1
|
Jaarah N, Lam CFJ, Lodhia N, Dulnoan D, Moore AE, Hampson G. Differential effects of teriparatide, denosumab and zoledronate on hip structural and mechanical parameters in osteoporosis; a real-life study. J Endocrinol Invest 2024; 47:1667-1677. [PMID: 38191946 PMCID: PMC11196340 DOI: 10.1007/s40618-023-02280-4] [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: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE The aim of this study was to evaluate changes in hip geometry parameters following treatment with teriparatide (TPD), denosumab (Dmab) and zoledronate (ZOL) in real-life setting. METHODS We studied 249 patients with osteoporosis (OP) with mean [SD] age of 71.5 [11.1] years divided into 3 treatment groups; Group A received TPD; n = 55, Group B (Dmab); n = 116 and Group C (ZOL); n = 78 attending a routine metabolic bone clinic. Bone mineral density (BMD) was measured by DXA at the lumbar spine (LS), total hip (TH) and femoral neck (FN) prior to treatment and after 2 years (Group A), after a mean treatment duration of 3.3 [1.3] years (Group B) and after 1, 2 and 3 doses of ZOL (Group C) to assess treatment response. Hip structural analysis (HSA) was carried out retrospectively from DXA-acquired femur images at the narrow neck (NN), the intertrochanter (IT) and femoral shaft (FS). RESULTS Changes in parameters of hip geometry and mechanical strength were seen in the following treatment. Percentage change in cross-sectional area (CSA): 3.56[1.6] % p = 0.01 and cross-sectional moment of inertia (CSMI): 4.1[1.8] % p = 0.029 increased at the NN only in Group A. Improvement in HSA parameters at the IT were seen in group B: CSA: 3.3[0.67]% p < 0.001, cortical thickness (Co Th): 2.8[0.78]% p = 0.001, CSMI: 5.9[1.3]% p < 0.001, section modulus (Z):6.2[1.1]% p < 0.001 and buckling ratio (BR): - 3.0[0.86]% p = 0.001 with small changes at the FS: CSA: 1.2[0.4]% p = 0.005, Z:1.6 [0.76]%, p = 0.04. Changes at the IT were also seen in Group C (after 2 doses): CSA: 2.5[0.77]% p = 0.017, Co Th: 2.4[0.84]% p = 0.012, CSMI: 3.9[1.3]% p = 0.017, Z:5.2[1.16]% p < 0.001 and BR: - 3.1[0.88]% p = 0.001 and at the NN (following 3 doses): outer diameter (OD): 4.0[1.4]% p = 0.0005, endocortical diameter(ED): 4.3[1.67% p = 0.009, CSA:5.2[1.8]% p = 0.003, CSMI: 9.3[3.8]% p = 0.019. CONCLUSIONS Analysis of the effect of OP therapies on hip geometry is useful in understanding the mechanisms of their anti-fracture effect and may provide additional information on their efficacy.
Collapse
Affiliation(s)
- N Jaarah
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - C F J Lam
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - N Lodhia
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - D Dulnoan
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - A E Moore
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK
| | - G Hampson
- Department of Chemical Pathology and Metabolic Medicine, St Thomas' Hospital, 5Th Floor, North Wing, Lambeth Palace Road, London, UK.
- Osteoporosis Unit, Guy's Hospital, London, SE1 7EH, UK.
| |
Collapse
|
2
|
Syed Mohd Hamdan SN, Radzi Z, Abdul Rahim AH, Rahmat RAA, Ibrahim N. Computed tomography study of cranial vault thickness in Malaysian subadult population. Int J Legal Med 2024:10.1007/s00414-024-03276-2. [PMID: 38940946 DOI: 10.1007/s00414-024-03276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
Cranial vault thickness (CVT) and its variations provide valuable insights into an individual's biological attributes such as age and sex. This paper aimed to assess the correlations of CVT with age and sex and develop a regression model for age estimation in Malaysian subadults using computed tomography (CT) images. A total of 521 CT images (male/female: 279/242; age range: 0-20 years; Malay/Chinese/Indian: 221/145/155) were included in the study. Correlations of CVT measurements with age and sex, including frontal bone thickness (FBT), occipital bone thickness (OBT), left parietal bone thickness (LPBT), and right parietal bone thickness (RPBT) were assessed and regression formulae were developed for age estimation in subadults. A significant correlation between CVT measurements and age was demonstrated (p < 0.001). Age estimation was most accurate in the younger age group (< 2 years) at frontal and occipital, and accuracy decreases in the older age groups. Additionally, sexual dimorphism was evident in the frontal and parietal bone thickness within the age range of 3-6 years and 16-20 years, respectively. In conclusion, the findings suggested CVT measurements could be used to corroborate other age estimation methods for subadults.
Collapse
Affiliation(s)
| | - Zamri Radzi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Amir Hazwan Abdul Rahim
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Lembah Pantai, Kuala Lumpur, 50603, Malaysia
| | - Rabiah Al-Adawiyah Rahmat
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Lembah Pantai, Kuala Lumpur, 50603, Malaysia
| | - Norliza Ibrahim
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Lembah Pantai, Kuala Lumpur, 50603, Malaysia.
| |
Collapse
|
3
|
Maeda K, Mochizuki T, Tanifuji O, Katsumi R, Kobayashi K, Kawashima H. Medial cortical bone thickness of the tibial diaphysis in osteoarthritis is related to lower extremity alignment and tibial morphology. J Orthop Surg Res 2024; 19:355. [PMID: 38879553 PMCID: PMC11179327 DOI: 10.1186/s13018-024-04849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The purpose of this study was to clarify (1) the differences in cortical bone thickness (CBT) of the tibial diaphysis between healthy and osteoarthritic knees and (2) the influences of the femorotibial angle (FTA) and inclination of the medial compartment of the proximal tibia (MCT) on tibial CBT. METHODS The study assessed 60 subjects with varus knee osteoarthritis (OA) (22 males and 38 females; mean age, 74 ± 7 years) and 53 healthy elderly subjects (28 males and 25 females; mean age, 70 ± 6 years). Three-dimensional estimated CBT of the tibial diaphysis was automatically calculated for 2752-11,296 points using high-resolution measurements from CT. The standardized CBT was assessed in 24 regions by combining six heights and four areas. Additionally, the association between the CBT, each FTA, and MCT inclination was investigated. RESULTS The OA group showed a thicker CBT in the medial areas than in the lateral areas of the proximal tibia, while the healthy group had a thicker lateral CBT. The medial-to-lateral ratio of the proximal tibia was significantly higher in the OA group than in the healthy group. The proximal-medial CBT correlated with FTA and MCT inclinations in the OA group. CONCLUSIONS This study demonstrated that varus osteoarthritic knees showed a different trend of proximal-medial CBT with associations in FTA and MCT inclination from healthy knees, possibly due to medial load concentration.
Collapse
Affiliation(s)
- Keisuke Maeda
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| |
Collapse
|
4
|
Kamiński P, Nurzynska K, Kwiecień J, Obuchowicz R, Piórkowski A, Pociask E, Stępień A, Kociołek M, Strzelecki M, Augustyniak P. Sex Differentiation of Trabecular Bone Structure Based on Textural Analysis of Pelvic Radiographs. J Clin Med 2024; 13:1904. [PMID: 38610669 PMCID: PMC11012966 DOI: 10.3390/jcm13071904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Objectives: The purpose of this paper is to assess the determination of male and female sex from trabecular bone structures in the pelvic region. The study involved analyzing digital radiographs for 343 patients and identifying fourteen areas of interest based on their medical significance, with seven regions on each side of the body for symmetry. Methods: Textural parameters for each region were obtained using various methods, and a thorough investigation of data normalization was conducted. Feature selection approaches were then evaluated to determine a small set of the most representative features, which were input into several classification machine learning models. Results: The findings revealed a sex-dependent correlation in the bone structure observed in X-ray images, with the degree of dependency varying based on the anatomical location. Notably, the femoral neck and ischium regions exhibited distinctive characteristics between sexes. Conclusions: This insight is crucial for medical professionals seeking to estimate sex dependencies from such image data. For these four specific areas, the balanced accuracy exceeded 70%. The results demonstrated symmetry, confirming the genuine dependencies in the trabecular bone structures.
Collapse
Affiliation(s)
- Paweł Kamiński
- Clinic of Locomotor Disorders, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland;
- Małopolska Orthopedic and Rehabilitation Hospital, Modrzewiowa 22, 30-224 Krakow, Poland
| | - Karolina Nurzynska
- Department of Algorithmics and Software, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Joanna Kwiecień
- Department of Automatic Control and Robotics, AGH University of Krakow, 30-059 Krakow, Poland;
| | - Rafał Obuchowicz
- Department of Diagnostic Imaging, Jagiellonian University Medical College, Kopernika 19, 31–501 Krakow, Poland;
| | - Adam Piórkowski
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
| | - Elżbieta Pociask
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
| | | | - Marcin Kociołek
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland; (M.K.); (M.S.)
| | - Michał Strzelecki
- Institute of Electronics, Lodz University of Technology, 93-590 Lodz, Poland; (M.K.); (M.S.)
| | - Piotr Augustyniak
- Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland (E.P.); (P.A.)
| |
Collapse
|
5
|
Ding K, Zhu Y, Li J, Yuwen P, Yang W, Zhang Y, Wang H, Ren C, Chen W, Zhang Q, Zhang Y. Age-related Changes with the Trabecular Bone of Ward's Triangle and Neck-shaft Angle in the Proximal Femur: A Radiographic Study. Orthop Surg 2023; 15:3279-3287. [PMID: 37853985 PMCID: PMC10694024 DOI: 10.1111/os.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE The Ward triangle is an important area used clinically to diagnose and assess osteoporosis and its fracture risk in the proximal femur. The main objective of this study was to investigate the rules of development and maturation of the trabeculae of Ward's triangle to provide a basis for the prevention and treatment proximal femur fracture. METHODS From January 2018 to December 2019, individuals from 4 months to 19 years old who underwent hip growth and development assessments at the Third Hospital of Hebei Medical University were selected retrospectively. The outpatient electronic medical record system was used to collect information such as age, gender, imaging images, and clinical diagnosis. The development score and maturity characteristics of the trabecular bone were analyzed using hip radiograph data. Correlation analysis was performed to identify the relationship among age, neck-shaft angle and development and maturity score of the trabecular bone. RESULTS A total of 941 patients were enrolled in this study, including 539 males and 402 females. Primary compression trabeculae were all present at 1 year of age and matured at 7 years of age and older; primary tension trabeculae were all present at 4 years of age and matured at 18 years of age. Secondary compression trabeculae were present at 4 years of age and matured at 18 years of age. In addition, the neck-shaft angle progressively decreases from 4 months to 14 years of age but barely changes between 15 and 19 years of age. CONCLUSION In short, the development and maturation of the trabeculae in the ward' triangle followed a specific temporal pattern that was related to the neck-shaft angle. Therefore, these findings can help us understand structure and mechanical characteristics of proximal femoral trabeculae, and improve our understanding of the mechanism and treatment of proximal femoral fractures.
