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Yang J, Pei Q, Wu X, Dai X, Li X, Pan J, Wang B. Stress reduction through cortical bone thickening improves bone mechanical behavior in adult female Beclin-1 +/- mice. Front Bioeng Biotechnol 2024; 12:1357686. [PMID: 38600946 PMCID: PMC11004267 DOI: 10.3389/fbioe.2024.1357686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Fragility fractures, which are more prevalent in women, may be significantly influenced by autophagy due to altered bone turnover. As an essential mediator of autophagy, Beclin-1 modulates bone homeostasis by regulating osteoclast and chondrocyte differentiation, however, the alteration in the local bone mechanical environment in female Beclin-1+/- mice remains unclear. In this study, our aim is to investigate the biomechanical behavior of femurs from seven-month-old female wild-type (WT) and Beclin-1+/- mice under peak physiological load, using finite element analysis on micro-CT images. Micro-CT imaging analyses revealed femoral cortical thickening in Beclin-1+/- female mice compared to WT. Three-point bending test demonstrated a 63.94% increase in whole-bone strength and a 61.18% increase in stiffness for female Beclin-1+/- murine femurs, indicating improved biomechanical integrity. After conducting finite element analysis, Beclin-1+/- mice exhibited a 26.99% reduction in von Mises stress and a 31.62% reduction in maximum principal strain in the femoral midshaft, as well as a 36.64% decrease of von Mises stress in the distal femurs, compared to WT mice. Subsequently, the strength-safety factor was determined using an empirical formula, revealing that Beclin-1+/- mice exhibited significantly higher minimum safety factors in both the midshaft and distal regions compared to WT mice. In summary, considering the increased response of bone adaptation to mechanical loading in female Beclin-1+/- mice, our findings indicate that increasing cortical bone thickness significantly improves bone biomechanical behavior by effectively reducing stress and strain within the femoral shaft.
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Affiliation(s)
- Jiaojiao Yang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Qilin Pei
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
- Department of Biomedical Engineering, Fourth Military Medical University, Xi’an, China
| | - Xingfan Wu
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Xin Dai
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Xi Li
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
| | - Jun Pan
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, College of Bioengineering, Chongqing University, Chongqing, China
| | - Bin Wang
- Institute of Life Sciences, College of Basic Medicine, Chongqing Medical University, Chongqing, China
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Vlachos C, Ampadiotaki MM, Papagrigorakis E, Galanis A, Zachariou D, Vavourakis M, Rodis G, Vasiliadis E, Kontogeorgakos VA, Pneumaticos S, Vlamis J. Distinctive Geometrical Traits of Proximal Femur Fractures-Original Article and Review of Literature. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2131. [PMID: 38138234 PMCID: PMC10744519 DOI: 10.3390/medicina59122131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The incidence of proximal femoral fractures is escalating rapidly, generating a significant challenge for healthcare systems globally and, carrying serious social and economic implications. The primarily object of this study was to discover potential distinguishing factors between fractures occurring in the femoral neck and trochanteric region. Materials and Methods: We performed a prospective cohort study of the radiographic images of 70 people over 65 years of age who were admitted to the orthopedic department with hip fracture and who fulfilled our eligibility criteria. Neck Length (NL), Offset Lenth (OL), Hip Axis Length (HAL), Neck Shaft Angle (NSA), Wiberg Angle (WA), Acetabular Angle (AA), Femoral Neck Diameter (FND), Femoral Head Diameter (FHD), Femoral Shaft Diameter (FSD), Femoral Canal Diameter (FCD) and Tonnis classification were recorded. For the comparison of the categorical variables, Pearson's χ2 criterion was used, while Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results: There were no statistically significant variances observed while comparing the selected geometric parameters of the proximal femur with the type of fracture. This finding was reaffirmed in relation to age, gender, and Tonnis classification. However, a moderate correlation was noted, revealing comparatively reduced values of HAL, FHD, and FND in women as opposed to men. Conclusions: The inability of our research to establish the differentiative geometric factors between femoral neck and trochanteric fractures underscores the need for further investigations, which would take into consideration the intrinsic characteristics of the proximal femur.
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Affiliation(s)
- Christos Vlachos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | | | - Eftychios Papagrigorakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Athanasios Galanis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Dimitrios Zachariou
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Michail Vavourakis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - George Rodis
- Department of Radiology, KAT General Hospital, 14561 Athens, Greece;
| | - Elias Vasiliadis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - Vasileios A. Kontogeorgakos
- 1st Orthopedic Department, National and Kapodistrian University of Athens, Attikon General University Hospital, 12462 Chaidari, Greece;
| | - Spiros Pneumaticos
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
| | - John Vlamis
- 3rd Orthopedic Department, National and Kapodistrian University of Athens, KAT General Hospital, 14561 Athens, Greece; (E.P.); (A.G.); (D.Z.); (M.V.); (E.V.); (S.P.); (J.V.)
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3
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Hong N, Kim JH, Treece G, Kim HC, Choi JY, Rhee Y. Cortical and Trabecular Bone Deficit in Middle-Aged Men Living with HIV. J Bone Miner Res 2023; 38:1288-1295. [PMID: 37358254 DOI: 10.1002/jbmr.4873] [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: 12/06/2022] [Revised: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
A significant increase in the risk of hip fracture was observed in middle-aged men living with human immunodeficiency virus (MLWH), almost a decade earlier than those without infection. Data regarding cortical and trabecular bone deficit of hip, an important determinant of bone strength, in MLWH are limited. Quantitative CT was performed in consecutive MLWH aged ≥30 years between November 2017 and October 2018 at Severance Hospital, Seoul, Korea. Volumetric bone mineral density (vBMD) and cortical bone mapping parameters of hip (cortical thickness [CTh], cortical bone vBMD [CBMD], cortical mass surface density [CMSD], endocortical trabecular density [ECTD]) were compared to age-matched and body mass index (BMI)-matched controls (1:2) using a community-based healthy adults cohort. Among 83 MLWH and 166 controls (mean age: 47.2 years; BMI: 23.6 kg/m2 ), MLWH had lower total hip vBMD (280 ± 41 versus 296 ± 41 mg/cm3 ), CMSD (155 versus 160 mg/cm2 ), and ECTD (158 versus 175 mg/cm3 ) than controls that remained robust after adjustment for covariates (adjusted β: total hip vBMD, -18.8; CMSD, -7.3; ECTD, -18.0; p < 0.05 for all). Cortical bone mapping revealed localized deficit of CTh, CBMD, and CMSD in the anterolateral trochanteric region and femoral neck in MLWH compared to controls, with a more extensive ECTD deficit. In MLWH, lower CD4 T-cell count (/100 cells/mm3 decrement) and protease inhibitor (PI)-based regimen (versus non-PI regimen) at the time of antiretroviral treatment initiation were associated with lower total hip vBMD (adjusted β -7.5 for lower CD4 count; -28.3 for PI-based regimen) and CMSD (adjusted β -2.6 for lower CD4 count; -12.7 for PI-based regimen; p < 0.05 for all) after adjustment for covariates including age, BMI, smoking, alcohol use, hepatitis C virus co-infection, tenofovir exposure, and CT scanner types. MLWH had lower hip bone density with cortical and trabecular bone deficit compared to community-dwelling controls. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Severance Hospital, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Graham Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Hyeon Chang Kim
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, South Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Severance Hospital, AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Kancherla K, Constantin H, Kanawati A, Graham E. Iron-induced Hypophosphatemic Osteomalacia-An Atypical Case of Bilateral Femoral Stress Fractures. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202305000-00010. [PMID: 37146096 PMCID: PMC10162788 DOI: 10.5435/jaaosglobal-d-22-00155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/27/2023] [Indexed: 05/07/2023]
Abstract
We present a case of a 61-year-old healthy man who had bilateral femoral neck insufficiency fractures attributed to repeated iron transfusions, causing iron-induced hypophosphatemic rickets, requiring surgical intervention. Atraumatic insufficiency fractures present a diagnostic dilemma in orthopaedics. Chronic fractures with no acute precipitating trigger can often go unrecognized until complete fracturing or displacement occurs. Early identification of the risk factors in conjunction with a comprehensive history, clinical examination, and imaging can potentially avoid these serious complications. Atraumatic femoral neck insufficiency fractures have been sporadically reported in the literature, often unilateral and attributed to the use of long-term bisphosphonates. Through this case, we elaborate on the relatively unknown link between iron transfusions and insufficiency fractures. This case highlights the importance of early detection and imaging of such fractures from an orthopaedic perspective.
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Affiliation(s)
- Kiran Kancherla
- From the Orthopaedic Department, Westmead Hospital, Sydney, Australia
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Xu Y, Gao S. Clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures. Biotechnol Genet Eng Rev 2023:1-9. [PMID: 36848034 DOI: 10.1080/02648725.2023.2183581] [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: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
To explore the clinical value of quantitative parameters of multi-slice computer tomography (MSCT) in the diagnosis of occult femoral neck fractures.The clinical data of 94 patients with suspected occult femoral neck fractures admitted to our hospital from April 2021 to April 2022 were selected for retrospective analysis, and they were divided into group A (accurate diagnosis, n = 63) and group B (non-occult femoral neck fractures, n = 31) according to the results of pathological and surgical diagnosis as the gold standard. All patients received MSCT examination to obtain quantitative parameters related to imaging, and receiver operator characteristic (ROC) curves were used to comprehensively evaluate the clinical value of quantitative parameters of MSCT in the diagnosis of occult femoral neck fractures.The quantitative parameters of MSCT in group A were overtly lower than those in group B (P < 0.05). The AUC value, Youden index and sensitivity of the combined detection were higher than those of single detection.The use of quantitative parameters of MSCT effectively reduces the missed diagnosis rate of occult femoral neck fractures, which could make an accurate diagnosis of the fracture type, as a basis for the formulation of clinical treatment plans.
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Affiliation(s)
- Yongzhong Xu
- Imaging Department, Yantai Mountain Hospital, Yantai, Shandong, China
| | - Shan Gao
- Emergency Department, Qingdao West Coast New Area Central Hospital, Qingdao, Shandong, China
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6
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Jeong SH, Hong N, Lee HS, Han S, Lee YG, Lee Y, Rhee Y, Sohn YH, Lee PH. Low skull bone density is associated with poor motor prognosis in women with Parkinson’s disease. Front Aging Neurosci 2022; 14:1053786. [DOI: 10.3389/fnagi.2022.1053786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Parkinson’s disease (PD) and osteoporosis are degenerative diseases that have shared pathomechanisms. To investigate the associations of skull bone density with nigrostriatal dopaminergic degeneration and longitudinal motor prognosis in female patients with PD. We analyzed the data of 260 drug-naïve female PD patients aged ≥50 years old who were followed-up for ≥3 years after their first visit to the clinic with baseline dopamine transporter (DAT) imaging. We measured skull bone density as a surrogate marker for systemic bone loss by calculating the Hounsfield unit (HU) in computed tomography scans. A Cox proportional hazard model was built to compare the rates of levodopa-induced dyskinesia (LID) or wearing-off according to skull HU. Longitudinal changes in levodopa-equivalent dose (LED) during a 3-year follow-up were assessed using a linear mixed model. A lower skull HU was associated with lower baseline DAT availability in striatal subregions; however, this relationship was not significant after adjusting for age, disease duration, body mass index, and white matter hyperintensities. After adjusting for confounding factors, a lower skull HU was significantly associated with an increased risk of LID development (hazard ratio = 1.660 per 1 standard deviation decrease, p = 0.007) and wearing-off (hazard ratio = 1.613, p = 0.016) in younger (<67 years) but not in older patients. Furthermore, a lower skull HU was associated with a steeper increase in LED during follow-up in younger patients only (β = –21.99, p < 0.001). This study suggests that baseline skull bone density would be closely linked to motor prognosis in drug naïve women with PD.
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7
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Guo J, Zhou Y, Shang M, Chen W, Hou Z, Zhang Y, Dong W. Morphological characteristics of the surgical neck region in the proximal humerus at different ages. Eur J Med Res 2022; 27:102. [PMID: 35773745 PMCID: PMC9245283 DOI: 10.1186/s40001-022-00724-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study was to demonstrate the cortical thickness character in the humeral surgical neck region using 3D cortical bone mapping technique and try to illustrate its morphological changes with age. MATERIAL AND METHODS Normal individuals, including 11 volunteers younger than 18 years, 87 adult men and 46 adult women, were enrolled. The cortical thickness and height of the surgical neck region was measured with Mimic and 3 Matic software. The height of the region was compared and measured. People with an age of 18-30 years was identified as Group I, people in 31-40 years as Group II, people in 41-50 years as Group III, people in 51-60 years as Group IV, and Group V including people ≥ 61 years. RESULTS Compared with the baseline Group I, cortical thickness was significantly decreased by 0.52 mm (P = 0.006) in Group III, by 0.76 mm (P < 0.001) in Group IV, and by 0.77 mm (P < 0.001) in Group V. Age moderately predicted cortical thickness with r = -0.5481. The height of the cortical change region was significantly decreased by 2.25 mm (P = 0.007) in Group II, by 2.98 mm (P < 0.001) in Group III, and by 2.07 mm (P = 0.02) in Group IV. However, no significant decrease was illustrated in Group V (0.57 mm) (P = 0.891). The relation between age and the height of the cortical thickness change region was nonlinear. CONCLUSIONS This study identified an obvious decrease in cortical thickness with aging, and the height was curve fitted with aging in surgical neck region.
