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Lau RWL, Cheuk KY, Hung VWY, Yu FWP, Tam EMS, Wong LLN, Zhang J, Lee WYW, Cheng JCY, Lam TP, Lau AYC. Handgrip strength assessment at baseline in addition to bone parameters could potentially predict the risk of curve progression in adolescent idiopathic scoliosis. Front Pediatr 2023; 11:1258454. [PMID: 38027290 PMCID: PMC10655030 DOI: 10.3389/fped.2023.1258454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Adolescent idiopathic scoliosis (AIS) is characterized by deranged bone and muscle qualities, which are important prognostic factors for curve progression. This retrospective case-control study aims to investigate whether the baseline muscle parameters, in addition to the bone parameters, could predict curve progression in AIS. Methods The study included a cohort of 126 female patients diagnosed with AIS who were between the ages of 12 and 14 years old at their initial clinical visit. These patients were longitudinally followed up every 6 months (average 4.08 years) until they reached skeletal maturity. The records of these patients were thoroughly reviewed as part of the study. The participants were categorized into two sub-groups: the progressive AIS group (increase in Cobb angle of ≥6°) and the stable AIS group (increase in Cobb angle <6°). Clinical and radiological assessments were conducted on each group. Results Cobb angle increase of ≥6° was observed in 44 AIS patients (34.9%) prior to skeletal maturity. A progressive AIS was associated with decreased skeletal maturity and weight, lower trunk lean mass (5.7%, p = 0.027) and arm lean mass (8.9%, p < 0.050), weaker dominant handgrip strength (8.8%, p = 0.027), deranged cortical compartment [lower volumetric bone mineral density (vBMD) by 6.5%, p = 0.002], and lower bone mechanical properties [stiffness and estimated failure load lowered by 13.2% (p = 0.005) and 12.5% (p = 0.004)]. The best cut-off threshold of maximum dominant handgrip strength is 19.75 kg for distinguishing progressive AIS from stable AIS (75% sensitivity and 52.4% specificity, p = 0.011). Discussion Patients with progressive AIS had poorer muscle and bone parameters than patients with stable AIS. The implementation of a cut-off threshold in the baseline dominant handgrip strength could potentially be used as an additional predictor, in addition to bone parameters, for identifying individuals with AIS who are at higher risk of experiencing curve progression.
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Affiliation(s)
- Rufina Wing Lum Lau
- School of Medical and Health Sciences, Tung Wah College, Hong Kong, Hong Kong SAR, China
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ka Yee Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Vivian Wing Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Fiona Wai Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elisa Man Shan Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Lyn Lee Ning Wong
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jiajun Zhang
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Wayne Yuk Wai Lee
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Jack Chun Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Tsz Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Adam Yiu Chung Lau
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Kuker AP, Agarwal S, Shane E, Cohen A, Nickolas TL, Stein EM, Reid TJ, Hans D, Cremers S, Bruce JN, Freda PU. Persistent Deficits in Bone Quality in Treated Acromegaly: Evidence From Assessments of Microstructure. J Endocr Soc 2023; 7:bvad121. [PMID: 37809053 PMCID: PMC10553518 DOI: 10.1210/jendso/bvad121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Fractures are increased in patients with acromegaly, both before and after successful acromegaly treatment. Abnormalities of bone microstructure, which may underlie this fragility, are present in active acromegaly but to what extent these improve with acromegaly treatment or persist despite biochemical remission remains unclear. To examine these questions, we studied the effects of acromegaly treatment and remission on bone quality. Methods Sixty-five women and men with acromegaly were studied. Subgroups underwent assessments of areal bone mineral density by dual x-ray absorptiometry, trabecular bone score (TBS), and volumetric bone mineral density, microarchitecture, stiffness and failure load of the distal radius and tibia by high-resolution peripheral quantitative tomography in a longitudinal study before and after acromegaly treatment and in a cross-sectional study in which patients were compared to sex-, age-, and body mass index-matched healthy controls. Results In the longitudinal study, significant increases in total, cortical, and trabecular densities at the radius and tibia and increased stiffness and failure load of the tibia occurred with acromegaly treatment. In the cross-sectional study, patients in biochemical remission after surgery had larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to controls. TBS did not change with acromegaly treatment but correlated with some microstructural parameters. Conclusion We show, for the first time, that volumetric bone mineral density and microarchitecture of the peripheral skeleton improve with acromegaly treatment but remain abnormal in patients in remission after surgery compared to controls. These abnormalities, known to be associated with fractures in other populations, may play a role in the pathogenesis of persistent fragility in treated acromegaly.
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Affiliation(s)
- Adriana P Kuker
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Sanchita Agarwal
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elizabeth Shane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Adi Cohen
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Thomas L Nickolas
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Diseases, Hospital for Special Surgery, New York, NY 10032, USA
| | - Tirissa J Reid
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Didier Hans
- Center for Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Serge Cremers
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Pamela U Freda
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Sadoughi S, Subramanian A, Ramil G, Burghardt AJ, Kazakia GJ. A Laplace-Hamming Binarization Approach for Second-Generation HR-pQCT Rescues Fine Feature Segmentation. J Bone Miner Res 2023; 38:1006-1014. [PMID: 37102793 PMCID: PMC10524566 DOI: 10.1002/jbmr.4819] [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: 01/27/2023] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 04/28/2023]
Abstract
Although second-generation high-resolution peripheral quantitative computed tomography (XCTII) provides the highest-resolution in vivo bone microstructure assessment, the manufacturer's standard image processing protocol omits fine features in both trabecular and cortical compartments. To optimize fine structure segmentation, we implemented a binarization approach based on a Laplace-Hamming (LH) segmentation and documented the reproducibility and accuracy of XCTII structure segmentation using both the standard Gaussian-based binarization and the proposed LH segmentation approach. To evaluate reproducibility, 20 volunteers (9 women, 11 men; aged 23-75 years) were recruited, and three repeat scans of the radii and tibias were acquired using the manufacturer's standard in vivo protocol. To evaluate accuracy, cadaveric structure phantoms (14 radii, 6 tibias) were scanned on XCTII using the same standard in vivo protocol and on μCT at 24.5 μm resolution. XCTII images were analyzed twice-first, with the manufacturer's standard patient evaluation protocol and, second, with the proposed LH segmentation approach. The LH approach rescued fine features evident in the grayscale images but omitted or overrepresented (thickened) by the standard approach. The LH approach significantly reduced error in trabecular volume fraction (BV/TV) and thickness (Tb.Th) compared with the standard approach; however, higher error was introduced for trabecular separation (Tb.Sp). The LH approach improved the correlation between XCTII and μCT for cortical porosity (Ct.Po) and significantly reduced error in cortical pore diameter (Ct.Po.Dm) compared with the standard approach. The LH approach resulted in improved precision compared with the standard approach for BV/TV, Tb.Th, Ct.Po, and Ct.Po.Dm at the radius and for Ct.Po at the tibia. Our results suggest that the proposed LH approach produces substantially improved binary masks, reduces proportional bias, and provides greater accuracy and reproducibility in important outcome metrics, all due to more accurate segmentation of the fine features in both trabecular and cortical compartments. © 2023 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)
- Saghi Sadoughi
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Aditya Subramanian
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Gabby Ramil
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Andrew J Burghardt
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Galateia J Kazakia
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Levy RV, McMahon DJ, Agarwal S, Dempster D, Zhou H, Misof BM, Guo X, Kamanda-Kosseh M, Aponte MA, Reidy K, Kumar J, Fusaro M, Brown DD, Melamed ML, Nickolas TL. Comprehensive Associations between Acidosis and the Skeleton in Patients with Kidney Disease. J Am Soc Nephrol 2023; 34:668-681. [PMID: 36749125 PMCID: PMC10103353 DOI: 10.1681/asn.0000000000000085] [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: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 02/08/2023] Open
Abstract
SIGNIFICANCE STATEMENT Renal osteodystrophy (ROD) contributes substantially to morbidity in CKD, including increased fracture risk. Metabolic acidosis (MA) contributes to the development of ROD, but an up-to-date skeletal phenotype in CKD-associated acidosis has not been described. We comprehensively studied associations between acidosis and bone in patients with CKD using advanced methods to image the skeleton and analyze bone-tissue, along with biochemical testing. Cross-sectionally, acidosis was associated with higher markers of bone remodeling and female-specific impairments in cortical and trabecular bone quality. Prospectively, acidosis was associated with cortical expansion and trabecular microarchitectural deterioration. At the bone-tissue level, acidosis was associated with deficits in bone mineral content. Future work investigating acidosis correction on bone quality is warranted. BACKGROUND Renal osteodystrophy is a state of impaired bone quality and strength. Metabolic acidosis (MA) is associated with alterations in bone quality including remodeling, microarchitecture, and mineralization. No studies in patients with CKD have provided a comprehensive multimodal skeletal phenotype of MA. We aim to describe the structure and makeup of bone in patients with MA in the setting of CKD using biochemistry, noninvasive imaging, and histomorphometry. METHODS The retrospective cross-sectional analyses included 180 patients with CKD. MA was defined as bicarbonate ≤22 mEq/L. We evaluated circulating bone turnover markers and skeletal imaging with dual energy x-ray absorptiometry and high-resolution peripheral computed tomography. A subset of 54 participants had follow-up. We assessed associations between baseline and change in bicarbonate with change in bone outcomes. Histomorphometry, microCT, and quantitative backscatter electron microscopy assessed bone biopsy outcomes in 22 participants. RESULTS The mean age was 68±10 years, 54% of participants were male, and 55% were White. At baseline, acidotic subjects had higher markers of bone turnover, lower areal bone mineral density at the radius by dual energy x-ray absorptiometry, and lower cortical and trabecular volumetric bone mineral density and impaired trabecular microarchitecture. Over time, acidosis was associated with opposing cortical and trabecular effects: cortical expansion but trabecular deterioration. Bone-tissue analyses showed reduced tissue mineral density with increased heterogeneity of calcium distribution in acidotic participants. CONCLUSIONS MA is associated with multiple impairments in bone quality. Future work should examine whether correction of acidosis improves bone quality and strength in patients with CKD.
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Affiliation(s)
- Rebecca V. Levy
- Nephrology, Department of Medicine, University of Rochester Medical Center Rochester, New York, USA
- Pediatric Nephrology, Department of Pediatrics, University of Rochester Medical Center, Rochester, New York, USA
| | | | | | - David Dempster
- Columbia University Irving Medical Center, New York, USA
| | - Hua Zhou
- Columbia University Irving Medical Center, New York, USA
| | - Barbara M. Misof
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - X.E. Guo
- Columbia University Biomedical Engineering, New York, New York, USA
| | | | | | - Kimberly Reidy
- Nephrology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | - Juhi Kumar
- Nephrology, Department of Pediatrics, Weill-Cornell Medical Center, New York, New York
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Pisa, Italy
- Department of Medicine, University of Padova, Padova, Padua, Italy
| | - Denver D. Brown
- Division of Nephrology, Children's National Hospital, Washington, DC
| | - Michal L. Melamed
- Nephrology, Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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Bojan AJ, Stadelmann VA, Wu D, Pujari-Palmer M, Insley G, Sundh D, Persson C, Engqvist H, Procter P. A new bone adhesive candidate- does it work in human bone? An ex-vivo preclinical evaluation in fresh human osteoporotic femoral head bone. Injury 2022; 53:1858-1866. [PMID: 35469636 DOI: 10.1016/j.injury.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The fixation of small intraarticular bone fragments is clinically challenging and an obvious first orthopaedic indication for an effective bone adhesive. In the present study the feasibility of bonding freshly harvested human trabecular bone with OsSticR, a novel phosphoserine modified cement, was evaluated using a bone cylinder model pull-out test and compared with a commercial fibrin tissue adhesive. METHODS Femoral heads (n=13) were collected from hip fracture patients undergoing arthroplasty and stored refrigerated overnight in saline medium prior to testing. Cylindrical bone cores with a pre-inserted bone screw, were prepared using a coring tool. Each core was removed and glued back in place with either the bone adhesive (α-tricalcium phosphate, phosphoserine and 20% trisodium citrate solution) or the fibrin glue. All glued bones were stored in bone medium at 37°C. Tensile loading, using a universal testing machine (5 kN load cell), was applied to each core/head. For the bone adhesive, bone cores were tested at 2 (n=13) and 24 (n=11) hours. For the fibrin tissue adhesive control group (n=9), bone cores were tested exclusively at 2 hours. The femoral bone quality was evaluated with micro-CT. RESULTS The ultimate pull-out load for the bone adhesive at 2 hours ranged from 36 to 171 N (mean 94 N, SD 42 N). At 24 hours the pull-out strength was similar, 47 to 198 N (mean 123 N, SD 43 N). The adhesive failure usually occurred through the adhesive layer, however in two samples, at 167 N and 198 N the screw pulled out of the bone core. The fibrin tissue adhesive group reached a peak force of 8 N maximally at 2 hours (range 2.8-8 N, mean 5.4 N, SD 1.6 N). The mean BV/TV for femoral heads was 0.15 and indicates poor bone quality. CONCLUSION The bone adhesive successfully glued wet and fatty tissue of osteoporotic human bone cores. The mean ultimate pull-out force of 123 N at 24 hours corresponds to ∼ 300 kPa shear stress acting on the bone core. These first ex-vivo results in human bone are a promising step toward potential clinical application in osteochondral fragment fixation.
