [PMID: 30274880 DOI: 10.1016/j.jocd.2018.07.012] [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: 07/03/2018] [Revised: 07/30/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Abstract
Regions of the proximal femur with less adaptive protection by mechanical loading may be at increased risk of structural failure. Since the size and location of these regions diverge from those defined by the dual-energy X-ray absorptiometry manufacturers the purpose of this study was to compare areal bone mineral density (aBMD) of different regions of the proximal femur considering impact loads from physical activity (PA). The participants were 134 young adults divided into 2 groups according to the impact of PA performed in the last 12 mo: high-impact PA and low-impact PA. The aBMD of the proximal femur was assessed by dual-energy X-ray absorptiometry at the standard femoral neck, intertrochanter, and trochanter, and at specific locations of the superolateral femoral neck and intertrochanteric region. The bone-specific physical activity questionnaire was used to estimate the impact load of PA. Comparisons between groups were adjusted for body height and body lean mass. Interaction analysis between sex and PA groups were conducted with analysis of variance. Comparisons of aBMD between bone regions were analyzed separately for men and women with repeated measures analysis of variance. In the high-impact PA group, men benefit more than women at all bone regions, except the aBMD at intertrochanteric region. Analyses of repeated measures did not reveal any significant interaction effect between bone regions (standard vs specific) and PA groups (low vs high-impact). In conclusion, aBMD differences due to mechanical loading were more pronounced in men than in women; the magnitude of the aBMD differences as a result of different levels of PA was similar between standard and localized regions.
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Affiliation(s)
- Fátima Baptista
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
| | - Edgar Lopes
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Ángel Matute-Llorente
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Department of Physiatry and Nursing, Faculty of Health and Sports Sciences, Universidad de Zaragoza, Zaragoza, Spain
| | - Júlia Teles
- Mathematics Unit, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Vera Zymbal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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38
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Su YB, Wang L, Wu XB, Yi C, Yang MH, Yan D, Cheng KB, Cheng XG. The spatial differences in bone mineral density and hip structure between low-energy femoral neck and trochanteric fractures in elderly Chinese using quantitative computed tomography. Bone 2019; 124:62-68. [PMID: 31004806 DOI: 10.1016/j.bone.2019.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/12/2019] [Accepted: 04/13/2019] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to investigate the differences in bone mineral density (BMD) and hip structure between femoral neck and trochanteric fractures in elderly Chinese individuals using quantitative computed tomography (QCT). A total of 625 Chinese patients (mean age 75.8 years) who sustained low-energy hip fractures (female: 293 femoral neck, 175 trochanteric; male: 82 femoral neck, 75 trochanteric) were recruited. Each patient underwent a hip QCT scan. The areal BMD (aBMD) of the contralateral normal hip was obtained using a computed tomography X-ray absorptiometry module. Using the bone investigation toolkit (BIT) module, the femoral neck was divided into four quadrants: supero-anterior (SA), infero-anterior (IA), infero-posterior (IP), and supero-posterior (SP). Estimated cortical thickness, cortical BMD, and trabecular BMD were measured in each quadrant. Using the hip structure analysis (HSA) function, several parameters were calculated. Stratified by sex, covariance analyses were applied to compare the femoral neck fractures group with trochanteric fractures group after adjustments for age, height, and weight. In women, trochanteric fractures exhibited lower trabecular BMD and estimated cortical thickness at three quadrants of the femoral neck (IA: P = 0.02, P < 0.01; IP: P < 0.01, P = 0.01; SP: P = 0.01, P < 0.01), and lower aBMD at the trochanter area (P < 0.01); femoral neck fractures exhibited lower cortical BMD and estimated cortical thickness at the SA quadrant (P = 0.04, P = 0.01). Differences in HSA parameters were not statistically significant. Among all parameters, the most valuable ones to discrimination of hip fracture type are estimated cortical thickness of the SA quadrant of femoral neck and the aBMD of the trochanter area. In men, only lower cortical BMD at the SP quadrant and aBMD at the trochanter were found in the trochanteric fractures (P = 0.02, P < 0.01). QCT outcomes indicate that spatial differences are helpful to explore the pathogenesis of different type of hip fractures. In women, trochanteric fractures are related to severer osteoporosis, whereas cortical fragility in the SA region of the femoral neck predominates in cases of femoral neck fractures. In men, trochanteric fractures are related to more bone loss of trochanter.