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Affiliation(s)
- Jialiang Guo
- The School of Medicine, Nankai University, Tianjin, People's Republic of China.,Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yali Zhou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Meishuang Shang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wei Chen
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yingze Zhang
- Department of Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China. .,Chinese Academy of Engineering, Beijing, People's Republic of China. .,NHC Key Laboratory of Intelligent Orthopeadic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, People's Republic of China.
| | - Weichong Dong
- Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
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Hoffmeister BK, Delahunt SI, Downey KL, Viano AM, Thomas DM, Georgiou LA, Gray AJ, Newman WR, Main EN, Pirro G. In Vivo Comparison of Backscatter Techniques for Ultrasonic Bone Assessment at the Femoral Neck. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:997-1009. [PMID: 35282987 DOI: 10.1016/j.ultrasmedbio.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/15/2022] [Accepted: 01/27/2022] [Indexed: 06/14/2023]
Abstract
Ultrasonic techniques are being developed to detect changes in cancellous bone caused by osteoporosis. The goal of this study was to test the relative in vivo performance of eight backscatter parameters developed over the last several years for ultrasonic bone assessment: apparent integrated backscatter (AIB), frequency slope of apparent backscatter (FSAB), frequency intercept of apparent backscatter (FIAB), normalized mean of the backscatter difference (nMBD), normalized slope of the backscatter difference (nSBD), normalized intercept of the backscatter difference (nIBD), normalized backscatter amplitude ratio (nBAR) and backscatter amplitude decay constant (BADC). Backscatter measurements were performed on the left and right femoral necks of 80 adult volunteers (age = 25 ± 11 y) using an imaging system equipped with a convex array transducer. For comparison, additional ultrasonic measurements were performed at the left and right heel using a commercially available heel-bone ultrasonometer that measured the stiffness index. Six of the eight backscatter parameters (all but nSBD and nIBD) exhibited similar and highly significant (p < 0.000001) left-right correlations (0.51 ≤ R ≤ 0.68), indicating sensitivity to naturally occurring variations in bone tissue. Left-right correlations for the stiffness index measured at the heel (R = 0.75) were not significantly better than those produced by AIB, FSAB and FIAB. The short-term precisions of AIB, nMBD, nBAR and BADC (7.8%-11.7%) were comparable to that of the stiffness index measured with the heel-bone ultrasonometer (7.5%).
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Affiliation(s)
| | | | - Kiera L Downey
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | - Ann M Viano
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | - Doni M Thomas
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | | | - Aubrey J Gray
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | - Will R Newman
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | - Evan N Main
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
| | - Gia Pirro
- Department of Physics, Rhodes College, Memphis, Tennessee, USA
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Cen H, Gong H, Liu H, Jia S, Wu X, Fan Y. A Comparative Study on the Multiscale Mechanical Responses of Human Femoral Neck Between the Young and the Elderly Using Finite Element Method. Front Bioeng Biotechnol 2022; 10:893337. [PMID: 35600894 PMCID: PMC9117745 DOI: 10.3389/fbioe.2022.893337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Femoral neck fracture (FNF) is the most serious bone disease in the elderly population. The multiscale mechanical response is a key to predicting the strength of the femoral neck, assessing the risk of FNF, and exploring the role of mechanosensation and mechanotransmission in bone remodeling, especially in the context of aging bone.Methods: Multiscale finite element (FE) models of the proximal femur for both young and elderly people were developed. The models included organ scale (proximal femur), tissue scale (cortical bone), tissue element scale (osteon), and cell scale [osteocyte lacuna-canalicular network (LCN) and extracellular matrix (ECM), OLCEM]. The mechanical responses of cortical bone and osteocytes in the mid-femoral neck and the differences in mechanical responses between these two scales were investigated.Results: The mechanical responses of cortical bone and osteocyte showed significant differences between the elderly and the young. The minimum principal strains and mean SEDs of cortical bone in the elderly were 2.067–4.708 times and 3.093–14.385 times of the values in the young, respectively; the minimum principal strains and mean SEDs of osteocyte in the elderly were 1.497–3.246 times and 3.044–12 times of the values in the young, respectively; the amplification factors of minimum principal strain in the inferior (Inf), anterior (Ant), and posterior (Post) quadrants in the young were 1.241–1.804 times of the values in the elderly, but the amplification factor of minimum principal strain in the superior (Sup) quadrant was 87.4% of the value in the elderly; the amplification factors of mean SED in the young were 1.124–9.637 times of the values in the elderly.Conclusion: The mass and bone mineral density (BMD) of cortical bone in the femoral neck is closely related to the mechanical response of osteocytes, which provides a new idea for improving cortical bone quality. Perhaps cortical bone quality could be improved by stimulating osteocytes. Quadrantal differences of bone quality in the mid-femoral neck should be considered to improve fracture risk prediction in the future.
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Affiliation(s)
- Haipeng Cen
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - He Gong
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- *Correspondence: He Gong,
| | - Haibo Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shaowei Jia
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xiaodan Wu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- School of Engineering Medicine, Beihang University, Beijing, China
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Abe S, Kouhia R, Nikander R, Narra N, Hyttinen J, Sievänen H. Effect of fall direction on the lower hip fracture risk in athletes with different loading histories: A finite element modeling study in multiple sideways fall configurations. Bone 2022; 158:116351. [PMID: 35131487 DOI: 10.1016/j.bone.2022.116351] [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: 06/11/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022]
Abstract
Physical loading makes bones stronger through structural adaptation. Finding effective modes of exercise to improve proximal femur strength has the potential to decrease hip fracture risk. Previous proximal femur finite element (FE) modeling studies have indicated that the loading history comprising impact exercises is associated with substantially higher fracture load. However, those results were limited only to one specified fall direction. It remains thus unclear whether exercise-induced higher fracture load depends on the fall direction. To address this, using magnetic resonance images of proximal femora from 91 female athletes (mean age 24.7 years with >8 years competitive career) and their 20 non-athletic but physically active controls (mean age 23.7 years), proximal femur FE models were created in 12 different sideways fall configurations. The athletes were divided into five groups by typical loading patterns of their sports: high-impact (H-I: 9 triple- and 10 high-jumpers), odd-impact (O-I: 9 soccer and 10 squash players), high-magnitude (H-M: 17 powerlifters), repetitive-impact (R-I: 18 endurance runners), and repetitive non-impact (R-NI: 18 swimmers). Compared to the controls, the FE models showed that the H-I and R-I groups had significantly (p < 0.05) higher fracture loads, 11-17% and 22-28% respectively, in all fall directions while the O-I group had significantly 10-11% higher fracture loads in four fall directions. The H-M and R-NI groups did not show significant benefit in any direction. Also, the analyses of the minimum fall strength (MFS) among these multiple fall configurations confirmed significantly 15%, 11%, and 14% higher MFSs in these impact groups, respectively, compared to the controls. These results suggest that the lower hip fracture risk indicated by higher fracture loads in athletes engaged in high impact or repetitive impact sports is independent of fall direction whereas the lower fracture risk attributed to odd-impact exercise is more modest and specific to the fall direction. Moreover, in concordance with the literature, the present study also confirmed that the fracture risk increases if the impact is imposed on the more posterolateral aspect of the hip. The present results highlight the importance of engaging in the impact exercises to prevent hip fractures and call for retrospective studies to investigate whether specific impact exercise history in adolescence and young adulthood is also associated with lower incidence of hip fractures in later life.
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Affiliation(s)
- Shinya Abe
- Structural Mechanics, Faculty of Built Environment, Tampere University, Tampere, Finland.
| | - Reijo Kouhia
- Structural Mechanics, Faculty of Built Environment, Tampere University, Tampere, Finland
| | - Riku Nikander
- Gerontology Research Center, Faculty of Sports Sciences, University of Jyväskylä, Jyväskylä, Finland; Central Hospital of Central Finland, Jyväskylä, Finland
| | - Nathaniel Narra
- BioMediTech Unit, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jari Hyttinen
- BioMediTech Unit, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
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11
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Hong N, Burm SW, Treece G, Ye Kim J, Hwan Kim M, Lee S, Shin S, Rhee Y. Protective effect of bisphosphonate on the cortical bone at key locations of the femur in aromatase inhibitor-associated bone loss: A three-dimensional cortical bone mapping study. J Bone Oncol 2022; 32:100409. [PMID: 35024328 PMCID: PMC8728402 DOI: 10.1016/j.jbo.2021.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022] Open
Abstract
Aromatase inhibitor use was associated with cortical bone loss in the hip. Bisphosphonate protected hip cortical bone against aromatase inhibitor use. The effect was prominent at the superior femoral neck and greater trochanter.
Aromatase inhibitor treatment in breast cancer is associated with accelerated bone loss and an increased risk of fracture. Bisphosphonates (BPs) are the mainstay treatment of aromatase inhibitor-associated bone loss (AIBL), which might improve femoral bone at key locations prone to fracture. To test this hypothesis, we performed three-dimensional cortical bone mapping based on quantitative computed tomography (QCT) scans in postmenopausal women with early breast cancer who were receiving aromatase inhibitors. Data of subjects who had both baseline and at least one follow-up QCT at Severance Hospital (South Korea) between 2005 and 2015 were analyzed (BP users, n = 93; BP non-users, n = 203). After exclusion of BP users with low medication persistence (proportion of days covered: <50%), BP users and non-users were 1:1 matched (n = 54 for each group) in terms of age, lumbar spine volumetric bone mineral density (LSvBMD), femoral neck areal BMD (FNaBMD), and total hip areal BMD (THaBMD). During a median follow-up of 2.1 years, BP use attenuated bone loss in LSvBMD (+7.2% vs. −3.8%, p < 0.001), FNaBMD (+1.3% vs. −2.7%, p < 0.001), and THaBMD (-0.3% vs. −2.5%, p = 0.024). BP had a protective effect on cortical parameters of femoral bone: estimated cortical thickness (CTh) (+3.3% vs. + 0.1%, p = 0.007) and cortical mass surface density (CMSD, cortical mass per unit surface area was calculated by multiplying cortical BMD with CTh) (+3.4% vs. −0.3%, p < 0.001). CMSD increased by up to 15% at key locations such as the superior part of the femoral neck and greater trochanter. BP prevented the thinning of average CTh of the femoral neck (-1.4% vs. −6.1%, p < 0.001), particularly at the superior anterior quadrant of femoral neck (absolute difference: +12.8% point vs. non-users). Compared to BP non-users, BP users had improved cross-sectional moment of inertia (+4.4% vs. −0.7%, p = 0.001) and less increase in buckling ratio (+1.3% vs. + 7.5%, p < 0.001). In summary, BP use prevented cortical bone deficits observed in AIBL at key locations of the proximal femur.
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Affiliation(s)
- Namki Hong
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seung Won Burm
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Graham Treece
- Department of Engineering, University of Cambridge, Trumpington St, Cambridge CB2 1PZ, UK
| | - Jee Ye Kim
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Min Hwan Kim
- Division of Oncology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Seunghyun Lee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Sungjae Shin
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Yumie Rhee
- Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
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12
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Park SY, Ha HI, Lee SM, Lee IJ, Lim HK. Comparison of diagnostic accuracy of 2D and 3D measurements to determine opportunistic screening of osteoporosis using the proximal femur on abdomen-pelvic CT. PLoS One 2022; 17:e0262025. [PMID: 34982780 PMCID: PMC8726491 DOI: 10.1371/journal.pone.0262025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 12/15/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To compare the osteoporosis-predicting ability of computed tomography (CT) indexes in abdomen-pelvic CT using the proximal femur and the reliability of measurements in two- and three-dimensional analyses. METHODS Four hundred thirty female patients (age range, 50-96 years) who underwent dual-energy X-ray absorptiometry and abdominal-pelvic CT within 1 month were retrospectively selected. The volumes of interest (VOIs) from the femoral head to the lesser trochanter and the femoral neck were expressed as 3DFemur. Round regions of interest (ROIs) of image plane drawn over the femoral neck touching the outer cortex were determined as 2Dcoronal. In HU histogram analysis (HUHA), the percentages of HU histogram ranges related to the ROI or VOI were classified as HUHAFat (<0 HU) and HUHABone (126 HU≤). Diagnostic performance, correlation analysis and measurement reliability were analyzed by receiver operating characteristic curves, correlation coefficient and interobserver correlation coefficient (ICC), respectively. RESULTS AUCs of each HUHA and mean-HU measurement on 2D-ROI and 3D-VOI were 0.94 or higher (P < 0.001). Both 3DFemur-Mean-HU and 3DFemur-HUHABone showed the highest AUC (0.96). The cut-off value of 3DFemur-Mean-HU was 231HU or less, (sensitivity: 94.8%; specificity: 85.0%; correlation coefficient: -0.65; P <0.001) for diagnosis of osteoporosis. There was no superiority between AUCs in 2D-ROI and 3D-VOI measurements (P > 0.05). Reliability of the 3D-VOI measurement showed perfect agreement (ICC ≥ 0.94), and 2D-ROI showed moderate to good agreement (ICC range: 0.63~0.84). CONCLUSIONS CT indexes on 3D-VOI for predicting femoral osteoporosis showed similar diagnostic accuracy with better reproducibility of measurement, compared with 2D-ROI.
