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Bhattacharya S, Nagendra L, Chandran M, Kapoor N, Patil P, Dutta D, Kalra S. Trabecular bone score in adults with type 1 diabetes: a meta-analysis. Osteoporos Int 2024; 35:105-115. [PMID: 37819402 DOI: 10.1007/s00198-023-06935-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is associated with a disproportionately high fracture rate despite a minimal decrease in bone mineral density. Though trabecular bone score (TBS), an indirect measure of bone architecture, is lower in adults with T1DM, the modest difference is unlikely to account for the large excess risk and calls for further exploration. INTRODUCTION Fracture rates in type 1 diabetes mellitus (T1DM) are disproportionately high compared to the modestly low bone mineral density (BMD). Distortion of bone microarchitecture compromises bone quality in T1DM and is indirectly measured by trabecular bone score (TBS). TBS could potentially be used as a screening tool for skeletal assessment; however, there are inconsistencies in the studies evaluating TBS in T1DM. We performed this meta-analysis to address this knowledge gap. METHODS An electronic literature search was conducted using PubMed, Scopus, and Web of Science resources (all-year time span) to identify studies relating to TBS in T1DM. Cross-sectional and retrospective studies in adults with T1DM were included. TBS and BMD data were extracted for pooled analysis. Fracture risk could not be analyzed as there were insufficient studies reporting it. RESULT Data from six studies were included (T1DM: n = 378 and controls: n = 286). Pooled analysis showed a significantly lower TBS [standardized mean difference (SMD) = - 0.37, 95% CI - 0.52 to - 0.21; p < 0.00001] in T1DM compared to controls. There was no difference in the lumbar spine BMD (6 studies, SMD - 0.06, 95% CI - 0.22 to 0.09; p = 0.43) and total hip BMD (6 studies, SMD - 0.17, 95% CI - 0.35 to 0.01; p = 0.06) in the case and control groups. CONCLUSIONS Adults with T1DM have a lower TBS but similar total hip and lumbar spine BMD compared to controls. The risk attributable to the significant but limited difference in TBS falls short of explaining the large excess propensity to fragility fracture in adults with T1DM. Further studies on clarification of the mechanism and whether TBS is suited to screen for fracture risk in adults with T1DM are necessary.
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Affiliation(s)
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, Karnataka, India.
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
- DUKE NUS Medical School, Singapore, Singapore
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes, and Metabolism, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
- B Non-Communicable Disease Unit, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Prakash Patil
- Central Research Laboratory, K.S Hegde Medical Academy (KSHEMA), NITTE (Deemed to Be University), Mangalore, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Centre for Endocrinology, Arthritis, and Rheumatism (CEDAR), Superspeciality Healthcare, Dwarka, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
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Nia A, Jeremic N, Popp D, Schmoelz L, Patsch J, Döring K, Weber M, Synek A, Pahr DH, Aldrian S. Feasibility of aluminum phantom radiography for osteoporosis detection in postmenopausal women with a fragility fracture of the distal radius compared to DXA and HR-pQCT. J Orthop Res 2023; 41:1774-1780. [PMID: 36694475 DOI: 10.1002/jor.25523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
Recently, promising results have been reported for detection of osteoporosis with use of an aluminum phantom. Therefore, the aim of this study was to evaluate the feasibility of radiography-based bone mineral density (BMD) measurement using a graded aluminum phantom. This study included 27 postmenopausal women with a distal radius fracture. Aluminum phantom radiography of the healthy radius was conducted as well as high-resolution peripheral quantitative computed tomography (HR-pQCT) measurement of the ultradistal radius and dual energy X-ray absorptiometry (DXA) of the radius, spine, and hip. A strong correlation was observed between aluminum phantom radiography-based mean gray value (mGV) and DXA-derived BMD, especially for the ultradistal radius (ρ = 0.75; p < 0.001). A moderate correlation for the femoral neck (ρ = 0.61 and p < 0.001) between modalities was found. Radius mGV and HR-pQCT-derived BMD only showed a moderate correlation (ρ = 0.48; p < 0.09). Aluminum phantom radiography might serve as a cost efficient, highly available, low-radiation dose screening, and diagnostic method for osteoporosis additively to DXA measurements. Especially, an application in areas with constrained DXA availability and such as preoperative trauma settings would be beneficial. However, further investigation and assessment of specificity and sensitivity is needed.
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Affiliation(s)
- Arastoo Nia
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Natasa Jeremic
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Domenik Popp
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lukas Schmoelz
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Janina Patsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Kevin Döring
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Wien, Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, Wien, Austria
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Silke Aldrian
- Department of Orthopedics and Trauma Surgery, Division of Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Bae WC. Advances and Shortfalls in MRI Evaluation of Osteoporosis. Radiology 2023; 307:e223144. [PMID: 36692406 PMCID: PMC10102620 DOI: 10.1148/radiol.223144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Won C. Bae
- From the Department of Radiology, University of California San Diego, 9427 Health Sciences Dr, La Jolla, CA 92093
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Holloway-Kew KL, Anderson KB, Tembo MC, Sui SX, Harland JW, Hyde NK, Kotowicz MA, Pasco JA. Peripheral quantitative computed tomography-derived bone parameters in men with impaired fasting glucose and diabetes. J Bone Miner Metab 2023; 41:131-142. [PMID: 36550385 DOI: 10.1007/s00774-022-01389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Individuals with type 2 diabetes mellitus (T2DM) are at higher risk of fracture, but paradoxically do not have reduced bone mineral density. We investigated associations between peripheral quantitative computed tomography (pQCT) and glycaemia status. MATERIALS AND METHODS Participants were men (n = 354, age 33-92 year) from the Geelong Osteoporosis Study. Diabetes was defined by fasting plasma glucose (FPG) ≥ 7.0 mmol/L, self-report of diabetes and/or antihyperglycaemic medication use and impaired fasting glucose (IFG) as FPG 5.6-6.9 mmol/L. Bone measures were derived using pQCT (XCT2000) at 4% and 66% radial and tibial sites. Linear regression was used, adjusting for age, body mass index and socio-economic status. RESULTS At the 4% site, men with T2DM had lower adjusted bone total area, trabecular area and cortical area at the radius (all - 6.2%) and tibia (all - 6.4%) compared to normoglycaemia. Cortical density was higher for T2DM at the radius (+ 5.8%) and tibia (+ 8.0%), as well as adjusted total bone density at the tibial site (+ 6.1%). At the 66% site, adjusted total bone area and polar stress strain index were lower for T2DM at the radius (- 4.3% and - 8.0%). Total density was also higher for T2DM (+ 1.2%). Only cortical density at the 4% tibial site was different between IFG and normoglycaemia in adjusted analyses (+ 4.5%). CONCLUSION Men with T2DM had lower total bone area, trabecular area, cortical area and polar stress strain index than the other two groups; however, total density and cortical density were higher. Only one difference was observed between IFG and normoglycaemia; increased tibial cortical density.
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Affiliation(s)
- Kara L Holloway-Kew
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia.
| | - Kara B Anderson
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Monica C Tembo
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Sophia X Sui
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Jacob W Harland
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Natalie K Hyde
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Mark A Kotowicz
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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Alvarenga JC, Caparbo VF, Domiciano DS, Pereira RMR. Age-related reference data of bone microarchitecture, volumetric bone density, and bone strength parameters in a population of healthy Brazilian men: an HR-pQCT study. Osteoporos Int 2022; 33:1309-1321. [PMID: 35059775 DOI: 10.1007/s00198-021-06288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED In a cross-sectional cohort of 340 healthy Brazilian men aged 20 to 92 years, data on density, structure, and strength of the distal radius and tibia were obtained using high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop age- and site-specific reference curves. Age-dependent changes differed between the sites and bone compartments (trabecular and cortical). INTRODUCTION The aim of this study was to establish age-related reference curves for bone densities, microarchitectural properties, and estimated failure load measured by HR-pQCT (distal radius and tibia) in men. Also, to correlate bone stiffness with the other HR-pQCT parameters, areal bone mineral density (BMD) by DXA and trabecular bone score (TBS). METHODS Healthy Brazilian men (n = 340) between the ages of 20 and 92 years were recruited. Non-dominant radius and left tibia were scanned using HR-pQCT (Xtreme CT I). Standard and automated segmentation methods were performed, and bone strength estimated by FE analysis. Bone mineral density at lumbar spine, total hip, femoral neck, and TBS were measured using DXA (Hologic, QDR4500). RESULTS Age-related reference curves were constructed at the distal radius and tibia for volumetric bone density, morphometry, and estimated bone strength parameters. There was a linear relationship with age only for thickness measurements of distal radius (trabecular: R2 0.108, p<0.001; cortical: R2 0.062, p=0.002) and tibia (trabecular: R2 0.109, p<0.001; cortical: R2 0.063, p=0.010), and bone strength at distal radius (R2 0.157, p<0.001). The significant correlations (p <0.05) found by Pearson's correlations (r) between bone stiffness and all other variables measured by HR-pQCT and DXA showed to be stronger at the tibia site than the distal radius. CONCLUSION The current study expands the HR-pQCT worldwide database and presents an adequate methodology for the construction of reference data in other populations. Moreover, the correlation of bone strength estimated by FEA with other bone microstructural parameters provided by HR-pQCT helps to determine the contribution of each of these variables to fracture risk prediction in men.
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Affiliation(s)
- J C Alvarenga
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil.
