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Design and simulation of a 2-D array flexible ultrasound transducer system for tissue characterization – A pilot study. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2021.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ultrasonic Assessment of Cancellous Bone Based on the Two-Wave Phenomenon. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:119-143. [DOI: 10.1007/978-3-030-91979-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Assessing underlying bone quality in spine surgery patients: a narrative review of dual-energy X-ray absorptiometry (DXA) and alternatives. Spine J 2021; 21:321-331. [PMID: 32890786 DOI: 10.1016/j.spinee.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/15/2020] [Accepted: 08/29/2020] [Indexed: 02/06/2023]
Abstract
Poor bone quality and low bone mineral density (BMD) have been previously tied to higher rates of postoperative mechanical complications in patients undergoing spinal fusion. These include higher rates of proximal junctional kyphosis, screw pullout, pseudoarthrosis, and interbody subsidence. For these reasons, accurate preoperative assessment of a patient's underlying bone quality is paramount for all elective procedures. Dual-energy X-ray absorptiometry (DXA) is currently considered to be the gold standard for assessing BMD. However, a growing body of research has suggested that in vivo assessments of BMD using DXA are inaccurate and have, at best, moderate correlations to postoperative mechanical complications. Consequently, there have been investigations into using alternative methods for assessing in vivo bone quality, including using computed tomography (CT) and magnetic resonance imaging (MRI) volumes that are commonly obtained as part of surgical evaluation. Here we review the data regarding the accuracy of DXA for the evaluation of spine bone quality and describe the alternative imaging modalities currently under investigation.
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Mullin BH, Tickner J, Zhu K, Kenny J, Mullin S, Brown SJ, Dudbridge F, Pavlos NJ, Mocarski ES, Walsh JP, Xu J, Wilson SG. Characterisation of genetic regulatory effects for osteoporosis risk variants in human osteoclasts. Genome Biol 2020; 21:80. [PMID: 32216834 PMCID: PMC7098081 DOI: 10.1186/s13059-020-01997-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/11/2020] [Indexed: 12/15/2022] Open
Abstract
Background Osteoporosis is a complex disease with a strong genetic contribution. A recently published genome-wide association study (GWAS) for estimated bone mineral density (eBMD) identified 1103 independent genome-wide significant association signals. Most of these variants are non-coding, suggesting that regulatory effects may drive many of the associations. To identify genes with a role in osteoporosis, we integrate the eBMD GWAS association results with those from our previous osteoclast expression quantitative trait locus (eQTL) dataset. Results We identify sixty-nine significant cis-eQTL effects for eBMD GWAS variants after correction for multiple testing. We detect co-localisation of eBMD GWAS and osteoclast eQTL association signals for 21 of the 69 loci, implicating a number of genes including CCR5, ZBTB38, CPE, GNA12, RIPK3, IQGAP1 and FLCN. Summary-data-based Mendelian Randomisation analysis of the eBMD GWAS and osteoclast eQTL datasets identifies significant associations for 53 genes, with TULP4 presenting as a strong candidate for pleiotropic effects on eBMD and gene expression in osteoclasts. By performing analysis using the GARFIELD software, we demonstrate significant enrichment of osteoporosis risk variants among high-confidence osteoclast eQTL across multiple GWAS P value thresholds. Mice lacking one of the genes of interest, the apoptosis/necroptosis gene RIPK3, show disturbed bone micro-architecture and increased osteoclast number, highlighting a new biological pathway relevant to osteoporosis. Conclusion We utilise a unique osteoclast eQTL dataset to identify a number of potential effector genes for osteoporosis risk variants, which will help focus functional studies in this area.
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Affiliation(s)
- Benjamin H Mullin
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. .,School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia.