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Affiliation(s)
- Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - In Jae Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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13
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Abraham AG, Sun J, Sharma A, Yin MT, Brown JK, Demehri S, Garza J, Shah JG, Palella FJ, Kingsley L, Jamieson BD, Althoff KN, Brown TT. The combined effects of age and HIV on the anatomic distribution of cortical and cancellous bone in the femoral neck among men and women. AIDS 2021; 35:2513-2522. [PMID: 34482349 PMCID: PMC8649032 DOI: 10.1097/qad.0000000000003061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate HIV-related and age-related differences in hip bone structure in men and women. DESIGN Cross sectional study of bone structure and HIV serostatus. METHODS We used Quantitative Computed Tomography (QCT) data from the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS) to examine cortical thickness (CT) and cortical (CBMD), trabecular (TBMD), and integral (IBMD) bone mineral density across anatomic quadrants of the femoral neck in older adult MSM and women with (PWH) and without (PWOH) HIV infection. The percentage difference (%diff) in the means for CT and BMD overall and by quadrant between PWH and PWOH were estimated. RESULTS Among 322 MSM (median age 60 years) with bone measures, distributions were similar between HIV serostatus groups with %diff in the quadrant means ranging from -7 to -1% for CT and from -1 to 4% for BMD, and overall lower hip cortical thickness than expected. In contrast, in 113 women (median age 51 years), PWH had lower CT, IBMD and TBMD consistently across all quadrants, with differences ranging from -10 to -20% for CT, -6 to -11% for IBMD and -3 to -6% for TBMD. Estimates reached statistical significance in superoanterior quadrant for CT and IBMD and inferoposterior for CT. CONCLUSION Among women, PWH appear to have a thinner cortex and less dense integral bone compared with PWOH, particularly in the superior quadrants whereas MSM overall had a thinner than expected hip cortex.
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Affiliation(s)
- Alison G Abraham
- Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Jing Sun
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Michael T Yin
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Shadpour Demehri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joshua Garza
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jayesh G Shah
- Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence Kingsley
- Infectious Diseases and Microbiology Department, University of Pittsburgh, Pennsylvania
| | - Beth D Jamieson
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Keri N Althoff
- Department of Epidemiology, The Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Todd T Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Fuchs RK, Carballido-Gamio J, Keyak JH, Kersh ME, Warden SJ. Physical activity induced adaptation can increase proximal femur strength under loading from a fall onto the greater trochanter. Bone 2021; 152:116090. [PMID: 34175500 PMCID: PMC8316435 DOI: 10.1016/j.bone.2021.116090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022]
Abstract
Physical activity enhances proximal femur bone mass, but it remains unclear whether the benefits translate into an enhanced ability to resist fracture related loading. We recently used baseball pitchers as a within-subject controlled model to demonstrate physical activity induced proximal femur adaptation in regions associated with weight bearing and increased strength under single-leg stance loading. However, there was no measurable benefit to resisting common injurious loading (e.g. a fall onto the greater trochanter). A lack of power and a small physical activity effect size may have contributed to the latter null finding. Softball pitchers represent an alternative within-subject controlled model to explore adaptation of the proximal femur to physical activity, exhibiting greater dominant-to-nondominant (D-to-ND) leg differences than baseball pitchers. The current study used quantitative computed tomography, statistical parametric mapping, and subject-specific finite element (FE) modeling to explore adaptation of the proximal femur to physical activity in female softball pitchers (n = 25). Female cross-country runners (n = 15) were included as symmetrically loaded controls, showing very limited D-to-ND leg differences. Softball pitchers had D-to-ND leg differences in proximal femur, femoral neck, and trochanteric volumetric bone mineral density and content, and femoral neck volume. Voxel-based morphometry analyses and cortical bone mapping showed D-to-ND leg differences within a large region connecting the superior femoral head, inferior femoral neck and medial intertrochanteric region, and within the greater trochanter. FE modeling revealed pitchers had 19.4% (95%CI, 15.0 to 23.9%) and 4.9% (95%CI, 1.7 to 8.2%) D-to-ND leg differences in predicted ultimate strength under single-leg stance loading and a fall onto the greater trochanter, respectively. These data affirm the spatial and strength adaptation of the proximal femur to weight bearing directed loading and demonstrate that the changes can also have benefits, albeit smaller, on resisting loads associated with a sideways fall onto the greater trochanter.
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Affiliation(s)
- Robyn K Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Joyce H Keyak
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States of America; Department of Mechanical and Aerospace Engineering, University of California, Irvine, Irvine, CA, United States of America; Department of Biomedical Engineering, University of California, Irvine, Irvine, CA, United States of America.
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States of America.
| | - Stuart J Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN, United States of America; Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, United States of America; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
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15
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Khoo BCC, Wang L, Lewis JR, Brown K, Cheng X, Prince RL. Structural Factors Associated With Femoral Neck Fractures and its Prediction in Chinese Males. J Clin Densitom 2021; 24:597-602. [PMID: 33500164 DOI: 10.1016/j.jocd.2021.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022]
Abstract
We have recently proposed a new approach to evaluate 2D femoral neck (FN) structure, named the Minimal Model (MM), that comprised FN areal bone mineral density (FNaBMD) and FNWidth and 2 new internal structural measures; (1) the standard deviation of normalized mineral mass projection profile distribution (FNSigma), and (2) the displacement between center-of-mineral mass and geometric center of mineral mass projection profile (FNDelta). The contralateral hip of 67 FN fracture Chinese male patients had a QCT scan shortly after fracture and was compared to 156 community participants without hip fracture. The QCT scans were analyzed using Mindways software to enable DXA-equivalent 2D images to be obtained; MM variables were calculated from these images. In FN fracture and nonfracture participants, the 4 MM variables as well as age, weight and height were compared. Compared to nonfracture, fracture participants were older, weighed less and were taller. After adjustment for these differences FN fracture participants compared to nonfracture had mean ± SD lower FNaBMD 0.54 ± 0.11 vs 0.70 ± 0.11 g/cm2 (p < 0.001); larger FNSigma 1.05 ± 0.11 vs 0.98 ± 0.10 cm (p < 0.001); larger FNDelta 0.43 ± 0.09 vs 0.33 ± 0.09 cm (p < 0.001), however FNWidth did not differ 2.96 ± 0.35 vs 2.92 ± 0.34 cm. All variables except FNaBMD and FNWidth were correlated; however logistic regression identified increased age and height, reduced FNaBMD and increased FNSigma as independent contributors to differentiating participants with FN fracture from nonfracture. Area under ROC analysis identified significant improvement in discrimination with addition of FNSigma to the base model of Age and FNaBMD (C statistic 0.88 and 0.91, p = 0.019). These analyses identified important internal structural information available from 2D DXA imaging that contributes to discrimination of FN fracture in addition to low bone mass. This analytical approach may contribute to improved clinical FN fracture prediction, extending value of widely available DXA technology.
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Affiliation(s)
- Benjamin Cheng Choon Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; Medical School, University of Western Australia, Nedlands, Australia.
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Joshua Richard Lewis
- Medical School, University of Western Australia, Nedlands, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | | | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
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16
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Sharma A, Hoover DR, Shi Q, Tien PC, Weber KM, Shah JG, Yin MT. Human Immunodeficiency Virus (HIV) and Menopause Are Independently Associated With Lower Bone Mineral Density: Results From the Women's Interagency HIV Study. Clin Infect Dis 2021; 75:65-72. [PMID: 34595517 PMCID: PMC9402636 DOI: 10.1093/cid/ciab874] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND We previously reported lower bone mineral density (BMD) among premenopausal women with HIV (WWH) compared to women without HIV (HIV-). Rate of bone loss may be even greater for WWH during the menopausal transition. METHODS Pre-, peri- and postmenopausal women in the Women\'s Interagency HIV Study (WIHS) underwent whole body DXA and central quantitative computed tomography to measure areal BMD (aBMD) and volumetric BMD (vBMD), respectively. Multivariable regression models with covariates associated with low aBMD (T score < -1.0) in univariate analyses (P≤.05) and known risk factors for low BMD assessed contributions of HIV and menopausal stage to the prediction of aBMD. RESULTS Compared to HIV- women, in unadjusted analyses, WWH had 5-9% lower aBMD at the lumbar spine (P=.001), femoral neck (P=.04), total hip (P=.003) and the ultradistal radius (P=.004), and higher osteoporosis prevalence (T score<-2.5) at the ultradistal radius only (13.5% vs 0%, P=.0003). WWH also had lower vBMD at the spine and hip. In fully adjusted models, HIV independently predicted reduced aBMD at the lumbar spine, total hip, femoral neck, and ultradistal radius; menopausal stage remained a significant predictor of lumbar spine and ultradistal radius aBMD. CONCLUSIONS HIV infection and menopausal stage were independent predictors of lower BMD, and had an additive effect on lumbar spine and total hip BMD. Additional research is needed to better understand underlying mechanisms by which HIV impacts BMD as women age and transition through menopause, and develop strategies to mitigate osteoporosis and fracture risk in this growing population.
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Affiliation(s)
- Anjali Sharma
- Correspondence: A. Sharma, Department of Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY 10467 ()
| | - Donald R Hoover
- Department of Statistics, Institute for Health, Health Care Policy and Aging Research, Rutgers University, Piscataway, New Jersey, USA
| | - Qiuhu Shi
- School of Health Sciences and Practice, New York Medical College, Valhalla, New York, USA
| | - Phyllis C Tien
- Department of Medicine, San Francisco VA Medical Center, San Francisco, California, USA,University of California San Francisco, San Francisco, California, USA
| | - Kathleen M Weber
- Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois, USAand
| | - Jayesh G Shah
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Michael T Yin
- Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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17
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Samanci B, Bilgiç B, Gelişin Ö, Tepgeç F, Guven G, Tüfekçioğlu Z, Alaylıoğlu M, Hanagasi HA, Gürvit H, Guerreiro R, Hardy J, Emre M. TREM2 variants as a possible cause of frontotemporal dementia with distinct neuroimaging features. Eur J Neurol 2021; 28:2603-2613. [PMID: 33969597 DOI: 10.1111/ene.14908] [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: 03/16/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Nasu-Hakola disease (NHD) is a rare, autosomal recessive disorder characterized by skeletal and neurological symptoms. Behavioral symptoms with cognitive impairment may mimic the behavioral variant of frontotemporal dementia (bvFTD) and other early-onset dementias. Our patients were analyzed and the literature was reviewed to delineate neurological and neuroimaging findings suggestive of NHD. METHOD Fourteen patients carrying a pathogenic mutation in the TREM2 gene were found in our database. Demographic, clinical, laboratory and radiological data were retrieved and analyzed. RESULTS The presenting clinical picture was behavioral changes with cognitive decline resembling bvFTD in all patients. The mean age was 37.1 ± 4.97 years and the mean duration of the disease was 8.9 ± 3.51 years. Only two patients had typical bone cysts. Seven patients had bilateral calcification of the basal ganglia in computed tomography of the brain. Magnetic resonance imaging of the brain revealed severe atrophy of the corpus callosum, enlargement of the ventricles, atrophy of the caudate nuclei and periventricular white matter changes in all patients. Symmetrical global atrophy of the brain mainly affecting frontoparietal and lateral temporal regions were observed in all cases, and 13 patients had atrophy of the hippocampus. Cerebrospinal fluid examination of 10 patients showed elevated protein levels in six and the presence of oligoclonal bands in four patients. CONCLUSION A combination of white matter changes, enlarged ventricles, atrophy of the caudate nuclei and thinning of the corpus callosum in magnetic resonance imaging strongly suggests NHD in patients with FTD syndrome. Molecular genetic analysis should be performed in suspected cases, and families should receive genetic counseling.
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Affiliation(s)
- Bedia Samanci
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Başar Bilgiç
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Özlem Gelişin
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatih Tepgeç
- Department of Medical Genetics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gamze Guven
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Tüfekçioğlu
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Merve Alaylıoğlu
- Department of Medical Biology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hasmet A Hanagasi
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hakan Gürvit
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Rita Guerreiro
- Center for Neurodegenerative Science, Van Andel Institute, Grand Rapids, MI, USA
| | - John Hardy
- Department of Neurodegenerative Disorders, Institute of Neurology, University College London, London, UK
| | - Murat Emre
- Behavioral Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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18
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Kawamura T, Minehara H, Tazawa R, Matsuura T, Sakai R, Takaso M. Biomechanical Evaluation of Extramedullary Versus Intramedullary Reduction in Unstable Femoral Trochanteric Fractures. Geriatr Orthop Surg Rehabil 2021; 12:2151459321998611. [PMID: 33717634 PMCID: PMC7917859 DOI: 10.1177/2151459321998611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 01/27/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: The failure rate of operations involving the cephalomedullary nail technique for unstable femoral trochanteric fractures is 3-12%. Changing the reduction strategy may improve the stability. This study aimed to confirm whether reducing the proximal fragment with the medial calcar contact, as opposed to utilizing an intramedullary reduction, would improve the stability of such fractures. Materials and Methods: The unstable femoral trochanteric fracture model was created with fixation by cephalomedullary nails in 22 imitation bones. The 2 reduction patterns were as follows: one was with the proximal head-neck fragment external to the distal bone in the frontal plane and anterior in the sagittal plane as “Extramedullary,” while the other was the opposite reduction position, that is, bone in the frontal plane and sagittal plane as “Intramedullary.” We evaluated the tip-apex distance, compression stiffness, change in femoral neck-shaft angle, amount of blade telescoping, and diameter of the distal screw hole after the compression test. Statistical analysis was conducted using the Mann-Whitney U test. Results: No significant differences were seen in compression stiffness (p = 0.804) and femoral neck-shaft angle change (p = 0.644). Although the “Extramedullary” tip-apex distance was larger than the “Intramedullary” distance (p = 0.001), it indicated clinically acceptable lengths. The amount of blade telescoping and the distal screw hole diameter were significantly larger in “Intramedullary” than in “Extramedullary” (p < 0.001, p = 0.019, respectively). Our results showed that “Intramedullary” had significantly larger blade telescoping and distal screw hole diameters than “Extramedullary,” and contrary to our hypothesis, no significant differences were seen in compression stiffness and femoral neck-shaft angle change. Conclusions: As opposed to the “Intramedullary” reduction pattern, the biomechanical properties of the “Extramedullary” reduction pattern improved stability during testing and decreased sliding.
