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Heck A, Godang K, Lekva T, Markussen KN, De Vincentis S, Ueland T, Bollerslev J. Endocortical Trabecularization in Acromegaly: The Cause for the Paradoxically Increased Vertebral Fracture Risk? JBMR Plus 2023; 7:e10787. [PMID: 37808394 PMCID: PMC10556260 DOI: 10.1002/jbm4.10787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023] Open
Abstract
Growth hormone (GH) is nonphysiologically increased in acromegaly, stimulating target tissues directly and indirectly via insulin-like growth factor type 1 (IGF-1). Despite GH having anabolic effects on bone growth and renewal, the risk of vertebral fractures is paradoxically increased in acromegaly. We hypothesized that bone tissue compartments were differentially affected by hormonal alterations in active and controlled acromegaly. We aimed to study the effect of sex and gonadal status on long-term outcome of bone mass and structure to understand the biomechanical competence of bone. We followed 62 patients with newly diagnosed acromegaly longitudinally (median 4.8 years after pituitary surgery) to investigate changes assessed by dual X-ray absorptiometry (DXA), trabecular bone score (TBS), and hip structure analysis (HSA). At diagnosis, patients had increased bone mineral density (BMD) in most compartments compared with normative data (Z-scores). Conversely, TBS Z-score was decreased (Z = -0.64 (SD 1.73), p = 0.028). Following treatment of acromegaly, BMD increased further in compartments containing predominantly trabecular bone, such as the lumbar spine, in eugonadal and male subjects, while compartments with predominantly cortical bone, such as the hip and femoral neck, were unchanged. Total body measurements showed further increase in BMD independent of sex and gonadal status. TBS did not change. HSA revealed a significant decrease in cortical thickness in both sexes independent of gonadal status, whereas the overall size of bone (hip axis length and neck width) did not change over time. In conclusion, patients with acromegaly had increased bone mass and dimensions by DXA. Following normalization of disease activity, BMD increased mainly in compartments rich in trabecular bone, reflecting a closure of the remodeling space. However, HSA revealed a significant decrease in cortical thickness, implying endocortical trabecularization, potentially explaining the increased risk for incident vertebral fractures following treatment. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ansgar Heck
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
| | - Kristin Godang
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
| | - Tove Lekva
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
| | - Kjersti Norman Markussen
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Sara De Vincentis
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Thor Ueland
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
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2
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Minonzio JG, Ramiandrisoa D, Schneider J, Kohut E, Streichhahn M, Stervbo U, Wirth R, Westhoff TH, Raum K, Babel N. Bi-Directional Axial Transmission measurements applied in a clinical environment. PLoS One 2022; 17:e0277831. [PMID: 36584002 PMCID: PMC9803229 DOI: 10.1371/journal.pone.0277831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 11/03/2022] [Indexed: 12/31/2022] Open
Abstract
Accurate measurement of cortical bone parameters may improve fracture risk assessment and help clinicians on the best treatment strategy. Patients at risk of fracture are currently detected using the current X-Ray gold standard DXA (Dual XRay Absorptiometry). Different alternatives, such as 3D X-Rays, Magnetic Resonance Imaging or Quantitative Ultrasound (QUS) devices, have been proposed, the latter having advantages of being portable and sensitive to mechanical and geometrical properties. The objective of this cross-sectional study was to evaluate the performance of a Bi-Directional Axial Transmission (BDAT) device used by trained operators in a clinical environment with older subjects. The device, positioned at one-third distal radius, provides two velocities: VFAS (first arriving signal) and VA0 (first anti-symmetrical guided mode). Moreover, two parameters are obtained from an inverse approach: Ct.Th (cortical thickness) and Ct.Po (cortical porosity), along with their ratio Ct.Po/Ct.Th. The areal bone mineral density (aBMD) was obtained using DXA at the femur and spine. One hundred and six patients (81 women, 25 men) from Marien Hospital and St. Anna Hospital (Herne, Germany) were included in this study. Age ranged from 41 to 95 years, while body mass index (BMI) ranged from 16 to 47 kg.m-2. Three groups were considered: 79 non-fractured patients (NF, 75±13years), 27 with non-traumatic fractures (F, 80±9years) including 14 patients with non-vertebral fractures (NVF, 84±7years). Weak to moderate significant Spearman correlations (R ranging from 0.23 to 0.53, p < 0.05) were found between ultrasound parameters and age, BMI. Using multivariate Partial Least Square discrimination analyses with Leave-One-Out Cross-Validation (PLS-LOOCV), we found the combination of VFAS and the ratio Ct.Po/Ct.Th to be predictive for all non traumatic fractures (F) with the odds ratio (OR) equals to 2.5 [1.6-3.4] and the area under the ROC curve (AUC) equal to 0.63 [0.62-0.65]. For the group NVF, combination of four parameters VA0. Ct.Th, Ct.Po and Ct.Po/Ct.Po, along with age provides a discrimination model with OR and AUC equals to 7.5 [6.0-9.1] and 0.75 [0.73-0.76]. When restricted to a smaller population (87 patients) common to both BDAT and DXA, BDAT ORs and AUCs are comparable or slightly higher to values obtained with DXA. The fracture risk assessment by BDAT method in older patients, in a clinical setting, suggests the benefit of the affordable and transportable device for the routine use.