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Holzer G, Hobusch G, Hansen S, Fischer L, Patsch JM. Is There an Association Between Bone Microarchitecture and Fracture in Patients who were Treated for High-grade Osteosarcoma? A Controlled Study at Long-term Follow-up Using High-resolution Peripheral Quantitative CT. Clin Orthop Relat Res 2021; 479:2493-2501. [PMID: 34077400 PMCID: PMC8509943 DOI: 10.1097/corr.0000000000001842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/05/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy in patients with primary osteosarcoma improves survival rates, but it also causes side effects in various organs including bone. Low bone mineral density (BMD) can occur owing partly to chemotherapy or limited mobility. This can cause a higher risk of fractures compared with those who do not receive such treatment. Changes in BMD alone cannot explain the propensity of fractures. Studying microarchitectural changes of bone might help to understand the effect. QUESTIONS/PURPOSES (1) Do patients who were treated for osteosarcoma (more than 20 years previously) have low BMD? (2) Do these patients experience more fractures than controls who do not have osteosarcoma? (3) What differences in bone microarchitecture are present between patients treated for high-grade osteosarcoma and individuals who have never had osteosarcoma? METHODS We contacted 48 patients who were treated for osteosarcoma and who participated in an earlier study. These patients underwent multimodal treatment including chemotherapy more than 20 years ago. Of the original patient group, 60% (29 of 48) were missing, leaving 40% (19 of 48) available for inclusion in this study; all 19 agreed to participate. There were nine men and 10 women with a mean age of 46 ± 4 years and a mean time from surgery to examination of 28 ± 3 years. BMD was measured by dual-energy x-ray absorptiometry, and any fracture history was assessed using a questionnaire. Additionally, high-resolution peripheral quantitative CT was performed to compare the groups in terms of microarchitectural changes, such as cortical and trabecular area, cortical and trabecular thickness, cortical porosity, and endocortical perimeter. Participants in the control group were selected from a cohort consisting of a population-based random sample of 499 healthy adult women and men. Osteoporosis or low BMD was not an exclusion criterion for entering this study; however, the patients in the control group were selected based on a normal BMD (that is, T score > -1.0 at both the spine and hip). Also, the participants were matched based on age and sex. Differences between patients and controls were assessed using the Wilcoxon rank sum test for continuous variables and a chi-square test for categorical variables. A multiple regression analysis was performed. Model assumptions were checked using histograms and quantile-quantile plots of residuals. RESULTS Twelve of 19 patients who were treated for osteosarcoma had either osteopenia (eight patients) or osteoporosis (four patients). More patients with osteosarcoma reported sustaining fractures (11 of 19 patients) than did control patients (2 of 19 controls; p < 0.001). Among all microarchitectural parameters, only the endocortical perimeter was increased in patients compared with the control group (75 ± 15 mm versus 62 ± 18 mm; p = 0.04); we found no differences between the groups in terms of cortical and trabecular area, cortical and trabecular thickness, or cortical porosity. CONCLUSION Although patients who were treated for osteosarcoma had osteopenic or osteoporotic BMD and a higher proportion of patients experienced fractures than did patients in the control group, we could not confirm differences in microarchitectural parameters using high-resolution peripheral quantitative CT. Therefore, it seems that bone geometry and microstructural parameters are not likely the cause of the increased proportion of fractures observed in our patients who were treated for osteosarcoma. Until we learn more about the bone changes associated with chemotherapy in patients with osteosarcoma, we recommend that patients undergo regular BMD testing, and we recommend that physicians consider osteoporosis treatment in patients with low BMD. These data might provide the impetus for future multicenter prospective studies examining the association between chemotherapy and bone microarchitecture. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Gerold Holzer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Gerhard Hobusch
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stinus Hansen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lukas Fischer
- Software Competence Center Hagenberg, Hagenberg, Austria
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Janina M. Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Luo Y. On challenges in clinical assessment of hip fracture risk using image-based biomechanical modelling: a critical review. J Bone Miner Metab 2021; 39:523-533. [PMID: 33423096 DOI: 10.1007/s00774-020-01198-8] [Citation(s) in RCA: 1] [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: 08/13/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Hip fracture is a common health risk among elderly people, due to the prevalence of osteoporosis and accidental fall in the population. Accurate assessment of fracture risk is a crucial step for clinicians to consider patient-by-patient optimal treatments for effective prevention of fractures. Image-based biomechanical modeling has shown promising progress in assessment of fracture risk, and there is still a great possibility for improvement. The purpose of this paper is to identify key issues that need be addressed to improve image-based biomechanical modeling. MATERIALS AND METHODS We critically examined issues in consideration and determination of the four biomechanical variables, i.e., risk of fall, fall-induced impact force, bone geometry and bone material quality, which are essential for prediction of hip fracture risk. We closely inspected: limitations introduced by assumptions that are adopted in existing models; deficiencies in methods for construction of biomechanical models, especially for determination of bone material properties from bone images; problems caused by separate use of the variables in clinical study of hip fracture risk; availability of clinical information that are required for validation of biomechanical models. RESULTS AND CONCLUSIONS A number of critical issues and gaps were identified. Strategies for effectively addressing the issues were discussed.
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Affiliation(s)
- Yunhua Luo
- Department of Mechanical Engineering, University of Manitoba, 75A Chancellor's Circle, Winnipeg, MB, R3T 2N2, Canada.
- Department of Biomedical Engineering, University of Manitoba, 75A Chancellor's Circle, Winnipeg, MB, R3T 2N2, Canada.
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Mehany SN, Patsch JM. Imaging of pediatric bone and growth disorders: Of diagnostic workhorses and new horizons. Wien Med Wochenschr 2021; 171:102-110. [PMID: 33570693 PMCID: PMC8016808 DOI: 10.1007/s10354-021-00815-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022]
Abstract
Children and adolescents with bone and growth disorders require interdisciplinary care from various specialists including pediatric radiologists with a focus on musculoskeletal disorders. This article covers routine topics, differential diagnoses, and selected research imaging in children with osteogenesis imperfecta (OI), X‑linked hypophosphatemic rickets (XLH), achondroplasia, and other bone and growth disorders from the standpoint of a tertiary referral center.
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Affiliation(s)
- Sarah N Mehany
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Vienna Bone and Growth Center, Vienna General Hospital and Medical University of Vienna, Vienna, Austria
| | - Janina M Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- Vienna Bone and Growth Center, Vienna General Hospital and Medical University of Vienna, Vienna, Austria.
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High Cortico-Trabecular Transitional Zone Porosity and Reduced Trabecular Density in Men and Women with Stress Fractures. J Clin Med 2021; 10:jcm10051123. [PMID: 33800284 PMCID: PMC7962637 DOI: 10.3390/jcm10051123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/23/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
To determine whether stress fractures are associated with bone microstructural deterioration we quantified distal radial and the unfractured distal tibia using high resolution peripheral quantitative computed tomography in 26 cases with lower limb stress fractures (15 males, 11 females; mean age 37.1 ± 3.1 years) and 62 age-matched healthy controls (24 males, 38 females; mean age 35.0 ± 1.6 years). Relative to controls, in men, at the distal radius, cases had smaller cortical cross sectional area (CSA) (p = 0.012), higher porosity of the outer transitional zone (OTZ) (p = 0.006), inner transitional zone (ITZ) (p = 0.043) and the compact-appearing cortex (CC) (p = 0.023) while trabecular vBMD was lower (p = 0.002). At the distal tibia, cases also had a smaller cortical CSA (p = 0.008). Cortical porosity was not higher, but trabecular vBMD was lower (p = 0.001). Relative to controls, in women, cases had higher distal radial porosity of the OTZ (p = 0.028), ITZ (p = 0.030) not CC (p = 0.054). Trabecular vBMD was lower (p = 0.041). Distal tibial porosity was higher in the OTZ (p = 0.035), ITZ (p = 0.009), not CC. Stress fractures are associated with compromised cortical and trabecular microstructure.
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Papageorgiou M, Föger-Samwald U, Wahl K, Kerschan-Schindl K, Pietschmann P. Age- and Strain-Related Differences in Bone Microstructure and Body Composition During Development in Inbred Male Mouse Strains. Calcif Tissue Int 2020; 106:431-443. [PMID: 31901965 DOI: 10.1007/s00223-019-00652-8] [Citation(s) in RCA: 8] [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: 09/25/2019] [Accepted: 12/21/2019] [Indexed: 01/31/2023]
Abstract
We explored age- and strain-related differences in bone microstructure and body composition in male C57BL/6J, DBA/2JRj and C3H/J mice. Bone microstructure of the femur, tibia and L4 was assessed by μCT at the age of 8, 16 and 24 weeks. The weight of several muscles and fat depots were measured at the same time points. At all timepoints, C3H/J mice had the thickest cortices followed by DBA/2JRj and C57BL/6J mice. Nevertheless, C57BL/6J mice had higher Tb.BV/TV and Tb.N, and lower Tb.Sp than DBA/2JRj and C3H/J mice at least at 24 weeks of age. Skeletal development patterns differed among strains. C57BL/6J and DBA/2JRj mice, but not C3H/J mice, experienced significant increases in the sum of the masses of 6 individual muscles by 24 weeks of age. In C57BL/6J and DBA/2JRj mice, the mass of selected fat depots reached highest values at 24 weeks, whist, in C3H/J mice, the highest values of fat depots masses were achieved at 16 weeks. Early strain differences in muscle and fat masses were largely diminished by 24 weeks of age. C3H/J and C57BL/6J mice displayed the most favorable cortical and trabecular bone parameters, respectively. Strain differences in body composition were less overt than strain specificity in bone microstructure, however, they possibly influenced aspects of skeletal development.
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Affiliation(s)
- Maria Papageorgiou
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Bone Diseases, Department of Internal Medicine Specialties, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
| | - Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Katharina Wahl
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Parveen B, Parveen A, Vohora D. Biomarkers of Osteoporosis: An Update. Endocr Metab Immune Disord Drug Targets 2019; 19:895-912. [DOI: 10.2174/1871530319666190204165207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/16/2018] [Accepted: 01/19/2019] [Indexed: 02/06/2023]
Abstract
Background:
Osteoporosis, characterized by compromised bone quality and strength is
associated with bone fragility and fracture risk. Biomarkers are crucial for the diagnosis or prognosis
of a disease as well as elucidating the mechanism of drug action and improve decision making.
Objective:
An exhaustive description of traditional markers including bone mineral density, vitamin D,
alkaline phosphatase, along with potential markers such as microarchitectural determination, trabecular
bone score, osteocalcin, etc. is provided in the current piece of work. This review provides insight into
novel pathways such as the Wnt signaling pathway, neuro-osseous control, adipogenic hormonal imbalance,
gut-bone axis, genetic markers and the role of inflammation that has been recently implicated
in osteoporosis.
Methods:
We extensively reviewed articles from the following databases: PubMed, Medline and Science
direct. The primary search was conducted using a combination of the following keywords: osteoporosis,
bone, biomarkers, bone turnover markers, diagnosis, density, architecture, genetics, inflammation.
Conclusion:
Early diagnosis and intervention delay the development of disease and improve treatment
outcome. Therefore, probing for novel biomarkers that are able to recognize people at high risk for
developing osteoporosis is an effective way to improve the quality of life of patients and to understand
the pathomechanism of the disease in a better way.