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Affiliation(s)
- Yong-Bin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xin-Bao Wu
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Yi
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Ming-Hui Yang
- Department of Orthopaedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ke-Bin Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiao-Guang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
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Lee Y, Ogihara N, Lee T. Assessment of finite element models for prediction of osteoporotic fracture. J Mech Behav Biomed Mater 2019; 97:312-320. [PMID: 31151004 DOI: 10.1016/j.jmbbm.2019.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/05/2019] [Accepted: 05/09/2019] [Indexed: 12/16/2022]
Abstract
With increasing life expectancy and mortality rates, the burden of osteoporotic hip fractures is continually on an upward trend. In terms of prevention, there are several osteoporosis treatment strategies such as anti-resorptive drug treatments, which attempt to retard the rate of bone resorption, while promoting the rate of formation. With respect to prediction, several studies have provided insights into obtaining bone strength by non-invasive means through the application of FE analysis. However, what valuable information can we obtain from FE studies that have focused on osteoporosis research, with respect to the prediction of osteoporotic fractures? This paper aims to fine studies that have used FE analysis to predict fractures in the proximal femur through a systematic search of literature using PUBMED, with the main objective of supporting the diagnosis of osteoporosis. The focus of these FE studies is first discussed, and the methodological aspects are summarized, by mainly comparing and contrasting their meshing properties, material properties, and boundary conditions. The implications of these methodological differences in FE modelling processes and propositions with the aim of consolidating or minimalizing these differences are further discussed. We proved that studies need to start converging in terms of their input parameters to make the FE method applicable to clinical settings. This, in turn, will decrease the time needed for in vitro tests. Current advancements in FE analysis need to be consolidated before any further steps can be taken to implement engineering analysis into the clinical scenario.
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Affiliation(s)
- Yeokyeong Lee
- Department of Architectural Engineering, Ewha Womans University, Republic of Korea
| | | | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Republic of Korea.
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40
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Ischemia Injury: A New Method Accelerates Bone Healing in a Rat Tibia Fracture Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6592464. [PMID: 31139643 PMCID: PMC6500703 DOI: 10.1155/2019/6592464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/14/2019] [Accepted: 03/07/2019] [Indexed: 12/26/2022]
Abstract
To find a simple and noninvasive method to promote fracture healing, we are trying to explore whether repetitive brief ischemia would promote bone healing. 88 rats divided into 6 groups were used to make right tibia closed fracture caused by the heavy weight collision method. Healthy side groups received homemade tourniquet placed on left and affected side group placed on right thigh 10 min inflated/10 min deflated 3 times every 24 hours or 48 hours after tibia fractured. Rats in control groups received homemade tourniquet uninflated placed on right thigh 1 hour every 24 hours or 48 hours. X-rays were checked at 1, 2, and 4 weeks. Micro-CT inspected the bone healing at 2 and 4 weeks. Serum cytokines, such as bone morphogenetic protein-2 (BMP-2), vascular endothelial growth factor (VEGF), diethanolamine enzyme activity unit of alkaline phosphatase (ALP) and transforming growth factor-β1 (TGF-β1), interleukin 10 (IL-10) and interleukin 6 (IL-6), were checked at 1, 2, and 4 weeks. Local histology was evaluated at 2 weeks. HE dye and BMP-2, VEGF, TGF-β, and ALP immunohistochemical stains were made. Callus areas of posterior-anterior and lateral views were calculated and repetitive brief ischemia increased the callus areas ratio at 1 and 2 weeks. Besides, from micro-CT results, repetitive brief ischemia increased the bone volume (BV) at 2 and 4 weeks and also increased the total bone tissue volume (TV) at 2 weeks and BV/TV at 4 weeks. The serum cytokines, such as BMP-2, VEGF, diethanolamine enzyme activity unit of ALP and TGF-β1, have increased by repetitive brief ischemia at 1, 2 weeks. It is opposite of affected side group that the level of serum IL-10 increased and IL-6 decreased in healthy side group at 1, 2 weeks. Repetitive brief ischemia increased the callus area at 2 weeks and boosted the synthesis of BMP-2, VEGF, TGF-β, and ALP in the fracture region at 2 weeks from tissue stains. Repetitive brief ischemia promotes bone healing no matter on the affected side or the healthy side limb.