Collapse
Affiliation(s)
- Kai Ding
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yanbin Zhu
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Jiaxing Li
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Peizhi Yuwen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Weijie Yang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yifan Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Haicheng Wang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Chuan Ren
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Wei Chen
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Qi Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Hebei Orthopaedic Clinical Research CenterThe Third Hospital of Hebei Medical UniversityShijiazhuangChina
- Key Laboratory of Biomechanics of Hebei ProvinceOrthopaedic Research Institute of Hebei ProvinceHebeiChina
- NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University)ShijiazhuangChina
- Engineering Research Center of Orthopaedic Minimally Invasive Intelligent EquipmentMinistry of EducationShijiazhuangChina
- Chinese Academy of EngineeringBingjiaokou HutongBejingChina
| |
Collapse
|
6
|
Atkins PR, Morris A, Elhabian SY, Anderson AE. A Correspondence-Based Network Approach for Groupwise Analysis of Patient-Specific Spatiotemporal Data. Ann Biomed Eng 2023; 51:2289-2300. [PMID: 37357248 PMCID: PMC11047278 DOI: 10.1007/s10439-023-03270-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
Methods for statistically analyzing patient-specific data that vary both spatially and over time are currently either limited to summary statistics or require elaborate surface registration. We propose a new method, called correspondence-based network analysis, which leverages particle-based shape modeling to establish correspondence across a population and preserve patient-specific measurements and predictions through statistical analysis. Herein, we evaluated this method using three published datasets of the hip describing cortical bone thickness of the proximal femur, cartilage contact stress, and dynamic joint space between control and patient cohorts to evaluate activity- and group-based differences, as applicable, using traditional statistical parametric mapping (SPM) and our proposed spatially considerate correspondence-based network analysis approach. The network approach was insensitive to correspondence density, while the traditional application of SPM showed decreasing area of the region of significance with increasing correspondence density. In comparison to SPM, the network approach identified broader and more connected regions of significance for all three datasets. The correspondence-based network analysis approach identified differences between groups and activities without loss of subject and spatial specificity which could improve clinical interpretation of results.
Collapse
Affiliation(s)
- Penny R Atkins
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Alan Morris
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
| | - Shireen Y Elhabian
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA
- School of Computing, University of Utah, Salt Lake City, UT, USA
| | - Andrew E Anderson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, USA.
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA.
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
- Department of Physical Therapy, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
7
|
Cui Q, Zhu W, Zhao H, Zhu J, Wu B. Clinical significance of femoral cortical thickness parameters and trabecular density in the treatment of hip fracture in the elderly. Minerva Med 2023; 114:560-562. [PMID: 34672165 DOI: 10.23736/s0026-4806.21.07825-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Qingda Cui
- Department of Joint Trauma Surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, China
| | - Weijie Zhu
- Department of Joint Trauma Surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, China
| | - Haijun Zhao
- Department of Joint Trauma Surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, China
| | - Jianhua Zhu
- Department of Joint Trauma Surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, China
| | - Bowen Wu
- Department of Orthopedics, The Affiliated Zhuzhou Hospital Xiangya Medical College CSU, Zhuzhou, China -
| |
Collapse
|
8
|
Skedros JG, Cronin JT, Dayton MR, Bloebaum RD, Bachus KN. Exploration of the synergistic role of cortical thickness asymmetry ("Trabecular Eccentricity" concept) in reducing fracture risk in the human femoral neck and a control bone (Artiodactyl Calcaneus). J Theor Biol 2023; 567:111495. [PMID: 37068584 DOI: 10.1016/j.jtbi.2023.111495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/24/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023]
Abstract
The mechanobiology of the human femoral neck is a focus of research for many reasons including studies that aim to curb age-related bone loss that contributes to a near-exponential rate of hip fractures. Many believe that the femoral neck is often loaded in rather simple bending, which causes net tension stress in the upper (superior) femoral neck and net compression stress in its inferior aspect ("T/C paradigm"). This T/C loading regime lacks in vivo proof. The "C/C paradigm" is a plausible alternative simplified load history that is characterized by a gradient of net compression across the entire femoral neck; action of the gluteus medius and external rotators of the hip are important in this context. It is unclear which paradigm is at play in natural loading due to lack of in vivo bone strain data and deficiencies in understanding mechanisms and manifestations of bone adaptation in tension vs. compression. For these reasons, studies of the femoral neck would benefit from being compared to a 'control bone' that has been proven, by strain data, to be habitually loaded in bending. The artiodactyl (sheep and deer) calcaneus model has been shown to be a very suitable control in this context. However, the application of this control in understanding the load history of the femoral neck has only been attempted in two prior studies, which did not examine the interplay between cortical and trabecular bone, or potential load-sharing influences of tendons and ligaments. Our first goal is to compare fracture risk factors of the femoral neck in both paradigms. Our second goal is to compare and contrast the deer calcaneus to the human femoral neck in terms of fracture risk factors in the T/C paradigm (the C/C paradigm is not applicable in the artiodactyl calcaneus due to its highly constrained loading). Our third goal explores interplay between dorsal/compression and plantar/tension regions of the deer calcaneus and the load-sharing roles of a nearby ligament and tendon, with insights for translation to the femoral neck. These goals were achieved by employing the analytical model of Fox and Keaveny (J. Theoretical Biology 2001, 2003) that estimates fracture risk factors of the femoral neck. This model focuses on biomechanical advantages of the asymmetric distribution of cortical bone in the direction of habitual loading. The cortical thickness asymmetry of the femoral neck (thin superior cortex, thick inferior cortex) reflects the superior-inferior placement of trabecular bone (i.e., "trabecular eccentricity," TE). TE helps the femoral neck adapt to typical stresses and strains through load-sharing between superior and inferior cortices. Our goals were evaluated in the context of TE. Results showed the C/C paradigm has lower risk factors for the superior cortex and for the overall femoral neck, which is clinically relevant. TE analyses of the deer calcaneus revealed important synergism in load-sharing between the plantar/tension cortex and adjacent ligament/tendon, which challenges conventional understanding of how this control bone achieves functional adaptation. Comparisons with the control bone also exposed important deficiencies in current understanding of human femoral neck loading and its potential histocompositional adaptations.
Collapse
Affiliation(s)
- John G Skedros
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA.
| | - John T Cronin
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA
| | - Michael R Dayton
- University of Colorado, Department of Orthopedics, Aurora, CO, USA
| | - Roy D Bloebaum
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| | - Kent N Bachus
- University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; Research Service, Veterans Affairs Medical Center, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Hoellwarth JS, Oomatia A, Tetsworth K, Vrazas E, Al Muderis M. Bone density changes after five or more years of unilateral lower extremity osseointegration: Observational cohort study. Bone Rep 2023; 18:101682. [PMID: 37205925 PMCID: PMC10189091 DOI: 10.1016/j.bonr.2023.101682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/21/2023] Open
Abstract
Context Rehabilitation following lower extremity amputation presents multiple challenges, many related to the traditional prosthesis (TP) socket. Without skeletal loading, bone density also rapidly decreases. Transcutaneous osseointegration for amputees (TOFA) surgically implants a metal prosthesis attachment directly into the residual bone, facilitating direct skeletal loading. Quality of life and mobility are consistently reported to be significantly superior with TOFA than TP. Objective To investigate how femoral neck bone mineral density (BMD, g/cm2) changes for unilateral transfemoral and transtibial amputees at least five years following single-stage press-fit osseointegration. Methods Registry review was performed of five transfemoral and four transtibial unilateral amputees who had dual x-ray absorptiometry (DXA) performed preoperatively and after at least five years. The average BMD was compared using Student's t-test (significance p < .05). First, all nine Amputated versus Intact limbs. Second, the five patients with local disuse osteoporosis (ipsilateral femoral neck T-score < -2.5) versus the four whose T-score was greater than -2.5. Results The average Amputated Limb BMD was significantly less than the Intact Limb, both Before Osseointegration (0.658 ± 0.150 vs 0.929 ± 0.089, p < .001) and After Osseointegration (0.720 ± 0.096 vs 0.853 ± 0.116, p = .018). The Intact Limb BMD decreased significantly during the study period (0.929 ± 0.089 to 0.853 ± 0.116, p = .020), while the Amputated Limb BMD increased a not statistically significant amount (0.658 ± 0.150 to 0.720 ± 0.096, p = .347). By coincidence, all transfemoral amputees had local disuse osteoporosis (BMD 0.545 ± 0.066), and all transtibial patients did not (BMD 0.800 ± 0.081, p = .003). The local disuse osteoporosis cohort eventually had a greater average BMD (not statistically significant) than the cohort without local disuse osteoporosis (0.739 ± 0.100 vs 0.697 ± 0.101, p = .556). Conclusions Single-stage press-fit TOFA may facilitate significant BMD improvement to unilateral lower extremity amputees with local disuse osteoporosis.