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Affiliation(s)
- Bushra Parveen
- Department of Pharmacology, Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New-Delhi-10062, India
| | - Abida Parveen
- Department of Clinical Research, School of Interdisciplinary Sciences, Jamia Hamdard, New-Delhi-10062, India
| | - Divya Vohora
- Department of Pharmacology, Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Jamia Hamdard, New-Delhi-10062, India
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12
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Nebot E, Heimel P, Tangl S, Dockner M, Patsch J, Weber GW, Pretterklieber M, Teschler-Nicola M, Pietschmann P. Paget's Disease of Long Bones: Microstructural Analyses of Historical Bone Samples. Calcif Tissue Int 2019; 105:15-25. [PMID: 30850857 DOI: 10.1007/s00223-019-00539-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
Abstract
Although Paget's disease of bone (PDB) is the second most common metabolic bone disease, there is only limited information about the microarchitecture of affected bones. Therefore, the aim of this study was to determine cortical and trabecular bone properties in clinically relevant locations by microcomputed tomography (µCT). Ten femora and ten tibiae affected by Paget's disease taken from the Natural History Museum Vienna were compared to 13 femora and 10 tibiae of non-affected body donors. Digitization of the cortical and trabecular bone microarchitecture was performed with an X-ray-based µCT scanner. Additionally, semi-quantitative gradings of trabecular and cortical architectural parameters of the femora and the tibiae were generated. Microcomputed tomography images showed changes in the thickness of cortices, cortical porosity, and trabecularization of cortical structures. Moreover, severe disorganization of trabecular structures, trabecular defects, and thickening of (remaining) trabeculae were detected. Numerical cortical analyses showed lower total bone volume (BV) and lower BV in the outer region (66-100%) (- 36%, p = 0.004, and - 50%, p < 0.001, respectively), lower total volume (TV) in the outer region (66-100%) (- 42%, p < 0.001), lower total bone volume fraction (BV/TV) and BV/TV in the outer region (66-100%) (- 23%, and - 12%, p < 0.001, respectively), higher BV and TV in the middle region (33-66%) and higher BV/TV in the inner region (0-33%) (123%, p = 0.011, 147%, p = 0.010, and 33%, p = 0.025, respectively) in Pagetic compared to non-affected bones. Trabecular analyses showed higher BV/TV (96%, p = 0.008) and Tb.Th (43%, p = 0.004) in Pagetic compared to non-affected bones. There is a major and consistent structural alteration of PDB at cortical and trabecular sites in weight-bearing long bones. Our findings are relevant for the differential diagnosis of PDB and for the pathogenesis of associated complications, since the disorder produces abnormalities in the structure that might lead to bone fragility.
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Affiliation(s)
- Elena Nebot
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090, Vienna, Austria
- Department of Physiology, School of Pharmacy, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
- Department of Preventive Medicine and Public Health, School of Pharmacy, University of Granada, Granada, Spain
| | - Patrick Heimel
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology - Austrian Cluster for Tissue Regeneration, AUVA Research Center, Vienna, Austria
| | - Stefan Tangl
- Karl Donath Laboratory for Hard Tissue and Biomaterial Research, Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Martin Dockner
- Department of Anthropology, and Core Facility for Micro-Computed Tomography, University of Vienna, Vienna, Austria
| | - Janina Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Gerhard W Weber
- Department of Anthropology, and Core Facility for Micro-Computed Tomography, University of Vienna, Vienna, Austria
| | - Michael Pretterklieber
- Division of Anatomy, Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Maria Teschler-Nicola
- Pathological-Anatomical Collection in the Fool's Tower, Department of Anthropology, Natural History Museum Vienna, Vienna, Austria
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, 1090, Vienna, Austria.
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13
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Ramme AJ, Vira S, Hotca A, Miller R, Welbeck A, Honig S, Egol KA, Rajapakse CS, Chang G. A Novel MRI Tool for Evaluating Cortical Bone Thickness of the Proximal Femur. BULLETIN OF THE HOSPITAL FOR JOINT DISEASE (2013) 2019; 77:115-121. [PMID: 31128580 PMCID: PMC7336874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Osteoporotic hip fractures heavily cost the health care system. Clinicians and patients can benefit from improved tools to assess bone health. Herein, we aim to develop a three-dimensional magnetic resonance imaging (MRI) method to assess cortical bone thickness and assess the ability of the method to detect regional changes in the proximal femur. METHODS Eighty-nine patients underwent hip magnetic resonance imaging. FireVoxel and 3DSlicer were used to generate three-dimensional proximal femur models. ParaView was used to define five regions: head, neck, greater trochanter, intertrochanteric region, and subtrochanteric region. Custom software was used to calculate the cortical bone thickness and generate a color map of the proximal femur. Mean cortical thickness values for each region were calculated. Statistical t-tests were performed to evaluate differences in cortical thickness based on proximal femur region. Measurement reliability was evaluated using coefficient of variation, intraclass correlation coefficients, and overlap metrics. RESULTS Three-dimensional regional cortical thickness maps for all subjects were generated. The subtrochanteric region was found to have the thickest cortical bone and the femoral head had the thinnest cortical bone. There were statistically significant differences between regions (p < 0.01) for all possible comparisons. CONCLUSIONS Cortical bone is an important contributor to bone strength, and its thinning results in increased hip fracture risk. We describe the development and measurement reproducibility of an MRI tool permitting assessment of proximal femur cortical thickness. This study represents an important step toward longitudinal clinical trials interested in monitoring the effectiveness of drug therapy on proximal femur cortical thickness.
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14
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Alvarenga JC, Boyd SK, Pereira RMR. The relationship between estimated bone strength by finite element analysis at the peripheral skeleton to areal BMD and trabecular bone score at lumbar spine. Bone 2018; 117:47-53. [PMID: 30219479 DOI: 10.1016/j.bone.2018.09.009] [Citation(s) in RCA: 5] [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: 02/28/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 01/16/2023]
Abstract
Bone strength, estimated by finite element (FE) analysis based on high resolution peripheral quantitative computed tomography (HR-pQCT) images is an important contributor to understanding risk of fracture. However, it is a peripheral device and cannot be evaluated in vivo at lumbar spine L1-L4. The aim of this study was to investigate if the axial bone quality can be predicted by strength measurements of peripheral bone. Peripheral bone microarchitecture, areal bone mineral density (aBMD) and trabecular bone score (TBS) were measured in adults individuals (n = 262, 60 years and older; 63% women). Stiffness and failure load were estimated by FE analysis at HR-pQCT images at radius and tibia. Areal BMD and TBS were measured by dual energy X-ray absorptiometry (DXA) at L1-L4. Correlations between peripheral and axial data were estimated for each gender adjusted by age, weight, and height. Areal BMD L1-L4 resulted in weak to moderate significant correlations with stiffness and failure load at radius (women: R2 = 0.178, p < 0.05 and R2 = 0.187, p < 0.001, respectively; men: R2 = 0.454 and R2 = 0.451, p < 0.001, respectively) and at tibia (women: R2 = 0.211 and R2 = 0.216, p < 0.001, respectively; men: R2 = 0.488 and R2 = 0.502, p < 0.001, respectively). TBS showed a very weak or no correlation with stiffness and failure load at radius (women: R2 = 0.148 and R2 = 0.150, p < 0.05, respectively; men: R2 = 0.108 and R2 = 0.106, p < 0.05, respectively) and at tibia (women: R2 = 0.146 and R2 = 0.150, p < 0.05, respectively; men: R2 = 0.072 and R2 = 0.078, respectively). These data suggest that aBMD L1-L4 was better explained by peripheral bone strength characteristics than the TBS, mainly in men and tibia is generally the site with a better relationship.
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Affiliation(s)
- Jackeline C Alvarenga
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade Medicina FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Rosa M R Pereira
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade Medicina FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil.
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15
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Bergwitz C, Miyamoto KI. Hereditary hypophosphatemic rickets with hypercalciuria: pathophysiology, clinical presentation, diagnosis and therapy. Pflugers Arch 2018; 471:149-163. [PMID: 30109410 DOI: 10.1007/s00424-018-2184-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/06/2018] [Accepted: 07/10/2018] [Indexed: 12/24/2022]
Abstract
Hereditary hypophosphatemic rickets with hypercalciuria (HHRH; OMIM: 241530) is a rare autosomal recessive disorder with an estimated prevalence of 1:250,000 that was originally described by Tieder et al. Individuals with HHRH carry compound-heterozygous or homozygous (comp/hom) loss-of-function mutations in the sodium-phosphate co-transporter NPT2c. These mutations result in the development of urinary phosphate (Pi) wasting and hypophosphatemic rickets, bowing, and short stature, as well as appropriately elevated 1,25(OH)2D levels, which sets this fibroblast growth factor 23 (FGF23)-independent disorder apart from the more common X-linked hypophosphatemia. The elevated 1,25(OH)2D levels in turn result in hypercalciuria due to enhanced intestinal calcium absorption and reduced parathyroid hormone (PTH)-dependent calcium-reabsorption in the distal renal tubules, leading to the development of kidney stones and/or nephrocalcinosis in approximately half of the individuals with HHRH. Even heterozygous NPT2c mutations are frequently associated with isolated hypercalciuria (IH), which increases the risk of kidney stones or nephrocalcinosis threefold in affected individuals compared with the general population. Bone disease is generally absent in individuals with IH, in contrast to those with HHRH. Treatment of HHRH and IH consists of monotherapy with oral Pi supplements, while active vitamin D analogs are contraindicated, mainly because the endogenous 1,25(OH)2D levels are already elevated but also to prevent further worsening of the hypercalciuria. Long-term studies to determine whether oral Pi supplementation alone is sufficient to prevent renal calcifications and bone loss, however, are lacking. It is also unknown how therapy should be monitored, whether secondary hyperparathyroidism can develop, and whether Pi requirements decrease with age, as observed in some FGF23-dependent hypophosphatemic disorders, or whether this can lead to osteoporosis.