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Affiliation(s)
- Alicja J Bojan
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Vincent A Stadelmann
- Department of Teaching, Research, and Development, Schulthess Klinik, Zürich, Switzerland
| | - Dan Wu
- Department of Materials Science and Engineering, Uppsala University, Sweden
| | | | - Gerard Insley
- Department of Materials Science and Engineering, Uppsala University, Sweden
| | - Daniel Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Cecilia Persson
- Department of Materials Science and Engineering, Uppsala University, Sweden
| | - Håkan Engqvist
- Department of Materials Science and Engineering, Uppsala University, Sweden
| | - Philip Procter
- Department of Materials Science and Engineering, Uppsala University, Sweden
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Mys K, Stockmans F, Gueorguiev B, Wyers CE, van den Bergh JPW, van Lenthe GH, Varga P. Adaptive local thresholding can enhance the accuracy of HR-pQCT-based trabecular bone morphology assessment. Bone 2022; 154:116225. [PMID: 34634527 DOI: 10.1016/j.bone.2021.116225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/23/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) devices can scan extremities at bone microstructural level in vivo and are used mainly in research of bone diseases. Two HR-pQCT scanners are commercially available to date: XtremeCT (first generation) and XtremeCT-II (second generation) from Scanco Medical AG (Switzerland). Recently, we have proposed an adaptive local thresholding (AT) technique and showed that it can improve quantification accuracy of bone microstructural parameters, with visually less sharp cone-beam CT (CBCT) images providing a similar accuracy than XtremeCT. The aim of this study was to evaluate whether the AT segmentation technique could enhance the accuracy of HR-pQCT in quantifying bone microstructural images and to assess whether the agreement between XtremeCT and XtremeCT-II could be improved. Nineteen radii were scanned with three scanners from Scanco Medical AG: (1) XtremeCT at 82 μm, (2) XtremeCT-II at 60.7 μm and (3) the small animal microCT scanner VivaCT40 at 19 μm voxel size. The scans were segmented applying two different methods, once following the manufacturer standard technique (ST), and once by means of AT. Three-dimensional (3D) morphological analysis was performed on the trabecular volume of the segmented images using the manufacturer's standard software to calculate bone volume fraction (BV/TV), trabecular thickness (Tb.Th), separation (Tb.Sp) and number (Tb.N). The average accuracy of XtremeCT improved from R2 = 0.76 (ST) to 0.85 (AT) and reached the same level of accuracy as XtremeCT-II with ST (R2 = 0.86). The largest improvements were obtained for BV/TV and Tb.Th. For XtremeCT-II, mean accuracy improved slightly from R2 = 0.86 (ST) to 0.89 (AT). For both segmentations and both scanners, the standard section was quantified slightly more accurate than the subchondral section. The agreement between the scanners was enhanced from R2 = 0.89 (ST) to 0.98 (AT). In conclusion, AT can enhance the accuracy of XtremeCT to quantify distal radius bone microstructural parameters close to XtremeCT-II level and increases the agreement between the two HR-pQCT scanners. High-resolution peripheral quantitative computed tomography, segmentation, bone microstructural parameters.
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Affiliation(s)
- Karen Mys
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium; AO Research Institute Davos, Davos, Switzerland.
| | - Filip Stockmans
- Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | - Caroline E Wyers
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Joop P W van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - G Harry van Lenthe
- Biomechanics Section, Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Peter Varga
- AO Research Institute Davos, Davos, Switzerland
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Krez A, Agarwal S, Bucovsky M, McMahon DJ, Hu Y, Bessler M, Schrope B, Carrelli A, Clare S, Guo XDE, Silverberg SJ, Stein EM. Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women. J Clin Endocrinol Metab 2021; 106:e1868-e1879. [PMID: 33098299 PMCID: PMC8502471 DOI: 10.1210/clinem/dgaa654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN Four-year prospective cohort study. PATIENTS African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.
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Affiliation(s)
- Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mariana Bucovsky
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Beth Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Carrelli
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shannon Clare
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Shonni J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Correspondence and Reprint Requests: Emily M. Stein, MD, MS, Director of Research, Metabolic Bone Service, Hospital for Special Surgery, Associate Professor of Medicine, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021. E-mail:
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Ohs N, Collins CJ, Atkins PR. Validation of HR-pQCT against micro-CT for morphometric and biomechanical analyses: A review. Bone Rep 2020; 13:100711. [PMID: 33392364 PMCID: PMC7772687 DOI: 10.1016/j.bonr.2020.100711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022] Open
Abstract
High-resolution peripheral quantitative computed-tomography (HR-pQCT) has the potential to become a powerful clinical assessment and diagnostic tool. Given the recent improvements in image resolution, from 82 to 61 μm, this technology may be used to accurately quantify in vivo bone microarchitecture, a key biomarker of degenerative bone diseases. However, computational methods to assess bone microarchitecture were developed for micro computed tomography (micro-CT), a higher-resolution technology only available for ex vivo studies, and validation of these computational analysis techniques against the gold-standard micro-CT has been inconsistent and incomplete. Herein, we review methods for segmentation of bone compartments and microstructure, quantification of bone morphology, and estimation of mechanical strength using finite-element analysis, highlighting the need throughout for improved standardization across the field. Studies have relied on homogenous datasets for validation, which does not allow for robust comparisons between methods. Consequently, the adaptation and validation of novel segmentation approaches has been slow to non-existent, with most studies still using the manufacturer's segmentation for morphometric analysis despite the existence of better performing alternative approaches. The promising accuracy of HR-pQCT for capturing morphometric indices is overshadowed by considerable variability in outcomes between studies. For finite element analysis (FEA) methods, the use of disparate material models and FEA tools has led to a fragmented ability to assess mechanical bone strength with HR-pQCT. Further, the scarcity of studies comparing 62 μm HR-pQCT to the gold standard micro-CT leaves the validation of this imaging modality incomplete. This review revealed that without standardization, the capabilities of HR-pQCT cannot be adequately assessed. The need for a public, extendable, heterogeneous dataset of HR-pQCT and corresponding gold-standard micro-CT images, which would allow HR-pQCT users to benchmark existing and novel methods and select optimal methods depending on the scientific question and data at hand, is now evident. With more recent advancements in HR-pQCT, the community must learn from its past and provide properly validated technologies to ensure that HR-pQCT can truly provide value in patient diagnosis and care.
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Affiliation(s)
- Nicholas Ohs
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Osteoporosis, Inselspital, Bern, Switzerland
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9
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Schmidutz F, Milz S, Schiuma D, Richards RG, Windolf M, Sprecher CM. Cortical parameters predict bone strength at the tibial diaphysis, but are underestimated by HR-pQCT and μCT compared to histomorphometry. J Anat 2020; 238:669-678. [PMID: 33084063 PMCID: PMC7855080 DOI: 10.1111/joa.13337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Cortical bone and its microstructure are crucial for bone strength, especially at the long bone diaphysis. However, it is still not well‐defined how imaging procedures can be used as predictive tools for mechanical bone properties. This study evaluated the capability of several high‐resolution imaging techniques to capture cortical bone morphology and assessed the correlation with the bone's mechanical properties. The microstructural properties (cortical thickness [Ct.Th], porosity [Ct.Po], area [Ct.Ar]) of 11 female tibial diaphysis (40–90 years) were evaluated by dual‐energy X‐ray absorptiometry (DXA), high‐resolution peripheral‐quantitative‐computed‐tomography (HR‐pQCT), micro‐CT (μCT) and histomorphometry. Stiffness and maximal torque to failure were determined by mechanical testing. T‐Scores determined by DXA ranged from 0.6 to −5.6 and a lower T‐Score was associated with a decrease in Ct.Th (p ≤ 0.001) while the Ct.Po (p ≤ 0.007) increased, and this relationship was independent of the imaging method. With decreasing T‐Score, histology showed an increase in Ct.Po from the endosteal to the periosteal side (p = 0.001) and an exponential increase in the ratio of osteons at rest to those after remodelling. However, compared to histomorphometry, HR‐pQCT and μCT underestimated Ct.Po and Ct.Th. A lower T‐Score was also associated with significantly reduced stiffness (p = 0.031) and maximal torque (p = 0.006). Improving the accuracy of Ct.Po and Ct.Th did not improve prediction of the mechanical properties, which was most closely related to geometry (Ct.Ar). The ex‐vivo evaluation of mechanical properties correlated with all imaging modalities, with Ct.Th and Ct.Po highly correlated with the T‐Score of the tibial diaphysis. Cortical microstructural changes were underestimated with the lower resolution of HR‐pQCT and μCT compared to the histological ‘gold standard’. The increased accuracy did not result in an improved prediction for local bone strength in this study, which however might be related to the limited number of specimens and thus needs to be evaluated in a larger collective.
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Affiliation(s)
- Florian Schmidutz
- AO Research Institute Davos, Davos, Switzerland.,Department of Orthopaedic Surgery, University of Munich (LMU), Munich, Germany.,University of Tübingen, BG Trauma Center, Tübingen, Germany
| | - Stefan Milz
- Department of Anatomy II, University of Munich (LMU), Munich, Germany
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Fuusager G, Milandt N, Shanbhogue VV, Hermann AP, Schou AJ, Christesen HT. Lower estimated bone strength and impaired bone microarchitecture in children with type 1 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001384. [PMID: 32816873 PMCID: PMC7437694 DOI: 10.1136/bmjdrc-2020-001384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/30/2020] [Accepted: 06/06/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Patients with type 1 diabetes has an increased risk of fracture. We wished to evaluate estimated bone strength in children and adolescents with type 1 diabetes and assess peripheral bone geometry, volumetric bone mineral density (vBMD) and microarchitecture. RESEARCH DESIGN AND METHODS In a cross-sectional study, high-resolution peripheral quantitative CT (HR-pQCT) was performed of the radius and tibia in 84 children with type 1 diabetes and 55 healthy sibling controls. Estimated bone strength was assessed using a microfinite element analysis solver. Multivariate regression analyses were performed adjusting for age, sex, height and body mass index. RESULTS The median age was 13.0 years in the diabetes group vs 11.5 years in healthy sibling controls. The median (range) diabetes duration was 4.2 (0.4-15.9) years; median (range) latest year Hb1Ac was 7.8 (5.9-11.8) % (61.8 (41-106) mmol/mol). In adjusted analyses, patients with type 1 diabetes had reduced estimated bone strength in both radius, β -390.6 (-621.2 to -159.9) N, p=0.001, and tibia, β -891.9 (-1321 to -462.9) N, p<0.001. In the radius and tibia, children with type 1 diabetes had reduced cortical area, trabecular vBMD, trabecular number and trabecular bone volume fraction and increased trabecular inhomogeneity, adjusted p<0.05 for all. Latest year HbA1c was negatively correlated with bone microarchitecture (radius and tibia), trabecular vBMD and estimated bone strength (tibia). CONCLUSION Children with type 1 diabetes had reduced estimated bone strength. This reduced bone strength could partly be explained by reduced trabecular bone mineral density, adverse microarchitecture and reduced cortical area. We also found increasing latest year HbA1c to be associated with several adverse changes in bone parameters. HR-pQCT holds potential to identify early adverse bone changes and to explain the increased fracture risk in young patients with type 1 diabetes.
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Affiliation(s)
- Gitte Fuusager
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Department of Internal Medicine, Hospitalsenheden Vest, Herning, Denmark
- OPEN - Odense Patient data Explorative Network, Odense Universitets Hospital, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
| | - Nikolaj Milandt
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- The Orthopedic Research Unit, Odense University Hospital, Odense, Denmark
| | | | | | - Anders Jørgen Schou
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Henrik Thybo Christesen
- Clinical Research, Syddansk Universitet, Odense, Syddanmark, Denmark
- Hans Christian Andersen Children's Hospital, Odense Universitetshospital, Odense, Denmark
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Dash AS, Agarwal S, McMahon DJ, Cosman F, Nieves J, Bucovsky M, Guo XE, Shane E, Stein EM. Abnormal microarchitecture and stiffness in postmenopausal women with isolated osteoporosis at the 1/3 radius. Bone 2020; 132:115211. [PMID: 31870633 PMCID: PMC8853460 DOI: 10.1016/j.bone.2019.115211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/18/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postmenopausal women with isolated osteoporosis at the 1/3 radius (1/3RO) present a therapeutic dilemma. Little is known about whether these patients have generalized skeletal fragility, and whether this finding warrants treatment. The aim of this study was to investigate the biochemical and microarchitectural phenotype of women with 1/3RO compared to women with classic postmenopausal osteoporosis by DXA at the spine and hip (PMO), and controls without osteoporosis at any site. METHODS This cross-sectional study enrolled 266 postmenopausal women, who were grouped according to densitometric pattern. Subjects had serum biochemistries, areal BMD (aBMD) measured by DXA, trabecular and cortical vBMD, microarchitecture, and stiffness by high resolution peripheral QCT (HR-pQCT, voxel size ~82 μm) of the distal radius and tibia. RESULTS Mean age was 68 ± 7 years. DXA T-Scores reflected study design. By HR-pQCT, 1/3RO had abnormalities at both radius and tibia compared to controls: lower total, cortical and trabecular vBMD, cortical thickness and trabecular number, higher trabecular separation and heterogeneity, and lower whole bone stiffness. In contrast, the magnitude and pattern of abnormalities in vBMD, microarchitecture and stiffness in 1/3RO were similar to those in PMO; the difference compared to controls was similar among the two groups. Serum calcium, creatinine, parathyroid hormone, 25-hydroxyvitamin D, and 24-hour urine calcium did not differ. CONCLUSIONS Although aBMD appeared relatively preserved at the spine and hip by DXA, women with 1/3RO had significant microarchitectural and biomechanical deficits comparable to those in women with typical PMO. Further study is required to guide treatment decisions in this population.