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Affiliation(s)
- Tadashi Kawamura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Hiroaki Minehara
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Ryo Tazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Terumasa Matsuura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Rina Sakai
- Department of Medical Engineering and Technology, Kitasato University, Minami-ku, Sagamihara, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, Minami-ku, Sagamihara, Kanagawa, Japan
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19
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Lee HW, Ha HI, Park SY, Lim HK. Reliability of 3D image analysis and influence of contrast medium administration on measurement of Hounsfield unit values of the proximal femur. PLoS One 2020; 15:e0241012. [PMID: 33085702 PMCID: PMC7577441 DOI: 10.1371/journal.pone.0241012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the reliability of 3D image analysis and the effect of an iodine contrast agent on the computed tomography (CT) Hounsfield unit (HU) values of the proximal femur. MATERIALS AND METHODS Fifty female patients (mean age, 61.3 years; age range, 50-79 years) who underwent both pre- and post-enhancement abdominopelvic CT scans were included in this retrospective study. Whole 3D volumes of the left proximal femur from the head to the lesser trochanter were extracted using the regional growth technique with commercial 3D software. Total volume, mean HU, and HU histogram analysis (HUHA) values of the extracted femur were calculated. HUHA distribution was classified into HUHAfat for the assumed fatty marrow (percentage of negative HU values) and HUHAdense-bone (percentage of HU values ≥ 126 HU). Reliability was assessed by calculating intra- and interobserver correlation coefficients (ICCs) and by drawing Bland-Altman plots. The effect of contrast medium administration was evaluated by the paired t-test. RESULTS All intra- and interobserver ICCs of 3D volume measurements showed excellent reproducibility (all ICCs > 0.90). On Bland-Altman analysis of two observers' 3D volume measurements, the differences in the mean total volume, HUHAfat, HUHAdense-bone, and mean HU were 2.4 cm3, 0.17%, 0.6%, and 1.9 HU, respectively. The mean difference in HU after contrast agent administration (-2.2 HU) was not significant (P = 0.27). The mean difference in HUHAfat and HUHAdense-bone after contrast agent administration were -1.1% and -2.2%, respectively, on the Bland-Altman plot. HUHAfat and HUHAdense-bone showed significant differences (P < 0.05). The 95% limits of agreement for HUHAfat, HUHAdense-bone, and mean HU were -3.6% to 1.3%, -6.5% to 2.1%, and -30.0 to 25.5 HU, respectively. CONCLUSION Image analysis based on 3D volume measurement of the proximal femur showed excellent reliability, with the contrast agent administration showing negligible influence on the mean HU.
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Affiliation(s)
- Hye-Won Lee
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hong Il Ha
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - Sun-Young Park
- Department of Radiology, Hallym University Sacred Heart Hospital, Anyang-si, Gyeonggi-do, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
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20
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Su Y, Wang L, Liu X, Yang M, Yi C, Liu Y, Huang P, Guo Z, Yu A, Cheng X, Wu X, Blake GM, Engelke K. Lack of periosteal apposition in the head and neck of femur after menopause in Chinese women with high risk for hip fractures - A cross-sectional study with QCT. Bone 2020; 139:115545. [PMID: 32730940 DOI: 10.1016/j.bone.2020.115545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
In elderly subjects and in particular in those with osteoporosis the evidence on age related volume changes of the hip is still very limited. Even less is known about bone changes of the femoral head. The aim of this study is to explore associations of bone size of the femoral head and neck with age in postmenopausal women with very high risk of hip fracture and to investigate associations of femoral head and neck bone mineral density. MIAF (medical image analysis framework)-Femur was used for the analysis of CT datasets from 319 females with acute hip fractures age 50 to 98. Integral BMD and volume of the head and neck were assessed. The femoral head was divided into four quadrants to address differential vBMD and volume responses of its superior, inferior, posterior and anterior parts. Areal BMD (aBMD) of femoral neck was also obtained. In this population of postmenopausal women we did not observe age-related changes in bone volume of the femoral head or neck between ages 50 and 98 years. Integral vBMD in the head in the 90-98 year group was 48.0 mg/cm3 lower than that in 50-59 year group, which accounts for nearly 30% decrease in vBMD with 40 years increase. Age-related vBMD changes in the head quadrants were similar to that in total. With age, the trend line correlation coefficients for vBMD in quadrants were relatively small, but significant (p < 0.001) for all. The femoral head integral vBMD correlates well with neck vBMD and FN aBMD. FN aBMD explained 45% of head integral vBMD variance (p < 0.0001). Elderly women had relative preservation of femoral head and neck bone volume from 50 yrs. over four decades but markedly lower integral vBMD of proximal femur. The findings of our study call in question about the concept of bone expansion with aging even in elderly age.
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Affiliation(s)
- Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Xiaoyan Liu
- Department of Internal Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Yi
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Pengju Huang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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21
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Gastaldi D, Baleani M, Fognani R, Airaghi F, Bonanni L, Vena P. An experimental procedure to perform mechanical characterization of small-sized bone specimens from thin femoral cortical wall. J Mech Behav Biomed Mater 2020; 112:104046. [PMID: 32911224 DOI: 10.1016/j.jmbbm.2020.104046] [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: 02/12/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
The cortical shell of the femoral neck plays a role in determining the overall neck strength. However, there is a lack of knowledge about the mechanical properties of cortical tissue of the femoral neck due to challenges in implementing accurate testing protocols for the thin shell. Indeed, mechanical properties are commonly derived from mechanical testing performed on tissue samples extracted from the femoral diaphysis, i.e. assuming tissue homogeneity along the femur. The aim of this work was to set up a reliable methodology to determine mechanical properties of bone samples extracted from thin cortical shell of the femoral neck. A three-point bending test was used to determine elastic and post-elastic properties of cortical bone samples extracted from the inferior and superior femoral neck. An optical system was used to monitor the sample deflection. Accuracy was preliminarily evaluated by determining the elastic modulus of an aluminium alloy. A good intra- and inter-sample variability was found on determining aluminium elastic modulus: 1.6% and 3.6%, respectively. Additionally, aluminium elastic modulus value was underestimated by less than 1%. A pilot trial was performed on a human femoral neck to assess the procedure feasibility. A total of 22 samples were extracted from the inferior and superior femoral neck and successfully tested. Preliminary results suggest that mechanical properties of cortical bone tissue extracted from human femoral neck might be side dependent, the superior tissue seems to exhibit better mechanical properties than the inferior one, at least in terms of yield stress and maximum strain. This supposedly different mechanical competence must be further investigated. The proposed procedure makes it feasible to carry out such studies.
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Affiliation(s)
- Dario Gastaldi
- Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Laboratory of Biological Structure Mechanics (LaBS) - Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
| | - Massimiliano Baleani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy.
| | - Roberta Fognani
- IRCCS Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy.
| | - Fulvio Airaghi
- Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Laboratory of Biological Structure Mechanics (LaBS) - Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
| | - Livio Bonanni
- Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Laboratory of Biological Structure Mechanics (LaBS) - Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
| | - Pasquale Vena
- Department of Chemistry, Materials and Chemical Engineering Giulio Natta, Laboratory of Biological Structure Mechanics (LaBS) - Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milano, Italy.
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22
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Khoo BCC, Wang L, Lewis JR, Brown K, Cheng X, Prince RL. Anatomical factors associated with femoral neck fractures of elderly Beijing women. Arch Osteoporos 2020; 15:112. [PMID: 32700117 DOI: 10.1007/s11657-020-00780-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Analyses using newly developed structural measures of minimal model (aBMD, W, Sigma, Delta) in a Chinese female age-matched cohort of femoral neck fracture patients and non-fracture community controls resulted in improved fracture prediction, suggesting the usefulness of new variables, extending the value of widely available DXA technology. INTRODUCTION We have developed a new approach to evaluate 2D femoral neck (FN) structure, the minimal model (MM). This model includes FNaBMD and FNWidth with two new internal structural measures, the standard deviation of normalized mineral mass projection profile distribution (FNSigma) and the displacement between center of mineral (CoM) mass and geometric center of mineral mass projection profile (FNDelta). METHODS Differences in these four structural measurements together with age, weight, and height were compared in the contralateral hip of 285 FN fracture Chinese female patients and 261 age-matched community controls. Structural variables were calculated from DXA equivalent 2D images obtained from QCT scans analyzed using Mindways Software. RESULTS Review of FN scanned profiles of fracture patients and controls identified substantial reduction in mineral mass in the superior segment of FN. Fracture participants were taller, weighed less, and had lower FNaBMD and larger FNDelta, due to a larger inferior displacement in the CoM, consistent with greater reduction in superior segment bone. Logistic regression identified increased height, reduced FNaBMD, increased FNDelta, and reduced FNSigma per SD as significant independent contributors to differentiating fracture from non-fracture. Area under ROC analysis identified significant improvement in discrimination with the addition of FNDelta and FNSigma to the model including age, height, weight, and FNaBMD (C statistic 0.87 and 0.84 respectively). CONCLUSIONS These data extend previous data that identified the benefit of 2D FN internal structural information in discriminating those at increased future fracture risk from recently fractured individuals. These data support continuing investigation of MM analysis as a straightforward analytical approach adding value to DXA hip aBMD in predicting fracture risk.
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Affiliation(s)
- Benjamin Cheng Choon Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia. .,School of Biomedical Sciences, University of Western Australia, Nedlands, WA, Australia.
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Joshua Richard Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, University of Western Australia, Nedlands, Australia
| | | | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Richard Lewis Prince
- Medical School, University of Western Australia, Nedlands, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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23
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Ricklan SJ, Decrausaz SL, Wells JCK, Stock JT. Obstetric dimensions of the female pelvis are less integrated than locomotor dimensions and show protective scaling patterns: Implications for the obstetrical dilemma. Am J Hum Biol 2020; 33:e23451. [PMID: 32567787 DOI: 10.1002/ajhb.23451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The "obstetrical dilemma" hypothesis assumes that the modern human female pelvis serves two discrete functions: obstetrics and locomotion. We investigate whether these differing functions create observable patterns of morphological covariation and whether those patterns differ by height, weight, and age. This allows evaluation of evidence for canalization and phenotypic plasticity relevant to obstetric and locomotor function among a living female population. METHODS Landmarks (N = 86) were collected and inter-landmark distances were calculated (N = 36) on the pelvis and proximal femur of CT scans of living women aged 20 to 90 years (M = 93) receiving a routine CT scan. Partial least squares and relative SD of eigenvalues analyses were used to evaluate integration overall and within locomotor and obstetric modules, respectively. Ordinary Least Squared regression was used to evaluate scaling relationships between inter-landmark distances and height, weight, and age. RESULTS The obstetric pelvis was significantly less internally integrated than the locomotor pelvis. Many obstetric measurements were constrained in absolute terms relative to height; shorter women had relatively larger birth canal dimensions, and several key obstetric dimensions showed relative freedom from height. Lower weight women had some relatively larger obstetric and locomotor dimensions. Regarding age, younger women showed a few relatively larger outlet dimensions. CONCLUSIONS This study suggests that the obstetric pelvis and the locomotor pelvis function are morphologically distinct, with the obstetric pelvis showing relatively greater flexibility. These relationships between relative constraints support the hypothesis that the modern female pelvis shows evidence of both canalization and phenotypic plasticity in obstetric and locomotor structures.
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Affiliation(s)
- Sarah J Ricklan
- Department of Archaeology, University of Cambridge, Cambridge, UK.,New York University Grossman School of Medicine, New York, New York, USA
| | - Sarah-Louise Decrausaz
- Department of Archaeology, University of Cambridge, Cambridge, UK.,Department of Anthropology, University of Victoria, Victoria, British Columbia, Canada
| | - Jonathan C K Wells
- Childhood Nutrition Research Centre, Population, Policy, and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Jay T Stock
- Department of Archaeology, University of Cambridge, Cambridge, UK.,Department of Anthropology, Western University, London, Ontario, Canada.,Department of Archaeology, Max Planck Centre for the Science of Human History, Jena, Germany
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24
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Seong YJ, Shin JK, Park WR. Early detected femoral neck insufficiency fracture in a patient treated with long-term bisphosphonate therapy for osteoporosis: A need for MRI. Int J Surg Case Rep 2020; 70:213-215. [PMID: 32417741 PMCID: PMC7229416 DOI: 10.1016/j.ijscr.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 12/03/2022] Open
Abstract
If long term bisphosphonate users complain of non-traumatic hip pain, medical examination should be taken with care. Even though no fractures are identified in their radiographs, it is recommended to check an MRI. If the fracture can be identified before cortical breakage, the treatment success rate for the fracture will be high.