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Affiliation(s)
- Jean-Gabriel Minonzio
- Sorbonne Université, INSERM UMR S 1146, CNRS UMR 7371, Laboratoire d’Imagerie Biomédicale, Paris, France
- Escuela de Ingeniería Informática, Universidad de Valparaíso, Valparaíso, Chile
- Centro de Investigación y Desarrollo en Ingeniería en Salud, Universidad de Valparaíso, Valparaíso, Chile
- * E-mail:
| | | | - Johannes Schneider
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
| | - Eva Kohut
- Medical Clinic I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Melanie Streichhahn
- Medical Clinic I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Ulrik Stervbo
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Timm Henning Westhoff
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
| | - Kay Raum
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
| | - Nina Babel
- Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital Herne, Ruhr University, Bochum, Herne, Germany
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Barkaoui A, Ait Oumghar I, Ben Kahla R. Review on the use of medical imaging in orthopedic biomechanics: finite element studies. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.1888317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Abdelwahed Barkaoui
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
| | - Imane Ait Oumghar
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Rabeb Ben Kahla
- Laboratoire de Systémes et de Mécanique Appliquée, Ecole Polytechnique de Tunis, Université de Carthage, Tunis, Tunisia
- Ecole Nationale d’Ingénieurs de Tunis, Université de Tunis el Manar, Campus Universitaire, Tunis, Tunisia
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Aleksova J, Milat F, Kotowicz MA, Pasco JA, Schultz C, Wong P, Ebeling PR, Elder GJ. Patients with end-stage kidney disease have markedly abnormal cortical hip parameters by dual-energy X-ray absorptiometry. Nephrol Dial Transplant 2021; 36:543-550. [PMID: 31697355 DOI: 10.1093/ndt/gfz195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/01/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Patients with end-stage kidney disease (ESKD) have higher fracture rates and post-fracture mortality than the general population, but bone mineral density by dual-energy X-ray absorptiometry (DXA) is less predictive of fracture in this patient group. Bone biopsy and high-resolution imaging indicate that cortical thickness (CT) is reduced and cortical porosity is increased in ESKD. The aim of this study was to assess cortical parameters using DXA in patients with ESKD. It was hypothesized that these parameters would show deterioration and be associated with fracture. METHODS Using advanced hip analysis, normal age-related ranges were determined from 752 female and 861 male femur scans and were compared with scans of 226 patients with ESKD at the time of transplantation. RESULTS Compared with controls, female patients had lower mean±SD CT (mms) at the femoral neck (FN) (2.59 ± 1.42 versus 5.23 ± 1.85), calcar (3.46 ± 1.07 versus 5.09 ± 1.30) and shaft (4.42 ± 1.21 versus 7.44 ± 2.07; P < 0.001 for each), and buckling ratios were higher (8.21 ± 4.6 versus 3.63 ± 1.42; P < 0.001), indicating greater FN instability. All findings were similar for men. Prevalent fracture was documented in 28.8% of patients; 12.4% vertebral only, 8.4% non-vertebral only and 8% vertebral plus non-vertebral. In adjusted models, each 1 SD reduction in FN CT and increase in the buckling ratio was associated with a respective 1.73 (1.22-2.46)- and 1.82 (1.49-2.86)-fold increase in the risk of prevalent vertebral fracture. CONCLUSIONS In patients with ESKD, DXA-derived cortical parameters are markedly abnormal compared with age- and sex-matched controls. These parameters should be assessed for incident fracture prediction and targeting treatment.