Collapse
Affiliation(s)
- Jason Shih Hoellwarth
- Limb Lengthening and Complex Reconstruction Service, Osseointegration Limb Replacement Center, Hospital for Special Surgery, 535 East 70th Street, New York 10021, NY, USA
- Corresponding author.
| | - Atiya Oomatia
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Elisabeth Vrazas
- Macquarie School of Medicine Macquarie University, Suite 305, Level 3/2 Technology Pl, Macquarie Park, NSW 2109, Australia
| | - Munjed Al Muderis
- Limb Reconstruction Centre, Macquarie University Hospital, Macquarie University, Macquarie Park, Australia
| |
Collapse
|
10
|
Wysocki MA, Doyle ST. Advancing Osteoporosis Evaluation Procedures: Detailed Computational Analysis of Regional Structural Vulnerabilities in Osteoporotic Bone. J Pers Med 2023; 13:jpm13020321. [PMID: 36836558 PMCID: PMC9962183 DOI: 10.3390/jpm13020321] [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: 01/07/2023] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Osteoporotic fractures of the femur are associated with poor healing, disability, reduced quality of life, and high mortality rates within 1 year. Moreover, osteoporotic fractures of the femur are still considered to be an unsolved problem in orthopedic surgery. In order to more effectively identify osteoporosis-related fracture risk and develop advanced treatment approaches for femur fractures, it is necessary to acquire a greater understanding of how osteoporosis alters the diaphyseal structure and biomechanical characteristics. The current investigation uses computational analyses to comprehensively examine how femur structure and its associated properties differ between healthy and osteoporotic bones. The results indicate statistically significant differences in multiple geometric properties between healthy femurs and osteoporotic femurs. Additionally, localized disparities in the geometric properties are evident. Overall, this approach will be beneficial in the development of new diagnostic procedures for highly detailed patient-specific detection of fracture risk, for establishing novel injury prevention treatments, and for informing advanced surgical solutions.
Collapse
|
11
|
Wang Y, Li J, Men Y, Wei W. Intrinsic Cortical Property Analysis of the Medial Column of Proximal Humerus. Orthop Surg 2023; 15:793-800. [PMID: 36716195 PMCID: PMC9977591 DOI: 10.1111/os.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Adequate mechanical support of the medial column is paramount to maintain fracture reduction in locking plating of proximal humerus fractures. However, intrinsic cortical properties of the medial column are rarely discussed. The purpose of the study is to describe regional variation of cortex in the medial column. METHODS A total of 147 healthy participants were eligible for enrollment between December 2016 and December 2018. Subjects were divided into three groups: group A (20-39 years), group B (40-59 years), and group C (>60 years). For each individual, a color 3D thickness map for proximal humerus was created by cortical bone mapping (CBM) technique after bilateral shoulders were imaged by computed tomography. Measurement Indices including the cortical thickness (CTh), cortical mass surface density (CM) and the endocortical trabecular density (ECTD) were determined, after six regions of interest (ROI) were defined in metaphyseal region. Regional parameter variations were analyzed by one-way ANOVA. RESULTS The CTh, CM and ECTD values were approximately equivalent between genders in the proximal part of the medial column across all ages (P > 0.05).The greatest difference between sexes was found in CTh and CM values of middle and distal part (P < 0.05). The CTh and CM within medial column were negatively associated with age (P < 0.05). The proximal cortical bone of the medial column was thicker and more dense, compared to the lateral column (P < 0.05). Significant regional variation was found in all measured parameters in group A, but not in groups B and C. CONCLUSION Our finding proved that regional differences in the distribution of cortical bone in the medial column The attenuation of cortical bone heterogeneity in the medial column was found after the age of 40 years.
Collapse
Affiliation(s)
- Yeming Wang
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| | - Jian Li
- Department of RadiologyTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yutao Men
- Tianjin Key Laboratory of the Design and Intelligent Control of the Advanced Mechanical SystemTianjin University of TechnologyTianjinChina,National Demonstration Center for Experimental Mechanical and Electrical Engineering EducationTianjin University of TechnologyTianjinChina
| | - Wanfu Wei
- Department of OrthopaedicsTianjin Hospital, Tianjin UniversityTianjinChina
| |
Collapse
|
12
|
Tsurumoto T, Endo D, Saiki K, Imamura T, Murai K, Nishi K, Manabe Y, Oyamada J, Sakamoto J, Ogami-Takamura K. Cross-sectional geometry of the femoral diaphyseal cortical bones: analysis of central mass distribution. Anat Sci Int 2023; 98:77-88. [PMID: 35718803 DOI: 10.1007/s12565-022-00676-5] [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: 11/27/2021] [Accepted: 05/25/2022] [Indexed: 01/20/2023]
Abstract
A detailed analysis of differences in skeletal shape among many individuals is expected to reveal the mechanical significance behind various morphological features. To confirm the distribution of the cortical bone region in cross sections, the relative position of the central mass distribution (CMD) of the cortical bone region to the CMD of the entire cross section was examined. A total of 90 right human femoral skeletons were examined using clinical multi-slice computed tomography. For nine cross sections of each femur, we determined the CMD of the whole area, including both cortical bone and medullary areas, as CMD-W, and that of the cortical bone region in the same cross section as CMD-C, and they were compared. The medial and anterior portion of the cortex was relatively thick just below the lesser trochanter. The posterior cortical bone tended to be relatively thick in the region from the center to the distal part of the diaphysis. Females had a significantly more medially deviated CMD than males throughout the entire diaphysis. These results suggest that femurs with advanced cortical bone thinning tend to have a concentration of cortical bone in their medial portion. CMD-C was located farther from the diaphysis axis as the degree of medial bending increased. Conversely, the greater the lateral bending of the diaphysis, the closer CMD-C was to the diaphysis axis. As the amount of bone decreases with age, self-adjustment could occur so that the cortical bone's critical area remains to prevent a decrease in mechanical strength.
Collapse
Affiliation(s)
- Toshiyuki Tsurumoto
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan. .,Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, Nagasaki, 852-8523, Japan.
| | - Daisuke Endo
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan.,Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Kazunobu Saiki
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Takeshi Imamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Kiyohito Murai
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Keita Nishi
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Yoshitaka Manabe
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Joichi Oyamada
- Department of Oral Anatomy and Dental Anthropology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan
| | - Junya Sakamoto
- Department of Physical Therapy Science, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8520, Japan
| | - Keiko Ogami-Takamura
- Department of Macroscopic Anatomy, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 852-8523, Japan.,Center of Cadaver Surgical Training, School of Medicine, Nagasaki University, Nagasaki, 852-8523, Japan
| |
Collapse
|
13
|
Kistler-Fischbacher M, Yong JS, Weeks BK, Beck BR. High-Intensity Exercise and Geometric Indices of Hip Bone Strength in Postmenopausal Women on or off Bone Medication: The MEDEX-OP Randomised Controlled Trial. Calcif Tissue Int 2022; 111:256-266. [PMID: 35690931 PMCID: PMC9188729 DOI: 10.1007/s00223-022-00991-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
Abstract
To compare the effects of high-intensity resistance and impact training (HiRIT) to low-intensity, Pilates-based exercise (LiPBE) on proximal femur geometry and explore the influence of antiresorptive medication on those effects. Postmenopausal women with low bone mass, on or off antiresorptive bone medications were randomly allocated, stratified on medication intake, to eight months of twice-weekly, supervised HiRIT (Onero™) or LiPBE (Buff Bones®). 3D hip software was used to analyse proximal femur DXA scans. Outcomes included femoral neck (FN) and total hip (TH), volumetric (e.g. vBMC, vBMD) and geometric (e.g. cortical thickness, cross-sectional area [CSA], section modulus [Z]) indices of bone strength. Data were analysed using analysis of variance. Scans of 102 women were examined: LiPBE, 43; HiRIT, 37; LiPBE-med, 11; HiRIT-med, 11. HiRIT improved TH trabecular vBMC and vBMD (3.1 ± 1.1% versus - 1.2 ± 1.2%, p = 0.008; and 1.5 ± 1.0% versus - 1.6 ± 1.2%, p = 0.042, respectively) and FN and TH total vBMC (2.0 ± 0.8% versus - 0.2 ± 0.7%, p = 0.032; and 0.7 ± 0.4% versus - 0.8 ± 0.6%, p = 0.032, respectively), compared to losses in LiPBE. HiRIT also increased Z while LiPBE did not (p = 0.035). The combination of HiRIT and medication achieved greater improvements in FN total and trabecular vBMD, total BMC, CSA and Z than HiRIT alone. HiRIT improved geometric parameters of proximal femur strength, while LiPBE exercise was largely ineffective. Medication may enhance some HiRIT effects. Findings suggest reduced hip fracture risk in response to HiRIT.Trial registration number ACTRN12617001511325.
Collapse
Affiliation(s)
- Melanie Kistler-Fischbacher
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD, 4222, Australia
- Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, QLD, 4222, Australia
| | - Jedidah S Yong
- Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, QLD, 4222, Australia
| | - Benjamin K Weeks
- Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, QLD, 4222, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, QLD, 4222, Australia.
- Exercise Science, School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, QLD, 4222, Australia.
- The Bone Clinic, 26 Turbo Dr, Brisbane, QLD, 4151, Australia.
| |
Collapse
|
14
|
Holcombe SA, Derstine BA. Rib cortical bone thickness variation in adults by age and sex. J Anat 2022; 241:1344-1356. [PMID: 36004686 DOI: 10.1111/joa.13751] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Rib fractures are a common and serious outcome of blunt thoracic trauma and their likelihood is greater in older individuals. Osteoporotic bone loss is a well-documented aging phenomenon with sex-specific characteristics, but within rib bones, neither baseline maps of regional thickness nor the rates of bone thinning with age have been quantified across whole ribs. This study presents such data from 4014 ribs of 240 adult subjects aged 20-90. A validated cortical bone mapping technique was applied to clinical computed tomography scans to obtain local rib cortical bone thickness measurements over the surfaces of ribs 2 through 11. Regression models to age and sex gave rates of cortex thinning in local zones and aggregated across whole ribs. The statistical parametric mapping provided these relationships regionally as a function of rib surface location. All models showed significant reductions in bone thickness with age (p < 0.01). Average whole-rib thinning occurred at between 0.011 to 0.032 mm/decade (males) and 0.035 to 0.043 mm/decade (females), with sex and age accounting for up to 37% of population variability (R2 ). Rates of thinning differed regionally and by rib, with the highest bone loss of up to 0.074 mm/decade occurring in mid-rib cutaneous and superior regions of ribs 2-6. Rates were consistently higher in females than males (significantly so across whole ribs but not all local regions) and were more pronounced in cutaneous, superior, and inferior rib aspects (average 0.025 mm/decade difference in ribs 4-8) compared to pleural aspects which had the thickest cortices but saw only minor differences in thinning rates by sex (0.045 mm/decade for females and 0.040 mm/decade for males). Regional analysis showed male and female bone thickness differences that were not statistically significant at 20 years of age (p > 0.05 across practically all regions) but subsequent cortex thinning meant that substantial pleural and cutaneous regions were thinner (p < 0.05) in females than males by 55 years of age. The techniques and results from this study can be applied to assess rib bone content loss in clinical settings across wide populations. Additionally, average cortex thickness results can be mapped directly to finite element models of the thorax, and regression results are used to modify such models to represent the ribs of men and women across their full adult lifespan.