| | - Jennifer Tickner
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Kun Zhu
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Jacob Kenny
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Shelby Mullin
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Suzanne J Brown
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Frank Dudbridge
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nathan J Pavlos
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Edward S Mocarski
- Department of Microbiology and Immunology, Emory Vaccine Center, School of Medicine, Emory University, Atlanta, GA, USA
| | - John P Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Medical School, The University of Western Australia, Crawley, WA, Australia
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia
| | - Scott G Wilson
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Biomedical Sciences, The University of Western Australia, Crawley, WA, 6009, Australia.,Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
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Wear KA. Mechanisms of Interaction of Ultrasound With Cancellous Bone: A Review. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:454-482. [PMID: 31634127 PMCID: PMC7050438 DOI: 10.1109/tuffc.2019.2947755] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of attenuation and sound speed in cancellous bone. This review discusses fundamental mechanisms underlying the interaction between ultrasound and cancellous bone. Because of its two-phase structure (mineralized trabecular network embedded in soft tissue-marrow), its anisotropy, and its inhomogeneity, cancellous bone is more difficult to characterize than most soft tissues. Experimental data for the dependencies of attenuation, sound speed, dispersion, and scattering on ultrasound frequency, bone mineral density, composition, microstructure, and mechanical properties are presented. The relative roles of absorption, scattering, and phase cancellation in determining attenuation measurements in vitro and in vivo are delineated. Common speed of sound metrics, which entail measurements of transit times of pulse leading edges (to avoid multipath interference), are greatly influenced by attenuation, dispersion, and system properties, including center frequency and bandwidth. However, a theoretical model has been shown to be effective for correction for these confounding factors in vitro and in vivo. Theoretical and phantom models are presented to elucidate why cancellous bone exhibits negative dispersion, unlike soft tissue, which exhibits positive dispersion. Signal processing methods are presented for separating "fast" and "slow" waves (predicted by poroelasticity theory and supported in cancellous bone) even when the two waves overlap in time and frequency domains. Models to explain dependencies of scattering on frequency and mean trabecular thickness are presented and compared with measurements. Anisotropy, the effect of the fluid filler medium (marrow in vivo or water in vitro), phantoms, computational modeling of ultrasound propagation, acoustic microscopy, and nonlinear properties in cancellous bone are also discussed.
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Acciaioli A, Falco L, Baleani M. Measurement of apparent mechanical properties of trabecular bone tissue: Accuracy and limitation of digital image correlation technique. J Mech Behav Biomed Mater 2020; 103:103542. [DOI: 10.1016/j.jmbbm.2019.103542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/21/2019] [Accepted: 11/15/2019] [Indexed: 01/02/2023]
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Qin YX, Xia Y, Muir J, Lin W, Rubin CT. Quantitative ultrasound imaging monitoring progressive disuse osteopenia and mechanical stimulation mitigation in calcaneus region through a 90-day bed rest human study. J Orthop Translat 2019; 18:48-58. [PMID: 31508307 PMCID: PMC6718925 DOI: 10.1016/j.jot.2018.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 11/21/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background Osteoporosis parallels aging and functional mechanical unloading (e.g., space flight and bed rest), jeopardizing mineral density, microstructure, and integrity of bone and leading to an increased risk of fracture. A way to combat this deterioration is to harness the sensitivity of bone to mechanical signals. Objective This study evaluates the longitudinal effect of a dynamic mechanical loading through the heel on human bone in vivo during 90-day bed rest, monitored by quantitative ultrasound (QUS) imaging and dual-energy X-ray absorptiometry (DXA) in localized regions of interests, i.e., calcaneus. Methods A total of 29 bed rest individuals were evaluated (11 control and 18 treatment) with a brief (10-minute) daily low-intensity (0.3g), high-frequency (30Hz) dynamic mechanical stimulation countermeasure through vibrational inhibition bone erosion (VIBE). Both QUS and DXA detected longitudinal bone density and quality changes. Results Ultrasound velocity (UV) decreased in the control group and increased in the group treated with low-intensity loading. The UV increased by 1.9% and 1.6% at 60- and 90-day bed rest (p=0.01) in VIBE over control groups. A trend was found in broadband ultrasound attenuation (BUA), with a VIBE benefit of 1.8% at day 60 and 0.5% at day 90 in comparison with control (p=0.5). Bone mineral density (BMD) assessed by DXA decreased -4.50% for control individuals and -2.18% for VIBE individuals, showing a moderate effect of the mechanical intervention (p=0.19). Significant correlations between QUS and DXA were observed, with a combined BUA and UV vs. BMD: r2=0.70. Conclusion These results indicated that low-intensity, high-frequency loading has the potential to mitigate regional bone loss induced by long-term bed rest and that QUS imaging may be able to assess the subtle changes in bone alteration. Translational potential of this article Quantitative ultrasound has shown the efficacy of noninvasively assessing bone mass and structural properties in cadaver and isolated trabecular bone samples. While its ability in measuring in vivo bone quality and density is still unclear, a scanning confocal ultrasound imaging is developed and can perform an instant assessment for the subtle changes of such bone loss. This ultrasound imaging modality can potentially be used in the clinical assessment of bone mass. Moreover, physical stimulation has shown the ability to prevent bone loss induced by functional disuse and estrogen deficiency in animal models. However, its treatment capability is unclear. This study has shown that low-magnitude mechanical signals, introduced using low-intensity vibration (LIV), can mitigate regional bone loss caused by functional disuse. Thus localized mechanical treatment, and the quantitative ultrasound imaging have shown translational potential to noninvasively attenuate bone loss, and assess bone mass in the clinic, e.g., in an extreme condition such as long-term space mission, and long-term bedrest such as in case of spinal cord injury.