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Affiliation(s)
- Jasna Aleksova
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Frances Milat
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Mark A Kotowicz
- Deakin University, Geelong, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- Deakin University, Geelong, Australia.,Barwon Health, University Hospital, Geelong, Australia.,Department of Medicine-Western Health, University of Melbourne, St Albans, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Chris Schultz
- Department of Nuclear Medicine, PET and Bone Densitometry, Royal Adelaide Hospital, Adelaide, Australia
| | - Phillip Wong
- Hudson Institute for Medical Research, Clayton, Australia.,Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Peter R Ebeling
- Department of Medicine, Monash University, Clayton, Australia.,Department of Endocrinology, Monash Health, Clayton, Australia
| | - Grahame J Elder
- Department of Renal Medicine, Westmead Hospital, Sydney, Australia.,Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
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5
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Jazinizadeh F, Adachi JD, Quenneville CE. Advanced 2D image processing technique to predict hip fracture risk in an older population based on single DXA scans. Osteoporos Int 2020; 31:1925-1933. [PMID: 32415372 DOI: 10.1007/s00198-020-05444-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/29/2020] [Indexed: 01/04/2023]
Abstract
UNLABELLED A new technique to enhance hip fracture risk prediction in older adults was presented and assessed. The new method dramatically improved prediction at high specificity levels using only a standard clinical diagnostic scan. This has the potential to be implemented in clinical practice to enhance patient fragility diagnosis. INTRODUCTION Diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scans. However, studies have shown this to be insufficient to accurately predict hip fractures. Therefore, complementary methods are needed to enhance hip fracture risk prediction to identify vulnerable patients. METHODS Hip DXA scans were obtained for 192 subjects from the Canadian Multicenter Osteoporosis Study (CaMos), 50 of whom had experienced a hip fracture within 5 years of the scan. 2D statistical shape and appearance modeling was performed to account for the effect of the femur's geometry and BMD distribution on hip fracture risk. Statistical shape modeling (SSM), and statistical appearance modeling (SAM) were also used separately to predict the fracture risk based solely on the femur's geometry and BMD distribution, respectively. Combined with BMD, age, and body mass index (BMI), logistic regression was performed to estimate the fracture risk over the 5-year period. RESULTS Using the new technique, hip fractures were correctly predicted in 78% of cases compared with 36% when using the T-score. The accuracy of the prediction was not greatly reduced when using SSM and SAM (78% and 74% correct, respectively). Various geometric and BMD distribution traits were identified in the fractured and non-fractured groups. CONCLUSION 2D SSAM can dramatically improve hip fracture prediction at high specificity levels and estimate the year of the impending fracture using standard clinical images. This has the potential to be implemented in clinical practice to estimate hip fracture risk.
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Affiliation(s)
- F Jazinizadeh
- Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - C E Quenneville
- Department of Mechanical Engineering, McMaster University, ABB-C308, 1280 Main St. West, Hamilton, Ontario, L8S 4L8, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.
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Alcântara ACS, Assis I, Prada D, Mehle K, Schwan S, Costa-Paiva L, Skaf MS, Wrobel LC, Sollero P. Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis-A Survey. MATERIALS (BASEL, SWITZERLAND) 2019; 13:E106. [PMID: 31878356 PMCID: PMC6981613 DOI: 10.3390/ma13010106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.