Collapse
Affiliation(s)
- Sven A Holcombe
- Morphomics Analysis Group, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian A Derstine
- Morphomics Analysis Group, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
15
|
Mandolini M, Brunzini A, Facco G, Mazzoli A, Forcellese A, Gigante A. Comparison of Three 3D Segmentation Software Tools for Hip Surgical Planning. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22145242. [PMID: 35890923 PMCID: PMC9323631 DOI: 10.3390/s22145242] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 06/01/2023]
Abstract
In hip arthroplasty, preoperative planning is fundamental to reaching a successful surgery. Nowadays, several software tools for computed tomography (CT) image processing are available. However, research studies comparing segmentation tools for hip surgery planning for patients affected by osteoarthritic diseases or osteoporotic fractures are still lacking. The present work compares three different software from the geometric, dimensional, and usability perspectives to identify the best three-dimensional (3D) modelling tool for the reconstruction of pathological femoral heads. Syngo.via Frontier (by Siemens Healthcare) is a medical image reading and post-processing software that allows low-skilled operators to produce prototypes. Materialise (by Mimics) is a commercial medical modelling software. 3D Slicer (by slicer.org) is an open-source development platform used in medical and biomedical fields. The 3D models reconstructed starting from the in vivo CT images of the pathological femoral head are compared with the geometries obtained from the laser scan of the in vitro bony specimens. The results show that Mimics and 3D Slicer are better for dimensional and geometric accuracy in the 3D reconstruction, while syngo.via Frontier is the easiest to use in the hospital setting.
Collapse
Affiliation(s)
- Marco Mandolini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy; (A.B.); (A.F.)
| | - Agnese Brunzini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy; (A.B.); (A.F.)
| | - Giulia Facco
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/a, Torrette di Ancona, 60126 Ancona, Italy; (G.F.); (A.G.)
| | - Alida Mazzoli
- Department of Materials, Environmental Sciences and Urban Planning, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy;
| | - Archimede Forcellese
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131 Ancona, Italy; (A.B.); (A.F.)
| | - Antonio Gigante
- Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Via Tronto 10/a, Torrette di Ancona, 60126 Ancona, Italy; (G.F.); (A.G.)
| |
Collapse
|
16
|
Deng Y, Wang L, Zhao C, Tang S, Cheng X, Deng HW, Zhou W. A deep learning-based approach to automatic proximal femur segmentation in quantitative CT images. Med Biol Eng Comput 2022; 60:1417-1429. [PMID: 35322343 DOI: 10.1007/s11517-022-02529-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Automatic CT segmentation of proximal femur has a great potential for use in orthopedic diseases, especially in the imaging-based assessments of hip fracture risk. In this study, we proposed an approach based on deep learning for the fast and automatic extraction of the periosteal and endosteal contours of proximal femur in order to differentiate cortical and trabecular bone compartments. A three-dimensional (3D) end-to-end fully convolutional neural network (CNN), which can better combine the information among neighbor slices and get more accurate segmentation results by 3D CNN, was developed for our segmentation task. The separation of cortical and trabecular bones derived from the QCT software MIAF-Femur was used as the segmentation reference. Two models with the same network structures were trained, and they achieved a dice similarity coefficient (DSC) of 97.82% and 96.53% for the periosteal and endosteal contours, respectively. Compared with MIAF-Femur, it takes half an hour to segment a case, and our CNN model takes a few minutes. To verify the excellent performance of our model for proximal femoral segmentation, we measured the volumes of different parts of the proximal femur and compared it with the ground truth, and the relative errors of femur volume between predicted result and ground truth are all less than 5%. This approach will be expected helpful to measure the bone mineral densities of cortical and trabecular bones, and to evaluate the bone strength based on FEA.
Collapse
Affiliation(s)
- Yu Deng
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, 710121, Shaanxi, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chen Zhao
- College of Computing, Michigan Technological University, Houghton, MI, 49931, USA
| | - Shaojie Tang
- School of Automation, Xi'an University of Posts and Telecommunications, Xi'an, 710121, Shaanxi, China. .,Xi'an Key Laboratory of Advanced Controlling and Intelligent Processing (ACIP), Xi'an, , 71021, Shaanxi, China.
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Hong-Wen Deng
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, 70118, USA
| | - Weihua Zhou
- College of Computing, Michigan Technological University, Houghton, MI, 49931, USA
| |
Collapse
|
17
|
Li C, Ma C, Zhuo X, Li L, Li B, Li S, Lu WW. Focal osteoporosis defect is associated with vertebral compression fracture prevalence in a bone mineral density-independent manner. JOR Spine 2022; 5:e1195. [PMID: 35386753 PMCID: PMC8966878 DOI: 10.1002/jsp2.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/19/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Focal osteoporosis defect has shown a high association with the bone fragility and osteoporotic fracture prevalence. However, no routine computed tomography (CT)‐based vertebral focal osteoporosis defect measurement and its association with vertebral compression fracture (VCF) were discussed yet. This study aimed to develop a routine CT‐based measurement method for focal osteoporosis defect quantification, and to assess its association with the VCF prevalence. Materials and Methods A total of 205 cases who underwent routine CT scanning, were retrospectively reviewed and enrolled into either the VCF or the control group. The focal bone mineral content loss (focal BMC loss), measured as the cumulated demineralization within bone void space, was proposed for focal osteoporosis defect quantification. Its scan‐rescan reproducibility and its correlation with trabecular bone mineral density (BMD) and apparent microarchitecture parameters were evaluated. The association between focal BMC loss and the prevalence of VCF was studied by logistic regression. Results The measurement of focal BMC loss showed high reproducibility (RMSSD = 0.011 mm, LSC = 0.030 mm, ICC = 0.97), and good correlation with focal bone volume fraction (r = 0.79, P < 0.001), trabecular bone separation (r = 0.76, P < 0.001), but poor correlation with trabecular BMD (r = 0.37, P < 0.001). The focal BMC loss was significantly higher in the fracture group than the control (1.03 ± 0.13 vs. 0.93 ± 0.11 mm; P < 0.001), and was associated with prevalent VCF (1.87, 95% CI = 1.31–2.65, P < 0.001) independent of trabecular BMD level. Discussion As a surrogate measure of focal osteoporosis defect, focal BMC Loss independently associated with the VCF prevalence. It suggests that focal osteoporosis defect is a common manifestation that positively contributed to compression fracture risk and can be quantified with routine CT using focal BMC Loss.
Collapse
Affiliation(s)
- Chentian Li
- Department of Orthopedics and Taumatology Zhujiang Hospital, Southern Medical University Guangzhou Guangdong China.,Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Chi Ma
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China
| | - Xianglong Zhuo
- Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Li Li
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Bing Li
- Department of Orthopaedics Liuzhou Worker's Hospital, Guangxi Medical University Liuzhou Guangxi China
| | - Songjian Li
- Department of Orthopedics and Taumatology Zhujiang Hospital, Southern Medical University Guangzhou Guangdong China
| | - William W Lu
- Department of Orthopaedics & Traumatology, Li Ka Shing Faculty of Medicine The University of Hong Kong Hong Kong SAR China.,SIAT & Shenzhen Institutes of Advanced Technology Chinese Academy of Science Shenzhen Guangdong China
| |
Collapse
|
18
|
Poole KE, Treece GM, Pearson RA, Gee AH, Bolognese MA, Brown JP, Goemaere S, Grauer A, Hanley DA, Mautalen C, Recknor C, Yang YC, Rojeski M, Libanati C, Whitmarsh T. Romosozumab Enhances Vertebral Bone Structure in Women With Low Bone Density. J Bone Miner Res 2022; 37:256-264. [PMID: 34738660 PMCID: PMC9299688 DOI: 10.1002/jbmr.4465] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 11/17/2022]
Abstract
Romosozumab monoclonal antibody treatment works by binding sclerostin and causing rapid stimulation of bone formation while decreasing bone resorption. The location and local magnitude of vertebral bone accrual by romosozumab and how it compares to teriparatide remains to be investigated. Here we analyzed the data from a study collecting lumbar computed tomography (CT) spine scans at enrollment and 12 months post-treatment with romosozumab (210 mg sc monthly, n = 17), open-label daily teriparatide (20 μg sc, n = 19), or placebo (sc monthly, n = 20). For each of the 56 women, cortical thickness (Ct.Th), endocortical thickness (Ec.Th), cortical bone mineral density (Ct.bone mineral density (BMD)), cancellous BMD (Cn.BMD), and cortical mass surface density (CMSD) were measured across the first lumbar vertebral surface. In addition, color maps of the changes in the lumbar vertebrae structure were statistically analyzed and then visualized on the bone surface. At 12 months, romosozumab improved all parameters significantly over placebo and resulted in a mean vertebral Ct.Th increase of 10.3% versus 4.3% for teriparatide, an Ec.Th increase of 137.6% versus 47.5% for teriparatide, a Ct.BMD increase of 2.1% versus a -0.1% decrease for teriparatide, and a CMSD increase of 12.4% versus 3.8% for teriparatide. For all these measurements, the differences between romosozumab and teriparatide were statistically significant (p < 0.05). There was no significant difference between the romosozumab-associated Cn.BMD gains of 22.2% versus 18.1% for teriparatide, but both were significantly greater compared with the change in the placebo group (-4.6%, p < 0.05). Cortical maps showed the topographical locations of the increase in bone in fracture-prone areas of the vertebral shell, walls, and endplates. This study confirms widespread vertebral bone accrual with romosozumab or teriparatide treatment and provides new insights into how the rapid prevention of vertebral fractures is achieved in women with osteoporosis using these anabolic agents. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Kenneth Es Poole
- Department of Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Rose A Pearson
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Cambridge, UK
| | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Quebec City, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Kim KY, Kim KM. Similarities and differences between bone quality parameters, trabecular bone score and femur geometry. PLoS One 2022; 17:e0260924. [PMID: 35015756 PMCID: PMC8751997 DOI: 10.1371/journal.pone.0260924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
Bone quality is a critical factor that, along with bone quantity, determines bone strength. Image-based parameters are used for assessing bone quality non-invasively. The trabecular bone score (TBS) is used to assess quality of trabecular bone and femur geometry for cortical bone. Little is known about the associations between these two bone quality parameters and whether they show differences in the relationships with age and body mass index (BMI). We investigated the associations between the trabecular bone score (TBS) and femur cortical geometry. Areal bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry (DXA) and the TBS was assessed using iNsight software and, femur geometry using APEX (Hologic). A total of 452 men and 517 women aged 50 years and older with no medical history of a condition affecting bone metabolism were included. Z-scores for TBS and cortical thickness were calculated using the age-specific mean and SD for each parameter. A ‘discrepancy group’ was defined as patients whose absolute Z-score difference between TBS and cortical thickness was > 1 point. TBS and cortical thickness correlated negatively with age both in men and women, but the associations were stronger in women. Regarding the associations with BMI, TBS provided significant negative correlation with BMI in the range of BMI > 25 kg/m2. By contrast, cortical thickness correlated positively with BMI for all BMI ranges. These bone quality-related parameters, TBS and cortical thickness, significantly correlated, but discordance between these two parameters was observed in about one-third of the men and women (32.7% and 33.4%, respectively). Conclusively, image-based bone quality parameters for trabecular and cortical bone exhibit both similarities and differences in terms of their associations with age and BMI. These different profiles in TBS and FN cortical thickness might results in different risk profiles for the vertebral fractures or hip fractures in a certain percentage of people.