Introduction Atypical femoral fracture is an uncommon complication of prolonged use of bisphosphonates, mainly occurring in the femoral shaft. We report a case of an atraumatic insufficiency fracture of femoral neck after four years of treatment with a bisphosphonate. Presentation of case A 71-year-old female presented with history of pain on Lt. hip and difficulty in walking. Although there was no fracture on the radiographs, diagnosis could be made early using magnetic resonance imaging (MRI) scans. She was treated by internal fixation using cannulated screws. Discussion Because bisphosphonate prevents bone healing and remodeling, it is difficult to accomplish the bony union despite of proper treatment in patients who have fractured after long-term use of bisphosphonate. Conclusion A high suspicion index and early diagnosis through the use of MRI are essential for the successful treatment of these fractures.
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Affiliation(s)
- Yoon Jae Seong
- Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea
| | - Jong Ki Shin
- Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea
| | - Won Ro Park
- Department of Orthopaedic Surgery, Dongeui Medical Center, 62 Yangjung-ro, Jin-gu, Busan, 47227, South Korea.
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25
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Warden SJ, Carballido-Gamio J, Weatherholt AM, Keyak JH, Yan C, Kersh ME, Lang TF, Fuchs RK. Heterogeneous Spatial and Strength Adaptation of the Proximal Femur to Physical Activity: A Within-Subject Controlled Cross-Sectional Study. J Bone Miner Res 2020; 35:681-690. [PMID: 31826314 PMCID: PMC7145739 DOI: 10.1002/jbmr.3939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 11/06/2019] [Accepted: 12/03/2019] [Indexed: 11/10/2022]
Abstract
Physical activity (PA) enhances proximal femur bone mass, as assessed using projectional imaging techniques. However, these techniques average data over large volumes, obscuring spatially heterogeneous adaptations. The current study used quantitative computed tomography, statistical parameter mapping, and subject-specific finite element (FE) modeling to explore spatial adaptation of the proximal femur to PA. In particular, we were interested in adaptation occurring at the superior femoral neck and improving strength under loading from a fall onto the greater trochanter. High/long jump athletes (n = 16) and baseball pitchers (n = 16) were utilized as within-subject controlled models as they preferentially load their take-off leg and leg contralateral to their throwing arm, respectively. Controls (n = 15) were included but did not show any dominant-to-nondominant (D-to-ND) leg differences. Jumping athletes showed some D-to-ND leg differences but less than pitchers. Pitchers had 5.8% (95% confidence interval [CI] 3.9%-7.6%) D-to-ND leg differences in total hip volumetric bone mineral density (vBMD), with increased vBMD in the cortical compartment of the femoral neck and trochanteric cortical and trabecular compartments. Voxel-based morphometry analyses and cortical bone mapping showed pitchers had D-to-ND leg differences within the regions of the primary compressive trabeculae, inferior femoral neck, and greater trochanter but not the superior femoral neck. FE modeling revealed pitchers had 4.1% (95% CI 1.4%-6.7%) D-to-ND leg differences in ultimate strength under single-leg stance loading but no differences in ultimate strength to a fall onto the greater trochanter. These data indicate the asymmetrical loading associated with baseball pitching induces proximal femur adaptation in regions associated with weight bearing and muscle contractile forces and increases strength under single-leg stance loading. However, there were no benefits evident at the superior femoral neck and no measurable improvement in ultimate strength to common injurious loading during aging (ie, fall onto the greater trochanter), raising questions as to how to better target these variables with PA. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Stuart J. Warden
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alyssa M. Weatherholt
- Department of Kinesiology and Sport, Pott College of Science, Engineering, and Education, University of Southern Indiana, Evansville, IN
| | - Joyce H. Keyak
- Departments of Radiological Sciences, Mechanical and Aerospace Engineering, and Biomedical Engineering, University of California Irvine, Irvine CA
| | - Chenxi Yan
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Mariana E. Kersh
- Department of Mechanical Science and Engineering, College of Engineering, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL
| | - Thomas F. Lang
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Robyn K. Fuchs
- Department of Physical Therapy, School of Health and Human Sciences, Indiana University, Indianapolis, IN
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN
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26
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Liu Y, Wang L, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan C, Yan D, Cheng X. CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone. Arch Osteoporos 2020; 15:50. [PMID: 32193671 DOI: 10.1007/s11657-020-00721-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution. PURPOSE Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively. METHODS We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement. RESULT In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm3, 0.9 cm3, 2.5 cm3, and 4.3 cm3 respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm3). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm3, 0.8 cm3, 2.6 cm3, and 4.4 cm3 respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values. CONCLUSION The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.
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Affiliation(s)
- Y Liu
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - L Wang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Su
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - K Brown
- Mindways Software, Austin, 78704, TX, USA
| | - R Yang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Duanmu
- Department of Radiology, The First Affiliated Hospital of USTC South District, Hefei, 230036, China
| | - Z Guo
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - W Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - C Yan
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - D Yan
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - X Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China.
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27
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Mant M, de la Cova C, Ives R, Brickley MB. Perimortem fracture manifestations and mortality after hip fracture in a documented skeletal series. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 27:56-65. [PMID: 31586732 DOI: 10.1016/j.ijpp.2019.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/03/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Unhealed hip fractures are underrepresented in the archaeological record, suggesting that better identification criteria are required. This paper evaluates whether a sample of documented perimortem hip fractures displayed classic perimortem features and which features may facilitate better identification of such fractures in the archaeological record. MATERIALS Ten individuals from the Robert J. Terry Anatomical Skeletal Collection with documented hip fractures and intervals of survival. METHODS We observed the skeletal remains macroscopically and with a Keyence VHX-2000 digital microscope at a range of 5x to 100x magnification. RESULTS 90% of the individuals and 64% of the fragments had identifiable perimortem features; hinging was the most consistent feature. Eburnation was found in two individuals who died 13 days after sustaining a hip fracture. CONCLUSIONS This study underscores the importance of examining fracture margins for evidence of hinging. Eburnation may be added to the list of potential perimortem fracture identification criteria. SIGNIFICANCE Identifying perimortem trauma unequivocally remains challenging. Using collections with documented perimortem fractures aids in determining which criteria are most likely to appear in archaeological human bone. LIMITATIONS The fracture location patterning (70% intertrochanteric) may be the result of sample selection. SUGGESTIONS FOR FUTURE RESEARCH Further intensive comparative investigation with the Hamann-Todd Collection would elucidate patterns further.
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Affiliation(s)
- Madeleine Mant
- Memorial University, Department of Archaeology, St. John's, Newfoundland and Labrador, A1B 3R6, Canada; McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
| | - Carlina de la Cova
- University of South Carolina, Department of Anthropology, Columbia, South Carolina, 29208, USA.
| | - Rachel Ives
- Natural History Museum, Department of Earth Sciences, Cromwell Road, SW7 5BD, London, United Kingdom.
| | - Megan B Brickley
- McMaster University, Department of Anthropology, Hamilton, Ontario, L8S 4L9, Canada.
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28
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Liu GB, Li R, Lu Q, Ma HY, Zhang YX, Quan Q, Liang XZ, Peng J, Lu SB. Three-dimensional distribution of cystic lesions in osteonecrosis of the femoral head. J Orthop Translat 2019; 22:109-115. [PMID: 32440506 PMCID: PMC7231955 DOI: 10.1016/j.jot.2019.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to investigate the location characteristics of cystic lesions in a three-dimensional context and discuss the mechanism of formation. Methods A total of 155 femoral head computed tomography images from 94 patients diagnosed with stage II and III osteonecrosis of the femoral head were retrospectively reviewed. Three-dimensional structures of the femoral head including the cystic lesions and necrotic area were reconstructed. We divided each femoral head into eight regions to observe the positional relationship of the cystic lesions, normal areas, and necrotic areas. Results The regional distribution revealed 14 (13%), 35 (32%), 9 (8%), 25 (23%), 6 (6%), 15 (14%), 4 (4%), and 0 (0%) cystic lesions in regions Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ, respectively. The anteromedial zone, A (Ⅰ + Ⅲ), contained 22% of the lesions, anterolateral zone, B (Ⅱ + Ⅳ), contained 54%, posteromedial zone, C (Ⅴ +Ⅶ), contained 9% of the lesions, and posterolateral zone, D (Ⅵ + Ⅷ), contained 15% of the lesions. Most of the cystic lesions (78%) were located between the normal and necrotic areas; 18% of cystic lesions were in the necrotic area and 4% were in the normal area. Conclusions Cystic lesions most often occur at the junction of the necrotic and normal areas and are most commonly located in the anterolateral femoral head, which is similar to the distribution of the stress concentration region. The translational potential of this article The study showed the location characteristics of cystic lesions in osteonecrosis of femoral head, which suggested that the formation of cystic lesions may be related to stress and could accelerate the collapse of femoral head. The results can support further research on cystic lesions and provide a reference for doctors' treatment strategies for patients with osteonecrosis of femoral head.
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Affiliation(s)
- Guang-Bo Liu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Rui Li
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qiang Lu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hai-Yang Ma
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yu-Xuan Zhang
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qi Quan
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xue-Zhen Liang
- The First Clinical Medical School, Shandong University of Traditional Chinese Medicine, Shandong, 250355, China
| | - Jiang Peng
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
- Corresponding author.
| | - Shi-Bi Lu
- Institute of Orthopedics, Beijing Key Laboratory of Regenerative Medicine in Orthopedics, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Chinese PLA General Hospital, Beijing, 100853, China
- Corresponding author.
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Uemura K, Takao M, Otake Y, Hamada H, Sakai T, Sato Y, Sugano N. The distribution of bone mineral density in the femoral heads of unstable intertrochanteric fractures. J Orthop Surg (Hong Kong) 2019; 26:2309499018778325. [PMID: 29852815 DOI: 10.1177/2309499018778325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Intertrochanteric fractures are usually treated with open reduction and internal fixation, but controversy still remains regarding the proper placement of the lag screw on the anteroposterior view. The stability of the lag screw has been shown to correlate with the bone quality around the screw, but the three-dimensional distribution of the bone mineral density (BMD) in the femoral head has not been studied in detail. Herein, the BMD along the femoral neck axis was measured to clarify the recommended position of the lag screw. METHODS Ten femoral heads acquired from intertrochanteric fractures were evaluated in this study. Each femoral head was scanned with micro computed tomography and the BMD along the femoral neck axis was measured in five regions: center, anterior, posterior, superior, and inferior. The BMD on the anteroposterior view (superior, center, and inferior) and the BMD on the lateral view (anterior, center, and posterior) were compared. RESULTS The BMD of the center region (173.0 ± 50.6 mg/cm3) was significantly higher than that of the inferior region (139.7 ± 50.1 mg/cm3) on the anteroposterior view ( p < 0.01). On the lateral view, the BMD was lower than the center region in the anterior region (165.7 ± 52.8 mg/cm3) and in the posterior region (157.5 ± 42.3 mg/cm3), but the difference was not significant. CONCLUSION The BMD was higher in the center region of the femoral head than in the inferior region. Therefore, lag screws are recommended to be inserted into the center of the femoral head.
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Affiliation(s)
- Keisuke Uemura
- 1 Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masaki Takao
- 1 Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshito Otake
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Hidetoshi Hamada
- 3 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Sakai
- 3 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshinobu Sato
- 2 Graduate School of Information Science, Nara Institute of Science and Technology, Ikoma, Nara, Japan
| | - Nobuhiko Sugano
- 1 Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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30
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Wang X, Das R, Fernandez J. A surrogate mechanostatistical microstructural model to inform whole hip cortical bone remodelling. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3183. [PMID: 30701692 DOI: 10.1002/cnm.3183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/05/2019] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
Multiscale models of bone remodelling which incorporate clinically important features at a wide range of spatial scales are computationally intractable. In addition, there is a large gap in existing bone remodelling literature which deals with Haversian-level cortical bone remodelling behaviour and its effect on whole organ bone strength. In this study, we present an integration between continuum mechanics and surrogate modelling as an efficient circumvention to the problem of intractability, linked with an intricate 3D cortical bone remodelling algorithm which captures realistic microanatomical features at the Haversian level. The surrogate model predicted clear differentiation in long-term bone strength changes in clinically significant cases with extremely high computational efficiency.