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Serrien B, Goossens M, Baeyens JP. Statistical parametric mapping of biomechanical one-dimensional data with Bayesian inference. Int Biomech 2019; 6:9-18. [PMID: 34042004 PMCID: PMC8211129 DOI: 10.1080/23335432.2019.1597643] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Recent developments in Statistical Parametric Mapping (SPM) for continuum data (e.g. kinematic time series) have been adopted by the biomechanics research community with great interest. The Python/MATLAB package spm1d developed by T. Pataky has introduced SPM into the biomechanical literature, adapted originally from neuroimaging. The package already allows many of the statistical analyses common in biomechanics from a frequentist perspective. In this paper, we propose an application of Bayesian analogs of SPM based on Bayes factors and posterior probability with default priors using the BayesFactor package in R. Results are provided for two typical designs (two-sample and paired sample t-tests) and compared to classical SPM results, but more complex standard designs are possible in both classical and Bayesian frameworks. The advantages of Bayesian analyses in general and specifically for SPM are discussed. Scripts of the analyses are available as supplementary materials.
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Affiliation(s)
- Ben Serrien
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maggy Goossens
- Faculty of Applied Engineering, Universiteit Antwerpen, Antwerp, Belgium.,Thim Van Der Laan University College Physiotherapy, Landquart, Switzerland
| | - Jean-Pierre Baeyens
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Faculty of Applied Engineering, Universiteit Antwerpen, Antwerp, Belgium.,Thim Van Der Laan University College Physiotherapy, Landquart, Switzerland
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Warden SJ, Carballido-Gamio J, Avin KG, Kersh ME, Fuchs RK, Krug R, Bice RJ. Adaptation of the proximal humerus to physical activity: A within-subject controlled study in baseball players. Bone 2019; 121:107-115. [PMID: 30634064 PMCID: PMC6391178 DOI: 10.1016/j.bone.2019.01.008] [Citation(s) in RCA: 12] [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: 10/22/2018] [Revised: 12/18/2018] [Accepted: 01/07/2019] [Indexed: 11/29/2022]
Abstract
The proximal humerus is a common, yet understudied site for osteoporotic fracture. The current study explored the impact of prolonged physical activity on proximal humerus bone health by comparing bone properties between the throwing and nonthrowing arms within professional baseball players. The proximal humerus in throwing arms had 28.1% (95% CI, 17.8 to 38.3%) greater bone mass compared to nonthrowing arms, as assessed using dual-energy x-ray absorptiometry. At the level of the surgical neck, computed tomography revealed 12.0% (95% CI, 8.2 to 15.8%) greater total cross-sectional area and 31.0% (95% CI, 17.8 to 44.2%) greater cortical thickness within throwing arms, which contributed to 56.8% (95% CI, 44.9 to 68.8%) greater polar moment of inertia (i.e., estimated ability to resist torsional forces) compared to nonthrowing arms. Within the humeral head and greater tubercle regions, throwing arms had 3.1% (95% CI, 1.1 to 5.1%) more trabecular bone, as assessed using high-resolution magnetic resonance imaging. Three-dimensional mapping of voxel- and vertex-wise differences between arms using statistical parametric mapping techniques revealed throwing arms had adaptation within much of the proximal diaphysis, especially the posterolateral cortex. The pattern of proximal diaphysis adaptation approximated the pattern of strain energy distribution within the proximal humerus during a fastball pitch derived from a musculoskeletal and finite element model in a representative player. These data demonstrate the adaptive ability of the proximal humerus to physical activity-related mechanical loads. It remains to be established how they translate to exercise prescription to improve bone health within the proximal humerus; however, they provide unique insight into the relationship between prolonged loading and skeletal adaptation at a clinically relevant osteoporotic site.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, United States of America
| | - Keith G Avin
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, IL, United States of America
| | - Robyn K Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ryan J Bice
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America
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Wang Y, Li J, Yang J, Dong J. Regional characteristics of cortical bone quality in the proximal humerus of postmenopausal women: a preliminary study. J Shoulder Elbow Surg 2019; 28:685-691. [PMID: 30527884 DOI: 10.1016/j.jse.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures represent the third most common fragility fracture treated in osteoporotic populations, after hip and distal radial fractures. The purpose of this study was to characterize the spatial variability in cortical geometry in the proximal humerus in postmenopausal women. METHODS The proximal humeri in 43 healthy postmenopausal women were imaged by computed tomography. Cortical bone mapping was applied to create color 3-dimensional thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and endocortical trabecular density, were measured over the humeral head and metaphyseal region after 15 regions of interest (ROIs) were defined. RESULTS In the humeral head region, significant differences in CTh and CM values were detected between the anterior, lateral, and posterior walls (P < .05). The highest CTh and CM were found in the anterior wall in each plane (P < .05). Regarding the endocortical trabecular density, no significant findings were noted in the 3 planes (P > .05). In the metaphyseal region, the cortical structure in the medial column had higher CTh and CM values in ROI 10 compared with the lateral column (P < .05). The highest CTh and CM values of compact bone were seen in ROI 10 of the medial column (ROIs 10-12) (P < .05). CONCLUSION Our results showed significant regional variation of cortical bone in the humeral head region in postmenopausal women. Similar conditions were seen in the medial column in the metaphyseal region. This finding provides discriminatory information for stronger fixation of implants.