Collapse
Affiliation(s)
- Kyong Young Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon, South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, South Korea
- Division of Endocrinology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- * E-mail:
| |
Collapse
|
20
|
Wang Y, Li J, Men Y, Wei W. Menopause-related cortical loss of the humeral head region mainly occurred in the greater tuberosity. Front Endocrinol (Lausanne) 2022; 13:942803. [PMID: 36093094 PMCID: PMC9449578 DOI: 10.3389/fendo.2022.942803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Proximal humerus fractures are commonly observed in postmenopausal women. The goal of this study was to investigate menopause-related changes in cortical structure of the humeral head. MATERIALS AND METHODS Clinical computed tomography (CT) scans of 75 healthy women spanning a wide range of ages (20-72 years) were analyzed. For each subject, cortical bone mapping (CBM) was applied to create a color three-dimensional (3D) thickness map for the proximal humerus. Nine regions of interest (ROIs) were defined in three walls of the humeral head. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD), were measured. RESULTS Compared to premenopausal women, postmenopausal women were characterized by a significantly lower CTh and CM value in the lateral part of the greater tuberosity. Similar changes were only found in ROI 4, but not in ROIs 5-6 in the lesser tuberosity. Linear regression analysis revealed that the CTh and CM value of ROIs 1, 3, and 4 were negatively associated with age. These results showed that menopause-related loss in CTh and CM was mainly in the greater tuberosity besides the proximal part of the lesser tuberosity. Trabecular bone variable measured as ECTD showed a notably lower value in ROIs 1-9 in postmenopausal vs. premenopausal group. Inverse linear associations for ECTD and age were found in ROIs 2, 3, 5, 6, 7, and 9, indicating no site-specific differences of endocortical trabecular bone loss between the greater and lesser tuberosity. CONCLUSIONS Menopause-related cortical loss of the humeral head mainly occurred in the lateral part of the greater tuberosity. The increased rate of humeral bone loss in the greater tuberosity may contribute materially to complex proximal humerus fractures.
Collapse
Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
- *Correspondence: Yeming Wang, ; Wanfu Wei,
| | - Jian Li
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
| | - Yutao Men
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China
- National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Wanfu Wei
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
- *Correspondence: Yeming Wang, ; Wanfu Wei,
| |
Collapse
|
21
|
Yao Q, Liu J, Yuan K, Qiu X, Wang J, Li J, Li C, Zhu J, Qin J. Comparison of L1 CT-attenuation and cortical thickness in predicting osteoporosis by opportunistic CT. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:631-640. [PMID: 35253725 DOI: 10.3233/xst-211106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In vertebrae, the amount of cortical bone has been estimated at 30-60%, but 45-75% of axial load on a vertebral body is borne by cortical bone. OBJECTIVE To compare the role of L1 CT-attenuation and cortical thickness in predicting osteoporosis by opportunistic CT and explore cortical thickness value in osteoporosis. METHODS We collected data of 94 patients who underwent DXA and thoracic and/or abdominal CT to demonstrate an entire L1 for other indications in routine practice. Patients were divided into three groups according to T-score: osteoporosis, osteopenia, or normal. CT-attenuation value and cortical thickness of L1 were measured. ANOVA analysis was utilized to analyze CT-attenuation and cortical thickness among the three groups. Sensitivity, specificity, and area under the curve (AUC) predicting low BMD were determined using ROC. Pearson correlations were employed to describe relationship between L1 BMD and CT-attenuation value, BMD, as well as cortical thickness. RESULTS The mean cortical thickness was 0.83±0.11, 0.72±0.10, and 0.64±0.09 mm for normal, osteopenia, and osteoporotic subgroups, respectively. A statistically significant difference was observed in cortical thickness and CT-attenuation value among these three subgroups. A mean CT-attenuation value threshold of > 148.7 yielded 73.0% sensitivity and 86.0% specificity for distinguishing low BMD from normal with an AUC = 0.83. Pearson correlation analysis indicated that BMD was positively correlated with CT-attenuation (r = 0.666, P < 0.001) and cortical thickness (r = 0.604, P < 0.001). CONCLUSIONS L1 CT-attenuation and cortical thickness measured on opportunistic CT can help predict osteoporosis. Compared with cortical thickness, CT-attenuation is a more sensitive and accurate index for distinguishing low BMD from normal.
Collapse
Affiliation(s)
- Qianqian Yao
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Jiaojiao Liu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Kemei Yuan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Xiaoqian Qiu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Jiemiao Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Jiang Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Changqin Li
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Jianzhong Zhu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Jian Qin
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| |
Collapse
|
22
|
Ling M, Li X, Xu Y, Fan Y. Spatial distribution of hip cortical thickness in postmenopausal women with different osteoporotic fractures. Arch Osteoporos 2021; 16:172. [PMID: 34779934 DOI: 10.1007/s11657-021-01039-9] [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: 08/08/2021] [Accepted: 11/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Few studies h ave discussed the association between cortical bone outside the fracture site and the fracture itself. Focusing on hip cortical thickness, this study revealed distinct distributions of the parameters for hip (trochanteric or femoral neck), vertebral, and peripheral osteoporotic fractures and suggested that the spatial distribution of hip cortical thickness was fracture-specific. PURPOSE Cortical bone is critical for bone strength. Hip cortical thickness is reported to be closely associated with the incidence of hip fractures, but its relationship with nonhip fractures is rarely studied. As the hip is a major site for fracture risk assessment, it would be of great benefit to investigate the association between hip cortical thickness and different osteoporotic fractures. METHODS One hundred age-matched postmenopausal women were equally assigned to 4 osteoporotic fracture groups (trochanteric, femoral neck, vertebral, and peripheral fractures) and a nonfracture group. Each subject had a clinical quantitative computed tomography scan of the bilateral hips and the lumbar spine. A cortical bone mapping algorithm was adopted to calculate hip cortical thickness. Hip and lumbar trabecular density and the hip cortical thickness distribution were compared among the groups. RESULTS All the fracture groups presented lower lumbar trabecular density. Compared with nonfracture controls, patients with hip or vertebral fractures but not peripheral fractures showed decreased cortical thickness and trabecular density of the hip. Fracture-specific distributions of cortical thickness were revealed, including zonal defects on the neck-intertrochanter junction, greater trochanter, and the periphery of the lesser trochanter for trochanteric fractures, a focal defect on the anterosuperior neck for femoral neck fractures, a moderate and average distribution for vertebral fractures, and focally thicker cortices on the anterosuperior greater trochanter and the periphery of the lesser trochanter for peripheral fractures. CONCLUSION The spatial distribution of hip cortical thickness was different for each type of osteoporotic fracture, and patients with centrally located fractures demonstrated more severe cortical deterioration. This finding needs to be validated in a larger sample.
Collapse
Affiliation(s)
- Ming Ling
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xianlong Li
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yueyang Xu
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yongqian Fan
- Department of Orthopaedics, Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| |
Collapse
|
23
|
Cubillos PO, Dos Santos VO, Fernandes DA, Moré ADO, da Rosa E, Fancello EA, Roesler CR. Retrieval analysis of neck fracture on uni-modular total hip arthroplasty stems: The contributions of material processing and stem design. Proc Inst Mech Eng H 2021; 236:147-157. [PMID: 34672814 DOI: 10.1177/09544119211049580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Total hip arthroplasty stem fracture is an important contributor to morbidity rate and increases the cost of revision surgery. Failure is usually caused by issues related to overload, inadequate stem support, inappropriate stem design or dimensions and material processing. In this study, the role of the relationship between material characterization and biomechanical performance in the fracture of retrieved stems was explored. The stems were manufactured with forged stainless steel, had the same length, 12/14 trunnion, and 28-mm head. These stems were evaluated by macroscopic and microscopic examination to identify the causes of premature failure. Each stem was sectioned into four regions, and the cross-sections were used for the microhardness and grain size analysis. Finite element analysis (FEA) was carried out, considering the stem positioned at the femur, a musculoskeletal model, and biomechanical loading. All stems had fractured through a fatigue mechanism, mainly a unidirectional bending loading condition, with crack nucleation on the lateral side and propagation on the medial side. The numerical analysis revealed maximum mechanical stress on the lateral side of the stem neck, but this was below the yield stress calculated via the hardness. The use of a shorter head neck length could reduce the maximum mechanical stress at the neck. At a cross-section near the plane of the stem fracture, the hardness was lower than that normally reported by the ASM, and there were heterogonous and coarse grain sizes on the lateral side. The main cause of failure of the two stems analyzed was a combination of low hardness and coarse grain size, due to inappropriate materials processing, worsen by a high level of stress on the lateral side of the neck due to the large stem-head offset selected by the orthopedic surgeon.