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Affiliation(s)
- Alexander S Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Felicia Cosman
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Jeri Nieves
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
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12
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Next-generation imaging of the skeletal system and its blood supply. Nat Rev Rheumatol 2019; 15:533-549. [PMID: 31395974 DOI: 10.1038/s41584-019-0274-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 12/16/2022]
Abstract
Bone is organized in a hierarchical 3D architecture. Traditionally, analysis of the skeletal system was based on bone mass assessment by radiographic methods or on the examination of bone structure by 2D histological sections. Advanced imaging technologies and big data analysis now enable the unprecedented examination of bone and provide new insights into its 3D macrostructure and microstructure. These technologies comprise ex vivo and in vivo methods including high-resolution computed tomography (CT), synchrotron-based imaging, X-ray microscopy, ultra-high-field magnetic resonance imaging (MRI), light-sheet fluorescence microscopy, confocal and intravital two-photon imaging. In concert, these techniques have been used to detect and quantify a novel vascular system of trans-cortical vessels in bone. Furthermore, structures such as the lacunar network, which harbours and connects osteocytes, become accessible for 3D imaging and quantification using these methods. Next-generation imaging of the skeletal system and its blood supply are anticipated to contribute to an entirely new understanding of bone tissue composition and function, from macroscale to nanoscale, in health and disease. These insights could provide the basis for early detection and precision-type intervention of bone disorders in the future.
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13
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Bone measurements at multiple skeletal sites in adolescent idiopathic scoliosis-an in vivo correlation study using DXA, HR-pQCT and QCT. Arch Osteoporos 2019; 14:70. [PMID: 31250235 DOI: 10.1007/s11657-019-0621-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/17/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Significant correlations for bone mineral density and bone microstructure between spinal and non-spinal skeletal sites (distal radius and proximal femur) in adolescent idiopathic scoliosis (AIS) patients were observed, indicating that proximal femoral DXA and distal radial HR-pQCT could provide valid clinical assessments in patients with AIS. PURPOSE Low bone mass is an important feature of adolescent idiopathic scoliosis (AIS), which is a complex 3D spinal deformity that affects girls during puberty. However, no clinical imaging modality is suitable for regular monitoring on their spinal bone qualities in rapid growth period. Therefore, we investigated whether bone mineral density (BMD) and bone microstructure at non-spinal sites correlated with BMD and mechanical property in the spine in AIS patients. METHODS Thirty-two AIS girls (16.7 ± 3.5 years old with mean Cobb angle of 67 ± 11°) who underwent pre-operative spine CT examination for navigation surgery were recruited. Volumetric BMD (vBMD) of lumbar spine (LS) was measured by quantitative computed tomography (QCT), vBMD and bone microstructure of distal radius (DR) by high-resolution peripheral QCT (HR-pQCT) and areal BMDs of total hip (TH) and femoral necks (FN) by dual-energy X-ray absorptiometry (DXA). Biomechanical properties of the DR and LS were estimated by finite element analysis (FEA). Pearson correlation was performed to study the correlation between bone parameters at these three sites. RESULTS LS vBMD correlated significantly with both FN and TH aBMD (R = 0.663-0.725, both p < 0.01) and with DR microstructural parameters (R = 0.380-0.576, all p < 0.05). Mechanical properties of LS and DR were also correlated (R = 0.398, p = 0.039). CONCLUSIONS Bone measurement at proximal femur and distal radius could provide an additional predictive power in estimating the bone changes at spine, which is the primary site of deformity in AIS patients. Our result indicated that DXA and HR-pQCT could provide a valid surrogate for spine bone measurements in AIS patients.
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14
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Sukhdeo S, Parsons J, Niu XM, Ryan TM. Trabecular Bone Structure in the Distal Femur of Humans, Apes, and Baboons. Anat Rec (Hoboken) 2018; 303:129-149. [DOI: 10.1002/ar.24050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Simone Sukhdeo
- Department of AnthropologyPennsylvania State University University Park Pennsylvania
| | - Jacob Parsons
- Department of StatisticsPennsylvania State University University Park Pennsylvania
| | - Xiaoyue Maggie Niu
- Department of StatisticsPennsylvania State University University Park Pennsylvania
| | - Timothy M. Ryan
- Department of AnthropologyPennsylvania State University University Park Pennsylvania
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15
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Coiner-Collier S, Vogel ER, Scott RS. Trabecular Anisotropy in the Primate Mandibular Condyle Is Associated with Dietary Toughness. Anat Rec (Hoboken) 2018; 301:1342-1359. [DOI: 10.1002/ar.23810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022]
Affiliation(s)
| | - Erin R. Vogel
- Department of Anthropology and Center for Human Evolutionary Studies; Rutgers, The State University of New Jersey; New Brunswick New Jersey
| | - Robert S. Scott
- Department of Anthropology and Center for Human Evolutionary Studies; Rutgers, The State University of New Jersey; New Brunswick New Jersey
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16
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Nishiyama KK, Agarwal S, Kepley A, Rosete F, Hu Y, Guo XE, Keating CL, DiMango EA, Shane E. Adults with cystic fibrosis have deficits in bone structure and strength at the distal tibia despite similar size and measuring standard and relative sites. Bone 2018; 107:181-187. [PMID: 29154969 DOI: 10.1016/j.bone.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/25/2017] [Accepted: 11/13/2017] [Indexed: 11/30/2022]
Abstract
Individuals with cystic fibrosis (CF) have lower bone mineral density (BMD) by DXA and are at higher risk of fracture than healthy controls. However, the 2-dimensional measurement of areal BMD (aBMD) provided by DXA is influenced by bone size and the true extent of the bone deficit is unclear. Our objective was to use high-resolution peripheral quantitative computed tomography (HR-pQCT) and individual trabecula segmentation (ITS) analysis to compare volumetric BMD (vBMD), microarchitecture and estimated strength at the distal radius and tibia in 26 young adults with CF and 26 controls matched for age, gender, and race. To assess the effect of limb length and minimize the confounding effects of size on HR-pQCT outcomes, we scanned participants at both the standard fixed HR-pQCT measurement sites and at a subject-specific relative site that varied according to limb length. CF participants did not differ significantly in age, height, weight, or BMI from controls. Ulnar and tibial lengths were 9mm shorter in CF patients, though differences were not significant. CF patients had significantly lower BMI-adjusted aBMD by DXA at the lumbar spine (8.9%, p<0.01), total hip (11.5%, p<0.01) and femoral neck (14.5%, p<0.01), but not at the forearm. At the fixed radius site, thickness of trabecular plates and torsional stiffness were significantly lower in CF participants than controls. At the relative radius site, only torsional stiffness was significantly lower in CF participants. At the tibia, total, trabecular and cortical vBMD were significantly lower at both fixed and relative sites in CF participants, with fewer, more widely-spaced trabecular plates, lower trabecular connectivity, and lower axial and torsional stiffness. Our results confirm that aBMD is lower at the spine and hip in young adults with CF, independent of BMI and body size. We also conclude that vBMD and stiffness are lower at the weight-bearing tibia. The pathogenesis of these differences in bone density and strength at the tibia appear to be related to trabecular drop-out and reduced trabecular connectivity and to be independent of differences in limb length, as assessed by scanning participants at both standard and relative sites. We concluded that significant deficits in bone structure and strength persist in young adults with CF, despite advances in care that permit them to attain relatively normal height and weight.
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Affiliation(s)
- Kyle K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, United States
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, United States.
| | - Anna Kepley
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, United States
| | - Fernando Rosete
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, United States.
| | - Yizhong Hu
- Department of Biomedical Engineering, Columbia University, New York, NY, United States.
| | - X Edward Guo
- Department of Biomedical Engineering, Columbia University, New York, NY, United States.
| | - Claire L Keating
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY, United States.
| | - Emily A DiMango
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University, New York, NY, United States.
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, United States.
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17
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Metcalf LM, Dall'Ara E, Paggiosi MA, Rochester JR, Vilayphiou N, Kemp GJ, McCloskey EV. Validation of calcaneus trabecular microstructure measurements by HR-pQCT. Bone 2018; 106:69-77. [PMID: 28986143 DOI: 10.1016/j.bone.2017.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/22/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Assessment of calcaneus microstructure using high-resolution peripheral quantitative computed tomography (HR-pQCT) might be used to improve fracture risk predictions or to assess responses to pharmacological and physical interventions. To develop a standard clinical protocol for the calcaneus, we validated calcaneus trabecular microstructure measured by HR-pQCT against 'gold-standard' micro-CT measurements. METHODS Ten human cadaveric feet were scanned in situ using HR-pQCT (isotropic 82μm voxel size) at 100, 150 and 200ms integration times, and at 100ms integration time following removal of the calcaneus from the foot (ex vivo). Dissected portions of these bones were scanned using micro-computed tomography (micro-CT) at an isotropic 17.4μm voxel size. HR-pQCT images were rigidly registered to those obtained with micro-CT and divided into multiple 5mm sided cubes to evaluate and compare morphometric parameters between the modalities. Standard HR-pQCT measurements (derived bone volume fraction (BV/TVd); trabecular number, Tb.N; derived trabecular thickness, Tb.Thd; derived trabecular spacing, Tb.Spd) and corresponding micro-CT voxel-based measurements (BV/TV, Tb.N, Tb.Th, Tb.Sp) were compared. RESULTS A total of 108 regions of interest were analysed across the 10 specimens. At all integration times HR-pQCT BV/TVd was strongly correlated with micro-CT BV/TV (r2=0.95-0.98, RMSE=1%), but BV/TVd was systematically lower than that measured by micro-CT (mean bias=5%). In contrast, HR-pQCT systematically overestimated Tb.N at all integration times; of the in situ scans, 200ms yielded the lowest mean bias and the strongest correlation with micro-CT (r2=0.61, RMSE=0.15mm-1). Regional analysis revealed greater accuracy for Tb.N in the superior regions of the calcaneus at all integration times in situ (mean bias=0.44-0.85mm-1; r2=0.70-0.88, p<0.001 versus mean bias=0.63-1.46mm-1; r2≤0.08, p≥0.21 for inferior regions). Tb.Spd was underestimated by HR-pQCT compared to micro-CT, but showed similar trends with integration time and the region evaluated as Tb.N. HR-pQCT Tb.Thd was also underestimated and moderately correlated (r2=0.53-0.59) with micro-CT Tb.Th, independently from the integration time. Stronger correlations, smaller biases and error were found in the scans of the calcaneus ex vivo compared to in situ. CONCLUSION Calcaneus trabecular BV/TVd and trabecular microstructure, particularly in the superior region of the calcaneus, can be assessed by HR-pQCT. The highest integration time examined, 200ms, compared best with micro-CT. Weaker correlations for microstructure at inferior regions, and also with lower integration times, might limit the use of the proposed protocol, which warrants further investigation in vivo.
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Affiliation(s)
- Louis M Metcalf
- MRC-Arthritis UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, University of Sheffield, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism and INSIGNEO Institute for in silico Medicine, University of Sheffield, The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK
| | - Margaret A Paggiosi
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - John R Rochester
- Academic Unit of Medical Education, Medical School, University of Sheffield, Medical Education, The Medical School, Beech Hill Road, Sheffield S10 2RX, UK
| | | | - Graham J Kemp
- MRC-Arthritis UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Department of Musculoskeletal Biology, William Henry Duncan Building, West Derby Street, Liverpool L7 8TX, UK
| | - Eugene V McCloskey
- MRC-Arthritis UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, University of Sheffield, Metabolic Bone Centre, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK; Department of Oncology and Metabolism and INSIGNEO Institute for in silico Medicine, University of Sheffield, The Pam Liversidge Building, Sir Robert Hadfield Building, Mappin Street, Sheffield S1 3JD, UK.
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Zheng D, Cui C, Yu M, Li X, Wang L, Chen X, Lin Y. Coenzyme Q10 promotes osteoblast proliferation and differentiation and protects against ovariectomy-induced osteoporosis. Mol Med Rep 2017; 17:400-407. [PMID: 29115467 DOI: 10.3892/mmr.2017.7907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 09/08/2017] [Indexed: 11/06/2022] Open
Abstract
Coenzyme Q10 (CoQ10) is a fat‑soluble vitamin‑like substance used for the treatment of a variety of disorders, including osteoporosis. The exact mechanism underlying CoQ10‑mediated protection against osteoporosis remains to be elucidated. The present study aimed to evaluate the effect of CoQ10 on osteoblastic cell proliferation and differentiation, and therapeutic effects on a rat model of osteoporosis. Following treatment with different concentrations of CoQ10, cell proliferation and differentiation of rat bone marrow stromal cells (BMSCs), and expression of osteoblastogenic markers, were measured. Rats with osteoporosis subjected to ovariectomy (OVX) were treated with different concentrations of CoQ10. Serum levels of estrogen and bone metabolism markers were measured. Micro computed tomography scans were used to analyze morphological changes in bones. In addition, mRNA and protein levels of phosphatidylinositol 3,4,5‑trisphosphate 3‑phosphatase and dual‑specificity protein phosphatase PTEN (PTEN)/phosphatidylinositol 4,5‑bisphosphate 3‑kinase (PI3K)/RAC‑alpha serine/threonine‑protein kinase(AKT), were determined. CoQ10 significantly increased the proliferation and osteogenic differentiation of BMSCs in a dose‑dependent manner, with an increased expression of osteogenic markers. CoQ10 significantly decreased bone resorption but exhibited no effect on serum E2 levels in vivo. CoQ10 markedly enhanced bone formation. Furthermore, the abundance of p‑PI3K and p‑AKT increased while PTEN levels decreased in a dose‑dependent manner following administration of CoQ10. CoQ10 stimulates the proliferation and differentiation of BMSCs and is effective for the treatment of OVX‑induced osteoporosis in rats. The above effects of CoQ10 may be mediated by activation of the PTEN/PI3K/AKT pathway.