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Affiliation(s)
- Clemens Bergwitz
- Section Endocrinology and Metabolism, Yale University School of Medicine, Anlyan Center, Office S117, Lab S110, 1 Gilbert Street, New Haven, CT 06519, USA.
| | - Ken-Ichi Miyamoto
- Department of Molecular Nutrition, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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16
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Ensrud KE, Vo TN, Burghardt AJ, Schousboe JT, Cauley JA, Taylor BC, Hoffman AR, Orwoll ES, Lane NE, Langsetmo L. Weight loss in men in late life and bone strength and microarchitecture: a prospective study. Osteoporos Int 2018; 29:1549-1558. [PMID: 29572622 PMCID: PMC6035779 DOI: 10.1007/s00198-018-4489-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/12/2018] [Indexed: 01/22/2023]
Abstract
UNLABELLED Weight loss in men in late life was associated with lower bone strength. In contrast, weight gain was not associated with a commensurate increase in bone strength. Future studies should measure concurrent changes in weight and parameters of bone strength and microarchitecture and evaluate potential causal pathways underlying these associations. INTRODUCTION Our aim was to determine associations of weight loss with bone strength and microarchitecture. METHODS We used data from 1723 community-dwelling men (mean age 84.5 years) who attended the MrOS study Year (Y) 14 exam and had high-resolution peripheral quantitative computed tomography (HR-pQCT) scans at ≥ 1 skeletal sites (distal tibia, distal radius, or diaphyseal tibia). Weight change from Y7 to Y14 exams (mean 7.3 years between exams) was classified as moderate weight loss (loss ≥ 10%), mild weight loss (loss 5 to < 10%), stable weight (< 5% change), or weight gain (gain ≥ 5%). Mean HR-pQCT parameters (95%CI) were calculated by weight change category using linear regression models adjusted for age, race, site, health status, body mass index, limb length, and physical activity. The primary outcome measure was estimated failure load. RESULTS There was a nonlinear association of weight change with failure load at each skeletal site with different associations for weight loss vs. weight gain (p < 0.03). Failure load and total bone mineral density (BMD) at distal sites were lower with greater weight loss with 7.0-7.6% lower failure loads and 4.3-5.8% lower BMDs among men with moderate weight loss compared to those with stable weight (p < 0.01, both comparisons). Cortical, but not trabecular, BMDs at distal sites were lower with greater weight loss. Greater weight loss was associated with lower cortical thickness at all three skeletal sites. CONCLUSION Weight loss in men in late life is associated with lower peripheral bone strength and total BMD with global measures reflecting cortical but not trabecular parameters.
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Affiliation(s)
- K E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
- Center for Chronic Disease Outcomes Research, VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA.
| | - T N Vo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - A J Burghardt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J T Schousboe
- HealthPartners Institute, Bloomington, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - B C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, One Veterans Drive (111-0), Minneapolis, MN, 55417, USA
| | - A R Hoffman
- Department of Medicine, Stanford University, Stanford, CA, USA
| | - E S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - L Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
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17
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Jovanovic M, Schmidt FN, Guterman-Ram G, Khayyeri H, Hiram-Bab S, Orenbuch A, Katchkovsky S, Aflalo A, Isaksson H, Busse B, Jähn K, Levaot N. Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice. FASEB J 2018; 32:2507-2518. [PMID: 29295862 DOI: 10.1096/fj.201700661rr] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Changes in bone matrix composition are frequently found with bone diseases and may be associated with increased fracture risk. Bone is rich in the trace element zinc. Zinc was established to play a significant role in the growth, development, and maintenance of healthy bones; however, the mechanisms underlying zinc effects on the integrity of the skeleton are poorly understood. Here, we show that the zinc receptor (ZnR)/Gpr39 is required for normal bone matrix deposition by osteoblasts. Initial analysis showed that Gpr39-deficient ( Gpr39-/-) mice had weaker bones as a result of altered bone composition. Fourier transform infrared spectroscopy analysis showed high mineral-to-matrix ratios in the bones of Gpr39-/- mice. Histologic analysis showed abnormally high numbers of active osteoblasts but normal osteoclast numbers on the surfaces of bones from Gpr39-/- mice. Furthermore, Gpr39-/- osteoblasts had disorganized matrix deposition in vitro with cultures exhibiting abnormally low collagen and high mineral contents, findings that demonstrate a cell-intrinsic role for ZnR/Gpr39 in these cells. We show that both collagen synthesis and deposition by Gpr39-/- osteoblasts are perturbed. Finally, the expression of the zinc transporter Zip13 and a disintegrin and metalloproteinase with thrombospondin motifs family of zinc-dependent metalloproteases that regulate collagen processing was downregulated in Gpr39-/- osteoblasts. Altogether, our results suggest that zinc sensing by ZnR/Gpr39 affects the expression levels of zinc-dependent enzymes in osteoblasts and regulates collagen processing and deposition.-Jovanovic, M., Schmidt, F. N., Guterman-Ram, G., Khayyeri, H., Hiram-Bab, S., Orenbuch, A., Katchkovsky, S., Aflalo, A., Isaksson, H., Busse, B., Jähn, K., Levaot, N. Perturbed bone composition and integrity with disorganized osteoblast function in zinc receptor/Gpr39-deficient mice.
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Affiliation(s)
- Milena Jovanovic
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gali Guterman-Ram
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hanifeh Khayyeri
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Sahar Hiram-Bab
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Ayelet Orenbuch
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Svetlana Katchkovsky
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anastasia Aflalo
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hanna Isaksson
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Jähn
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Noam Levaot
- Department of Physiology and Cell Biology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Regenerative Medicine and Stem Cell Research Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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18
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Rajapakse CS, Padalkar MV, Yang HJ, Ispiryan M, Pleshko N. Non-destructive NIR spectral imaging assessment of bone water: Comparison to MRI measurements. Bone 2017; 103:116-124. [PMID: 28666972 PMCID: PMC5572678 DOI: 10.1016/j.bone.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/07/2017] [Accepted: 06/21/2017] [Indexed: 01/22/2023]
Abstract
Bone fracture risk increases with age, disease states, and with use of certain therapeutics, such as acid-suppressive drugs, steroids and high-dose bisphosphonates. Historically, investigations into factors that underlie bone fracture risk have focused on evaluation of bone mineral density (BMD). However, numerous studies have pointed to factors other than BMD that contribute to fragility, including changes in bone collagen and water. The goal of this study is to investigate the feasibility of using near infrared spectral imaging (NIRSI) to determine the spatial distribution and relative amount of water and organic components in whole cross-sections of bone, and to compare those results to those obtained using magnetic resonance imaging (MRI) methods. Cadaver human whole-section tibiae samples harvested from 18 donors of ages 27-97years underwent NIRSI and ultrashort echo time (UTE) MRI. As NIRSI data is comprised of broad absorbances, second derivative processing was evaluated as a means to narrow peaks and obtain compositional information. The (inverted) second derivative peak heights of the NIRSI absorbances correlated significantly with the mean peak integration of the water, collagen and fat NIR absorbances, respectively, indicating that either processing method could be used for compositional assessment. The 5797cm-1 absorbance was validated as arising from the fat present in bone marrow, as it completely disappeared after ultrasonication. The MRI UTE-determined bound water content in tibial cortical bone samples ranged from 62 to 91%. The NIRSI water peaks at 5152cm-1 and at 7008cm-1 correlated significantly with the UTE data, with r=0.735, p=0.016, and r=0.71, p=0.0096, respectively. There was also a strong correlation between the intensity of the NIRSI water peak at 7008cm-1 and the intensity of the collagen peak at 4608cm-1 (r=0.69, p=0.004). Since NIRSI requires minimal to no sample preparation, this approach has great potential to become a gold standard modality for the investigation of changes in water content, distribution, and environment in pre-clinical studies of bone pathology and therapeutics.
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Affiliation(s)
- Chamith S Rajapakse
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Mugdha V Padalkar
- Department of Bioengineering, Temple University, 1947 N. 12th St, Philadelphia, PA, USA
| | - Hee Jin Yang
- Department of Bioengineering, Temple University, 1947 N. 12th St, Philadelphia, PA, USA
| | - Mikayel Ispiryan
- Departments of Radiology and Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Nancy Pleshko
- Department of Bioengineering, Temple University, 1947 N. 12th St, Philadelphia, PA, USA.
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19
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Kroker A, Zhu Y, Manske SL, Barber R, Mohtadi N, Boyd SK. Quantitative in vivo assessment of bone microarchitecture in the human knee using HR-pQCT. Bone 2017; 97:43-48. [PMID: 28039095 DOI: 10.1016/j.bone.2016.12.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/10/2016] [Accepted: 12/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) is a novel imaging modality capable of visualizing bone microarchitecture in vivo at human peripheral sites such as the distal radius and distal tibia. This research has extended the technology to provide a non-invasive assessment of bone microarchitecture at the human knee by establishing new hardware, imaging protocols and data analysis. DESIGN A custom leg holder was developed to stabilize a human knee centrally within a second generation HR-pQCT field of view. Five participants with anterior cruciate ligament reconstructions had their knee joint imaged in a continuous scan of 6cm axially. The nominal isotropic voxel size was 60.7μm. Bone mineral density and microarchitecture were assessed within the weight-bearing regions of medial and lateral compartments of the knee at three depths from the weight-bearing articular bone surface, including both the cortical and trabecular bone regions. RESULTS Scan duration was approximately 18min per knee and produced 5GB of projection data and 10GB of reconstructed image data (2304×2304 image matrix, 1008 slices). Motion during the scan was minimized by the leg holder and was similar in magnitude as a scan of the distal tibia. Bone mineral density and microarchitectural parameters were assessed for 16 volumes of interest in the tibiofemoral joint. CONCLUSIONS This is a new non-invasive in vivo assessment tool for bone microarchitecture in the human knee that provides an opportunity to gain insight into normal, injured and surgically reconstructed human knee bone architecture in cross-sectional or longitudinal studies.
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Affiliation(s)
- Andres Kroker
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Ying Zhu
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Sarah L Manske
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Rhamona Barber
- University of Calgary Sport Medicine Centre, University of Calgary, Canada.
| | - Nicholas Mohtadi
- University of Calgary Sport Medicine Centre, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
| | - Steven K Boyd
- Department of Radiology, Cumming School of Medicine, University of Calgary, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Canada.