Collapse
Affiliation(s)
- Patricia O Cubillos
- Biomechanical Engineering Laboratory (LEBm) of University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Vinícius O Dos Santos
- Biomechanical Engineering Laboratory (LEBm) of University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Daniel A Fernandes
- Biomechanical Engineering Laboratory (LEBm) of University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ari DO Moré
- Biomechanical Engineering Laboratory (LEBm) of University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil.,Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Edison da Rosa
- GRANTE, Department of Mechanical Engineering, Florianópolis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Eduardo A Fancello
- GRANTE, Department of Mechanical Engineering, Florianópolis, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Carlos Rm Roesler
- Biomechanical Engineering Laboratory (LEBm) of University Hospital, Department of Mechanical Engineering, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| |
Collapse
|
24
|
Kim YH, Shin JY, Lee A, Park S, Han SS, Hwang HJ. Automated cortical thickness measurement of the mandibular condyle head on CBCT images using a deep learning method. Sci Rep 2021; 11:14852. [PMID: 34290333 PMCID: PMC8295413 DOI: 10.1038/s41598-021-94362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
This study proposes a deep learning model for cortical bone segmentation in the mandibular condyle head using cone-beam computed tomography (CBCT) and an automated method for measuring cortical thickness with a color display based on the segmentation results. In total, 12,800 CBCT images from 25 normal subjects, manually labeled by an oral radiologist, served as the gold-standard. The segmentation model combined a modified U-Net and a convolutional neural network for target region classification. Model performance was evaluated using intersection over union (IoU) and the Hausdorff distance in comparison with the gold standard. The second automated model measured the cortical thickness based on a three-dimensional (3D) model rendered from the segmentation results and presented a color visualization of the measurements. The IoU and Hausdorff distance showed high accuracy (0.870 and 0.928 for marrow bone and 0.734 and 1.247 for cortical bone, respectively). A visual comparison of the 3D color maps showed a similar trend to the gold standard. This algorithm for automatic segmentation of the mandibular condyle head and visualization of the measured cortical thickness as a 3D-rendered model with a color map may contribute to the automated quantification of bone thickness changes of the temporomandibular joint complex on CBCT.
Collapse
Affiliation(s)
- Young Hyun Kim
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Young Shin
- Department of Mathematics, Pohang University of Science and Technology, 150 Jigok-ro Nam-gu, Pohang-si, Gyeongsangbuk-do, 37666, South Korea
| | - Ari Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea
| | - Seungtae Park
- Department of Mathematics, Pohang University of Science and Technology, 150 Jigok-ro Nam-gu, Pohang-si, Gyeongsangbuk-do, 37666, South Korea
| | - Sang-Sun Han
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, South Korea.
| | - Hyung Ju Hwang
- Department of Mathematics, Pohang University of Science and Technology, 150 Jigok-ro Nam-gu, Pohang-si, Gyeongsangbuk-do, 37666, South Korea.
| |
Collapse
|
25
|
Bhattacharya P, Li Q, Lacroix D, Kadirkamanathan V, Viceconti M. A systematic approach to the scale separation problem in the development of multiscale models. PLoS One 2021; 16:e0251297. [PMID: 34003842 PMCID: PMC8130972 DOI: 10.1371/journal.pone.0251297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 04/25/2021] [Indexed: 11/19/2022] Open
Abstract
Throughout engineering there are problems where it is required to predict a quantity based on the measurement of another, but where the two quantities possess characteristic variations over vastly different ranges of time and space. Among the many challenges posed by such 'multiscale' problems, that of defining a 'scale' remains poorly addressed. This fundamental problem has led to much confusion in the field of biomedical engineering in particular. The present study proposes a definition of scale based on measurement limitations of existing instruments, available computational power, and on the ranges of time and space over which quantities of interest vary characteristically. The definition is used to construct a multiscale modelling methodology from start to finish, beginning with a description of the system (portion of reality of interest) and ending with an algorithmic orchestration of mathematical models at different scales within the system. The methodology is illustrated for a specific but well-researched problem. The concept of scale and the multiscale modelling approach introduced are shown to be easily adaptable to other closely related problems. Although out of the scope of this paper, we believe that the proposed methodology can be applied widely throughout engineering.
Collapse
Affiliation(s)
- Pinaki Bhattacharya
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
- * E-mail:
| | - Qiao Li
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Damien Lacroix
- Department of Mechanical Engineering, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Visakan Kadirkamanathan
- INSIGNEO Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, United Kingdom
| | - Marco Viceconti
- Dipartimento di Ingegneria Industriale, Alma Mater Studiorum – University of Bologna, Bologna, Italy
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
26
|
Telfer S, Brunnquell CL, Allen JD, Linnau KF, Zamora D, Kleweno CP. The effect of age and sex on pelvic bone density measured opportunistically in clinical CT scans. J Orthop Res 2021; 39:485-492. [PMID: 32617998 DOI: 10.1002/jor.24792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
Unstable pelvic ring fractures are severe and complex injuries, and surgical fixation is challenging and can be complicated by early failure due in part to difficulties with securely fixing screws in low-density bone. There is limited information in the literature about how the density distribution across the pelvic bones changes with age and sex. In this study, we used 60 sets of calibrated bone density measurements obtained opportunistically from clinical computed tomography scans of the pelvis. Three-dimensional models of the innominate bone were produced and the effects of age and sex on cortical bone density modeled. Overall trends and regions where these factors had a significant effect were identified, and the results visualized. Across the entire innominate bone, the mean loss of density was found to be 1.6 mg/cc per year, with several specific areas (pubic body, iliac fossa, posterior ilium, and anterior inferior iliac spine for example) showing significant rates of loss up to three times greater than the rest of the bone. Areas significantly affected by sex included the posterior pubic root, anterior aspect of the pubic body, and iliac crest. Despite overall trends of attenuation, there remains significant variability between individuals. This supports the need to further explore subject-specific planning tools for pelvic fracture repair. Statement of clinical significance: Bone density changes across the innominate bone due to age and sex tend to vary between individuals, although consistent effects were seen at specific regions. This information may help in surgical planning of unstable fracture repairs.
Collapse
Affiliation(s)
- Scott Telfer
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| | | | - Jerad D Allen
- Department of Orthopaedic Surgery and Sports Medicine, Emory University, Atlanta, Georgia
| | - Ken F Linnau
- Department of Radiology, University of Washington, Seattle, Washington
| | - David Zamora
- Department of Radiology, University of Washington, Seattle, Washington
| | - Conor P Kleweno
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
| |
Collapse
|
27
|
Harrison KD, Hiebert BD, Panahifar A, Andronowski JM, Ashique AM, King GA, Arnason T, Swekla KJ, Pivonka P, Cooper DM. Cortical Bone Porosity in Rabbit Models of Osteoporosis. J Bone Miner Res 2020; 35:2211-2228. [PMID: 32614975 PMCID: PMC7702175 DOI: 10.1002/jbmr.4124] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/20/2022]
Abstract
Cortical bone porosity is intimately linked with remodeling, is of growing clinical interest, and is increasingly accessible by imaging. Thus, the potential of animal models of osteoporosis (OP) to provide a platform for studying how porosity develops and responds to interventions is tremendous. To date, rabbit models of OP have largely focused on trabecular microarchitecture or bone density; some such as ovariectomy (OVX) have uncertain efficacy and cortical porosity has not been extensively reported. Our primary objective was to characterize tibial cortical porosity in rabbit-based models of OP, including OVX, glucocorticoids (GC), and OVX + GC relative to controls (SHAM). We sought to: (i) test the hypothesis that intracortical remodeling is elevated in these models; (ii) contrast cortical remodeling and porosity in these models with that induced by parathyroid hormone (1-34; PTH); and (iii) contrast trabecular morphology in the proximal tibia across all groups. Evidence that an increase in cortical porosity occurred in all groups was observed, although this was the least robust for GC. Histomorphometric measures supported the hypothesis that remodeling rate was elevated in all groups and also revealed evidence of uncoupling of bone resorption and formation in the GC and OVX + GC groups. For trabecular bone, a pattern of loss was observed for OVX, GC, and OVX + GC groups, whereas the opposite was observed for PTH. Change in trabecular number best explained these patterns. Taken together, the findings indicated rabbit models provide a viable and varied platform for the study of OP and associated changes in cortical remodeling and porosity. Intriguingly, the evidence revealed differing effects on the cortical and trabecular envelopes for the PTH model. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR)..