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Affiliation(s)
- Delu Zheng
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Chenli Cui
- Department of Gynecology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Meng Yu
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Xiang Li
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Lu Wang
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Xinyan Chen
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
| | - Yichen Lin
- Department of Osteoporosis Diagnostic, Research and Treatment Center, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning 116001, P.R. China
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Helfen T, Sprecher CM, Eberli U, Gueorguiev B, Müller PE, Richards RG, Schmidutz F. High-Resolution Tomography-Based Quantification of Cortical Porosity and Cortical Thickness at the Surgical Neck of the Humerus During Aging. Calcif Tissue Int 2017; 101:271-279. [PMID: 28432379 DOI: 10.1007/s00223-017-0279-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
Fractures of the proximal humerus are highly related to age and osteoporotic bone remodeling. Previous studies have highlighted the cortex as a major side of the bone loss, but the microstructural changes of the humerus have not been evaluated entirely. Sixty-four (n = 64) humeri of a representative collective (18-100 years) were scanned with high-resolution peripheral quantitative computed tomography (82 µm). Bone mineral density (BMD), trabecular bone volume fraction (Tb.BV/TV), cortical thickness (Ct.Th), and cortical porosity (Ct.Po) were determined with respect to four age groups. The BMD (r = -0.42), Ct.Th (r = 0.57), and Tb.BV/TV (r = 0.68) showed an age group-related decrease, while the Ct.Po increased (r = -0.55). The oldest group (80-100 years) revealed an extensively higher Ct.Po of +87% compared to the youngest group (18-44 years), while the Ct.Th and Tb.BV/TV were significantly lower by -35 and -49% (p < 0.05). The main cortical bone loss occurred after 65 years with the Ct.Th (-34%) and Tb.BV/TV (-40%) being clearly lower and the Ct.Po (+93%) clearly higher compared to the youngest group. In summary, osteoporosis leads to an age-related higher Ct.Po and reduced Ct.Th at the humeral cortex of the surgical neck. The bone loss of the cortex predominantly occurs around the age of 65 years and is very likely to reduce the mechanical strength and highly increases the fracture risk.
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Affiliation(s)
- Tobias Helfen
- AO Research Institute Davos, Davos, Switzerland
- Department of General-, Trauma- and Reconstructive Surgery, University of Munich (LMU), Munich, Germany
| | | | | | | | - Peter E Müller
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | | | - Florian Schmidutz
- AO Research Institute Davos, Davos, Switzerland.
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
- BG Trauma Center, University of Tübingen, Tübingen, Germany.
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Frølich J, Hansen S, Winkler LAD, Andresen AK, Hermann AP, Støving RK. The Role of Body Weight on Bone in Anorexia Nervosa: A HR-pQCT Study. Calcif Tissue Int 2017; 101:24-33. [PMID: 28224178 PMCID: PMC5486942 DOI: 10.1007/s00223-017-0254-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/06/2017] [Indexed: 01/13/2023]
Abstract
Anorexia nervosa (AN) is associated with decreased bone mineral density and increased risk of fracture. The aim of this study was to assess bone geometry, volumetric bone mineral density (vBMD), trabecular microarchitecture and estimated failure load in weight-bearing vs. non-weight-bearing bones in AN. We included twenty-five females with AN, and twenty-five female controls matched on age and height. Bone geometry, vBMD and trabecular microarchitecture were assessed using high-resolution peripheral quantitative computed tomography of the distal radius and tibia. At both sites, cortical perimeter and total bone area were similar in patients and controls. Total vBMD was lower in the AN group in the tibia (p < 0.0005) but not in the radius. In the tibia, cortical thickness was approximately 25% lower (p < 0.0005) in the AN group, whereas there was no significant difference in the radius. In terms of trabecular microarchitecture, all indices [bone volume/tissue volume (BV/TV); trabecular thickness (Tb.Th.), trabecular number (Tb.N) and trabecular spacing (Tb.Sp.)] were impaired in AN in the tibia (p values range < 0.01-0.0001). In the radius, BV/TV and Tb.N were lower (p < 0.05 and p < 0.001, respectively); Tb.Sp. was higher (p < 0.001), whereas Tb.Th. did not differ, compared to controls. Estimated failure load was lower in patients in both the radius and the tibia (p < 0.0005 and p < 0.0001, respectively), most pronounced in the tibia. In conclusion, the impairment of cortical thickness and estimated failure load were significantly more pronounced in the weight-bearing tibia, compared to the non-weight-bearing radius, implying a direct effect of low body weight on bone loss in AN.
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Affiliation(s)
- Jacob Frølich
- Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital & Psychiatry of Region Southern Denmark, University of Southern Denmark, Odense, Denmark.
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.
- Centre of Eating Disorders and Department of Endocrinology, Odense University Hospital, Kloevervaenget 10, 6th floor, 5000, Odense C, Denmark.
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Laura Al-Dakhiel Winkler
- Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital & Psychiatry of Region Southern Denmark, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Andreas K Andresen
- Center for Spine Surgery and Research, Region of Southern Denmark, Middelfart, Denmark
| | | | - René K Støving
- Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital & Psychiatry of Region Southern Denmark, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Manske SL, Davison EM, Burt LA, Raymond DA, Boyd SK. The Estimation of Second-Generation HR-pQCT From First-Generation HR-pQCT Using In Vivo Cross-Calibration. J Bone Miner Res 2017; 32:1514-1524. [PMID: 28294415 DOI: 10.1002/jbmr.3128] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/07/2022]
Abstract
Second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) provides the highest resolution in vivo to assess bone density and microarchitecture in 3D. Although strong agreement of most outcomes measured with first- (XCTI) and second- (XCTII) generation HR-pQCT has been demonstrated, the ability to use the two systems interchangeably is unknown. From in vivo measurements, we determined the limits of estimating XCTII data from XCTI scans conducted in vivo and whether that estimation can be improved by linear cross-calibration equations. These data are crucial as the research field transitions to the new technology. Our study design established cross-calibration equations by scanning 62 individuals on both systems on the same day and then tested those cross-calibrations on the same cohort 6 months later so that estimated (denoted as XCTII*) and "true" XCTII parameters could be compared. We calculated the generalized least-significant change (GLSC) for those predictions. There was strong agreement between both systems for density (R2 > 0.94), macroarchitecture (R2 > 0.95), and most microarchitecture outcomes with the exception of trabecular thickness (Tb.Th, R2 = 0.51 to 0.67). Linear regression equations largely eliminated the systematic error between XCTII and XCTII* and produced a good estimation of most outcomes, with individual error estimates between 0.2% and 3.4%, with the exception of Tt.BMD. Between-system GLSC was similar to within-XCTI LSC (eg, 8.3 to 41.9 mg HA/cm3 for density outcomes). We found that differences between outcomes assessed with XCTI and XCTII can be largely eliminated by cross-calibration. Tb.Th is poorly estimated because it is measured more accurately by XCTII than XCTI. It may be possible to use cross-calibration for most outcomes when both scanner generations are used for multicenter and longitudinal studies. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Erin M Davison
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Duncan A Raymond
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Walker MD, Kepley A, Nishiyama K, Zhou B, Guo E, Nickolas TL. Cortical microstructure compensates for smaller bone size in young Caribbean Hispanic versus non-Hispanic white men. Osteoporos Int 2017; 28:2147-2154. [PMID: 28341899 DOI: 10.1007/s00198-017-4013-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Hispanic men have smaller bone size but thicker and denser cortices compared to white men, leading to similar mechanical competence. INTRODUCTION The purpose of this study was to assess differences in vBMD and microarchitecture in young Caribbean Hispanic (n = 30) and non-Hispanic Caucasian (n = 30) men. METHODS We measured areal bone mineral density (aBMD) at the spine, total hip (TH), femoral neck (FN), and forearm by dual-energy X-ray absorptiometry (DXA) and bone geometry, mass, microarchitecture, and mechanical competence by high-resolution peripheral quantitative computed tomography (HRpQCT), individual trabecula segmentation (ITS), and finite element analysis (FEA). RESULTS Hispanic men were slightly older, shorter, and heavier and had higher BMI compared with white men. aBMD, measured by DXA, did not differ at the spine, TH, or forearm before or after adjustment for age, height, weight, and the interaction of height and weight. At the FN, marginally significant higher BMD in Hispanics prior to adjustment was attenuated and no longer differed after adjustment for covariates. Adjusted HRpQCT indices indicated smaller total and trabecular area at the radius but greater total volumetric density and cortical thickness in Hispanic versus white men. The adjusted difference in cortical density at the radius was of borderline significance. Trabecular and ITS microstructure tended not to differ at the radius. At the tibia, results were similar. Bone size tended to be smaller and covariate-adjusted cortical density and cortical thickness were greater in Hispanic versus white men. Additionally, cortical porosity was lower at the tibia in Hispanic compared to white men. Stiffness and failure load did not differ at either skeletal site by ethnicity. CONCLUSION In conclusion, greater cortical thickness and density as well as lower cortical porosity tend to compensate for smaller bone size in Hispanic men, leading to similar mechanical competence compared with white men.
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Affiliation(s)
- M D Walker
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA.
| | - A Kepley
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - K Nishiyama
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
| | - B Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - E Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, New York, NY, 10027, USA
| | - T L Nickolas
- Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, NY, 10032, USA
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Patsch JM, Rasul S, Huber FA, Leitner K, Thomas A, Kocijan R, Boutroy S, Weber M, Resch H, Kainberger F, Schüller-Weidekamm C, Kautzky-Willer A. Similarities in trabecular hypertrophy with site-specific differences in cortical morphology between men and women with type 2 diabetes mellitus. PLoS One 2017; 12:e0174664. [PMID: 28384358 PMCID: PMC5383225 DOI: 10.1371/journal.pone.0174664] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 03/13/2017] [Indexed: 01/13/2023] Open
Abstract
The goal of our study was to investigate interactions between sex and type 2 diabetes mellitus (T2DM) with regard to morphology of the peripheral skeleton. We recruited 85 subjects (mean age, 57±11.4 years): women with and without T2DM (n = 17; n = 16); and men with and without T2DM (n = 26; n = 26). All patients underwent high-resolution, peripheral, quantitative, computed tomography (HR-pQCT) imaging of the ultradistal radius (UR) and tibia (UT). Local bone geometry, bone mineral density (BMD), and bone microarchitecture were obtained by quantitative analysis of HR-pQCT images. To reduce the amount of data and avoid multi-collinearity, we performed a factor-analysis of HR-pQCT parameters. Based on factor weight, trabecular BMD, trabecular number, cortical thickness, cortical BMD, and total area were chosen for post-hoc analyses. At the radius and tibia, diabetic men and women exhibited trabecular hypertrophy, with a significant positive main effect of T2DM on trabecular number. At the radius, cortical thickness was higher in diabetic subjects (+20.1%, p = 0.003). Interestingly, there was a statistical trend that suggested attenuation of tibial cortical hypertrophy in diabetic men (cortical thickness, pinteraction = 0.052). Moreover, we found an expected sexual dichotomy, with higher trabecular BMD, Tb.N, cortical BMD, Ct.Th, and total area in men than in women (p≤ 0.003) at both measurement sites. Our results suggest that skeletal hypertrophy associated with T2DM is present in men and women, but appears attenuated at the tibial cortex in men.
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Affiliation(s)
- Janina M. Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | - Sazan Rasul
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian A. Huber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Karoline Leitner
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Anita Thomas
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
| | - Roland Kocijan
- Department of Internal Medicine II, Karl Landsteiner Institute for Rheumatology and Gastroenterology, St. Vincent Hospital Vienna, Vienna, Austria
| | | | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Heinrich Resch
- Department of Internal Medicine II, Karl Landsteiner Institute for Rheumatology and Gastroenterology, St. Vincent Hospital Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Claudia Schüller-Weidekamm
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Neuroradiology and Musculoskeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Kautzky-Willer
- Department of Internal Medicine III, Division of Endocrinology and Metabolism, Gender Medicine Unit, Medical University of Vienna, Vienna, Austria
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24
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Kepley AL, Nishiyama KK, Zhou B, Wang J, Zhang C, McMahon DJ, Foley KF, Walker MD, Guo XE, Shane E, Nickolas TL. Differences in bone quality and strength between Asian and Caucasian young men. Osteoporos Int 2017; 28:549-558. [PMID: 27638138 DOI: 10.1007/s00198-016-3762-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED This is a cross-sectional study to assess differences in bone quality in young Asian and Caucasian (n = 30/group) men between 25 and 35 years. We found that Asians had smaller bones, thicker and denser cortices, and more plate-like trabeculae, but stiffness did not differ between groups. INTRODUCTION We conducted a cross-sectional study to assess differences in bone quality in young Asian and Caucasian (n = 30/group) men between 25 and 35 years. METHODS We measured bone mineral density (BMD) at the spine, total hip (TH), femoral neck (FN), and forearm by dual energy X-ray absorptiometry (DXA), and bone geometry, density, microarchitecture, and mechanical competence at the radius and tibia by high-resolution peripheral quantitative computed tomography (HR-pQCT) with application of individual trabecula segmentation (ITS) and trabecular and whole bone finite element analysis (FEA). We measured load-to-strength ratio to account for differences in bone size and height, respectively. We used Wilcoxon rank sum and generalized linear models adjusted for height, weight, and their interaction for comparisons. RESULTS Asians were 3.9 % shorter and weighed 6.5 % less than Caucasians. In adjusted models: by DXA, there were no significant race-based differences in areal BMD; by HR-pQCT, at the radius, Asians had smaller total and trabecular area (p = 0.003 for both), and denser (p = 0.01) and thicker (p = 0.04) cortices at the radius; by ITS, at the radius Asians, had more plate-like than rod-like trabeculae (PR ratio p = 0.01), greater plate trabecular surface (p = 0.009) and longer rod length (p = 0.002). There were no significant race-based differences in FEA or the load-to-strength ratio. CONCLUSIONS Asians had smaller bones, thicker and denser cortices, and more plate-like trabeculae, but biomechanical estimates of bone strength did not differ between groups. Studies are needed to determine whether these differences persist later in life.