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20
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Alvarenga JC, Fuller H, Pasoto SG, Pereira RMR. Age-related reference curves of volumetric bone density, structure, and biomechanical parameters adjusted for weight and height in a population of healthy women: an HR-pQCT study. Osteoporos Int 2017; 28:1335-1346. [PMID: 27981337 DOI: 10.1007/s00198-016-3876-0] [Citation(s) in RCA: 21] [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: 01/14/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED In a cross-sectional cohort of 450 healthy women aged 20 to 85 years, data on the density, structure, and strength of the distal radius and tibia were obtained using high-resolution peripheral quantitative computed tomography (HR-pQCT) and were adjusted for age, weight, and height. Age-dependent patterns of change differed between the sites and between the trabecular and cortical compartments. In postmenopausal women, the trabecular bone remained relatively stable at the distal tibia, but the cortical compartment changed significantly. Cortical porosity exhibited a very weak correlation with stiffness. INTRODUCTION The aim of this study is to provide information on age-related, weight-related, and height-related changes in the volumetric bone mineral density (vBMD), structure, and biomechanical parameters of the cortical and trabecular compartments in a healthy female population using HR-pQCT. METHODS For a cross-sectional Brazilian cohort of 450 women aged 20 to 85 years, age-related reference curves of the vBMD, structure, and biomechanical parameters of the distal radius (DR) and distal tibia (DT) were constructed and adjusted for weight and height, and comparisons between premenopausal and postmenopausal women were performed. RESULTS Reference curves were obtained for all parameters. At the DR, age-related changes varied from -8.68% (cortical thickness [Ct.Th]) to 26.7% (trabecular separation [Tb.Sp]). At the DT, the changes varied from -12.4% (Ct.Th) to 26.3% (Tb.Sp). Cortical porosity (Ct.Po) exhibited the largest percent changes: 342.2% at the DR and 381.5% at the DT. In premenopausal women, Ct.Th remained constant; in postmenopausal women, structural trabecular parameters (trabecular number (Tb.N), trabecular thickness (Tb.Th), Tb.Sp) did not change, whereas cortical parameters and stiffness were significantly altered. Cortical vBMD showed the greatest absolute decrease at both sites, and the slopes were highly negative after menopause. Pearson correlations between stiffness (S) and HR-pCT parameters revealed a significant correlation between the densities and structures of the trabecular and cortical compartments. A weak correlation was observed between S and Ct.Po (DR r = -0.162, DT r = -0.273; p < 0.05). CONCLUSIONS These data provide reference curves from healthy women and demonstrate that density and structural and biomechanical parameters differ between the radius and tibia and between the trabecular and cortical compartments. In postmenopausal women, the trabecular bone remained relatively stable at the tibia site, whereas the cortical compartment changed significantly.
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Affiliation(s)
- J C Alvarenga
- Rheumatology Division, Faculdade Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o andar, sala 3193, Sao Paulo, 01246-903, Brazil
| | - H Fuller
- Rheumatology Division, Faculdade Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o andar, sala 3193, Sao Paulo, 01246-903, Brazil
| | - S G Pasoto
- Rheumatology Division, Faculdade Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o andar, sala 3193, Sao Paulo, 01246-903, Brazil
| | - R M R Pereira
- Rheumatology Division, Faculdade Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3o andar, sala 3193, Sao Paulo, 01246-903, Brazil.
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Rafferty J, Farr L, James T, Chase D, Heinrich J, Brady M. A new magnetic resonance-based technique for high-resolution quantification of amorphous and quasi-amorphous structures. J R Soc Interface 2016; 13:rsif.2016.0589. [PMID: 27733695 DOI: 10.1098/rsif.2016.0589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/12/2016] [Indexed: 11/12/2022] Open
Abstract
We present a novel, high-resolution magnetic resonance technique, fine structure analysis (FSA) for the quantification and analysis of amorphous and quasi-amorphous biological structures. The one-dimensional technique is introduced mathematically and then applied to one simulated phantom, two physical phantoms and a set of ex vivo biological samples, scanned with interpoint spacings of 0.0038-0.195 mm and cross-sectional sizes of 3 × 3 or 5 × 5 mm. The simulated phantom and one of the physical phantoms consists of randomly arranged beads of known size in two and three dimensions, respectively. The second physical phantom was constructed by etching lines on Perspex. The ex vivo samples are human bone specimens. We show that for all three phantoms, the FSA technique is able to elucidate the average spacing of the structures present within each sample using structural spectroscopy, the smallest of which was 180 µm in size. We further show that in samples of trabecular bone, FSA is able to produce comparable results to micro-computed tomography, the current gold standard for measuring bone microstructure, but without the need for ionizing radiation. Many biological structures are too small to be captured by conventional, clinically deployed medical imaging techniques. FSA has the potential for use in the analysis of pathologies where such small-scale repeating structures are disrupted or their size, and spacing is otherwise altered.
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Affiliation(s)
- James Rafferty
- Acuitas Medical Ltd, 8 Technium 1, Kings Road, Swansea SA1 8PH, UK
| | - Lance Farr
- Acuitas Medical Ltd, 8 Technium 1, Kings Road, Swansea SA1 8PH, UK
| | - Tim James
- Cbrite Inc., 421 Pine Avenue, Goleta, CA 93117, USA
| | - David Chase
- Vareda Engineering Inc., 144 Santa Felicia Drive, Goleta, CA 93117, USA
| | - John Heinrich
- Acuitas Medical Ltd, 8 Technium 1, Kings Road, Swansea SA1 8PH, UK
| | - Michael Brady
- Department of Oncology, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
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Eller-Vainicher C, Bassotti A, Imeraj A, Cairoli E, Ulivieri FM, Cortini F, Dubini M, Marinelli B, Spada A, Chiodini I. Bone involvement in adult patients affected with Ehlers-Danlos syndrome. Osteoporos Int 2016; 27:2525-31. [PMID: 27084695 DOI: 10.1007/s00198-016-3562-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients. INTRODUCTION The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients. METHODS Fifty consecutive Caucasian patients, aged 30-50 years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects' calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed. RESULTS Patients showed reduced BMD (Z-scores LS -0.45 ± 1.00, FN -0.56 ± 1.01, FT -0.58 ± 0.92) and TBS (1.299 ± 0.111) and increased prevalence of morphometric VFx (32 %) than controls (Z-scores LS 0.09 ± 1.22, FN 0.01 ± 0.97, FT 0.08 ± 0.89; TBS 1.382 ± 0.176; VFx 8 %, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245 ± 0.138 vs 1.325 ± 0.086, p < 0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency. CONCLUSIONS EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.
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Affiliation(s)
- C Eller-Vainicher
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - A Bassotti
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Imeraj
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Cairoli
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - F M Ulivieri
- Nuclear medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - F Cortini
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - M Dubini
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - B Marinelli
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Spada
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - I Chiodini
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
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Machine learning based analytics of micro-MRI trabecular bone microarchitecture and texture in type 1 Gaucher disease. J Biomech 2016; 49:1961-1968. [DOI: 10.1016/j.jbiomech.2016.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/29/2016] [Accepted: 04/07/2016] [Indexed: 11/21/2022]
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Kemp JP, Medina-Gomez C, Tobias JH, Rivadeneira F, Evans DM. The case for genome-wide association studies of bone acquisition in paediatric and adolescent populations. BONEKEY REPORTS 2016; 5:796. [PMID: 27257477 DOI: 10.1038/bonekey.2016.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022]
Abstract
Peak bone mass, the maximum amount of bone accrued at the end of the growth period, is an important predictor of future risk of osteoporosis and fracture. Hence, the contribution of genetic factors influencing bone accrual is of considerable interest to the osteoporosis research community. In this article, we review evidence that genetic factors play an important role in bone growth, describe the genetic loci implicated so far and briefly discuss lessons learned from the application of genome-wide association studies. Moreover, we attempt to make the case for genetic investigations of bone mineral density in paediatric and young adult populations, describing their potential to increase our knowledge of the process of bone metabolism throughout the life course, and in turn, identify novel targets for the pharmacological treatment of osteoporosis.
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Affiliation(s)
- John P Kemp
- University of Queensland Diamantina Institute, Level 5 Translational Research Institute, Brisbane, Queensland, Australia; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Joint first authors
| | - Carolina Medina-Gomez
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Joint first authors
| | - Jonathan H Tobias
- School of Clinical Sciences, University of Bristol, Bristol, UK; Joint senior authors
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; The Generation R Study Group, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Joint senior authors
| | - David M Evans
- University of Queensland Diamantina Institute, Level 5 Translational Research Institute, Brisbane, Queensland, Australia; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Joint senior authors
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Assessment of bone turnover and bone quality in type 2 diabetic bone disease: current concepts and future directions. Bone Res 2016; 4:16001. [PMID: 27019762 PMCID: PMC4802604 DOI: 10.1038/boneres.2016.1] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/21/2015] [Indexed: 12/25/2022] Open
Abstract
Substantial evidence exists that in addition to the well-known complications of diabetes, increased fracture risk is an important morbidity. This risk is probably due to altered bone properties in diabetes. Circulating biochemical markers of bone turnover have been found to be decreased in type 2 diabetes (T2D) and may be predictive of fractures independently of bone mineral density (BMD). Serum sclerostin levels have been found to be increased in T2D and appear to be predictive of fracture risk independent of BMD. Bone imaging technologies, including trabecular bone score (TBS) and quantitative CT testing have revealed differences in diabetic bone as compared to non-diabetic individuals. Specifically, high resolution peripheral quantitative CT (HRpQCT) imaging has demonstrated increased cortical porosity in diabetic postmenopausal women. Other factors such as bone marrow fat saturation and advanced glycation endproduct (AGE) accumulation might also relate to bone cell function and fracture risk in diabetes. These data have increased our understanding of how T2D adversely impacts both bone metabolism and fracture risk.
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Fratzl-Zelman N, Misof BM, Klaushofer K, Roschger P. Bone mass and mineralization in osteogenesis imperfecta. Wien Med Wochenschr 2015. [PMID: 26208477 DOI: 10.1007/s10354-015-0369-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The main clinical features of osteogenesis imperfecta (OI) are low bone mass and high bone fragility. While the decrease in bone mass is generally regarded as an indicator of disease severity, bone fragility appears as the hallmark of the disorder. Bone has a multiscale hierarchical structural organization and is optimized to resist to fractures. In OI, modifications at the molecular level affect the total mechanical integrity of the bone. A specific characteristic in OI is that the bone matrix is abnormally high mineralized independently of the underlying mutation or clinical severity. The increased matrix mineralization affects bone material quality, leading to increased stiffness and brittleness and making bone prone to fractures. The purpose of this review is to give further insights on bone matrix mineralization in OI and to discuss advantages and pitfalls of invasive and noninvasive imaging techniques.