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Affiliation(s)
- Amadeus C. S. Alcântara
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Israel Assis
- Department of Integrated Systems, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Daniel Prada
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Konrad Mehle
- Department of Engineering and Natural Sciences, University of Applied Sciences Merseburg, 06217 Merseburg, Germany;
| | - Stefan Schwan
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, 06120 Halle/Saale, Germany;
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-887, Brazil;
| | - Munir S. Skaf
- Institute of Chemistry and Center for Computing in Engineering and Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Luiz C. Wrobel
- Institute of Materials and Manufacturing, Brunel University London, Uxbridge UB8 3PH, UK;
- Department of Civil and Environmental Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, Brazil
| | - Paulo Sollero
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
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7
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Godang K, Lekva T, Normann KR, Olarescu NC, Øystese KAB, Kolnes A, Ueland T, Bollerslev J, Heck A. Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study. JBMR Plus 2019; 3:e10240. [PMID: 31844828 PMCID: PMC6894724 DOI: 10.1002/jbm4.10240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 02/03/2023] Open
Abstract
Long‐standing growth hormone (GH) excess causes the skeletal clinical signs of acromegaly with typical changes in bone geometry, including increased cortical bone thickness (CBT). However, a high prevalence and incidence of vertebral fractures has been reported. The aim of this study was to assess the course of cortical bone dimensions in the hip by comparing patients with acromegaly and clinically nonfunctioning pituitary adenomas (NFPAs) at baseline and 1 year after pituitary surgery (1‐year PO) in a longitudinal cohort study. DXA was performed in patients with acromegaly (n = 56) and NFPA (n = 47). CBT in the femoral neck (CBTneck), calcar (CBTcalcar), and shaft (CBTshaft) were determined by hip structural analysis (HSA). CBT at baseline and the change to 1‐year PO were compared. Test results were adjusted for differences in gender distribution, age, and gonadal status. Cortical thickness analyses showed higher values [mm] at baseline in patients with acromegaly compared with NFPA: CBTneck median [25th; 75th] 6.2 [4.7; 8.0] versus 5.1 [4.1; 6.4] (p = 0.006), CBTcalcar 4.8 [4.2, 5.7] versus 4.0 [3.2, 4.5] (p < 0.001), CBTshaft 6.2 [5.1, 7.2] versus 5.2 [4.6, 6.0], (p = 0.003). In acromegaly, GH was correlated with CBTneck (r = 0.31, p = 0.020), whereas IGF‐1 was correlated with CBTcalcar (r = 0.39, p = 0.003) at baseline. In acromegaly, CBTneck decreased by 11.2%, p = 0.002 during follow‐up. Finally, the decrease in CBTneck and CBTcalcar in acromegaly was significant compared with NFPA (p = 0.023 and p = 0.017, respectively). Previous observations of increased CBT in acromegaly were confirmed with DXA‐derived HSA in a large, well‐defined cohort. The decline in CBT in acromegaly could contribute to the increased fracture risk in acromegaly despite increased bone dimensions and disease control. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Kristin Godang
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
| | - Tove Lekva
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway
| | - Kjersti Ringvoll Normann
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| | | | | | - Anders Kolnes
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
| | - Thor Ueland
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway.,KG Jebsen TREC University of Tromsø Tromsø Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| | - Ansgar Heck
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
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8
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Duperron M, Grygoryev K, Nunan G, Eason C, Gunther J, Burke R, Manley K, O’brien P. Diffuse reflectance spectroscopy-enhanced drill for bone boundary detection. BIOMEDICAL OPTICS EXPRESS 2019; 10:961-977. [PMID: 30800526 PMCID: PMC6377869 DOI: 10.1364/boe.10.000961] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 05/08/2023]
Abstract
Intramedullary nailing is a routine orthopedic procedure used for treating fractures of femoral or tibial shafts. A critical part of this procedure involves the drilling of pilot holes in both ends of the bone for the placement of the screws that will secure the IM rod to sections of the fractured bone. This step introduces a risk of soft tissue damage because the drill bit, if not stopped in time, can transverse the bone-tissue boundary into the overlying muscle, causing unnecessary injury and prolonging healing time due to periosteum damage. In this respect, detecting the bone-tissue boundary before break-through can reduce the risks and complications associated with intramedullary nailing. Hence, in the present study, a two-wavelength diffuse reflectance spectroscopy technique was integrated into a surgical drill to optically detect bone-tissue boundary and automatically trigger the drill to stop. Furthermore, Monte-Carlo simulations were used to estimate the maximum distance from within the bone at which the bone-tissue boundary could be detected using DRS. The simulation results estimated that the detection distance, termed the "look-ahead-distance" was ∼1.5 mm for 1.3 mm source-detector fiber separation. Experimental measurements with 1.3 mm source-detector fiber separation showed that the look-ahead-distance was in the order of 250 µm in experiments with set drill rate and in the range of 1 mm in experiments where the holes were drilled by hand. Despite this difference, the automated DRS enhanced drill successfully detected the approaching bone tissue boundary when tested on samples of bovine femur and muscle tissue.