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Affiliation(s)
- Xiaoming Wang
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Raj Das
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand
| | - Justin Fernandez
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
- Department of Engineering Science, The University of Auckland, Auckland, New Zealand
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31
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Tasinkevych Y, Falińska K, Lewin PA, Litniewski J. Improving broadband ultrasound attenuation assessment in cancellous bone by mitigating the influence of cortical bone: Phantom and in-vitro study. ULTRASONICS 2019; 94:382-390. [PMID: 30001852 DOI: 10.1016/j.ultras.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 06/08/2023]
Abstract
The purpose of this work was to present a new approach that allows the influence of cortical bone on noninvasive measurement of broadband ultrasound attenuation (BUA) to be corrected. The method, implemented here at 1 MHz makes use of backscattered signal and once refined and clinically confirmed, it would offer an alternative to ionizing radiation based methods, such as DEXA (Dual-energy X-ray absorptiometry), quantitative computed tomography (QCT), radiographic absorptiometry (RA) or single X-ray absorptiometry (SXA), which are clinically approved for assessment of progress of osteoporosis. In addition, as the method employs reflected waves, it might substantially enhance the applicability of BUA - from being suitable to peripheral bones only it would extend this applicability to include such embedded bones as hip and femoral neck. The proposed approach allows the cortical layer parameters used for correction and the corrected value and parameter of the cancellous bone (BUA) to be determined simultaneously from the single (pulse-echo) bone backscattered wave; to the best of the authors' knowledge such approach was not previously reported. The validity of the method was tested using acoustic data obtained from a custom-designed bone-mimicking phantom and a calf femur. The relative error of the attenuation coefficient assessment was determined to be 3.9% and 4.7% for the bone phantom and calf bone specimens, respectively. When the cortical shell influence was not taken into account the corresponding errors were considerably higher 8.3% (artificial bone) and 9.2% (calf femur). As indicated above, once clinically proven, the use of this BUA measurement technique in reflection mode would augment diagnostic power of the attending physician by permitting to include bones, which are not accessible for transmission mode evaluation, e.g. hip, spine, humerus and femoral neck.
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Affiliation(s)
- Yuriy Tasinkevych
- Department of Ultrasound, Institute of Fundamental Technological Research of the Polish Academy of Sciences, Warsaw, Poland.
| | - Katarzyna Falińska
- Department of Ultrasound, Institute of Fundamental Technological Research of the Polish Academy of Sciences, Warsaw, Poland
| | | | - Jerzy Litniewski
- Department of Ultrasound, Institute of Fundamental Technological Research of the Polish Academy of Sciences, Warsaw, Poland
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DeKeyser GJ, Kellam PJ, Haller JM. Locked Plating and Advanced Augmentation Techniques in Osteoporotic Fractures. Orthop Clin North Am 2019; 50:159-169. [PMID: 30850075 DOI: 10.1016/j.ocl.2018.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
"The incidence of osteoporotic fracture is increasing with the aging US population. Because osteoporosis leads to a decrease in bone mineral density with a decrease in both trabecular and cortical bones, osteoporotic fracture presents fixation challenges with standard plate and screw constructs. Locked plating has been developed to create a fixed-angle plate-screw construct that is more resistant to failure in osteoporotic bone. Endosteal replacement, additional plates, and cement augmentation have all been demonstrated to further supplement osteoporotic fracture fixation. Technologies on the horizon to treat osteoporotic fracture include SMV screws, hydroxyapatite-coated implants, and far cortical locking screws."
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Affiliation(s)
- Graham J DeKeyser
- University of Utah, Department of Orthopaedics, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Patrick J Kellam
- University of Utah, Department of Orthopaedics, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Justin M Haller
- University of Utah, Department of Orthopaedics, Orthopaedic Center, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Khoo BCC, Brown K, Lewis JR, Perilli E, Prince RL. Ageing Effects on 3-Dimensional Femoral Neck Cross-Sectional Asymmetry: Implications for Age-Related Bone Fragility in Falling. J Clin Densitom 2019; 22:153-161. [PMID: 30205985 DOI: 10.1016/j.jocd.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/01/2018] [Indexed: 01/27/2023]
Abstract
This paper explores the effects of aging on femoral neck (FN) anatomy in a study of women aged 20-90years in relation to implications for FN fracture propensity in buckling. Five hundred and four participants were scanned by Quantitative Computed Tomography and analyzed using Quantitative Computed Tomography Pro BIT (Mindways). FN cross-section was split through geometric center into superior and inferior sectors. Bone mass, structural measurements, and bone mineral density were analyzed. Buckling ratio was calculated as ratio of buckling radius to cortical thickness. Between 2nd decade and 8th decade, age-related integral bone mass reduction in superior sector was substantially larger than in inferior sector (33% compared to 21%), especially in cortical bone superiorly compared to inferiorly (53% vs 21%; p < 0.001), principally due to reduction in cortical thickness, averaged cortical thickness (56%) with little difference in density. Superior and inferior sector trabecular bone mineral density reduction was similar at 41% and 43% respectively. Differential cortical bone loss in superior sector resulted in a 59% inferior displacement (δ) of center-of-mass from geometric center. Differences in δ and averaged cortical thickness with age accounted for a 151% increase in mean superior buckling ratio from 9 to 23. Analysis confirms significant progressive age-related superior cortical bone loss as the major age effect on FN structure with relative preservation of inferior cortex probably related to maintenance of inferior sector by regular loading as a result of standing and walking. Computation of buckling ratio may allow prediction of fracture propensity in a sideways fall.
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Affiliation(s)
- B C C Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; University of Western Australia, Medical School, Nedlands, WA, Australia
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - J R Lewis
- University of Western Australia, Medical School, Nedlands, WA, Australia; Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - E Perilli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide, SA, Australia
| | - R L Prince
- University of Western Australia, Medical School, Nedlands, WA, Australia; Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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Wang L, Museyko O, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan D, Cheng X, Engelke K. QCT of the femur: Comparison between QCTPro CTXA and MIAF Femur. Bone 2019; 120:262-270. [PMID: 30342226 DOI: 10.1016/j.bone.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
QCT is commonly employed in research studies and clinical trials to measure BMD at the proximal femur. In this study we compared two analysis software options, QCTPro CTXA and MIAF-Femur, using CT scans of the semi-anthropometric European Proximal Femur Phantom (EPFP) and in vivo data from 130 Chinese elderly men and women aged 60-80 years. Integral (Int), cortical (Cort) and trabecular (Trab) vBMD, volume, and BMC of the neck (FN), trochanter (TR), inter-trochanter (IT), and total hip (TH) VOIs were compared. Accuracy was determined in the 5 mm wide central portion of the femoral neck of the EPFP. Nominal values were: cross-sectional area (CSA) 4.9 cm2, cortical thickness (C.Th) 2 mm, CortBMD 723 mg/cm3 and TrabBMD 100 mg/cm3. In MIAF the so-called peeled trabecular VOI was analyzed, which excludes subcortical bone to avoid partial volume artefacts at the endocortical border that artificially increase TrabBMD. For CTXA uncorrected, so called raw cortical values were used for the analysis. QCTPro and MIAF phantom results were: CSA 5.9 cm2 versus 5.1 cm2; C.Th 1.68 mm versus 1.92 mm; CortBMD 578 mg/cm3 versus 569 mg/cm3; and TrabBMD 154 mg/cm3 versus 104 mg/cm3. In vivo correlations (R2) of integral and trabecular bone parameters ranged from 0.63 to 0.96. Bland-Altman analysis for TH and FN TrabBMD showed that lower mean values were associated with higher differences, which means that TrabBMD differences between MIAF and CTXA are larger for osteoporotic than for normal patients, which can be largely explained by the inclusion of subcortical BMD in the trabecular VOI analyzed by CTXA in combination with fixed thresholds used to separate cortical from trabecular bone compartments. Correlations between CTXA corrected CortBMD and MIAF were negative, whereas raw data correlated positively with MIAF measurements for all VOIs questioning the validity of the CTXA corrections. The EPFP results demonstrated higher MIAF accuracy of cortical thickness and TrabBMD. Integral and trabecular bone parameters were highly correlated between CTXA and MIAF. Partial volume artefacts at the endocortical border artificially increased trabecular BMD by CTXA, especially for osteoporosis patients. With respect to volumetric cortical measurements with CTXA, the use raw data is recommended, because corrected data cause a negative correlation with MIAF CortBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China; Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Oleg Museyko
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | | | - Ruopei Yang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangyang Duanmu
- Department of Radiology, Anhui Provincial Hospital, Anhui, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Dept of Medicine 3, University Hospital Erlangen, Germany.
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Hu ZS, Liu XL, Zhang YZ. Comparison of Proximal Femoral Geometry and Risk Factors between Femoral Neck Fractures and Femoral Intertrochanteric Fractures in an Elderly Chinese Population. Chin Med J (Engl) 2019; 131:2524-2530. [PMID: 30381585 PMCID: PMC6213826 DOI: 10.4103/0366-6999.244118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Few studies have investigated the differences in proximal femoral geometry and risk factors between patients with different types of hip fracture, especially in elderly Chinese. This study aimed to assess the differences in proximal femoral geometry parameters between patients with femoral neck fractures and patients with intertrochanteric fractures to provide guidance for individualized customized prosthesis and accurate reconstruction of proximal femurs in elderly Chinese patients. Methods We retrospectively studied the electronic medical records of 198 elderly patients over 65 years of age who were admitted to the orthopedic department with hip fractures between January 2017 and December 2017 in The Third Hospital, Hebei Medical University. Age, fracture site, gender, and proximal femoral geometry parameters (neck shaft angle [NSA], center edge angle [CEA], femoral head diameter [FHD], femoral neck diameter [FND], femoral neck axial length [FNAL], hip axial length [HAL], and femoral shaft diameter [FSD]) were recorded. Student's t-test was used to compare the continuous variables, Chi-square test was used to analyze categorical variables, and multiple logistic stepwise regression analysis was used to evaluate the influencing factors of hip fracture type. Results Statistically significant differences in NSA (137.63 ± 4.56° vs. 132.07 ± 4.17°, t = 1.598, P < 0.001), CEA (37.62 ± 6.77° vs. 43.11 ± 7.09°, t = 5.597, P < 0.001), FND (35.21 ± 3.25 mm vs. 34.09 ± 3.82 mm, t = 2.233, P = 0.027), and FNAL (99.30 ± 7.91 mm vs. 103.58 ± 8.39 mm, t = 3.715, P < 0.001) were found between the femoral neck fracture group and femoral intertrochanteric fracture group. FHD, FND, FSD, HAL, and FNAL were different between sexes (all P < 0.001). The greater NSA was the risk factor for femoral neck fractures (odds ratio [OR]: 0.70, P < 0.001), greater CEA and longer FNAL were risk factors for femoral intertrochanteric fractures (OR: 1.15, 1.17, all P < 0.001), and greater FND was a protective factor for femoral intertrochanteric fractures (OR: 0.74, P < 0.001). Conclusions We demonstrate differences in geometric morphological parameters of the proximal femur in different hip fracture types, as well as an effect of sex. These differences should be considered in the selection of prostheses for fracture internal fixation and hip replacements. These data could help guide the design of individualized customized prostheses and improve the accurate reconstruction of the proximal femur for elderly Chinese hip fracture patients.
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Affiliation(s)
- Zu-Sheng Hu
- Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051, China
| | - Xian-Ling Liu
- Department of Nosocomial Infection, Anqing Hospital, Anhui Medical University, Anqing, Anhui 246003, China
| | - Ying-Ze Zhang
- Department of Orthopaedic Surgery, The Third Hospital, Hebei Medical University; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei 050051; Chinese Academy of Engineering, Beijing 100088, China
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Johannesdottir F, Allaire B, Bouxsein ML. Fracture Prediction by Computed Tomography and Finite Element Analysis: Current and Future Perspectives. Curr Osteoporos Rep 2018; 16:411-422. [PMID: 29846870 DOI: 10.1007/s11914-018-0450-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This review critiques the ability of CT-based methods to predict incident hip and vertebral fractures. RECENT FINDINGS CT-based techniques with concurrent calibration all show strong associations with incident hip and vertebral fracture, predicting hip and vertebral fractures as well as, and sometimes better than, dual-energy X-ray absorptiometry areal biomass density (DXA aBMD). There is growing evidence for use of routine CT scans for bone health assessment. CT-based techniques provide a robust approach for osteoporosis diagnosis and fracture prediction. It remains to be seen if further technical advances will improve fracture prediction compared to DXA aBMD. Future work should include more standardization in CT analyses, establishment of treatment intervention thresholds, and more studies to determine whether routine CT scans can be efficiently used to expand the number of individuals who undergo evaluation for fracture risk.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA.
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Brett Allaire
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN 120, Boston, MA, 02215, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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Abe S, Narra N, Nikander R, Hyttinen J, Kouhia R, Sievänen H. Impact loading history modulates hip fracture load and location: A finite element simulation study of the proximal femur in female athletes. J Biomech 2018; 76:136-143. [PMID: 29921524 DOI: 10.1016/j.jbiomech.2018.05.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 04/11/2018] [Accepted: 05/30/2018] [Indexed: 10/14/2022]
Abstract
Sideways falls impose high stress on the thin superolateral cortical bone of the femoral neck, the region regarded as a fracture-prone region of the hip. Exercise training is a natural mode of mechanical loading to make bone more robust. Exercise-induced adaptation of cortical bone along the femoral neck has been previously demonstrated. However, it is unknown whether this adaption modulates hip fracture behavior. The purpose of this study was to investigate the influence of specific exercise loading history on fall-induced hip fracture behavior by estimating fracture load and location with proximal femur finite element (FE) models created from magnetic resonance images (MRI) of 111 women with distinct exercise histories: 91 athletes (aged 24.7 ± 6.1 years, >8 years competitive career) and 20 women as controls (aged 23.7 ± 3.8 years). The athletes were divided into five groups based on typical loading patterns of their sports: high-impact (H-I: 9 triple-jumpers and 10 high jumpers), odd-impact (O-I: 9 soccer and 10 squash players), high-magnitude (H-M: 17 power-lifters), repetitive-impact (R-I: 18 endurance runners), and repetitive non-impact (R-NI: 18 swimmers). Compared to the controls, the H-I, O-I, and R-I groups had significantly higher (11-26%, p < 0.05) fracture loads. Also, the fracture location in the H-I and O-I groups was significantly more proximal (7-10%) compared to the controls. These results suggest that an exercise loading history of high impacts, impacts from unusual directions, or repetitive impacts increases the fracture load and may lower the risk of fall-induced hip fracture.