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Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
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Chandran V, Maquer G, Gerig T, Zysset P, Reyes M. Supervised learning for bone shape and cortical thickness estimation from CT images for finite element analysis. Med Image Anal 2019; 52:42-55. [DOI: 10.1016/j.media.2018.11.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/24/2018] [Accepted: 11/02/2018] [Indexed: 01/31/2023]
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A cross-sectional study on the age-related cortical and trabecular bone changes at the femoral head in elderly female hip fracture patients. Sci Rep 2019; 9:305. [PMID: 30670734 PMCID: PMC6343024 DOI: 10.1038/s41598-018-36299-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
Bone is in a continuous state of remodeling whereby old bone is absorbed and new bone is formed in its place. During this process, new formations reinforce the bone in the direction of the dominant stress trajectories through a functional adaptation. In normal aging, the balance between bone resorption and formation can be shifted. How this affects the functional adaptation remains to be investigated. Furthermore, how or whether the bone continues to change beyond the age of 85 is not yet studied in detail. In this study we examined the age-related changes in the cortical and trabecular bone in old age, and assessed whether we can find evidence of the presence of functional adaptation. We measured cortical and trabecular parameters from micro-computed tomography scans of the femoral head extracted from hip fracture patients between the age of 70 and 93 years. A significant decrease in global trabecular bone mineral density (38.1%) and cortical thickness (13.0%) was seen from the 9th to the 10th decade of life. The degree of anisotropy was maintained globally as well as locally in both high and low stress regions. The local trabecular bone mineral density decreased in both high stress and low stress regions between the 9th and 10th decade of life with similar trends. This suggests that the role of functional adaptation in maintaining the bone structural integrity in old age may be limited. This study highlights the need for a controlled clinical trial examining the cause of the continued bone degradation throughout old age.
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Abstract
PURPOSE OF REVIEW Cortical bone mapping (CBM) is a technique for measuring localised skeletal changes from computed tomography (CT) images. It can provide measurements with accuracy surpassing the underlying imaging resolution. CBM can detect changes in several properties of the cortex, with no prior assumptions about the likely location of said changes. This paper summarises the theory behind CBM, discusses its strengths and limitations, and reviews some studies in which it has been applied. RECENT FINDINGS CBM has revealed associations between fracture risk and cortical properties in specific regions of the proximal femur which present feasible therapeutic targets. Analyses of several pharmaceutical and exercise interventions quantify effects that are distinct both in location and in the nature of the micro-architectural changes. CBM has illuminated age-related changes in the proximal femur and has recently been applied to other bones, as well as to the assessment of cartilage. The CBM processing pipeline is designed primarily for large cohort studies. Its main impact thus far has not been in the realm of clinical practice, but rather to improve our fundamental understanding of localised bone structure and changes.
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Affiliation(s)
- Graham Treece
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK.
| | - Andrew Gee
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
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Comparison of the diagnostic performance of CT Hounsfield unit histogram analysis and dual-energy X-ray absorptiometry in predicting osteoporosis of the femur. Eur Radiol 2018; 29:1831-1840. [PMID: 30255256 DOI: 10.1007/s00330-018-5728-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of Hounsfield unit histogram analysis (HUHA) of precontrast abdominal-pelvic CT scans for predicting osteoporosis. MATERIALS AND METHODS The study included 271 patients who had undergone dual X-ray absorptiometry (DXA) and abdominal-pelvic CT within 1 month. HUHA was measured using commercial 3D analysis software (Aquarius iNtuition v4.4.12Ⓡ, TeraRecon) and expressed as a percentage of seven HU range categories related to the ROI: A < 0, 0 ≤ B < 25, 25 ≤ C < 50, 50 ≤ D < 75, 75 ≤ E < 100, 100 ≤ F < 130, and 130 ≤ G. A coronal reformatted precontrast CT image containing the largest Ward's triangle was selected and then the ROI was drawn over the femoral neck. Correlation (r) and ROC curve analyses were used to assess diagnostic performance in predicting osteoporosis using the femur T-score as the reference standard. RESULTS When the femur T-score was used as the reference, the rs of HUHA-A and HUHA-G were 0.74 and -0.57, respectively. Other HUHA values had moderate to weak correlations (r = -0.33 to 0.27). The correlation of HUHA-A was significantly higher than that of HUHA-G (p = 0.03). The area under the curve (0.95) of HUHA-A differed significantly from that of HUHA-G (0.90; p < 0.01). A HUHA-A threshold ≥ 27.7% was shown to predict osteoporosis based on a sensitivity and specificity of 95.6% and 81.7%, respectively. CONCLUSION The HUHA-A value of the femoral neck is closely related to osteoporosis and may help predict osteoporosis. KEY POINTS • HUHA correlated strongly with the DXA femur T-score (HUHA-A, r = 0.74). • The diagnostic performance of HUHA for predicting osteoporosis (AUC = 0.95) was better than that of the average CT HU value (AUC = 0.91; p < 0.05). • HUHA may help predict osteoporosis and enable semi-quantitative measurement of changes in bone mineral density.