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Affiliation(s)
- A L Kepley
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - K K Nishiyama
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - B Zhou
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - J Wang
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - C Zhang
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - D J McMahon
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - K F Foley
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - M D Walker
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - X Edward Guo
- Biomedical Engineering, Department of Medicine, Columbia University, New York, NY, USA
| | - E Shane
- Department of Medicine, Endocrinology, Columbia Univeristy Medical Center, New York, NY, USA
| | - T L Nickolas
- Department of Medicine, Nephrology, Columbia University Medical Center, 622 West 168th Street, PH4-124, New York, NY, 10032, USA.
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Abstract
CONTEXT The health of the skeletal system is important for athletes young and old. From the early benefits of exercise on bones to the importance of osteoporosis prevention and treatment, bone health affects the ability to be active throughout life. EVIDENCE ACQUISITION PubMed articles dating from 1986 to 2016 were used for the review. Relevant terms such as keywords and section titles of the article were searched and articles identified were reviewed for relevance to this article. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Levels 1 through 4 evidence included. RESULTS There is strong evidence that exercise benefits bone health at every age and is a critical factor in osteoporosis prevention and treatment. Vitamin D, calcium, and hormones play vital roles in ensuring optimal bone health. When there is an imbalance between exercise and nutrition, as seen in the female athlete triad, bone health is compromised and can lead to bone stress injuries and early osteoporosis. Both of these can lead to morbidity and lost time from training and competition. Thus, early recognition and appropriate treatment of the female athlete triad and other stress fracture risk factors are vital to preventing long-term bone health problems. CONCLUSION To optimize bone health, adequate nutrition, appropriate weightbearing exercise, strength training, and adequate calcium and vitamin D are necessary throughout life.
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Okazaki N, Burghardt AJ, Chiba K, Schafer AL, Majumdar S. Bone microstructure in men assessed by HR-pQCT: Associations with risk factors and differences between men with normal, low, and osteoporosis-range areal BMD. Bone Rep 2016; 5:312-319. [PMID: 28580402 PMCID: PMC5440848 DOI: 10.1016/j.bonr.2016.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/12/2016] [Accepted: 10/30/2016] [Indexed: 11/16/2022] Open
Abstract
Purpose The primary objective of this study was to analyze the relationships between bone microstructure and strength, and male osteoporosis risk factors including age, body mass index, serum 25-hydroxyvitamin D level, and testosterone level. A secondary objective was to compare microstructural and strength parameters between men with normal, low, and osteoporosis-range areal bone mineral density (aBMD). Methods Seventy-eight healthy male volunteers (mean age 62.4 ± 7.8 years, range 50–84 years) were recruited. The participants underwent dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT) of the ultra-distal radius and tibia. From the HR-pQCT images, volumetric bone mineral density (BMD) and cortical and trabecular bone microstructure were evaluated, and bone strength and cortical load fraction (Ct.LF) were estimated using micro-finite element analysis (μFEA). Results Age was more strongly correlated with bone microstructure than other risk factors. Age had significant positive correlations with cortical porosity at both ultra-distal radius and tibia (r = 0.36, p = 0.001, and r = 0.47, p < 0.001, respectively). At the tibia, age was negatively correlated with cortical BMD, whereas it was positively correlated with trabecular BMD. In μFEA, age was negatively correlated with Ct.LF, although not with bone strength. Compared with men with normal aBMD, men with low or osteoporosis-range aBMD had significantly poor trabecular bone microstructure and lower bone strength at the both sites, while there was no significant difference in cortical bone. Conclusions Cortical bone microstructure was negatively affected by aging, and there was a suggestion that the influence of aging may be particularly important at the weight-bearing sites. Bone microstructure of the ultra-distal radius and tibia was analyzed by HR-pQCT. The subjects consisted of 78 healthy male volunteers ranging from 50 to 84 years. Cortical bone was more impaired with age compared with trabecular bone. Cortical porosity was increased with age, particularly at the ultra-distal tibia.
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Affiliation(s)
- Narihiro Okazaki
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.,Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Ko Chiba
- Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Anne L Schafer
- Medical Service, San Francisco VA Medical Center, USA.,Department of Medicine, University of California, San Francisco, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
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Agarwal S, Rosete F, Zhang C, McMahon DJ, Guo XE, Shane E, Nishiyama KK. In vivo assessment of bone structure and estimated bone strength by first- and second-generation HR-pQCT. Osteoporos Int 2016; 27:2955-66. [PMID: 27155883 DOI: 10.1007/s00198-016-3621-8] [Citation(s) in RCA: 34] [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: 01/14/2016] [Accepted: 04/28/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Bone strength is dependent on bone density and microstructure. High-resolution peripheral quantitative computed tomography (HR-pQCT) can measure microstructure but is somewhat limited due to its resolution. We compared a new HR-pQCT scanner to existing technology and found very good agreement for most parameters. This study will be important when interpreting results from different devices. INTRODUCTION Recently, a second-generation HR-pQCT scanner (XCT2) has been developed with a higher nominal isotropic resolution (61 μm) compared to the first-generation device (XCT1, 82 μm). It is unclear how in vivo measurements from these two devices compare. In this study, we obtained and analyzed in vivo XCT1 and XCT2 measurements of bone microarchitecture and estimated strength. METHODS We scanned 51 adults (16 men and 35 women, age 44.8 ± 16.0) on both XCT2 and XCT1 on the same day. We first compared XCT1 and XCT2 measurements obtained using their respective standard patient protocols. In XCT1, microarchitecture parameters were derived, while XCT2 measurements were directly measured. We also compared XCT2-D with XCT1 by finding the overlapping regions of interest and using the standard patient protocol for XCT1. RESULTS We obtained excellent agreement between XCT1 and XCT2 for most of the volumetric bone mineral density (vBMD), trabecular and cortical measurements (All R (2) > 0.820) except for cortical porosity at the radius (R (2) = 0.638), trabecular number (R (2) = 0.694, 0.787) and trabecular thickness (R (2) = 0.569, 0.527) at both radius and tibia, respectively. XCT1 and XCT2-D measurements also had excellent agreement for most of the measurements (all R (2) > 0.870) except trabecular number (R (2) = 0.524, 0.706), trabecular thickness (R (2) = 0.758, 0.734) at both radius and tibia, respectively, and trabecular separation (R (2) = 0.656) at the radius. CONCLUSION While some caution should be exercised for parameters that are more dependent on image resolution, results from our study indicate that second-generation scans can be compared to more widely available first-generation data and may be beneficial for multicenter and longitudinal studies using both scanner generations.
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Affiliation(s)
- S Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - F Rosete
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - C Zhang
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - D J McMahon
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - X E Guo
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - E Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA
| | - K K Nishiyama
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, USA.
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Klintström E, Klintström B, Moreno R, Brismar TB, Pahr DH, Smedby Ö. Predicting Trabecular Bone Stiffness from Clinical Cone-Beam CT and HR-pQCT Data; an In Vitro Study Using Finite Element Analysis. PLoS One 2016; 11:e0161101. [PMID: 27513664 PMCID: PMC4981445 DOI: 10.1371/journal.pone.0161101] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022] Open
Abstract
Stiffness and shear moduli of human trabecular bone may be analyzed in vivo by finite element (FE) analysis from image data obtained by clinical imaging equipment such as high resolution peripheral quantitative computed tomography (HR-pQCT). In clinical practice today, this is done in the peripheral skeleton like the wrist and heel. In this cadaveric bone study, fourteen bone specimens from the wrist were imaged by two dental cone beam computed tomography (CBCT) devices and one HR-pQCT device as well as by dual energy X-ray absorptiometry (DXA). Histomorphometric measurements from micro-CT data were used as gold standard. The image processing was done with an in-house developed code based on the automated region growing (ARG) algorithm. Evaluation of how well stiffness (Young’s modulus E3) and minimum shear modulus from the 12, 13, or 23 could be predicted from the CBCT and HR-pQCT imaging data was studied and compared to FE analysis from the micro-CT imaging data. Strong correlations were found between the clinical machines and micro-CT regarding trabecular bone structure parameters, such as bone volume over total volume, trabecular thickness, trabecular number and trabecular nodes (varying from 0.79 to 0.96). The two CBCT devices as well as the HR-pQCT showed the ability to predict stiffness and shear, with adjusted R2-values between 0.78 and 0.92, based on data derived through our in-house developed code based on the ARG algorithm. These findings indicate that clinically used CBCT may be a feasible method for clinical studies of bone structure and mechanical properties in future osteoporosis research.
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Affiliation(s)
- Eva Klintström
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
- * E-mail:
| | - Benjamin Klintström
- Center for medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Rodrigo Moreno
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
| | - Torkel B. Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Dieter H. Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Örjan Smedby
- Department of Medical and Health Science, Division of Radiology, Linköping University, Linköping, Sweden
- KTH Royal Institute of Technology, School of Technology and Health, Huddinge, Stockholm, Sweden
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Cheung TF, Cheuk KY, Yu FWP, Hung VWY, Ho CS, Zhu TY, Ng BKW, Lee KM, Qin L, Ho SSY, Wong GWK, Cheng JCY, Lam TP. Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2016; 27:2477-88. [PMID: 27010646 DOI: 10.1007/s00198-016-3552-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/23/2016] [Indexed: 12/25/2022]
Abstract
UNLABELLED Vitamin D deficiency and insufficiency are highly prevalent among adolescents in Hong Kong, which is a sub-tropical city with ample sunshine. Vitamin D level is significantly correlated with key bone density and bone quality parameters. Further interventional studies are warranted to define the role of vitamin D supplementation for improvement of bone health among adolescents. INTRODUCTION The relationship between bone quality parameters and vitamin D (Vit-D) status remains undefined among adolescents. The aims of this study were to evaluate Vit-D status and its association with both bone density and bone quality parameters among adolescents. METHODS Three hundred thirty-three girls and 230 boys (12-16 years old) with normal health were recruited in summer and winter separately from local schools. Serum 25(OH) Vit-D level, bone density and quality parameters by Dual Energy X-ray Absorptiometry (DXA) and High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), dietary calcium intake, and physical activity level were assessed. RESULTS Sixty-four point seven percent and 11.4 % of subjects were insufficient [25 ≤ 25(OH)Vit-D ≤ 50 nmol/L] and deficient [25(OH)Vit-D < 25 nmol/L] in Vit-D, respectively. The mean level of serum 25(OH)Vit-D in summer was significantly higher than that in winter (44.7 ± 13.6 and 35.9 ± 12.6 nmol/L, respectively) without obvious gender difference. In girls, areal bone mineral density (aBMD) and bone mineral content (BMC) of bilateral femoral necks, cortical area, cortical thickness, total volumetric bone mineral density (vBMD), and trabecular thickness were significantly correlated with 25(OH)Vit-D levels. In boys, aBMD of bilateral femoral necks, BMC of the dominant femoral neck, cortical area, cortical thickness, total vBMD, trabecular vBMD, BV/TV, and trabecular separation were significantly correlated with 25(OH)Vit-D levels. CONCLUSION Vit-D insufficiency was highly prevalent among adolescents in Hong Kong with significant correlation between Vit-D levels and key bone density and bone quality parameters being detected in this study. Given that this is a cross-sectional study and causality relationship cannot be inferred, further interventional studies investigating the role of Vit-D supplementation on improving bone health among adolescents are warranted.
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Affiliation(s)
- T F Cheung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - K Y Cheuk
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - F W P Yu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - V W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - C S Ho
- Department of Chemical Pathology, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - T Y Zhu
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - B K W Ng
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - K M Lee
- Lee Hysan Clinical Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - L Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
| | - S S Y Ho
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - G W K Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong, China
| | - J C Y Cheng
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China
- SH Ho Scoliosis Research Laboratory, Sha Tin, Hong Kong, China
| | - T P Lam
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, General Office, 5/F LCW Clinical Sciences Building, Sha Tin, NT, Hong Kong, China.
- SH Ho Scoliosis Research Laboratory, Sha Tin, Hong Kong, China.