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Affiliation(s)
- Shinya Abe
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland.
| | - Nathaniel Narra
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Riku Nikander
- Gerontology Research Center, Faculty of Sports Sciences, University of Jyväskylä, Jyväskylä, Finland; Central Hospital of Central Finland, Jyväskylä, Finland; GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
| | - Jari Hyttinen
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| | - Reijo Kouhia
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland.
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Pellikaan P, Giarmatzis G, Vander Sloten J, Verschueren S, Jonkers I. Ranking of osteogenic potential of physical exercises in postmenopausal women based on femoral neck strains. PLoS One 2018; 13:e0195463. [PMID: 29617448 PMCID: PMC5884624 DOI: 10.1371/journal.pone.0195463] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/22/2018] [Indexed: 01/03/2023] Open
Abstract
The current study aimed to assess the potential of different exercises triggering an osteogenic response at the femoral neck in a group of postmenopausal women. The osteogenic potential was determined by ranking the peak hip contact forces (HCFs) and consequent peak tensile and compressive strains at the superior and inferior part of the femoral neck during activities such as (fast) walking, running and resistance training exercises. Results indicate that fast walking (5-6 km/h) running and hopping induced significantly higher strains at the femoral neck than walking at 4 km/h which is considered a baseline exercise for bone preservation. Exercises with a high fracture risk such as hopping, need to be considered carefully especially in a frail elderly population and may therefore not be suitable as a training exercise. Since superior femoral neck frailness is related to elevated hip fracture risk, exercises such as fast walking (above 5 km/h) and running can be highly recommended to stimulate this particular area. Our results suggest that a training program including fast walking (above 5 km/h) and running exercises may increase or preserve the bone mineral density (BMD) at the femoral neck.
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Affiliation(s)
- Pim Pellikaan
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
- * E-mail:
| | - Georgios Giarmatzis
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jos Vander Sloten
- Biomechanics Section, Department of Mechanical Engineering, KU Leuven, Leuven, Belgium
| | - Sabine Verschueren
- Research Group for Musculoskeletal Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Human Movement Biomechanics Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
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Kuroda T, Ishikawa K, Nagai T, Fukui T, Hirano T, Inagaki K. Quadrant Analysis of Quantitative Computed Tomography Scans of the Femoral Neck Reveals Superior Region-Specific Weakness in Young and Middle-Aged Men With Type 1 Diabetes Mellitus. J Clin Densitom 2018; 21:172-178. [PMID: 28302354 DOI: 10.1016/j.jocd.2017.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/26/2016] [Accepted: 01/17/2017] [Indexed: 02/06/2023]
Abstract
We have previously shown that the intertrochanter of young and middle-aged patients with type 1 diabetes mellitus (T1DM) showed higher buckling ratio (an index of cortical instability) and lower volumetric bone mineral density (vBMD). However, we have not yet reported the detailed findings regarding the mechanical and density properties of the femoral neck. Therefore, we present a subanalysis of our previous study with the aim of further evaluating the middle third of the femoral neck via quadrant quantitative computed tomography in young and middle-aged patients with T1DM. Bone parameters in 4 anatomical quadrants (superoanterior [SA], inferoanterior [IA], inferoposterior [IP], and superoposterior [SP]) were cross-sectionally evaluated in 17 male T1DM patients and 18 sex-matched healthy controls aged between 18 and 49 yr using quadrant quantitative computed tomography analysis. Patients with T1DM had a thinner cortical thickness in the SP quadrant and a significantly lower cortical vBMD in the SA quadrant than the controls. The serum insulin-like growth factor-1 values in patients with T1DM were positively correlated with the average cortical thickness in the SA quadrant and the average trabecular vBMD in the SP quadrant of the femoral neck. The cortical thickness in controls was negatively correlated with age in the SP and IP quadrants. The cortical thickness in patients with T1DM showed no correlation with age in all quadrants. The fragility of the femoral neck was remarkable in the superior region of patients with T1DM. Insulin-like growth factor-1 may play an important role in superior cortical thinning and in lowering cortical vBMD. Furthermore, in young and middle-aged men with T1DM, the structure of the femoral neck exhibits similar changes as those observed with aging.
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Affiliation(s)
- Takuma Kuroda
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Koji Ishikawa
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan.
| | - Takashi Nagai
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
| | - Tomoyasu Fukui
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism, and Endocrinology, Showa University School of Medicine, Tokyo, Japan
| | - Katsunori Inagaki
- Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan
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Gee AH, Treece GM, Poole KES. How does the femoral cortex depend on bone shape? A methodology for the joint analysis of surface texture and shape. Med Image Anal 2018; 45:55-67. [PMID: 29414436 PMCID: PMC5842044 DOI: 10.1016/j.media.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/24/2017] [Accepted: 01/12/2018] [Indexed: 11/19/2022]
Abstract
In humans, there is clear evidence of an association between hip fracture risk and femoral neck bone mineral density, and some evidence of an association between fracture risk and the shape of the proximal femur. Here, we investigate whether the femoral cortex plays a role in these associations: do particular morphologies predispose to weaker cortices? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm2) in a cohort of 125 females. Principal component analysis of the femoral surfaces identified three modes of shape variation accounting for 65% of the population variance. We then used statistical parametric mapping (SPM) to locate regions of the cortex where CMSD depends on shape, allowing for age. Our principal findings were increased CMSD with increased gracility over much of the proximal femur; and decreased CMSD at the superior femoral neck, coupled with increased CMSD at the calcar femorale, with increasing neck-shaft angle. In obtaining these results, we studied the role of spatial normalization in SPM, identifying systematic misregistration as a major impediment to the joint analysis of CMSD and shape. Through a series of experiments on synthetic data, we evaluated a number of registration methods for spatial normalization, concluding that only those predicated on an explicit set of homologous landmarks are suitable for this kind of analysis. The emergent methodology amounts to an extension of Geometric Morphometric Image Analysis to the domain of textured surfaces, alongside a protocol for labelling homologous landmarks in clinical CT scans of the human proximal femur.
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Affiliation(s)
- A H Gee
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - G M Treece
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge CB2 1PZ, UK.
| | - K E S Poole
- Department of Medicine, University of Cambridge, Level 5, Addenbrooke's Hospital, Box 157, Hills Road, Cambridge CB2 2QQ, UK.
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41
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Hamada H, Takao M, Sakai T, Sugano N. Subchondral fracture begins from the bone resorption area in osteonecrosis of the femoral head: a micro-computerised tomography study. INTERNATIONAL ORTHOPAEDICS 2018. [PMID: 29541811 DOI: 10.1007/s00264-018-3879-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE For successful joint preservation in osteonecrosis of the femoral head (ONFH), it is important to understand the mechanism of collapse. The purpose of this study was to investigate the initiation of subchondral fracture in ONFH by using micro-CT imaging of the whole femoral head, focusing on the three-dimensional relationship between the subchondral fracture and the bone resorption area. METHODS A total of 40 femoral heads from 37 patients retrieved during total hip arthroplasty for stage 3A or 3B ONFH by Japanese Investigation Committee criteria were scanned using micro-CT with a 0.146-mm thickness cuts. We divided the cohort into early and late collapsed stages according to a threshold of 3 mm of collapse as measured by micro-CT. RESULTS According to the analysis on multiple radial plane views in the whole femoral head, there were two interesting findings. First, the initial fracture cracks ran between separated bone resorption areas at the anterosuperior portions of all 18 femoral heads in the early collapsed stage. Second, fractures of the necrotic bone at the sclerotic boundary and a fibrous, granulation-like, low-density tissue along the necrotic side of the sclerotic boundary were seen in 19 of the 22 in the late collapsed stage. After bone resorption around the retinaculum and teres insertion initiates the subchondral fracture, bone resorption expanding at the anterosuperior portion of the femoral head may result in the spread of fracture and the potential for massive collapse. CONCLUSIONS Three-dimensional micro-CT showed bone resorption around the reparative zone initiates the subchondral fracture in ONFH.
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Affiliation(s)
- Hidetoshi Hamada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Masaki Takao
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takashi Sakai
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Tang T, Cripton PA, Guy P, McKay HA, Wang R. Clinical hip fracture is accompanied by compression induced failure in the superior cortex of the femoral neck. Bone 2018; 108:121-131. [PMID: 29277713 DOI: 10.1016/j.bone.2017.12.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/22/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Hip fractures pose a major health problem throughout the world due to their devastating impact. Current theories for why these injuries are so prevalent in the elderly point to an increased propensity to fall and decreases in bone mass with ageing. However, the fracture mechanisms, particularly the stress and strain conditions leading to bone failure at the hip remain unclear. Here, we directly examined the cortical bone from clinical intra-capsular hip fractures at a microscopic level, and found strong evidence of compression induced failure in the superior cortex. A total of 143 sections obtained from 24 femoral neck samples that were retrieved from 24 fracturing patients at surgery were examined using laser scanning confocal microscopy (LSCM) after fluorescein staining. The stained microcracks showed significantly higher density in the superior cortex than in the inferior cortex, indicating a greater magnitude of strain in the superior femoral neck during the failure-associated deformation and fracture process. The predominant stress state for each section was reconstructed based on the unique correlation between the microcrack pattern and the stress state. Specifically, we found clear evidence of longitudinal compression and buckling as the primary failure mechanisms in the superior cortex. These findings demonstrate the importance of microcrack analysis in studying clinical hip fractures, and point to the central role of the superior cortex failure as an important aspect of the failure initiation in clinical intra-capsular hip fractures.
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Affiliation(s)
- Tengteng Tang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Peter A Cripton
- Department of Mechanical Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada; International Collaboration On Repair Discoveries, Vancouver, BC, Canada
| | - Pierre Guy
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Heather A McKay
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, Vancouver, BC, Canada.
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Young M, Johannesdottir F, Poole K, Shaw C, Stock JT. Assessing the accuracy of body mass estimation equations from pelvic and femoral variables among modern British women of known mass. J Hum Evol 2018; 115:130-139. [PMID: 29169679 DOI: 10.1016/j.jhevol.2017.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 11/15/2022]
Abstract
Femoral head diameter is commonly used to estimate body mass from the skeleton. The three most frequently employed methods, designed by Ruff, Grine, and McHenry, were developed using different populations to address different research questions. They were not specifically designed for application to female remains, and their accuracy for this purpose has rarely been assessed or compared in living populations. This study analyzes the accuracy of these methods using a sample of modern British women through the use of pelvic CT scans (n = 97) and corresponding information about the individuals' known height and weight. Results showed that all methods provided reasonably accurate body mass estimates (average percent prediction errors under 20%) for the normal weight and overweight subsamples, but were inaccurate for the obese and underweight subsamples (average percent prediction errors over 20%). When women of all body mass categories were combined, the methods provided reasonable estimates (average percent prediction errors between 16 and 18%). The results demonstrate that different methods provide more accurate results within specific body mass index (BMI) ranges. The McHenry Equation provided the most accurate estimation for women of small body size, while the original Ruff Equation is most likely to be accurate if the individual was obese or severely obese. The refined Ruff Equation was the most accurate predictor of body mass on average for the entire sample, indicating that it should be utilized when there is no knowledge of the individual's body size or if the individual is assumed to be of a normal body size. The study also revealed a correlation between pubis length and body mass, and an equation for body mass estimation using pubis length was accurate in a dummy sample, suggesting that pubis length can also be used to acquire reliable body mass estimates. This has implications for how we interpret body mass in fossil hominins and has particular relevance to the interpretation of the long pubic ramus that is characteristic of Neandertals.