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Affiliation(s)
- Yi-Xian Qin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA
| | - Yi Xia
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA
| | - Jesse Muir
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA
| | - Wei Lin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA
| | - Clinton T Rubin
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-5281, USA
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Mullin BH, Zhao JH, Brown SJ, Perry JR, Luan J, Zheng HF, Langenberg C, Dudbridge F, Scott R, Wareham NJ, Spector TD, Richards JB, Walsh JP, Wilson SG. Genome-wide association study meta-analysis for quantitative ultrasound parameters of bone identifies five novel loci for broadband ultrasound attenuation. Hum Mol Genet 2017; 26:2791-2802. [PMID: 28472463 PMCID: PMC5886185 DOI: 10.1093/hmg/ddx174] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 04/06/2017] [Accepted: 05/02/2017] [Indexed: 12/18/2022] Open
Abstract
Osteoporosis is a common and debilitating bone disease that is characterised by low bone mineral density, typically assessed using dual-energy X-ray absorptiometry. Quantitative ultrasound (QUS), commonly utilising the two parameters velocity of sound (VOS) and broadband ultrasound attenuation (BUA), is an alternative technology used to assess bone properties at peripheral skeletal sites. The genetic influence on the bone qualities assessed by QUS remains an under-studied area. We performed a comprehensive genome-wide association study (GWAS) including low-frequency variants (minor allele frequency ≥0.005) for BUA and VOS using a discovery population of individuals with whole-genome sequence (WGS) data from the UK10K project (n = 1268). These results were then meta-analysed with those from two deeply imputed GWAS replication cohorts (n = 1610 and 13 749). In the gender-combined analysis, we identified eight loci associated with BUA and five with VOS at the genome-wide significance level, including three novel loci for BUA at 8p23.1 (PPP1R3B), 11q23.1 (LOC387810) and 22q11.21 (SEPT5) (P = 2.4 × 10-8 to 1.6 × 10-9). Gene-based association testing in the gender-combined dataset revealed eight loci associated with BUA and seven with VOS after correction for multiple testing, with one novel locus for BUA at FAM167A (8p23.1) (P = 1.4 × 10-6). An additional novel locus for BUA was seen in the male-specific analysis at DEFB103B (8p23.1) (P = 1.8 × 10-6). Fracture analysis revealed significant associations between variation at the WNT16 and RSPO3 loci and fracture risk (P = 0.004 and 4.0 × 10-4, respectively). In conclusion, by performing a large GWAS meta-analysis for QUS parameters of bone using a combination of WGS and deeply imputed genotype data, we have identified five novel genetic loci associated with BUA.
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Affiliation(s)
- Benjamin H. Mullin
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth 6009, Australia
| | - Jing Hua Zhao
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Suzanne J. Brown
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia
| | - John R.B. Perry
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Jian'an Luan
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Hou-Feng Zheng
- Institute of Aging Research and the Affiliated Hospital, School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310036, China
- Institute for Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, Zhejiang 310036, China
| | | | - Frank Dudbridge
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Robert Scott
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Nick J. Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Tim D. Spector
- Twin & Genetic Epidemiology Research Unit, St. Thomas’ Hospital Campus, King’s College London, London SE1 7EH, UK
| | - J. Brent Richards
- Twin & Genetic Epidemiology Research Unit, St. Thomas’ Hospital Campus, King’s College London, London SE1 7EH, UK
- Departments of Medicine, Human Genetics, Epidemiology and Biostatistics, Jewish General Hospital, Lady Davis Institute, McGill University, Montreal H3T 1E2, Canada
| | - John P. Walsh
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth 6009, Australia
| | - Scott G. Wilson
- Department of Endocrinology & Diabetes, Sir Charles Gairdner Hospital, Perth 6009, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth 6009, Australia
- Twin & Genetic Epidemiology Research Unit, St. Thomas’ Hospital Campus, King’s College London, London SE1 7EH, UK
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