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Affiliation(s)
- Nadja Fratzl-Zelman
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling 1st Med. Dept. Hanusch Hospital, Heinrich Collin Str. 30, 1140, Vienna, Austria,
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Evans BAJ, James TW, James K, Cox A, Farr L, Paisey SJ, Dempster DW, Stone MD, Griffiths PA, Hugtenburg RP, Brady SM, Wells T. Preclinical assessment of a new magnetic resonance-based technique for determining bone quality by characterization of trabecular microarchitecture. Calcif Tissue Int 2014; 95:506-20. [PMID: 25380571 DOI: 10.1007/s00223-014-9922-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
The utility of HR-CT to study longitudinal changes in bone microarchitecture is limited by subject radiation exposure. Although MR is not subject to this limitation, it is limited both by patient movement that occurs during prolonged scanning at distal sites, and by the signal-to-noise ratio that is achievable for high-resolution images in a reasonable scan time at proximal sites. Recently, a novel MR-based technique, fine structure analysis (FSA) (Chase et al. Localised one-dimensional magnetic resonance spatial frequency spectroscopy. PCT/US2012/068284 2012, James and Chase Magnetic field gradient structure characteristic assessment using one-dimensional (1D) spatial frequency distribution analysis. 7932720 B2, 2011) has been developed which provides both high-resolution and fast scan times, but which generates at a designated set of spatial positions (voxels) a one-dimensional signal of spatial frequencies. Appendix 1 provides a brief introduction to FSA. This article describes an initial exploration of FSA for the rapid, non-invasive characterization of trabecular microarchitecture in a preclinical setting. For L4 vertebrae of sham and ovariectomized (OVX) rats, we compared FSA-generated metrics with those from CT datasets and from CT-derived histomorphometry parameters, trabecular number (Tb.N), bone volume density (BV/TV), trabecular thickness (Tb.Th) and trabecular separation (Tb.Sp). OVX caused a reduction of the higher frequency structures that correspond to a denser trabecular lattice, while increasing the preponderance of lower frequency structures, which correspond to a more open lattice. As one example measure, the centroid of the FSA spectrum (which we refer to as fSAcB) showed strong correlation in the same region with CT-derived histomorphometry values: Tb.Sp: r -0.63, p < 0.001; Tb.N: r 0.71, p < 0.001; BV/TV: r 0.64, p < 0.001, Tb.Th: r 0.44, p < 0.05. Furthermore, we found a 17.5% reduction in fSAcB in OVX rats (p < 0.0001). In a longitudinal study, FSA showed that the age-related increase in higher frequency structures was abolished in OVX rats, being replaced with a 78-194% increase in lower frequency structures (2.4-2.8 objects/mm range), indicating a more sparse trabecular lattice (p < 0.05). The MR-based fine structure analysis enables high-resolution, radiation-free, rapid quantification of bone structures in one dimension (the specific point and direction being chosen by the clinician) of the spine.
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Affiliation(s)
- B A J Evans
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
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Chiba K, Burghardt AJ, Osaki M, Majumdar S. Three-dimensional analysis of subchondral cysts in hip osteoarthritis: an ex vivo HR-pQCT study. Bone 2014; 66:140-5. [PMID: 24925444 PMCID: PMC4125434 DOI: 10.1016/j.bone.2014.06.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/30/2014] [Accepted: 06/01/2014] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Subchondral cysts are deeply related to the pathogenesis of osteoarthritis (OA), but the factors contributing to cyst formation are not well known. A three-dimensional analysis of subchondral cysts at the micro-structural level was conducted using a high-resolution peripheral quantitative CT (HR-pQCT), and their relationships with cartilage attrition and subchondral bone microstructure were investigated. METHODS Femoral heads extracted from ten female patients with hip OA were scanned using an HR-pQCT at a voxel size of 41μm. The volume fractions, numbers, and sizes of the cysts were measured in the subchondral bone region under the area of cartilage loss. Furthermore, the areas of cartilage loss, as well as the microstructure of the subchondral bones, were also measured, and their correlations with the cysts were analyzed. RESULTS The volume fractions of cysts within subchondral bone regions varied from 2% to 33%, the numbers of cysts varied from 6 to 87, and the sizes varied from 1mm(3) to 657mm(3). There was a positive correlation between the number of cysts and bone volume (r>0.8, p<0.01). CONCLUSION The degree of cyst formation showed a wide distribution in number and volume, and there was a close relationship between multiple cyst formation and bone sclerosis, which might be caused by reactive bone formation that occurred around each cyst.
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Affiliation(s)
- Ko Chiba
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA; Department of Orthopedic Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
| | - Andrew J Burghardt
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Sharmila Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
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Dhainaut A, Daibes K, Odinsson A, Hoff M, Syversen U, Haugeberg G. Exploring the relationship between bone density and severity of distal radius fragility fracture in women. J Orthop Surg Res 2014; 9:57. [PMID: 25030810 PMCID: PMC4423629 DOI: 10.1186/s13018-014-0057-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022] Open
Abstract
Background Bone mineral density (BMD) has been shown to be a consistent and independent risk factor for distal radius fracture. Inconsistent data have been reported on the association between BMD and severity of distal radius fracture. Our primary aim was to explore if there is an association between cortical BMD at the hand and the severity of fragility distal radius fracture. Methods Consecutively recruited females aged ≥50 years with fragility fracture at the distal radius (n = 110) from a county hospital were included. Cortical hand BMD was assessed by the digital X-ray radiogrammetry (DXR) method. X-rays of the fracture were scored by experienced orthopedic surgeons for fracture severity according to the Müller AO classification of long bones and radiographic parameters such as ulnar variance and dorsal angle. Results A weak association between lower DXR BMD and increased ulnar variance and dorsal angle was found but not with the AO scoring system for fracture type. A history of glucocorticoid (GC) use but not DXR-BMD was found to be significantly associated with the presence of having an intra- or extra-articular fracture. Conclusion Our data indicate that bone material properties which are impaired by GC use are more important for fracture severity than BMD.
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Affiliation(s)
- Alvilde Dhainaut
- INM Norwegian University of Science and Technology, Trondheim, 7491, Norway. .,MTFS-Department of Neuroscience, Division of Rheumatology, University Hospital of Trondheim, Norwegian University of Science and Technology, Trondheim, 7489, Norway.
| | - Kamil Daibes
- Department of Orthopedic Surgery, Sørlandet Hospital, Kristiansand, S 4604, Norway.
| | - Adalsteinn Odinsson
- INM Norwegian University of Science and Technology, Trondheim, 7491, Norway. .,Department of Orthopaedic Surgery, St. Olav's Hospital, Trondheim, 7030, Norway.
| | - Mari Hoff
- INM Norwegian University of Science and Technology, Trondheim, 7491, Norway. .,Department of Rheumatology, St. Olav's Hospital, Trondheim, 7030, Norway.
| | - Unni Syversen
- Institute of Cancer Research and Molecular Medicine, NTNU, Trondheim, 7491, Norway. .,Department of Endocrinology, St. Olav's Hospital, Trondheim, 7030, Norway.
| | - Glenn Haugeberg
- INM Norwegian University of Science and Technology, Trondheim, 7491, Norway. .,Department of Rheumatology, Sørlandet Hospital, Kristiansand, S 4604, Norway.
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Patsch JM, Zulliger MA, Vilayphou N, Samelson EJ, Cejka D, Diarra D, Berzaczy G, Burghardt AJ, Link TM, Weber M, Loewe C. Quantification of lower leg arterial calcifications by high-resolution peripheral quantitative computed tomography. Bone 2014; 58:42-7. [PMID: 23954758 PMCID: PMC4042679 DOI: 10.1016/j.bone.2013.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/31/2013] [Accepted: 08/02/2013] [Indexed: 01/21/2023]
Abstract
Vascular calcifications and bone health seem to be etiologically linked via common risk factors such as aging and subclinical chronic inflammation. Epidemiologic studies have shown significant associations between low bone mineral density (BMD), fragility fractures and calcifications of the coronary arteries and the abdominal aorta. In the last decade, high-resolution peripheral quantitative computed tomography (HR-pQCT) has emerged as in-vivo research tool for the assessment of peripheral bone geometry, density, and microarchitecture. Although vascular calcifications are frequently observed as incidental findings in HR-pQCT scans, they have not yet been incorporated into quantitative HR-pQCT analyses. We developed a semi-automated algorithm to quantify lower leg arterial calcifications (LLACs), captured by HR-pQCT. The objective of our study was to determine validity and reliability of the LLAC measure. HR-pQCT scans were downscaled to a voxel size of 250μm. After subtraction of bone volumes from the scans, LLACs were detected and contoured by a semi-automated, dual-threshold seed-point segmentation. LLAC mass (in mg hydroxyapatite; HA) was calculated as the product of voxel-based calcification volume (mm(3)) and mean calcification density (mgHA/cm(3))/1000. To determine validity, we compared LLACs to coronary artery calcifications (CACs), as quantified by multi-detector computed tomography (MDCT) and Agatston scoring in forty-six patients on chronic hemodialysis. Moreover, we investigated associations of LLACs with age, time on dialysis, type-2 diabetes mellitus, history of stroke, and myocardial infarction. In a second step, we determined intra- and inter-reader reliability of the LLAC measure. In the validity study, LLACs were present (>0mgHA) in 76% of patients, 78% of patients had CACs (>0mgHA). Median LLAC was 6.65 (0.08-24.40)mgHA and median CAC as expressed by Agatston score was 266.3 (15.88-1877.28). We found a significant positive correlation between LLAC and CAC (rho=0.6; p<0.01). Dialysis patients with type-2 diabetes mellitus (DM; 35%) and history of stroke (13%) had higher median LLAC than patients without those conditions (DM 20.0 fold greater, p=0.006; Stroke 5.1 fold greater, p=0.047). LLAC was positively correlated with time on dialysis (rho=0.337, p=0.029), there was a trend towards a positive association of LLAC and age (rho=0.289, p=0.053). The reliability study yielded excellent intra- and inter-reader agreement of the LLAC measure (intra-reader ICC=0.999, 95% CI=0.998-1.000; inter-reader ICC=0.998, 95% CI=0.994-0.999). Our study indicates that the LLAC measure has good validity and excellent reliability. The use of HR-pQCT for the simultaneous evaluation of arterial calcifications, peripheral bone geometry, bone density, and bone microarchitecture should facilitate future research on osteo-vascular interactions and potential associations with cardiovascular events.