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Affiliation(s)
- Mariel Young
- Department of Human Evolutionary Biology, Harvard University, 11 Divinity Avenue, Cambridge, MA 02138, USA.
| | | | - Ken Poole
- Department of Medicine, University of Cambridge, United Kingdom
| | - Colin Shaw
- PAVE Research Group, Department of Archaeology and Anthropology, University of Cambridge, United Kingdom
| | - J T Stock
- PAVE Research Group, Department of Archaeology and Anthropology, University of Cambridge, United Kingdom
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The Effects of Extramedullary Reduction in Unstable Intertrochanteric Fracture: A Biomechanical Study Using Cadaver Bone. ACTA ACUST UNITED AC 2018. [DOI: 10.12671/jkfs.2018.31.3.79] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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45
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Gifre L, Humbert L, Muxi A, Del Rio L, Vidal J, Portell E, Monegal A, Guañabens N, Peris P. Analysis of the evolution of cortical and trabecular bone compartments in the proximal femur after spinal cord injury by 3D-DXA. Osteoporos Int 2018; 29:201-209. [PMID: 29043391 DOI: 10.1007/s00198-017-4268-9] [Citation(s) in RCA: 2] [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: 04/12/2017] [Accepted: 10/11/2017] [Indexed: 01/18/2023]
Abstract
UNLABELLED Marked trabecular and cortical bone loss was observed at the proximal femur short-term after spinal cord injury (SCI). 3D-DXA provided measurement of vBMD evolution at both femoral compartments and cortical thinning, thereby suggesting that this technique could be useful for bone analysis in these patients. INTRODUCTION SCI is associated with a marked increase in bone loss and risk of osteoporosis development short-term after injury. 3D-DXA is a new imaging analysis technique providing 3D analysis of the cortical and trabecular bone from DXA scans. The aim of this study was to assess the evolution of trabecular macrostructure and cortical bone using 3D-DXA in patients with recent SCI followed over 12 months. METHODS Sixteen males with recent SCI (< 3 months since injury) and without antiosteoporotic treatment were included. Clinical assessment, bone mineral density (BMD) measurements by DXA, and 3D-DXA evaluation at proximal femur (analyzing the integral, trabecular and cortical volumetric BMD [vBMD] and cortical thickness) were performed at baseline and at 6 and 12 months of follow-up. RESULTS vBMD significantly decreased at integral, trabecular, and cortical compartments at 6 months (- 8.8, - 11.6, and - 2.4%), with a further decrease at 12 months, resulting in an overall decrease of - 16.6, - 21.9, and - 5.0%, respectively. Cortical thickness also decreased at 6 and 12 months (- 8.0 and - 11.4%), with the maximal decrease being observed during the first 6 months. The mean BMD losses by DXA at femoral neck and total femur were - 17.7 and - 21.1%, at 12 months, respectively. CONCLUSIONS Marked trabecular and cortical bone loss was observed at the proximal femur short-term after SCI. 3D-DXA measured vBMD evolution at both femoral compartments and cortical thinning, providing better knowledge of their differential contributory role to bone strength and probably of the effect of therapy in these patients.
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Affiliation(s)
- L Gifre
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - A Muxi
- Nuclear Medicine Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - J Vidal
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - E Portell
- Guttmann Neurorehabilitation Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Monegal
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - N Guañabens
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - P Peris
- Rheumatology Department, Hospital Clinic of Barcelona, IDIBAPS, CIBERehd, Metabolic Bone Diseases Unit, Service of Rheumatology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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Johannesdottir F, Thrall E, Muller J, Keaveny TM, Kopperdahl DL, Bouxsein ML. Comparison of non-invasive assessments of strength of the proximal femur. Bone 2017; 105:93-102. [PMID: 28739416 DOI: 10.1016/j.bone.2017.07.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 12/16/2022]
Abstract
It is not clear which non-invasive method is most effective for predicting strength of the proximal femur in those at highest risk of fracture. The primary aim of this study was to compare the abilities of dual energy X-ray absorptiometry (DXA)-derived aBMD, quantitative computed tomography (QCT)-derived density and volume measures, and finite element analysis (FEA)-estimated strength to predict femoral failure load. We also evaluated the contribution of cortical and trabecular bone measurements to proximal femur strength. We obtained 76 human cadaveric proximal femurs (50 women and 26 men; age 74±8.8years), performed imaging with DXA and QCT, and mechanically tested the femurs to failure in a sideways fall configuration at a high loading rate. Linear regression analysis was used to construct the predictive model between imaging outcomes and experimentally-measured femoral strength for each method. To compare the performance of each method we used 3-fold cross validation repeated 10 times. The bone strength estimated by QCT-based FEA predicted femoral failure load (R2adj=0.78, 95%CI 0.76-0.80; RMSE=896N, 95%CI 830-961) significantly better than femoral neck aBMD by DXA (R2adj=0.69, 95%CI 0.66-0.72; RMSE=1011N, 95%CI 952-1069) and the QCT-based model (R2adj=0.73, 95%CI 0.71-0.75; RMSE=932N, 95%CI 879-985). Both cortical and trabecular bone contribute to femoral strength, the contribution of cortical bone being higher in femurs with lower trabecular bone density. These findings have implications for optimizing clinical approaches to assess hip fracture risk. In addition, our findings provide new insights that will assist in interpretation of the effects of osteoporosis treatments that preferentially impact cortical versus trabecular bone.
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA.
| | - Erica Thrall
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Muller
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, USA
| | | | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
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Jenkins T, Katsamenis OL, Andriotis OG, Coutts LV, Carter B, Dunlop DG, Oreffo ROC, Cooper C, Harvey NC, Thurner PJ, The OStEO Group. The inferomedial femoral neck is compromised by age but not disease: Fracture toughness and the multifactorial mechanisms comprising reference point microindentation. J Mech Behav Biomed Mater 2017; 75:399-412. [PMID: 28803114 PMCID: PMC5619645 DOI: 10.1016/j.jmbbm.2017.06.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 12/19/2022]
Abstract
The influence of ageing on the fracture mechanics of cortical bone tissue is well documented, though little is known about if and how related material properties are further affected in two of the most prominent musculoskeletal diseases, osteoporosis and osteoarthritis (OA). The femoral neck, in close proximity to the most pertinent osteoporotic fracture site and near the hip joint affected by osteoarthritis, is a site of particular interest for investigation. We have recently shown that Reference Point micro-Indentation (RPI) detects differences between cortical bone from the femoral neck of healthy, osteoporotic fractured and osteoarthritic hip replacement patients. RPI is a new technique with potential for in vivo bone quality assessment. However, interpretation of RPI results is limited because the specific changes in bone properties with pathology are not well understood and, further, because it is not conclusive what properties are being assessed by RPI. Here, we investigate whether the differences previously detected between healthy and diseased cortical bone from the femoral neck might reflect changes in fracture toughness. Together with this, we investigate which additional properties are reflected in RPI measures. RPI (using the Biodent device) and fracture toughness tests were conducted on samples from the inferomedial neck of bone resected from donors with: OA (41 samples from 15 donors), osteoporosis (48 samples from 14 donors) and non age-matched cadaveric controls (37 samples from 10 donoros) with no history of bone disease. Further, a subset of indented samples were imaged using micro-computed tomography (3 osteoporotic and 4 control samples each from different donors) as well as fluorescence microscopy in combination with serial sectioning after basic fuchsin staining (7 osteoporotic and 5 control samples from 5 osteoporotic and 5 control donors). In this study, the bulk indentation and fracture resistance properties of the inferomedial femoral neck in osteoporotic fracture, severe OA and control bone were comparable (p > 0.05 for fracture properties and <10% difference for indentation) but fracture toughness reduced with advancing age (7.0% per decade, r = -0.36, p = 0.029). Further, RPI properties (in particular, the indentation distance increase, IDI) showed partial correlation with fracture toughness (r = -0.40, p = 0.023) or derived elastic modulus (r = -0.40, p = 0.023). Multimodal indent imaging revealed evidence of toughening mechanisms (i.e. crack deflection, bridging and microcracking), elastoplastic response (in terms of the non-conical imprint shape and presence of pile-up) and correlation of RPI with damage extent (up to r = 0.79, p = 0.034) and indent size (up to r = 0.82, p < 0.001). Therefore, crack resistance, deformation resistance and, additionally, micro-structure (porosity: r = 0.93, p = 0.002 as well as pore proximity: r = -0.55, p = 0.027 for correlation with IDI) are all contributory to RPI. Consequently, it becomes clear that RPI measures represent a multitude of properties, various aspects of bone quality, but are not necessarily strongly correlated to a single mechanical property. In addition, osteoporosis or osteoarthritis do not seem to further influence fracture toughness of the inferomedial femoral neck beyond natural ageing. Since bone is highly heterogeneous, whether this finding can be extended to the whole femoral neck or whether it also holds true for other femoral neck quadrants or other material properties remains to be shown.
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Affiliation(s)
- T Jenkins
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK; Gait Laboratory, Queen Mary's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK
| | - O L Katsamenis
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK; µ-VIS X-ray Imaging Centre, Faculty of Engineering and the Environment, University of Southampton, SO17 1BJ Southampton, UK
| | - O G Andriotis
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - L V Coutts
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - B Carter
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | - D G Dunlop
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R O C Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Institute for Development Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P J Thurner
- Bioengineering Science Research Group, Faculty of Engineering and the Environment, University of Southampton, Southampton, UK; Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria.
| | - The OStEO Group
- University Hospital Southampton NHS Foundation Trust, Southampton, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; Portsmouth Hospitals NHS Trust, Portsmouth, UK; University College London, London, UK
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Wang L, Cheng XG, Su YB, Brown K, Xu L, Li K, Zhang CX, Zhang Y, Duanmu YY, Wu XB, Wang MY. Sex-related variations in cortical and trabecular bone of the femoral neck in an elderly Chinese population. Osteoporos Int 2017; 28:2391-2399. [PMID: 28405730 DOI: 10.1007/s00198-017-4043-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) was used to investigate sex-related variations in cortical and trabecular bone of the femoral neck. Cortical bone thickness of women in the superior quadrant was thinner than that of men, and the cortex in all four quadrants was negatively associated with age in women. INTRODUCTION This cross-sectional study aimed to investigate sex-related similarities and differences in femoral neck structure in an elderly Chinese population by QCT bone investigational toolkit (BIT) analysis. METHODS This study included 207 male (67.9 ± 7.7 years; range, 55-87 years) and 400 female subjects (68.0 ± 8.7 years; range, 55-96 years). BIT module was used to measure cortical and trabecular bone in anatomic quadrants of the femoral neck. Measurements of cortical thickness (Ct.Th), cortical vBMD (Ct.vBMD), trabecular vBMD (Tb.vBMD), and integral vBMD (It.vBMD) at the femoral neck were determined in four anatomical sectors. RESULTS The greatest difference between sexes, after adjusting for age, height, and weight, was in Ct.Th of Quadrant Supero-anterior (SA), which was 27.4% lower in women (p<0.001). Ct.Th of Quadrant Supero-posterior (SP) was 15.1% lower in women (p = 0.027). Ct.Th and Tb.vBMD in all four quadrants appeared to be negatively associated with age in females, whereas no significant relationship was observed in males, except Ct.Th of Quadrant SP. CONCLUSIONS The superior femoral neck geometry between males and females was significantly different, even after adjustment for body size and age, and the sub-regional cortical and trabecular bone negatively age-related changes in women indicated that women apparently have a more vulnerable geometrical outcome with age for fractures than men.
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Affiliation(s)
- L Wang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X G Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China.
| | - Y B Su
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - L Xu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Li
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - C X Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Y Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X B Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - M Y Wang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
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Lopes VM, Neto MA, Amaro AM, Roseiro LM, Paulino M. FE and experimental study on how the cortex material properties of synthetic femurs affect strain levels. Med Eng Phys 2017. [DOI: 10.1016/j.medengphy.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Arentsen L, Hansen KE, Yagi M, Takahashi Y, Shanley R, McArthur A, Bolan P, Magome T, Yee D, Froelich J, Hui SK. Use of dual-energy computed tomography to measure skeletal-wide marrow composition and cancellous bone mineral density. J Bone Miner Metab 2017; 35:428-436. [PMID: 27942979 PMCID: PMC5689468 DOI: 10.1007/s00774-016-0796-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/24/2016] [Indexed: 11/25/2022]
Abstract
Temporal and spatial variations in bone marrow adipose tissue (MAT) can be indicative of several pathologies and confound current methods of assessing immediate changes in bone mineral remodeling. We present a novel dual-energy computed tomography (DECT) method to monitor MAT and marrow-corrected volumetric BMD (mcvBMD) throughout the body. Twenty-three cancellous skeletal sites in 20 adult female cadavers aged 40-80 years old were measured using DECT (80 and 140 kVp). vBMD was simultaneous recorded using QCT. MAT was further sampled using MRI. Thirteen lumbar vertebrae were then excised from the MRI-imaged donors and examined by microCT. After MAT correction throughout the skeleton, significant differences (p < 0.05) were found between QCT-derived vBMD and DECT-derived mcvBMD results. McvBMD was highly heterogeneous with a maximum at the posterior skull and minimum in the proximal humerus (574 and 0.7 mg/cc, respectively). BV/TV and BMC have a nearly significant correlation with mcvBMD (r = 0.545, p = 0.057 and r = 0.539, p = 0.061, respectively). MAT assessed by DECT showed a significant correlation with MRI MAT results (r = 0.881, p < 0.0001). Both DECT- and MRI-derived MAT had a significant influence on uncorrected vBMD (r = -0.86 and r = -0.818, p ≤ 0.0001, respectively). Conversely, mcvBMD had no correlation with DECT- or MRI-derived MAT (r = 0.261 and r = 0.067). DECT can be used to assess MAT while simultaneously collecting mcvBMD values at each skeletal site. MAT is heterogeneous throughout the skeleton, highly variable, and should be accounted for in longitudinal mcvBMD studies. McvBMD accurately reflects the calcified tissue in cancellous bone.
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Affiliation(s)
- Luke Arentsen
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Karen E Hansen
- Department of Medicine, Division of Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Yutaka Takahashi
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Ryan Shanley
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Angela McArthur
- Anatomy Bequest Program, University of Minnesota, Minneapolis, MN, USA
| | - Patrick Bolan
- Center for Magnetic Resonance Research, Minneapolis, MN, USA
| | - Taiki Magome
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jerry Froelich
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Susanta K Hui
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA.
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
- Department of Radiation Oncology, Beckman Research Institute, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, USA.
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