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Shanbhogue VV, Finkelstein JS, Bouxsein ML, Yu EW. Association Between Insulin Resistance and Bone Structure in Nondiabetic Postmenopausal Women. J Clin Endocrinol Metab 2016; 101:3114-22. [PMID: 27243136 PMCID: PMC4971339 DOI: 10.1210/jc.2016-1726] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The clinical consequences of insulin resistance and hyperinsulinemia on bone remain largely unknown. OBJECTIVE The objective of the study was to evaluate the effect of insulin resistance on peripheral bone geometry, volumetric bone mineral density (vBMD), bone microarchitecture, and estimated bone strength. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 146 postmenopausal, nondiabetic Caucasian women (mean age 60.3 ± 2.7 y) who were participating in the Study of Women's Health Across the Nation. INTERVENTIONS There were no interventions. MAIN OUTCOME MEASURES High-resolution peripheral quantitative computed tomography was used to assess bone density and microstructure at the distal radius and tibia. Fasting insulin and glucose were measured and insulin resistance was estimated using homeostasis model assessment of insulin resistance (HOMA-IR), with higher values indicating greater insulin resistance. RESULTS There was a negative association between HOMA-IR and bone size and a positive association between HOMA-IR and total vBMD, trabecular vBMD, trabecular thickness, and cortical thickness at the radius and tibia. These relationships remained, even after adjusting for body weight and other potential covariates (eg, time since menopause, cigarette smoking, physical activity, prior use of osteoporosis medications or glucocorticoids). CONCLUSIONS In nondiabetic, postmenopausal women, insulin resistance was associated with smaller bone size, greater volumetric bone mineral density, and generally favorable bone microarchitecture at weight-bearing and nonweight-bearing skeletal sites. These associations were independent of body weight and other potential covariates, suggesting that hyperinsulinemia directly affects bone structure independent of obesity and may explain, in part, the higher trabecular bone density and favorable trabecular microarchitecture seen in individuals with type 2 diabetes mellitus.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of Endocrinology (V.V.S.), Odense University Hospital, Odense 5000 C, Denmark; Endocrine Unit (J.S.F., M.L.B., E.W.Y.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Center for Advanced Orthopedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
| | - Joel S Finkelstein
- Department of Endocrinology (V.V.S.), Odense University Hospital, Odense 5000 C, Denmark; Endocrine Unit (J.S.F., M.L.B., E.W.Y.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Center for Advanced Orthopedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
| | - Mary L Bouxsein
- Department of Endocrinology (V.V.S.), Odense University Hospital, Odense 5000 C, Denmark; Endocrine Unit (J.S.F., M.L.B., E.W.Y.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Center for Advanced Orthopedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
| | - Elaine W Yu
- Department of Endocrinology (V.V.S.), Odense University Hospital, Odense 5000 C, Denmark; Endocrine Unit (J.S.F., M.L.B., E.W.Y.), Massachusetts General Hospital, Boston, Massachusetts 02114; and Center for Advanced Orthopedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215
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Cheuk KY, Tam EMS, Yu FWP, Yip BHK, Hung VWY, Wang X, Ghasem-Zadeh A, Zhu TY, Qin L, Cheng JCY, Lam TP. A Critical Comparison Between Two Scanning Protocols of High-Resolution Peripheral Quantitative Computed Tomography at the Distal Radius in Adolescents. J Clin Densitom 2016; 19:305-15. [PMID: 27130257 DOI: 10.1016/j.jocd.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is a unique technology for assessing bone mineral density and bone microarchitecture. Currently, no universally accepted protocol for selecting the region of interest (ROI) at the distal radius has been established for growing subjects. This study aimed (1) to investigate the differences in HR-pQCT measurements of 2 different ROI protocols applied to the distal radius of healthy adolescents and (2) to identify the least common area of ROI (the least common ROI) between the protocols. Twenty-six boys and 26 girls aged between 13 and 16 yr old were recruited. Nondominant distal radius was scanned by 2 HR-pQCT protocols, namely, the "5-mm protocol," where the distal end of ROI started at 5 mm proximal to a reference line, and the "4% protocol," where the ROI started at 4% of the ulnar length proximal to another reference line. The least common ROI between the 2 protocols was identified and the slice numbering within the common ROI was determined. Bland-Altman plots were used to check the agreement of the least common ROIs between the 2 protocols. Paired t-test and Wilcoxon signed-rank test were used for analysis. In boys, significant differences between protocols were found in most parameters with the maximum difference observed in the cortical area (25.0%, p < 0.001). In girls, differences were observed only for total volumetric bone mineral density (3.6%, p = 0.032). The number of slices in the least common ROI was 66 (60.0%) and 57 (51.8%) in boys and girls, respectively. Good agreements on all HR-pQCT parameters from the least common ROI between the 2 protocols were found. Significant differences in bone parameters were noted between the 2 protocols. When comparing the 2 protocols, observed gender differences could reflect the differences in skeletal growth at the peripubertal period between genders. Least common ROI could be useful for cross-center comparisons and when merging datasets from different centers.
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Affiliation(s)
- Ka-Yee Cheuk
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR
| | - Elisa Man-Shan Tam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR
| | - Fiona Wai-Ping Yu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Benjamin Hon-Kei Yip
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Vivian Wing-Yin Hung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xiaofang Wang
- Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, Australia
| | - Ali Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, Australia
| | - Tracy Y Zhu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Ling Qin
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Jack Chun-Yiu Cheng
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR
| | - Tsz-Ping Lam
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR; SH Ho Scoliosis Research Laboratory, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR; Joint Scoliosis Research Center of the Chinese University of Hong Kong and Nanjing University, The Chinese University of Hong Kong, Hong Kong SAR; Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR.
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Abbassy MA, Watari I, Bakry AS, Ono T, Hassan AH. Calcitonin and vitamin D3 have high therapeutic potential for improving diabetic mandibular growth. Int J Oral Sci 2016; 8:39-44. [PMID: 27025264 PMCID: PMC4822182 DOI: 10.1038/ijos.2015.47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Abstract
The goal of this study was to assess the effect of the intermittent combination of an antiresorptive agent (calcitonin) and an anabolic agent (vitamin D3) on treating the detrimental effects of Type 1 diabetes mellitus (DM) on mandibular bone formation and growth. Forty 3-week-old male Wistar rats were divided into four groups: the control group (normal rats), the control C+D group (normal rats injected with calcitonin and vitamin D3), the diabetic C+D group (diabetic rats injected with calcitonin and vitamin D3) and the diabetic group (uncontrolled diabetic rats). An experimental DM condition was induced in the male Wistar rats in the diabetic and diabetic C+D groups using a single dose of 60 mg·kg−1 body weight of streptozotocin. Calcitonin and vitamin D3 were simultaneously injected in the rats of the control C+D and diabetic C+D groups. All rats were killed after 4 weeks, and the right mandibles were evaluated by micro-computed tomography and histomorphometric analysis. Diabetic rats showed a significant deterioration in bone quality and bone formation (diabetic group). By contrast, with the injection of calcitonin and vitamin D3, both bone parameters and bone formation significantly improved (diabetic C+D group) (P < 0.05). These findings suggest that these two hormones might potentially improve various bone properties.
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Affiliation(s)
- Mona A Abbassy
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.,Alexandria University, Alexandria, Egypt
| | - Ippei Watari
- Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ahmed S Bakry
- Conservative Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.,Cariology and Operative Dentistry Department, Graduate School of Medical and Dental Sciences, Tokyo Medical & Dental University, Tokyo, Japan.,Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Takashi Ono
- Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ali H Hassan
- Orthodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Frederiksen KD, Hanson S, Hansen S, Brixen K, Gram J, Jørgensen NR, Støving RK. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT. Calcif Tissue Int 2016; 98:253-62. [PMID: 26661530 DOI: 10.1007/s00223-015-0091-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/20/2015] [Indexed: 11/27/2022]
Abstract
Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and bone architecture assessed using dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), 6 and 12 months after RYGB, and correlate them to changes in selected biochemical markers. A prospective cohort study included 25 morbidly obese patients (10 males, 15 females). Patients were examined with DXA of the hip and spine, HR-pQCT of radius and tibia, and blood sampling before and 6 and 12 months after RYGB. Patients lost in average 33.5 ± 12.1 kg (25.8 ± 8.5 %) in 12 months. In tibia, we found significant loss of total, cortical and trabecular volumetric BMD after 12 months (all p < 0.001). Microarchitectural changes involved lower trabecular number, increased trabecular separation, and network inhomogeneity along with thinning of the cortex. Estimated bone failure load was decreased after 12 months (p = 0.005). We found only minor changes in radius. Results demonstrate significant alterations of bone microarchitecture suggesting an accelerated endosteal resorption along with disintegration of the trabecular structure which resulted in a loss of estimated bone strength in tibia. Such changes may underlie the recently reported increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.
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Affiliation(s)
- Katrine Diemer Frederiksen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.
| | - Stine Hanson
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
| | - Jeppe Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Niklas Rye Jørgensen
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark
- Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - René Klinkby Støving
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
- Center for Eating Disorders, Odense University Hospital, Kløvervænget 6, 8. sal, 5000, Odense C, Denmark
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Vilayphiou N, Boutroy S, Sornay-Rendu E, Van Rietbergen B, Chapurlat R. Age-related changes in bone strength from HR-pQCT derived microarchitectural parameters with an emphasis on the role of cortical porosity. Bone 2016; 83:233-240. [PMID: 26525593 DOI: 10.1016/j.bone.2015.10.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 10/11/2015] [Accepted: 10/20/2015] [Indexed: 10/22/2022]
Abstract
The high resolution peripheral computed tomography (HR-pQCT) technique has seen recent developments with regard to the assessment of cortical porosity. In this study, we investigated the role of cortical porosity on bone strength in a large cohort of women. The distal radius and distal tibia were scanned by HR-pQCT. We assessed bone strength by estimating the failure load by microfinite element analysis (μFEA), with isotropic and homogeneous material properties. We built a multivariate model to predict it, using a few microarchitecture variables including cortical porosity. Among 857 Caucasian women analyzed with μFEA, we found that cortical and trabecular properties, along with the failure load, impaired slightly with advancing age in premenopausal women, the correlations with age being modest, with |rage| ranging from 0.14 to 0.38. After the onset of the menopause, those relationships with age were stronger for most parameters at both sites, with |rage| ranging from 0.10 to 0.64, notably for cortical porosity and failure load, which were markedly deteriorated with increasing age. Our multivariate model using microarchitecture parameters revealed that cortical porosity played a significant role in bone strength prediction, with semipartial r(2)=0.22 only at the tibia in postmenopausal women. In conclusion, in our large cohort of women, we observed a small decline of bone strength at the tibia before the onset of menopause. We also found an age-related increase of cortical porosity at both scanned sites in premenopausal women. In postmenopausal women, the relatively high increase of cortical porosity accounted for the decline in bone strength only at the tibia.
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Affiliation(s)
- Nicolas Vilayphiou
- INSERM Research Unit 1033, Université de Lyon, Lyon, France; Scanco Medical AG, Bruttisellen, Switzerland.
| | | | | | - Bert Van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Shanbhogue VV, Hansen S, Frost M, Jørgensen NR, Hermann AP, Henriksen JE, Brixen K. Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease. Eur J Endocrinol 2016; 174:115-24. [PMID: 26537860 DOI: 10.1530/eje-15-0860] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 11/04/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVE AND DESIGN Patients with type 2 diabetes mellitus (T2D) have an increased fracture risk despite a normal or elevated bone mineral density (BMD). The aim of this cross-sectional in vivo study was to assess parameters of peripheral bone microarchitecture, estimated bone strength and bone remodeling in T2D patients with and without diabetic microvascular disease (MVD+ and MVD- respectively) and to compare them with healthy controls. METHODS Fifty-one T2D patients (MVD+ group: n=25) were recruited from Funen Diabetic Database and matched for age, sex and height with 51 healthy subjects. High-resolution peripheral quantitative tomography (HR-pQCT) was used to assess bone structure at the non-dominant distal radius and tibia. Estimated bone strength was calculated using finite element analysis. Biochemical markers of bone turnover were measured in all participants. RESULTS After adjusting for BMI, MVD+ patients displayed lower cortical volumetric BMD (P=0.02) and cortical thickness (P=0.02) and higher cortical porosity at the radius (P=0.02) and a trend towards higher cortical porosity at the tibia (P=0.07) compared to controls. HR-pQCT parameters did not differ between MVD- and control subjects. Biochemical markers of bone turnover were significantly lower in MVD+ and MVD- patients compared to controls (all P<0.01). These were no significant correlations between disease duration, glycemic control (average glycated hemoglobin over the previous 3 years) and HR-pQCT parameters. CONCLUSION Cortical bone deficits are not a characteristic of all T2D patients but of a subgroup characterized by the presence of microvascular complications. Whether this influences fracture rates in these patients needs further investigation.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Stinus Hansen
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Morten Frost
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Anne Pernille Hermann
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Jan Erik Henriksen
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
| | - Kim Brixen
- Department of EndocrinologyOdense University Hospital, Institute of Clinical Research, University of Southern Denmark, Kloevervaenget 6.1.sal, DK-5000 Odense C, DenmarkDepartments of Diagnostics and Medicine MResearch Center for Ageing and Osteoporosis, Glostrup Hospital, Copenhagen, Denmark
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Shanbhogue VV, Hansen S, Frost M, Jørgensen NR, Hermann AP, Henriksen JE, Brixen K. Bone Geometry, Volumetric Density, Microarchitecture, and Estimated Bone Strength Assessed by HR-pQCT in Adult Patients With Type 1 Diabetes Mellitus. J Bone Miner Res 2015; 30:2188-99. [PMID: 26096924 DOI: 10.1002/jbmr.2573] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 05/25/2015] [Accepted: 06/08/2015] [Indexed: 12/28/2022]
Abstract
The primary goal of this cross-sectional in vivo study was to assess peripheral bone microarchitecture, bone strength, and bone remodeling in adult type 1 diabetes (T1D) patients with and without diabetic microvascular disease (MVD+ and MVD-, respectively) and to compare them with age-, gender-, and height-matched healthy control subjects (CoMVD+ and CoMVD-, respectively). The secondary goal was to assess differences in MVD- and MVD+ patients. Fifty-five patients with T1DM (MVD+ group: n = 29) were recruited from the Funen Diabetes Database. Dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT) of the ultradistal radius and tibia, and biochemical markers of bone turnover were performed in all participants. There were no significant differences in HR-pQCT parameters between MVD- and CoMVD- subjects. In contrast, MVD+ patients had larger total and trabecular bone areas (p = 0.04 and p = 0.02, respectively), lower total, trabecular, and cortical volumetric bone mineral density (vBMD) (p < 0.01, p < 0.04, and p < 0.02, respectively), and thinner cortex (p = 0.03) at the radius, and lower total and trabecular vBMD (p = 0.01 and p = 0.02, respectively) at the tibia in comparison to CoMVD+. MVD+ patients also exhibited lower total and trabecular vBMD (radius p = 0.01, tibia p < 0.01), trabecular thickness (radius p = 0.01), estimated bone strength, and greater trabecular separation (radius p = 0.01, tibia p < 0.01) and network inhomogeneity (radius p = 0.01, tibia p < 0.01) in comparison to MVD- patients. These differences remained significant after adjustment for age, body mass index, gender, disease duration, and glycemic control (average glycated hemoglobin over the previous 3 years). Although biochemical markers of bone turnover were significantly lower in MVD+ and MVD- groups in comparison to controls, they were similar between the MVD+ and MVD- groups. The results of our study suggest that the presence of MVD was associated with deficits in cortical and trabecular bone vBMD and microarchitecture that could partly explain the excess skeletal fragility observed in these patients.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Morten Frost
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niklas Rye Jørgensen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Anne Pernille Hermann
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Manske SL, Zhu Y, Sandino C, Boyd SK. Human trabecular bone microarchitecture can be assessed independently of density with second generation HR-pQCT. Bone 2015; 79:213-21. [PMID: 26079995 DOI: 10.1016/j.bone.2015.06.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 05/16/2015] [Accepted: 06/09/2015] [Indexed: 12/18/2022]
Abstract
The second generation HR-pQCT scanner (XtremeCTII, Scanco Medical) can assess human bone microarchitecture of peripheral limbs with a 61 μm nominal isotropic voxel size. This is a marked improvement from the first generation HR-pQCT that had a nominal isotropic voxel size of 82 μm, which is at the limit to accurately determine the thickness of individual human trabeculae. We sought to determine the accuracy of a direct morphometric approach to measure trabecular bone microarchitecture with three-dimensional morphological techniques using second generation HR-pQCT, and to compare this with the approach currently applied by the first generation HR-pQCT scanner based on derived indices using ex vivo scans of human cadaveric radii. We also compared images acquired and resampled to mimic the first generation HR-pQCT with those obtained directly from the first generation HR-pQCT. We evaluated 20 human cadaveric radii and a micro-CT performance phantom using the first (XtremeCT, Scanco Medical) and second generation HR-pQCT scanner (XtremeCTII) and compared a patient evaluation (XCTII, 61 μm) with a high resolution ex vivo protocol (HR, 30μm). We generated 82 μm scans of the same specimens to mimic a first-generation HR-pQCT evaluation (XCTIM, 82 μm) and compared these with a first-generation patient evaluation (XCTI, 82 μm). A standard structural extraction approach was applied to both XCTII and HR evaluations for assessment of bone volume fraction (BV/TV), and a distance transform was used to assess trabecular number (Tb.N), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). For XCTI and XCTIM evaluations we followed the manufacturer's standard procedure and assessed bone mineral density (BMD), Tb.N with a distance transform, and then derived bone volume ratio (BV/TV(d)), trabecular thickness (Tb.Th(d)) and separation (Tb.Sp(d)). The spatial resolution (10% MTF) was 142.2 μm for XCTI, 108.9 μm for XCTIM, 95.2μm for XCTII, and 55.9 μm for HR. XCTI and XCTIM provided strongly associated measurements of BMD and microarchitectural outcomes (R(2)>0.97), however there were systematic differences in all outcomes. The Tb.N was highly associated with HR by both XCTII (R(2)=0.93, mean error=-0.12 mm(-1)) and XCTIM (R(2)=0.98, mean error=0.25 mm(-1)). Also, both XCTII (R(2)=0.99, mean error=0.20mm) and XCTIM (R(2)=0.99, mean error=-0.18 mm) had Tb.Sp that were strongly related to HR. For Tb.Th, the XCTII was more closely related to HR (R(2)=0.94, mean error=0.04 mm) than the relatively weak XCTIM (R(2)=0.16, mean error=- 0.076 mm). We found that trabecular microarchitecture assessment following the XCTII direct morphometric approach accurately represented the HR data. In particular, the measure of Tb.Th was markedly improved for XCTII compared with the derived approach of XCTIM. These data support the application of analysis techniques in HR-pQCT that are analogous to those traditionally used for micro-CT to assess trabecular microarchitecture. The decreased dependence of structural outcomes on density provides a new, important opportunity to monitor human in vivo bone microarchitecture.