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Marques EA, Carballido-Gamio J, Gudnason V, Sigurdsson G, Sigurdsson S, Aspelund T, Siggeirsdottir K, Launer L, Eiriksdottir G, Lang T, Harris TB. Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study. Bone 2018; 114:72-80. [PMID: 29777918 PMCID: PMC6137723 DOI: 10.1016/j.bone.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk.
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Affiliation(s)
- Elisa A Marques
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Gunnar Sigurdsson
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland; Landspitalinn University Hospital, Reykjavik, Iceland
| | | | - Thor Aspelund
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kristin Siggeirsdottir
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Lenore Launer
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
| | | | - Thomas Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Tamara B Harris
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
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Power J, Loveridge N, Kröger H, Parker M, Reeve J. Femoral neck cortical bone in female and male hip fracture cases: Differential contrasts in cortical width and sub-periosteal porosity in 112 cases and controls. Bone 2018; 114:81-89. [PMID: 29807138 DOI: 10.1016/j.bone.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To quantitate differences between cases of hip fracture and controls in cortical width around the mid-femoral neck in men and women. METHODS Over 5 years, 64 (14 male) participants over age 55 (mean 79) years, who had never taken bone-active drugs and suffered intra-capsular hip fracture treated by arthroplasty, donated their routinely discarded distal intra-capsular femoral neck bone for histomorphometry. After embedding, complete femoral neck cross sections from the cut surface near the narrowest part of the neck were stained with von Kossa and cortical width was measured radially every 5 degrees of arc. Control material (n = 48, 25 male) was available through consented post mortems prior to the year 2000. Cortical widths were averaged for circumferential octants, each representing 45 degrees of arc. Divergence of individual cortical widths from their means was also examined. RESULTS Because sections were required to have a complete cortex, sampling was biased towards cases with sub-capital versus trans-cervical fractures. Compared to sex- and age matched controls, male cases showed larger relative differences in cortical widths than female cases. Unexpectedly, cortical widths in female but not male cases also showed marked over-representation of extremely narrow (<0.1 mm) cortical widths, located mainly posteriorly. The numbers of these very narrow cortical widths observed per subject retrospectively predicted female fracture status in logistic regression independently of mean cortical width values. Together with mean cortical width differences, the numbers of measured cortical widths <0.1 mm (out of 72 measured) raised the sensitivity of predicting fracture status in women from 48 to 80% at 80% specificity. In almost all cases, very narrow cortical widths were identified in regions enclosing a cortical pore roofed on its endosteal surface by thin structural bone defined a priori as trabecular. CONCLUSIONS Cortical widths <0.1 mm probably reflect zones where endosteal cortex has been trabecularised through expansion of an un-refilled sub-endosteal canal close to the periosteum. Persistent cortical defects occurring near the periosteal surface, where mechanical loading exerts its greatest stresses, are likely to result in extremes of localized concentrations of stress during a fall, unknown in young normal fallers. Such defects have the potential to help explain the excess of hip fractures among elderly women. Prevention of sub-periosteal tunnelling by osteoclasts might explain in part the additional benefits, beyond an increase in bone density, of treatments that reduce excessive bone resorption or else stimulate new bone formation on previously resorbed surfaces.
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Affiliation(s)
- Jon Power
- Department of Biological Sciences, University of Chester, Chester CH1 4BJ, UK
| | - Nigel Loveridge
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Box 180, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, P.O.BOX 100, FIN-70029 KYS Kuopio, Finland
| | - Martyn Parker
- Trauma and Orthopaedics, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, UK
| | - Jonathan Reeve
- NIHR Biomedical Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.
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Johannesdottir F, Allaire B, Bouxsein ML. Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives. Curr Osteoporos Rep 2018; 16:411-422. [PMID: 29846870 DOI: 10.1007/s11914-018-0450-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. RECENT FINDINGS CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA.
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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