Collapse
Affiliation(s)
- Kim D Harrison
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Beverly D Hiebert
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Arash Panahifar
- BioMedical Imaging and Therapy Beamline, Canadian Light Source, Saskatoon, Canada.,Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | | | - Gavin A King
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Terra Arnason
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Kurtis J Swekla
- Research Services and Ethics Office, Office of the Vice President of Research, University of Saskatchewan, Saskatoon, Canada
| | - Peter Pivonka
- School of Mechanical, Medical, and Process Engineering, Queensland University of Technology, Brisbane, Australia
| | - David Ml Cooper
- Department of Anatomy, Physiology, and Pharmacology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
28
|
Maeda K, Mochizuki T, Kobayashi K, Tanifuji O, Someya K, Hokari S, Katsumi R, Morise Y, Koga H, Sakamoto M, Koga Y, Kawashima H. Cortical thickness of the tibial diaphysis reveals age- and sex-related characteristics between non-obese healthy young and elderly subjects depending on the tibial regions. J Exp Orthop 2020; 7:78. [PMID: 33025285 PMCID: PMC7538524 DOI: 10.1186/s40634-020-00297-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/28/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study aimed to evaluate the age- and sex-related characteristics in cortical thickness of the tibial diaphysis between non-obese healthy young and elderly subjects as reference data. METHODS The study investigated 31 young subjects (12 men and 19 women; mean age, 25 ± 8 years) and 54 elderly subjects (29 men and 25 women; mean age, 70 ± 6 years). Three-dimensional estimated cortical thickness of the tibial diaphysis was automatically calculated for 5000-9000 measurement points using the high-resolution cortical thickness measurement from clinical computed tomography data. In 12 assessment regions created by combining three heights (proximal, central, and distal diaphysis) and four areas of the axial plane at 90° (medial, anterior, lateral, and posterior areas) in the tibial coordinate system, the standardized thickness was assessed using the tibial length. RESULTS As structural characteristics, there were no differences in the medial and lateral thicknesses, while the anterior thickness was greater than the posterior thickness in all groups. The sex-related difference was not shown. As an age-related difference, elderly subjects showed greater or lesser cortical thickness than the young subjects, depending on the regions of the tibia. CONCLUSIONS Cortical thickness was different depending on sex, age, and regions in the tibia. The results of this study are of clinical relevance as reference points to clarify the causes of various pathological conditions for diseases. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Keisuke Maeda
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Keiichiro Someya
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Sho Hokari
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yusuke Morise
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Makoto Sakamoto
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| |
Collapse
|
29
|
MacKay JW, Kaggie JD, Treece GM, McDonnell SM, Khan W, Roberts AR, Janiczek RL, Graves MJ, Turmezei TD, McCaskie AW, Gilbert FJ. Three-Dimensional Surface-Based Analysis of Cartilage MRI Data in Knee Osteoarthritis: Validation and Initial Clinical Application. J Magn Reson Imaging 2020; 52:1139-1151. [PMID: 32447815 DOI: 10.1002/jmri.27193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Traditional quantitative analysis of cartilage with MRI averages measurements (eg, thickness) across regions-of-interest (ROIs) which may reduce responsiveness. PURPOSE To validate and describe clinical application of a semiautomated surface-based method for analyzing cartilage relaxation times ("composition") and morphology on MRI, 3D cartilage surface mapping (3D-CaSM). STUDY TYPE Validation study in cadaveric knees and prospective observational (cohort) study in human participants. POPULATION Four cadaveric knees and 14 participants aged 40-60 with mild-moderate knee osteoarthritis (OA) and 6 age-matched healthy volunteers, imaged at baseline, 1, and 6 months. FIELD STRENGTH/SEQUENCE 3D spoiled gradient echo, T1 rho/T2 magnetization-prepared 3D fast spin echo for mapping of T1 rho/T2 relaxation times and delayed gadolinium enhanced MRI of cartilage (dGEMRIC) using variable flip angle T1 relaxation time mapping at 3T. ASSESSMENT 3D-CaSM was validated against high-resolution peripheral quantitative computed tomography (HRpQCT) in cadaveric knees, with comparison to expert manual segmentation. The clinical study assessed test-retest repeatability and sensitivity to change over 6 months for cartilage thickness and relaxation times. STATISTICAL TESTS Bland-Altman analysis was performed for the validation study and evaluation of test-retest repeatability. Six-month changes were assessed via calculation of the percentage of each cartilage surface affected by areas of significant change (%SC), defined using thresholds based on area and smallest detectable difference (SDD). RESULTS Bias and precision (0.06 ± 0.25 mm) of 3D-CaSM against reference HRpQCT data were comparable to expert manual segmentation (-0.13 ± 0.26 mm). 3D-CaSM demonstrated significant (>SDD) 6-month changes in cartilage thickness and relaxation times in both OA participants and healthy controls. The parameter demonstrating the greatest 6-month change was T2 relaxation time (OA median %SC [IQR] = 8.8% [5.5 to 12.6]). DATA CONCLUSION This study demonstrates the construct validity and potential clinical utility of 3D-CaSM, which may offer advantages to conventional ROI-based methods. LEVEL OF EVIDENCE 2. TECHNICAL EFFICACY STAGE 2. J. Magn. Reson. Imaging 2020;52:1139-1151.
Collapse
Affiliation(s)
- James W MacKay
- Department of Radiology, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Stephen M McDonnell
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Alexandra R Roberts
- Clinical Imaging, GlaxoSmithKline, London, UK
- Antaros Medical, Uppsala, Sweden
| | | | - Martin J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Tom D Turmezei
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Andrew W McCaskie
- Division of Trauma & Orthopaedics, Department of Surgery, University of Cambridge, Cambridge, UK
| | - Fiona J Gilbert
- Department of Radiology, University of Cambridge, Cambridge, UK
| |
Collapse
|
30
|
Profico A, Bondioli L, Raia P, O'Higgins P, Marchi D. morphomap: An R package for long bone landmarking, cortical thickness, and cross‐sectional geometry mapping. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 174:129-139. [DOI: 10.1002/ajpa.24140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/15/2020] [Accepted: 08/11/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Antonio Profico
- PalaeoHub, Department of Archaeology University of York York UK
| | - Luca Bondioli
- Service of Bioarchaeology Service Museo delle Civiltà Rome Italy
| | - Pasquale Raia
- Dipartimento di Scienze della Terra, dell'Ambiente e delle Risorse Università di Napoli Federico II Naples Italy
| | - Paul O'Higgins
- PalaeoHub, Department of Archaeology University of York York UK
- Hull York Medical School University of York York UK
- Centre for Forensic Anthropology University of Western Australia Perth Australia
| | - Damiano Marchi
- Department of Biology University of Pisa Pisa Italy
- Evolutionary Studies Institute and Centre for Excellence in PalaeoSciences University of the Witwatersrand Johannesburg‐Braamfontein South Africa
| |
Collapse
|
31
|
Iori G, Schneider J, Reisinger A, Heyer F, Peralta L, Wyers C, Glüer CC, van den Bergh JP, Pahr D, Raum K. Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck. Bone 2020; 137:115446. [PMID: 32450342 DOI: 10.1016/j.bone.2020.115446] [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: 01/26/2020] [Revised: 05/03/2020] [Accepted: 05/19/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck. METHODS The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 μm voxel size. Cortical thickness (Ct.Thtibia), porosity (Ct.Potibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 μm pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models. RESULTS Femur strength was associated with the total (vBMDtot; R2 = 0.23, p < 0.01) and trabecular (vBMDtrab; R2 = 0.26, p < 0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.ThFN; R2 = 0.29, p < 0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R2 = 0.34, p < 0.001), separation (Tb.SpFN; R2 = 0.25, p < 0.01) and number (Tb.NFN; R2 = 0.32, p < 0.001) of the femoral neck. Moreover, smaller Ct.Thtibia was associated with smaller Ct.ThFN (R2 = 0.31, p < 0.05), lower Tb.BV/TVFN (R2 = 0.29, p < 0.05), higher Tb.SpFN (R2 = 0.33, p < 0.05) and lower Tb.NFN (R2 = 0.42, p < 0.01). A higher prevalence of pores with diameter > 100 μm in tibial cortical bone (relCt.Po100μm-tibia) indicated higher Tb.SpFN (R2 = 0.36, p < 0.01) and lower Tb.NFN (R2 = 0.45, p < 0.01). CONCLUSION Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.
Collapse
Affiliation(s)
- Gianluca Iori
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Schneider
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Reisinger
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Frans Heyer
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Laura Peralta
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, INSERM UMR S 1146, CNRS UMR 7371, Paris, France; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Caroline Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Claus C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - J P van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Dieter Pahr
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria; Institute for Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Kay Raum
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| |
Collapse
|
32
|
Someya K, Mochizuki T, Hokari S, Tanifuji O, Katsumi R, Koga H, Takahashi Y, Kobayashi K, Morise Y, Sakamoto M, Koga Y, Endo N. Age- and sex-related characteristics in cortical thickness of femoral diaphysis for young and elderly subjects. J Bone Miner Metab 2020; 38:533-543. [PMID: 32002681 DOI: 10.1007/s00774-019-01079-9] [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: 04/07/2019] [Accepted: 12/21/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cortical thickness of the femoral diaphysis is assumed to be a preferred parameter in the assessment of the structural adaptation by mechanical use and biological factors. This study aimed to investigate the age- and sex-specific characteristics in cortical thickness of the femoral diaphysis between young and elderly non-obese people. MATERIALS AND METHODS This study investigated 34 young subjects (21 men and 13 women; mean age: 27 ± 8 years) and 52 elderly subjects (29 men and 23 women; mean age: 70 ± 6 years). Three-dimensional (3D) cortical thickness of the femoral diaphysis was automatically calculated for 5000-8000 measurement points using the high-resolution cortical thickness measurement from clinical CT data. In 12 assessment regions created by combining three heights (proximal, central, and distal diaphysis) and four areas of the axial plane at 90° (medial, anterior, lateral, and posterior areas) in the femoral coordinate system, the standardized thickness was assessed using the femoral length. RESULTS As per the trends, (1) there were no differences in medial and lateral thicknesses, while the posterior thickness was greater than the anterior thickness, (2) the thickness in men was higher than that in women, and (3) the thickness in young subjects was higher than that in elderly subjects. CONCLUSIONS The results of this study are of clinical relevance as reference points to clarify the causes of various pathological conditions for diseases of the lower extremities.