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Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Ying Zhu
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Clara Sandino
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
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Abstract
Age-related fragility fractures are an enormous public health problem. Both acquisition of bone mass during growth and bone loss associated with ageing affect fracture risk late in life. The development of high-resolution peripheral quantitative CT (HRpQCT) has enabled in vivo assessment of changes in the microarchitecture of trabecular and cortical bone throughout life. Studies using HRpQCT have demonstrated that the transient increase in distal forearm fractures during adolescent growth is associated with alterations in cortical bone, which include cortical thinning and increased porosity. Children with distal forearm fractures in the setting of mild, but not moderate, trauma also have increased deficits in cortical bone at the distal radius and in bone mass systemically. Moreover, these children transition into young adulthood with reduced peak bone mass. Elderly men, but not elderly women, with a history of childhood forearm fractures have an increased risk of osteoporotic fractures. With ageing, men lose trabecular bone primarily by thinning of trabeculae, whereas the number of trabeculae is reduced in women, which is much more destabilizing from a biomechanical perspective. However, age-related losses of cortical bone and increases in cortical porosity seem to have a much larger role than previously recognized, and increased cortical porosity might characterize patients at increased risk of fragility fractures.
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Affiliation(s)
- Joshua N Farr
- Endocrine Research Unit and Kogod Center on Aging, Mayo Clinic, Guggenheim 7-11, 200 First Street SW, Rochester, MN 55905, USA
| | - Sundeep Khosla
- Endocrine Research Unit and Kogod Center on Aging, Mayo Clinic, Guggenheim 7-11, 200 First Street SW, Rochester, MN 55905, USA
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Amstrup AK, Sikjaer T, Heickendorff L, Mosekilde L, Rejnmark L. Melatonin improves bone mineral density at the femoral neck in postmenopausal women with osteopenia: a randomized controlled trial. J Pineal Res 2015; 59:221-9. [PMID: 26036434 DOI: 10.1111/jpi.12252] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/29/2015] [Indexed: 01/11/2023]
Abstract
Melatonin is known for its regulation of circadian rhythm. Recently, studies have shown that melatonin may have a positive effect on the skeleton. By increasing age, the melatonin levels decrease, which may lead to a further imbalanced bone remodeling. We aimed to investigate whether treatment with melatonin could improve bone mass and integrity in humans. In a double-blind RCT, we randomized 81 postmenopausal osteopenic women to 1-yr nightly treatment with melatonin 1 mg (N = 20), 3 mg (N = 20), or placebo (N = 41). At baseline and after 1-yr treatment, we measured bone mineral density (BMD) by dual X-ray absorptiometry, quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) and determined calciotropic hormones and bone markers. Mean age of the study subjects was 63 (range 56-73) yr. Compared to placebo, femoral neck BMD increased by 1.4% in response to melatonin (P < 0.05) in a dose-dependent manner (P < 0.01), as BMD increased by 0.5% in the 1 mg/day group (P = 0.55) and by 2.3% (P < 0.01) in the 3 mg/day group. In the melatonin group, trabecular thickness in tibia increased by 2.2% (P = 0.04), and volumetric bone mineral density (vBMD) in the spine, by 3.6% (P = 0.04) in the 3 mg/day. Treatment did not significantly affect BMD at other sites or levels of bone turnover markers; however, 24-hr urinary calcium was decreased in response to melatonin by 12.2% (P = 0.02). In conclusion, 1-yr treatment with melatonin increased BMD at femoral neck in a dose-dependent manner, while high-dose melatonin increased vBMD in the spine. Further studies are needed to assess the mechanisms of action and whether the positive effect of nighttime melatonin will protect against fractures.
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Affiliation(s)
- Anne Kristine Amstrup
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, THG, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, THG, Aarhus, Denmark
| | - Lene Heickendorff
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Leif Mosekilde
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, THG, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine (MEA), Aarhus University Hospital, THG, Aarhus, Denmark
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Wong AKO, Beattie KA, Min KKH, Merali Z, Webber CE, Gordon CL, Papaioannou A, Cheung AMW, Adachi JD. A Trimodality Comparison of Volumetric Bone Imaging Technologies. Part III: SD, SEE, LSC Association With Fragility Fractures. J Clin Densitom 2015; 18:408-18. [PMID: 25129407 PMCID: PMC5092155 DOI: 10.1016/j.jocd.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 11/29/2022]
Abstract
Part II of this 3-part series demonstrated 1-yr precision, standard error of the estimate, and 1-yr least significant change for volumetric bone outcomes determined using peripheral (p) quantitative computed tomography (QCT) and peripheral magnetic resonance imaging (pMRI) modalities in vivo. However, no clinically relevant outcomes have been linked to these measures of change. This study examined 97 women with mean age of 75 ± 9 yr and body mass index of 26.84 ± 4.77 kg/m(2), demonstrating a lack of association between fragility fractures and standard deviation, least significant change and standard error of the estimate-based unit differences in volumetric bone outcomes derived from both pMRI and pQCT. Only cortical volumetric bone mineral density and cortical thickness derived from high-resolution pQCT images were associated with an increased odds for fractures. The same measures obtained by pQCT erred toward significance. Despite the smaller 1-yr and short-term precision error for measures at the tibia vs the radius, the associations with fractures observed at the radius were larger than at the tibia for high-resolution pQCT. Unit differences in cortical thickness and cortical volumetric bone mineral density able to yield a 50% increase in odds for fractures were quantified here and suggested as a reference for future power computations.
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Affiliation(s)
- Andy K O Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kevin K H Min
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zamir Merali
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Colin E Webber
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angela M W Cheung
- Osteoporosis Program, University Health Network, Toronto, ON, Canada
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Lomholt S, Amstrup AK, Moser E, Jakobsen NFB, Mosekilde L, Vestergaard P, Rejnmark L. Unexplained high BMD in DXA-scanned patients is generalized throughout the skeleton and characterized by thicker cortical and trabecular bone. Calcif Tissue Int 2015; 96:284-94. [PMID: 25609586 DOI: 10.1007/s00223-015-9955-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 01/09/2015] [Indexed: 10/24/2022]
Abstract
Unexplained high bone mineral density (BMD) is a rare condition and the mechanisms responsible are yet to be described in detail. The aim of the study was to identify patients with unexplained high BMD from a local DXA database and compare their radiological phenotype with an age- and a gender-matched group of population-based controls. We defined high BMD as a DXA Z-score ≥ + 2.5 at the total hip and lumbar spine. We characterized the findings as "unexplained" if no osteodegenerative changes, bone metabolic disease, or arthritis at the hip or lumbar spine was observed. All participants were investigated with high-resolution peripheral quantitative computed tomography (HR-pQCT), QCT, DXA, fasting blood samples, a 24-h urine sample, and questionnaires. The DXA database contained data on 25,118 patients. Initially, 138 (0.55%) potential participants with high BMD were identified, and during the study ten additional cases were identified from new DXA scans. Sixty-seven patients accepted to participate in the study, and among these we identified 15 women and one man with unexplained high BMD. These 15 women had higher BMD throughout the skeleton relative to controls, similar area/volume at the hip and the distal extremities, a higher number of trabeculae, which was thicker than in the controls, and a higher finite element estimated bone strength. The 15 women were heavier and had a higher fat mass then controls. We conclude that patients with unexplained high BMD have a generalized high BMD phenotype throughout their skeleton, which is characterized with a denser microarchitecture.
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Affiliation(s)
- S Lomholt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus, Denmark,
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Wong AKO, Beattie KA, Min KKH, Merali Z, Webber CE, Gordon CL, Papaioannou A, Cheung AMW, Adachi JD. A Trimodality Comparison of Volumetric Bone Imaging Technologies. Part II: 1-Yr Change, Long-Term Precision, and Least Significant Change. J Clin Densitom 2015; 18:260-9. [PMID: 25129406 PMCID: PMC5092156 DOI: 10.1016/j.jocd.2014.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 01/22/2023]
Abstract
The previous article in this 3-part series demonstrated short-term precision and validity for volumetric bone outcome quantification using in vivo peripheral (p) quantitative computed tomography (pQCT) and magnetic resonance imaging (MRI) modalities at resolutions 200 μm or higher. However, 1-yr precision error and clinically significant references are yet to be reported for these modalities. This study examined 59 women with mean age of 75 ± 9 yr and body mass index of 26.84 ± 4.77 kg/m², demonstrating the lowest 1-yr precision error, standard errors of the estimate, and least significant change values for high-resolution (hr) pQCT followed by pQCT, and 1.0-T pMRI for all volumetric bone outcomes except trabecular number. Like short-term precision, 1-yr statistics for trabecular separation were similar across modalities. Excluding individuals with a previous history of fragility fractures, or who were current users of antiresorptives reduced 1-yr change for bone outcomes derived from pQCT and pMR images, but not hr-pQCT images. In Part II of this 3-part series focused on trimodality comparisons of 1-yr changes, hr-pQCT was recommended to be the prime candidate for quantifying change where smaller effect sizes are expected, but pQCT was identified as a feasible alternative for studies expecting larger changes.