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Affiliation(s)
- Janina M. Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | - Elizabeth J. Samelson
- Institute for Aging Research, Hebrew SeniorLife, Division of Medicine, Harvard Medical School, Boston, MA, United States
| | - Daniel Cejka
- Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Danielle Diarra
- Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Gundula Berzaczy
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andrew J. Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, United States
| | - Michael Weber
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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Boskey AL. Bone composition: relationship to bone fragility and antiosteoporotic drug effects. BONEKEY REPORTS 2013; 2:447. [PMID: 24501681 DOI: 10.1038/bonekey.2013.181] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 02/06/2023]
Abstract
The composition of a bone can be described in terms of the mineral phase, hydroxyapatite, the organic phase, which consists of collagen type I, noncollagenous proteins, other components and water. The relative proportions of these various components vary with age, site, gender, disease and treatment. Any drug therapy could change the composition of a bone. This review, however, will only address those pharmaceuticals used to treat or prevent diseases of bone: fragility fractures in particular, and the way they can alter the composition. As bone is a heterogeneous tissue, its composition must be discussed in terms of the chemical makeup, properties of its chemical constituents and their distributions in the ever-changing bone matrix. Emphasis, in this review, is placed on changes in composition as a function of age and various diseases of bone, particularly osteoporosis. It is suggested that while some of the antiosteoporotic drugs can and do modify composition, their positive effects on bone strength may be balanced by negative ones.
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Affiliation(s)
- Adele L Boskey
- Musculoskeletal Integrity Program, Hospital for Special Surgery, affiliated with Weill Medical College of Cornell University , New York, NY, USA ; Department of Biophysics and Systems Biology, Weill Medical College of Cornell University , New York, NY, USA
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Chiba K, Burghardt AJ, Osaki M, Majumdar S. Heterogeneity of bone microstructure in the femoral head in patients with osteoporosis: an ex vivo HR-pQCT study. Bone 2013; 56:139-46. [PMID: 23748104 PMCID: PMC3740186 DOI: 10.1016/j.bone.2013.05.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Trabecular bone in the femoral head has a complicated and heterogeneous structure with few studies having analyzed heterogeneity in this structure quantitatively. We analyze trabecular bone microstructure in the femoral head with osteoporosis (OP) using high resolution peripheral quantitative CT (HR-pQCT) to investigate its regional characteristics. METHODS Fifteen femoral heads extracted from female OP patients with femoral neck fracture (85 ± 7, 67-94 years) were scanned by HR-pQCT at 41 μm voxel size. The femoral head was segmented into 15 regions (3 longitudinal regions: superior, center, and inferior, and 5 axial subregions: center, medial, lateral, anterior, posterior). Of these 15 regions, five were excluded due to overlap with the fracture site, leaving a total of 10 regions of cancellous bone microstructures to be quantitatively assessed using the following parameters: bone volume fraction, trabecular thickness, number, separation, connectivity density, structure model index, and degree and orientation of anisotropy. These parameters were compared among each region. RESULTS Trabecular bone at the center, superior, and supero-posterior regions of the femoral head had higher bone volume, trabecular number, thickness, narrower bone marrow spaces, higher connectivity and anisotropy, and more plate-like structure. This plate-like structure ran supero-inferiorly and antero-posteriorly at the superior and center regions. Bone volume at the anterior, posterior, and medial regions was almost half of the central and superior regions. CONCLUSION Significant heterogeneity of the trabecular bone microstructure in the OP femoral head was showed quantitatively in this study. These data offer new insight into bone microstructural anatomy and may prove to provide useful information on clinical medicine such as hip surgeries.
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Affiliation(s)
- Ko Chiba
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
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Eller-Vainicher C, Filopanti M, Palmieri S, Ulivieri FM, Morelli V, Zhukouskaya VV, Cairoli E, Pino R, Naccarato A, Verga U, Scillitani A, Beck-Peccoz P, Chiodini I. Bone quality, as measured by trabecular bone score, in patients with primary hyperparathyroidism. Eur J Endocrinol 2013; 169:155-62. [PMID: 23682095 DOI: 10.1530/eje-13-0305] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In primary hyperparathyroidism (PHPT), vertebral fractures (VFx) occur regardless of bone mineral density (BMD) and may depend on decreased bone quality. Trabecular bone score (TBS) is a texture measurement acquired during a spinal dual-energy X-ray absorptiometry (DXA). Recently, TBS has been proposed as an index of bone micro-architecture. DESIGN We studied 92 PHPT patients (74 females, age 62.1±9.7 years) and 98 control subjects. In all patients at baseline, in 20 surgically treated patients and in 10 conservatively treated patients after 24 months, TBS, spinal (lumbar spine (LS)) and femoral (total hip (TH) and femoral neck (FN)) BMD were assessed by DXA and VFx by spinal radiograph. RESULTS PHPT patients had lower TBS (-2.39±1.8) and higher VFx prevalence (43.5%) than controls (-0.98±1.07 and 8.2% respectively, both P<0.0001). TBS was associated with VFx (odds ratio 1.4, 95% CI 1.1-1.9, P=0.02), regardless of LS-BMD, age, BMI and gender, and showed a better compromise between sensitivity (75%) and specificity (61.5%) for detecting VFx than LS-BMD, TH-BMD and FN-BMD (31 and 75%, 72 and 44.2%, and 64 and 65% respectively). In surgically treated patients, TBS, LS-BMD, TH-BMD and FN-BMD increased (+47±44.8,+29.2±34.1,+49.4±48.7 and +30.2±39.3% respectively, all P<0.0001). Among patients treated conservatively, TBS decreased significantly in those (n=3) with incident VFx (-1.3±0.3) compared with those without (-0.01±0.9, P=0.048), while BMD changes were not statistically different (LS 0.3±1.2 vs -0.8±0.9 respectively, P=0.19; TH 0.4±0.8 vs -0.8±1.4 respectively, P=0.13 and FN 0.4±0.9 vs -0.8±1.4 respectively, P=0.14). CONCLUSIONS In PHPT, bone quality, as measured by TBS, is reduced and associated with VFx and improves after surgery.
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Affiliation(s)
- Cristina Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Tang XL, Griffith JF, Qin L, Hung VW, Kwok AW, Zhu TY, Kun EW, Leung PC, Li EK, Tam LS. SLE disease per se contributes to deterioration in bone mineral density, microstructure and bone strength. Lupus 2013; 22:1162-8. [PMID: 23884986 DOI: 10.1177/0961203313498802] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The objective of this report is to assess the effect of systemic lupus erythematosus (SLE) disease itself on deterioration of bone mineral density (BMD), microstructure and bone strength. METHOD Thirty age-matched SLE patients on long-term glucocorticoids (GC) (SLE/GC), 30 SLE patients without GC (SLE/non-GC) and 60 healthy controls were examined. Areal BMD (aBMD) was measured by dual-energy X-ray absorptiometry. Bone geometry, volumetric BMD (vBMD), and architectural parameters at the nondominant distal radius were assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone strength was estimated by HR-pQCT-based micro-finite element analysis. RESULTS Adjusted for menopausal status and adjusted calcium level, when compared with controls, SLE/non-GC patients had significantly lower aBMD at femoral neck and total hip, and diminished radial total vBMD, cortical area, vBMD and thickness, respectively, by 8.3%, 8%, 2.7% and 9.2%, as well as significant compromised bone strength (stiffness, failure load and apparent modulus) by 8.3%, 9.1% and 9.5%, respectively. Similar alterations were also found in SLE/GC patients when compared to controls. In the premenopausal subgroup analysis, when compared with controls, total hip aBMD and radial cortical area were significantly lower in SLE/non-GC patients, and cortical area and thickness were significantly deficit in SLE/GC patients. However, no significant difference in any bone variables was present between SLE/GC and SLE/non-GC patients in the entire cohort or in the premenopausal subgroup. CONCLUSION SLE disease per se contributes to the deterioration in bone density, cortical microstructure and bone strength. This might help to explain the considerably higher fracture risk seen in SLE patients.
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Affiliation(s)
- X L Tang
- 1Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong; Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong; Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, Hong Kong; Jockey Club Centre of Osteoporosis Care and Control; The Chinese University of Hong Kong, Hong Kong; and Department of Medicine & Geriatrics, Tai Po Hospital, Hong Kong
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Rautiainen J, Lehto LJ, Tiitu V, Kiekara O, Pulkkinen H, Brünott A, van Weeren R, Brommer H, Brama PAJ, Ellermann J, Kiviranta I, Nieminen MT, Nissi MJ. Osteochondral repair: evaluation with sweep imaging with fourier transform in an equine model. Radiology 2013; 269:113-21. [PMID: 23674789 DOI: 10.1148/radiol.13121433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the status of articular cartilage and bone in an equine model of spontaneous repair by using the sweep imaging with Fourier transform (SWIFT) magnetic resonance (MR) imaging technique. MATERIALS AND METHODS Experiments were approved by the Utrecht University Animal Ethics Committee. Six-millimeter-diameter chondral (n = 5) and osteochondral (n = 5, 3-4 mm deep into subchondral bone) defects were created in the intercarpal joints of seven 2-year-old horses and examined with SWIFT at 9.4 T after spontaneous healing for 12 months. Conventional T2 maps and gradient-echo images were obtained for comparison, and histologic assessment of cartilage and micro-computed tomography (CT) of bone were performed for reference. Signal-to-noise ratio (SNR) analysis was performed, and a radiologist evaluated the MR images. Structural bone parameters were derived from SWIFT and micro-CT datasets. Significance of differences was investigated with the Wilcoxon signed rank test and Pearson correlation analysis. RESULTS SWIFT was able to depict the different outcomes of spontaneous healing of focal chondral versus osteochondral defects. SWIFT produced constant signal intensity throughout cartilage, whereas T2 mapping showed elevated T2 values (P = .06) in repair tissue (mean T2 in superficial region of interest in an osteochondral lesion = 50.0 msec ± 10.2) in comparison to adjacent intact cartilage (mean T2 = 32.7 msec ± 4.2). The relative SNR in the subchondral plate with SWIFT (0.91) was more than four times higher than that with conventional fast spin-echo (0.12) and gradient-echo (0.19) MR imaging. The correlation between bone volume-to-tissue volume fractions determined with SWIFT and micro-CT was significant (r = 0.83, P < .01). CONCLUSION SWIFT enabled assessment of spontaneous osteochondral repair in an equine model.