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Affiliation(s)
- Matthieu Duperron
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
- First co-authors of this publication
| | - Konstantin Grygoryev
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
- First co-authors of this publication
| | - Gerard Nunan
- Stryker, Instruments Innovation Centre, IDA Business and Technology Park, Carrigtwohill, Cork,
Ireland
| | - Cormac Eason
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
| | - Jacqueline Gunther
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
| | - Ray Burke
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
| | - Kevin Manley
- Stryker, Instruments Innovation Centre, IDA Business and Technology Park, Carrigtwohill, Cork,
Ireland
| | - Peter O’brien
- Tyndall National Institute, Lee Maltings Complex, Dyke parade, Cork,
Ireland, T12R5CP
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9
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Lu RS, Dennison E, Denison H, Cooper C, Taylor M, Bottema MJ. Texture analysis based on Gabor filters improves the estimate of bone fracture risk from DXA images. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2017. [DOI: 10.1080/21681163.2016.1271726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Rui-Sheng Lu
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hayley Denison
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Mark Taylor
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia
| | - Murk J. Bottema
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, Australia
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10
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Luo Y. A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture. Osteoporos Int 2016; 27:423-39. [PMID: 26361947 DOI: 10.1007/s00198-015-3316-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/03/2015] [Indexed: 02/07/2023]
Abstract
Osteoporotic fracture has been found associated with many clinical risk factors, and the associations have been explored dominantly by evidence-based and case-control approaches. The major challenges emerging from the studies are the large number of the risk factors, the difficulty in quantification, the incomplete list, and the interdependence of the risk factors. A biomechanical sorting of the risk factors may shed lights on resolving the above issues. Based on the definition of load-strength ratio (LSR), we first identified the four biomechanical variables determining fracture risk, i.e., the risk of fall, impact force, bone quality, and bone geometry. Then, we explored the links between the FRAX clinical risk factors and the biomechanical variables by looking for evidences in the literature. To accurately assess fracture risk, none of the four biomechanical variables can be ignored and their values must be subject-specific. A clinical risk factor contributes to osteoporotic fracture by affecting one or more of the biomechanical variables. A biomechanical variable represents the integral effect from all the clinical risk factors linked to the variable. The clinical risk factors in FRAX mostly stand for bone quality. The other three biomechanical variables are not adequately represented by the clinical risk factors. From the biomechanical viewpoint, most clinical risk factors are interdependent to each other as they affect the same biomechanical variable(s). As biomechanical variables must be expressed in numbers before their use in calculating LSR, the numerical value of a biomechanical variable can be used as a gauge of the linked clinical risk factors to measure their integral effect on fracture risk, which may be more efficient than to study each individual risk factor.
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Affiliation(s)
- Y Luo
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada.
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada.
- Department of Anatomy, South Medical University, Guangzhou, China.
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Sarvi MN, Luo Y. A two-level subject-specific biomechanical model for improving prediction of hip fracture risk. Clin Biomech (Bristol, Avon) 2015; 30:881-7. [PMID: 26126498 DOI: 10.1016/j.clinbiomech.2015.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/23/2015] [Accepted: 05/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sideways fall-induced hip fracture is a major worldwide health problem among the elderly population. However, all existing biomechanical models for predicting hip fracture mainly consider the femur related parameters. Their accuracy is limited as hip fracture is significantly affected by loading conditions as well. The objective of this study was to develop a biomechanical model for improving assessment of hip fracture risk by subject-specific prediction of fall-induced loading conditions. METHOD All information required to construct the models was extracted from the subject's whole-body and hip medical image in order to make the models subject-specific. Fall-induced hip fracture risk for eighty clinical cases was calculated under two sets of loading conditions: subject-specific determined by the proposed model, and non-subject-specific obtained from empirical functions. The predicted hip fracture risk indices were then compared with clinical observations. FINDINGS It was found that the subject-specific prediction of fall-induced loading conditions significantly improves the hip fracture risk assessment. Consistent to the clinical observations, the fracture risk predicted by the proposed model suggested that obesity is a protective factor for hip fracture and underweight subjects are more likely to experience a hip fracture. INTERPRETATIONS This study shows that hip fracture risk is affected by a number of factors, including body weight, body height, impact force, body mass index, hip soft tissue thickness, and bone quality. The proposed model provides a comprehensive, fast, accurate, and non-expensive method for prediction of hip fracture risk which should lead to more effective prevention of hip fractures.
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Affiliation(s)
- Masoud Nasiri Sarvi
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada
| | - Yunhua Luo
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, 75A Chancellors Circle, Winnipeg, Manitoba R3T 2N2, Canada.
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