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Affiliation(s)
- Andy K O Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kevin K H Min
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Zamir Merali
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Colin E Webber
- Department of Nuclear Medicine, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | | | - Angela M W Cheung
- Osteoporosis Program, University Health Network, Toronto, ON, Canada
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Shanbhogue VV, Hansen S, Halekoh U, Brixen K. Use of Relative vs Fixed Offset Distance to Define Region of Interest at the Distal Radius and Tibia in High-Resolution Peripheral Quantitative Computed Tomography. J Clin Densitom 2015; 18:217-25. [PMID: 25690769 DOI: 10.1016/j.jocd.2014.12.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/17/2014] [Accepted: 12/19/2014] [Indexed: 11/25/2022]
Abstract
Although the region of interest in high-resolution peripheral quantitative computed tomography, defined based on the manufacturer's protocol for in vivo scanning, provides consistency and is practically convenient, it does not take into account possible variation in morphology in the regions adjacent to the measurement site. This study aimed at compare the morphologic variation in measurements using the standard fixed offset distance to define the distal starting slice against those obtained by using a relative measurement position scaled to the individual bone length at the distal radius and tibia in normal healthy adult subjects. A total of 40 healthy adult subjects (median height, 175.3 cm; range: 150.0-196.0 cm) were included in the study. High-resolution peripheral quantitative computed tomography at the distal radius and tibia was performed in all subjects, the region of interest defined by, first, the standard measurement protocol, where the most distal CT slice was 9.5 mm and 22.5 mm from the end plate of the radius and tibia, respectively, and second, the relative measurement method, where the most distal CT slice was at 4% and 7% of the radial and tibial lengths, respectively. Volumetric densities and microarchitectural parameters were compared between the 2 methods. Measurements of the total and cortical volumetric density and cortical thickness at the radius and tibia and cortical porosity, trabecular volumetric density, and trabecular number at the tibia were significantly different between the 2 methods (all p < 0.001). The predicted morphologic variation with varying measurement position was substantial at both the radius (up to 34%) and the tibia (up to 36%). A lack of consideration to height (and in turn the bone lengths) in the standard patient protocol could lead to the introduction of systematic errors in radial and tibial measurements. Although this may not be of particular significance in longitudinal studies in the same individual, it potentially assumes critical importance in cross-sectional studies.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulrich Halekoh
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Wuermser LA, Beck LA, Lamb JL, Atkinson EJ, Amin S. The effect of low-magnitude whole body vibration on bone density and microstructure in men and women with chronic motor complete paraplegia. J Spinal Cord Med 2015; 38:178-86. [PMID: 24621040 PMCID: PMC4397199 DOI: 10.1179/2045772313y.0000000191] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To examine the effect of low-magnitude whole body vibration on bone density and microstructure in women and men with chronic motor complete paraplegia. METHODS We studied nine subjects (four women and five men) with motor complete paraplegia of 2 years duration or more, age 20-50 years. Subjects were instructed to stand on a low-magnitude vibration plate within a standing frame for 20 minutes per day, 5 days a week, and for 6 months. Bone density at the proximal femur by dual-energy X-ray absorptiometry and bone microstructure at the distal tibia by high-resolution peripheral quantitative computed tomography were assessed at four timepoints over 12 months (baseline, at 3 months and 6 months while on intervention, and after 6 months off intervention). RESULTS Standing on the low-magnitude vibration plate with a standing frame was well tolerated by participants. However, most subjects did not show an improvement in bone density or microstructure after 6 months of intervention, or any relevant changes 6 months following the discontinuation of the low-magnitude vibration. CONCLUSION We were unable to identify an improvement in either bone density or microstructure following 6 months use of a low-magnitude vibration plate in women or men with chronic motor complete paraplegia. Longer duration of use may be necessary, or it is possible that this intervention is of limited benefit following chronic spinal cord injury.
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Affiliation(s)
- Lisa-Ann Wuermser
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Lisa A. Beck
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jeffry L. Lamb
- Department of Physical Medicine and Rehabilitation, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth J. Atkinson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shreyasee Amin
- Correspondence to: Shreyasee Amin, Division of Rheumatology, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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45
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Fischer L, Valentinitsch A, DiFranco MD, Schueller-Weidekamm C, Kienzl D, Resch H, Gross T, Weber M, Jaksch P, Klepetko W, Zweytick B, Pietschmann P, Kainberger F, Langs G, Patsch JM. High-Resolution Peripheral Quantitative CT Imaging: Cortical Porosity, Poor Trabecular Bone Microarchitecture, and Low Bone Strength in Lung Transplant Recipients. Radiology 2015; 274:473-81. [DOI: 10.1148/radiol.14140201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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46
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Wong AKO, Beattie KA, Min KKH, Webber CE, Gordon CL, Papaioannou A, Cheung AMW, Adachi JD. A trimodality comparison of volumetric bone imaging technologies. Part I: Short-term precision and validity. J Clin Densitom 2015; 18:124-35. [PMID: 25129405 PMCID: PMC5094893 DOI: 10.1016/j.jocd.2014.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 06/13/2014] [Accepted: 07/03/2014] [Indexed: 10/24/2022]
Abstract
In vivo peripheral quantitative computed tomography (pQCT) and peripheral magnetic resonance imaging (pMRI) modalities can measure apparent bone microstructure at resolutions 200 μm or higher. However, validity and in vivo test-retest reproducibility of apparent bone microstructure have yet to be determined on 1.0 T pMRI (196 μm) and pQCT (200 μm). This study examined 67 women with a mean age of 74±9 yr and body mass index of 27.65±5.74 kg/m2, demonstrating validity for trabecular separation from pMRI, cortical thickness, and bone volume fraction from pQCT images compared with high-resolution pQCT (hr-pQCT), with slopes close to unity. However, because of partial volume effects, cortical and trabecular thickness of bone derived from pMRI and pQCT images matched hr-pQCT more only when values were small. Short-term reproducibility of bone outcomes was highest for bone volume fraction (BV/TV) and densitometric variables and lowest for trabecular outcomes measuring microstructure. Measurements at the tibia for pQCT images were more precise than at the radius. In part I of this 3-part series focused on trimodality comparisons of precision and validity, it is shown that pQCT images can yield valid and reproducible apparent bone structural outcomes, but because of longer scan time and potential for more motion, the pMRI protocol examined here remains limited in achieving reliable values.
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Affiliation(s)
- Andy K O Wong
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Karen A Beattie
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kevin K H Min
- Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Colin E Webber
- Department of Nuclear Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Angela M W Cheung
- Osteoporosis Program, University Health Network, Toronto, ON, Canada
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Shanbhogue VV, Hansen S, Folkestad L, Brixen K, Beck-Nielsen SS. Bone geometry, volumetric density, microarchitecture, and estimated bone strength assessed by HR-pQCT in adult patients with hypophosphatemic rickets. J Bone Miner Res 2015; 30:176-83. [PMID: 25042721 DOI: 10.1002/jbmr.2310] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/02/2014] [Accepted: 07/08/2014] [Indexed: 11/07/2022]
Abstract
Hypophosphatemic rickets (HR) is characterized by a generalized mineralization defect. Although densitometric studies have found the patients to have an elevated bone mineral density (BMD), data on bone geometry and microstructure are scarce. The aim of this cross-sectional in vivo study was to assess bone geometry, volumetric BMD (vBMD), microarchitecture, and estimated bone strength in adult patients with HR using high-resolution peripheral quantitative computed tomography (HR-pQCT). Twenty-nine patients (aged 19 to 79 years; 21 female, 8 male patients), 26 of whom had genetically proven X-linked HR, were matched with respect to age and sex with 29 healthy subjects. Eleven patients were currently receiving therapy with calcitriol and phosphate for a median duration of 29.1 years (12.0 to 43.0 years). Because of the disproportionate short stature in HR, the region of interest in HR-pQCT images at the distal radius and tibia were placed in a constant proportion to the entire length of the bone in both patients and healthy volunteers. In age- and weight-adjusted models, HR patients had significantly higher total bone cross-sectional areas (radius 36%, tibia 20%; both p < 0.001) with significantly higher trabecular bone areas (radius 49%, tibia 14%; both p < 0.001) compared with controls. In addition, HR patients had lower total vBMD (radius -20%, tibia -14%; both p < 0.01), cortical vBMD (radius -5%, p < 0.001), trabecular number (radius -13%, tibia -14%; both p < 0.01), and cortical thickness (radius -19%; p < 0.01) compared with controls, whereas trabecular spacing (radius 18%, tibia 23%; p < 0.01) and trabecular network inhomogeneity (radius 29%, tibia 40%; both p < 0.01) were higher. Estimated bone strength was similar between the groups. In conclusion, in patients with HR, the negative impact of lower vBMD and trabecular number on bone strength seems to be compensated by an increase in bone diameter, resulting in HR patients having normal estimates of bone strength. © 2014 American Society for Bone and Mineral Research.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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48
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Ndiaye M, Terranova L, Mallet R, Mabilleau G, Chappard D. Three-dimensional arrangement of β-tricalcium phosphate granules evaluated by microcomputed tomography and fractal analysis. Acta Biomater 2015; 11:404-11. [PMID: 25242650 DOI: 10.1016/j.actbio.2014.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/26/2014] [Accepted: 09/11/2014] [Indexed: 02/01/2023]
Abstract
The macrophysical properties of granular biomaterials used to fill bone defects have rarely been considered. Granules of a given biomaterial occupy three-dimensional (3-D) space when packed together and create a macroporosity suitable for the invasion of vascular and bone cells. Granules of β-tricalcium phosphate were prepared using polyurethane foam technology and increasing the amount of material powder in the slurry (10, 11, 15, 18, 21 and 25 g). After sintering, granules of 1000-2000 μm were prepared by sieving. They were analyzed morphologically by scanning electron microscopy and placed in polyethylene test tubes to produce 3-D scaffolds. Microcomputed tomography (microCT) was used to image the scaffolds and to determine porosity and fractal dimension in three dimensions. Two-dimensional sections of the microCT models were binarized and used to compute classical morphometric parameters describing porosity (interconnectivity index, strut analysis and star volumes) and fractal dimensions. In addition, two newly important fractal parameters (lacunarity and succolarity) were measured. Compression analysis of the stacks of granules was done. Porosity decreased as the amount of material in the slurry increased but non-linear relationships were observed between microarchitectural parameters describing the pores and porosity. Lacunarity increased in the series of granules but succolarity (reflecting the penetration of a fluid) was maximal in the 15-18 g groups and decreased noticeably in the 25 g group. The 3-D arrangement of biomaterial granules studied by these new fractal techniques allows the optimal formulation to be derived based on the lowest amount of material, suitable mechanical resistance during crushing and the creation of large interconnected pores.
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Lu Y, Krause M, Bishop N, Sellenschloh K, Glüer CC, Püschel K, Amling M, Morlock MM, Huber G. The role of patient-mode high-resolution peripheral quantitative computed tomography indices in the prediction of failure strength of the elderly women's thoracic vertebral body. Osteoporos Int 2015; 26:237-44. [PMID: 25135580 DOI: 10.1007/s00198-014-2846-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 08/07/2014] [Indexed: 01/05/2023]
Abstract
UNLABELLED The correlations between the failure load of 20 T12 vertebral bodies, their patient-mode high-resolution peripheral quantitative computed tomography (HR-pQCT) indices, and the L1 areal bone mineral density (aBMD) were investigated. For the prediction of the T12 vertebral failure load, the T12 HR-pQCT microarchitectural parameters added significant information to that of L1 aBMD and to that of cortical BMD, but not to that of T12 vertebral BMD and not to that of T12 trabecular BMD. INTRODUCTION HR-pQCT is a new in vivo imaging technique for assessing the three-dimensional microarchitecture of cortical and trabecular bone at the distal radius and tibia. But little is known about this technique in the direct measurement of vertebral body. METHODS Twenty female donors with the mean age of 80.1 (7.6) years were included in the study. Dual X-ray absorptiometry of the lumbar spine and femur was performed. The spinal specimens (T11/T12/L1) were dissected, scanned using HR-pQCT scanner, and mechanically tested under 4° wedge compression. The L1 aBMD, T12 patient-mode HR-pQCT indices, and T12 vertebral failure loads were analyzed. RESULTS For the prediction of vertebral failure load, the inclusion of BV/TV into L1 aBMD was the best model (R (2) = 0.52), Tb.N and Tb.Sp added significant information to the L1 aBMD and to the cortical BMD, but none of the vertebral microarchitectural parameters yielded additional significant information to the trabecular BMD (or BV/TV) and to the vertebral BMD. CONCLUSION Vertebral microarchitectural parameters obtained from the patient-mode HR-pQCT analysis provide significant information on bone strength complementary to that of aBMD and to that of cortical BMD, but not to that of vertebral BMD and not to that of trabecular BMD.
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Affiliation(s)
- Y Lu
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany,
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Hansen S, Gudex C, Åhrberg F, Brixen K, Voss A. Bone geometry, volumetric bone mineral density, microarchitecture and estimated bone strength in Caucasian females with systemic lupus erythematosus. A cross-sectional study using HR-pQCT. Calcif Tissue Int 2014; 95:530-9. [PMID: 25326144 DOI: 10.1007/s00223-014-9918-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 10/08/2014] [Indexed: 12/13/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) have an increased risk of fracture. We used high resolution peripheral quantitative computed tomography (HR-pQCT) to measure bone geometry, volumetric bone mineral density (vBMD), cortical and trabecular microarchitecture and estimated bone strength by finite element analysis (FEA) at the distal radius and tibia to assess bone characteristics beyond BMD that may contribute to the increased risk of fracture. Thirty-three Caucasian women with SLE (median age 48, range 21-64 years) and 99 controls (median age 45, range 21-64 years) were studied. Groups were comparable in radius regarding geometry and vBMD, but SLE patients had lower trabecular number (-7%, p < 0.05), higher trabecular separation (13%, p < 0.05) and lower FEA-estimated failure load compared to controls (-10%, p < 0.05). In tibia, SLE patients had lower total vBMD (-11%, p < 0.01), cortical area (-14%, p < 0.001) and cortical thickness (-16%, p < 0.001) and higher trabecular area (8%, p < 0.05). In subgroup analyses of the premenopausal participants (SLE n = 21, controls n = 63), SLE patients had significantly lower trabecular bone volume fraction [(BV/TV); -17%, p < 0.01], trabecular number (-9%, p < 0.01), trabecular thickness (-9%, p < 0.05) and higher trabecular separation (13%, p < 0.01) and trabecular network inhomogeneity (14%, p < 0.05) in radius along with lower BV/TV (-15%, p < 0.01) and higher trabecular separation (11%, p < 0.05) in tibia. FEA-estimated bone strength was lower in both radius (-11%, p < 0.01) and tibia (-10%, p < 0.05). In conclusion, Caucasian women with SLE compared to controls had fewer and more widely separated trabeculae and lower estimated bone strength in radius and lower total vBMD, cortical area and thickness in tibia.
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Affiliation(s)
- Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Kloevervaenget 6.1.sal, 5000, Odense C, Denmark,
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