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Affiliation(s)
- Jari Rautiainen
- Department of Applied Physics, A. I. Virtanen Institute for Molecular Sciences, and Institute of Biomedicine, Anatomy, University of Eastern Finland, PO Box 1627, 70211 Kuopio, Finland; Department of Equine Sciences, Faculty of Veterinary Medicine, University of Utrecht, Utrecht, the Netherlands; Department of Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, Dublin, Ireland; Center for Magnetic Resonance Research, Departments of Radiology and Orthopaedic Surgery, University of Minnesota, Minneapolis, Minn; Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland; Department of Diagnostic Radiology, Institute of Diagnostics, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Chang G, Rajapakse CS, Diamond M, Honig S, Recht MP, Weiss DS, Regatte RR. Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers. Osteoporos Int 2013; 24:1407-17. [PMID: 22893356 PMCID: PMC3719856 DOI: 10.1007/s00198-012-2105-8] [Citation(s) in RCA: 11] [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: 03/12/2012] [Accepted: 07/10/2012] [Indexed: 02/07/2023]
Abstract
UNLABELLED Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation. INTRODUCTION The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls. METHODS This study had institutional review board approval. We recruited nine female modern dancers (25.7±5.8 years, 1.63±0.06 m, 57.1±4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1±4.8 years, 1.6±0.04 m, 55.8±5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE=31 ms/5.1 ms, 0.234 mm×0.234 mm×1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups. RESULTS Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p<0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p<0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p>0.07), but adjustment for cortical bone cross-sectional area did not (p<0.03). CONCLUSIONS Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.
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Affiliation(s)
- G Chang
- Quantitative Multinuclear Musculoskeletal Imaging Group, Center for Biomedical Imaging, NYU Langone Medical Center, 660 First Avenue, 2nd Floor, New York, NY 10016, USA.
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Romagnoli E, Cipriani C, Nofroni I, Castro C, Angelozzi M, Scarpiello A, Pepe J, Diacinti D, Piemonte S, Carnevale V, Minisola S. "Trabecular Bone Score" (TBS): an indirect measure of bone micro-architecture in postmenopausal patients with primary hyperparathyroidism. Bone 2013; 53:154-9. [PMID: 23228370 DOI: 10.1016/j.bone.2012.11.041] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 11/28/2012] [Accepted: 11/29/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with primary hyperparathyroidism (PHPT) generally show reduced bone mineral density (BMD) at cortical sites with relatively preserved trabecular bone. However, the increased fracture risk at all skeletal sites suggests that areal BMD probably is not effective in capturing all the determinants of bone strength. "Trabecular Bone Score" (TBS) has been recently proposed as an indirect measure of bone micro-architecture. Our study was aimed to investigate TBS in patients with PHPT. METHODS Seventy-three Caucasian postmenopausal women with PHPT and 74 age-matched healthy women (C) were studied. In all participants BMD at lumbar spine (LS) and at femoral sites (Neck-FN and total hip-TH) was measured by DXA and, in 67 patients and 34 C, also at the distal 1/3 of the radius (R). TBS was measured in the region of LS-BMD. Spine X ray was assessed in all patients. RESULTS Mean TBS values were significantly reduced in PHPT (1.19 ± 0.10) compared to C (1.24 ± 0.09, p<0.01). Patients and controls did not differ for age, years since menopause (YSM), BMI, 25(OH)D serum levels, creatinine clearance, LS-BMD and FN-BMD. On the contrary, mean BMD values at both TH and R were significantly lower in PHPT patients compared to controls (p<0.01 and p<0.0001, respectively). In PHPT with vertebral fractures (VF+, n=29) TBS was significantly lower than in those without fracture (VF-, n=44)(1.14 ± 0.10 vs. 1.22 ± 0.10, respectively; p<0.01), whose TBS values did not differ from C. Mean TBS values in patients with (n=18) and without (n=55) non-vertebral fractures did not significantly differ (1.16 ± 0.09 vs. 1.20 ± 0.11). The presence of vertebral fractures was independently associated with the reduction of TBS (OR=0.003, 95% CI=0-0.534, p=0.028) and with YSM (OR=1.076, 95% CI=1.017-1.139, p=0.011), but not with age, the reduction of LS-BMD and the increase of BMI. The combination of YSM > 10 years plus TBS < 1.2 was associated with a significant risk of VF (OR=11.73, 95% CI 2.43-66.55, p<0.001). A TBS value <1.2 showed a better performance in individuating VF (sensibility 79.3%, specificity 61.4%, positive predictive value 57.5%, and negative predictive value 81.8%) in respect to YSM > 10 years. CONCLUSIONS TBS seems to indirectly reflect an alteration of bone micro-architecture in postmenopausal women with PHPT.
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Affiliation(s)
- Elisabetta Romagnoli
- Department of Internal Medicine and Medical Disciplines, University of Rome Sapienza, Rome, Italy.
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Abstract
Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA.
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Abstract
The diagnosis and management of osteoporosis have been improved by the development of new quantitative methods of skeletal assessment and by the availability of an increasing number of therapeutic options, respectively. A number of imaging methods exist and all have advantages and disadvantages. Dual-energy X-ray absorptiometry (DXA) is the most widely available and commonly utilized method for clinical diagnosis of osteoporosis and will remain so for the foreseeable future. The WHO 10-year fracture risk assessment tool (FRAX(®)) will improve clinical use of DXA and the cost-effectiveness of therapeutic intervention. Improved reporting of radiographic features that suggest osteoporosis and the presence of vertebral fracture, which are powerful predictors of future fractures, could increase the frequency of appropriate DXA referrals. Quantitative CT remains predominantly a research tool, but has advantages over DXA--allowing measurement of volumetric density, separate measures of cortical and trabecular bone density, and evaluation of bone shape and size. High resolution imaging, using both CT and MRI, has been introduced to measure trabecular and cortical bone microstructure. Although these methods provide detailed insights into the effects of disease and therapies on bone, they are technically challenging and not widely available, so they are unlikely to be used in clinical practice.
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Affiliation(s)
- Judith E Adams
- Manchester Academic Health Science Centre, The Royal Infirmary and University of Manchester, Department of Radiology, The Royal Infirmary, Manchester M13 9WL, UK.
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Chappard C. [Microarchitecture assessment of human trabecular bone: description of methods]. Med Sci (Paris) 2012; 28:1111-5. [PMID: 23290412 DOI: 10.1051/medsci/20122812022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Trabecular bone microarchitecture changes in relation to mechanical stress, effects of age, osteoporosis and anti-osteoporotic drugs. In vivo, these anomalies can be evaluated using textural parameters on high resolution radiographs and images of DXA. It is possible to extract morphological and topological parameters: apparent on MRI images and 3D with a dedicated device called High resolution peripheral quantitative computed tomography (HR-pQCT) with a resolution close to the size of the trabeculae. In vitro, it is possible to obtain on bone samples a 2D analysis by histomorphometry and a 3D analysis from 10 µm images obtained by synchrotron radiation or conventional micro-CT.
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Affiliation(s)
- Christine Chappard
- Laboratoire de biomécanique et biomatériaux ostéo-articulaires (B2OA), UMR 7052 CNRS, Université Paris Diderot-PRES Sorbonne Paris Cité, 10, avenue de Verdun, 75010 Paris, France.
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Abstract
CONTEXT Differences in bone mineral density (BMD) as assessed with dual-energy x-ray absorptiometry are observed between geographic and ethnic groups, with important implications in clinical practice. EVIDENCE ACQUISITION PubMed was employed to identify relevant studies. A review of the literature was conducted, and data were summarized and integrated. EVIDENCE SYNTHESIS The available data highlight the complex ethnic variations in BMD, which only partially account for observed variations in fracture rates. Factors contributing to ethnic differences include genetics, skeletal size, body size and composition, lifestyle, and social determinants. Despite BMD differences, the gradient of risk for fracture from BMD and other clinical risk factors appears to be similar across ethnic groups. Furthermore, BMD variation is greater within an ethnic population than between ethnic populations. New imaging technologies have identified ethnic differences in bone geometry, volumetric density, microarchitecture, and estimated bone strength that may contribute to a better understanding of ethnic differences in fracture risk. CONCLUSIONS Factors associated with ethnicity affect BMD and fracture risk through direct and indirect mechanisms.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada R2H 2A6.
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Hammond CL, Moro E. Using transgenic reporters to visualize bone and cartilage signaling during development in vivo. Front Endocrinol (Lausanne) 2012; 3:91. [PMID: 22826703 PMCID: PMC3399225 DOI: 10.3389/fendo.2012.00091] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 07/03/2012] [Indexed: 01/11/2023] Open
Abstract
Green fluorescent protein was first used as a marker of protein expression in vivo 18 years ago, heralding the beginning of what became known as the Green Revolution. Since then, there has been an explosion in the number of transgenic lines in existence, and these transgenic tools are now being applied to skeletal research. Advances in transgenesis are also leading to increasing use of new model organisms for studying skeletogenesis. Such new models include the small teleosts zebrafish and medaka, which due to their optical translucency offer imaging possibilities in the live animals. In this review, we will introduce a number of recent advances in genetic engineering and transgenesis and the new genetic tools that are currently being developed. We will provide examples of how zebrafish and medaka transgenic lines are helping us to understand the behavior of skeletal cells in vivo. Finally, we will discuss future prospects for the application of transgenic technology to skeletal research.
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Affiliation(s)
- Chrissy L. Hammond
- Departments of Biochemistry, Physiology and Pharmacology, University of Bristol, Bristol, UK
- *Correspondence: Chrissy L. Hammond, Departments of Biochemistry, Physiology and Pharmacology, Medical Sciences, University of Bristol, University Walk, BS8 1TD Bristol, UK. e-mail:
| | - Enrico Moro
- Department of Biomedical Sciences, University of Padova, Padova, Italy
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