Collapse
Affiliation(s)
- Keiichiro Someya
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Tomoharu Mochizuki
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Sho Hokari
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Osamu Tanifuji
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Ryota Katsumi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Koga
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yuki Takahashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Koichi Kobayashi
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Yusuke Morise
- Graduate School of Science and Technology, Niigata University, Niigata, Japan
| | - Makoto Sakamoto
- School of Health Sciences, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Yoshio Koga
- Department of Orthopedic Surgery, Nioji Onsen Hospital, Niigata, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, 1-757 Asahimachi-dori Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| |
Collapse
|
33
|
Iori G, Peralta L, Reisinger A, Heyer F, Wyers C, van den Bergh J, Pahr D, Raum K. Femur strength predictions by nonlinear homogenized voxel finite element models reflect the microarchitecture of the femoral neck. Med Eng Phys 2020; 79:60-66. [PMID: 32291201 DOI: 10.1016/j.medengphy.2020.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 03/10/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022]
Abstract
In the human femoral neck, the contribution of the cortical and trabecular architecture to mechanical strength is known to depend on the load direction. In this work, we investigate if QCT-derived homogenized voxel finite element (hvFE) simulations of varying hip loading conditions can be used to study the architecture of the femoral neck. The strength of 19 pairs of human femora was measured ex vivo using nonlinear hvFE models derived from high-resolution peripheral QCT scans (voxel size: 30.3 µm). Standing and side-backwards falling loads were modeled. Quasi-static mechanical tests were performed on 20 bones for comparison. Associations of femur strength with volumetric bone mineral density (vBMD) or microstructural parameters of the femoral neck obtained from high-resolution QCT were compared between mechanical tests and simulations and between standing and falling loads. Proximal femur strength predictions by hvFE models were positively associated with the vBMD of the femoral neck (R² > 0.61, p < 0.001), as well as with its cortical thickness (R² > 0.27, p < 0.001), trabecular bone volume fraction (R² = 0.42, p < 0.001) and with the first two principal components of the femoral neck architecture (R² > 0.38, p < 0.001). Associations between femur strength and femoral neck microarchitecture were stronger for one-legged standing than for side-backwards falling. For both loading directions, associations between structural parameters and femur strength from hvFE models were in good agreement with those from mechanical tests. This suggests that hvFE models can reflect the load-direction-specific contribution of the femoral neck microarchitecture to femur strength.
Collapse
Affiliation(s)
- Gianluca Iori
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laura Peralta
- Laboratoire d'Imagerie Biomédicale, Sorbonne Universités, INSERM UMR S 1146, CNRS UMR, 7371, Paris, France; Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Andreas Reisinger
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Frans Heyer
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Caroline Wyers
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Joop van den Bergh
- Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
| | - Dieter Pahr
- Division Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria; Institute for Lightweight Design and Structural Biomechanics, TU Wien, Vienna, Austria
| | - Kay Raum
- Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| |
Collapse
|
34
|
Association between osteoporotic femoral neck fractures and DXA-derived 3D measurements at lumbar spine: a case-control study. Arch Osteoporos 2020; 15:8. [PMID: 31897775 DOI: 10.1007/s11657-019-0680-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/15/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED A case-control study assessing the association of DXA-derived 3D measurements at lumbar spine with osteoporotic hip fractures was performed. Stronger association was found between transcervical hip fractures and integral (AUC = 0.726), and cortical (AUC = 0.696) measurements at the lumbar spine compared with measurements at the trabecular bone (AUC = 0.617); although femur areal bone mineral density (aBMD) remains the referent measurement for hip fracture risk evaluation (AUC = 0.838). PURPOSE The aim of the present study was to evaluate the association between DXA-derived 3D measurements at lumbar spine and osteoporotic hip fractures. METHODS We analyzed a case-control database composed by 61 women with transcervical hip fractures and 61 age-matched women without any type of fracture. DXA scans at lumbar spine were acquired, and areal bone mineral density (aBMD) was measured. Integral, trabecular and cortical volumetric BMD (vBMD), cortical thickness, and cortical surface BMD (sBMD) at different regions of interest were assessed using a DXA-based 3D modeling software. Descriptive statistics, tests of difference, odds ratio (OR), and area under the receiver operating curve (AUC) were used to compare hip fracture and control groups. RESULTS Integral vBMD, cortical vBMD, cortical sBMD, and cortical thickness were the DXA-derived 3D measurements at lumbar spine that showed the stronger association with transcervical hip fractures, with AUCs in the range of 0.685-0.726, against 0.670 for aBMD. The highest AUC (0.726) and OR (2.610) at the lumbar spine were found for integral vBMD at the posterior vertebral elements. Significantly, lower AUC (0.617) and OR (1.607) were found for trabecular vBMD at the vertebral body. Overall, total femur aBMD remains the DXA-derived measurement showing the highest AUC (0.838) and OR (6.240). CONCLUSION This study showed the association of DXA-derived measurements at lumbar spine with transcervical hip fractures. A strong association between vBMD at the posterior vertebral elements and transcervical hip fractures was observed, probably because of global deterioration of the cortical bone. Further studies should be carried out to investigate on the relative risk of transcervical fracture in patients with long-term cortical structural deterioration.
Collapse
|
35
|
Zhu X, Mei J, Ni M, Jia G, Liu S, Dai Y, Zhang Y. [General anatomy and image reconstruction analysis of the proximal femoral trabecular structures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1254-1259. [PMID: 31544435 DOI: 10.7507/1002-1892.201904128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the three-dimensional structure of proximal femoral trabeculae, analyze the formation mechanism, and explore its relationship with the occurrence and treatment of proximal femoral fractures. Methods Six cadaver adult femur specimens were harvested and the gross specimens containing both trabecular system and cortical bone were established by hand scraping. All samples were scanned by micro-CT and the CT images were input into Mimics18.0 software to establish the digital proximal femoral model containing trabecular structure. The spatial distribution of trabecular system was observed, and the relations between trabecular bone and the proximal femur surface and related anatomical landmarks were analyzed in digital models. Results The gross specimen and digital models of trabecular system were successfully established. The trabecular system of proximal femur could be divided into two groups: the horizontal and vertical trabecular. The horizontal trabecular arose from the base of greater trochanter, gone along the direction of femoral neck, and terminated at the center of femoral head. The vertical trabecular began from the base of lesser trochanter and femoral calcar, gone radically upward, and reached the femoral head. The average distance of the horizontal trabecular to the greater trochanter was 22.66 mm (range, 17.3-26.8 mm). In the femoral head, the horizontal trabecula and the vertical trabecula were fused into a kind of sphere, and the distances from the horizontal trabecula to the surface of the femoral head vary in different sections. The average distance of trabecular ball to the femoral head surface was 6.88 mm (range, 6.3-7.2 mm) in sagittal plane, 6.32 mm (range, 5.8-7.6 mm) in coronal plane, and 6.30 mm (range, 5.6-6.3 mm) in cross section. The vertical and horizontal trabeculae intersect obliquely, and the average angle of horizontal trabecular and vertical one was 140.67° (range, 129-150°). Conclusion The trabecular system exhibits a unique spatial configuration, which is the main internal support of proximal femur. Restoration of the integrity of trabecular structure is the important goal of proximal femoral fractures.
Collapse
Affiliation(s)
- Xiaozhong Zhu
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| | - Jiong Mei
- Department of Orthopedics, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, 200233,
| | - Ming Ni
- Department of Orthopedics, Pudong New Area Peoples' Hospital, Shanghai, 201299, P.R.China
| | - Guangyao Jia
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| | - Shiwei Liu
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| | - Yahui Dai
- Department of Orthopedics, Songjiang Central Hospital, Shanghai, 201605, P.R.China
| | - Yingqi Zhang
- Department of Orthopedics, Tongji Hospital of Tongji University, Shanghai, 200065, P.R.China
| |
Collapse
|
36
|
Zymbal V, Baptista F, Letuchy EM, Janz KF, Levy SM. Mediating Effect of Muscle on the Relationship of Physical Activity and Bone. Med Sci Sports Exerc 2019; 51:202-210. [PMID: 30157107 DOI: 10.1249/mss.0000000000001759] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE This study analyzed prospective associations between distinct trajectories of objectively measured physical activity (PA) and late adolescent bone parameters and explored the mediating effects of lean soft tissue, a surrogate of muscle mass to associations. METHODS Physical activity was measured by accelerometry starting at age 5 yr and continuing at 8, 11, 13, 15, and 17 yr in approximately 524 participants from the Iowa Bone Development Study. Sex-specific group-based trajectory modeling was used to construct developmental trajectories of moderate- and vigorous-intensity PA (MVPA) from childhood to late adolescence. At age 17 yr, proximal femur bone mineral density (aBMD) was assessed by dual X-ray energy absorptiometry, and its distribution was calculated by aBMD ratios. Specific geometric measures of the proximal femur were assessed using hip structural analysis. RESULTS A significant portion of the total effect of MVPA from age 5 to 17 yr on bone parameters at age 17 yr was explained by an increase in leg lean soft tissue in both sexes. For males and females, indirect effects were observed on the total and all regional proximal femur aBMD, and on the ratio between the inferomedial and superolateral neck aBMD. The effect on the ratio between the trochanter and the total proximal femur was specific to females, whereas the effect on the hip axis length was specific to males. Direct effects of MVPA on aBMD were identified only in males. CONCLUSIONS Using robust mediation analysis, this is the first study addressing the indirect effect (through muscle) of PA across childhood and adolescence on proximal femur bone parameters. To improve bone health at the proximal femur, the results suggest PA interventions during growth that increase muscle mass, particularly in females.
Collapse
Affiliation(s)
- Vera Zymbal
- Department of Sport and Health, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, PORTUGAL
| | - Fátima Baptista
- Department of Sport and Health, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, PORTUGAL
| | - Elena M Letuchy
- Department of Epidemiology, The University of Iowa, Iowa City, IA
| | - Kathleen F Janz
- Department of Epidemiology, The University of Iowa, Iowa City, IA.,Department of Health and Human Physiology, The University of Iowa, Iowa City, IA
| | - Steven M Levy
- Department of Epidemiology, The University of Iowa, Iowa City, IA.,Department of Preventive and Community Dentistry, College of Dentistry, The University of Iowa, Iowa City, IA
| |
Collapse
|
37
|
Wu PH, Gibbons M, Foreman SC, Carballido-Gamio J, Han M, Krug R, Liu J, Link TM, Kazakia GJ. Cortical bone vessel identification and quantification on contrast-enhanced MR images. Quant Imaging Med Surg 2019; 9:928-941. [PMID: 31367547 DOI: 10.21037/qims.2019.05.23] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cortical bone porosity is a major determinant of bone strength. Despite the biomechanical importance of cortical bone porosity, the biological drivers of cortical porosity are unknown. The content of cortical pore space can indicate pore expansion mechanisms; both of the primary components of pore space, vessels and adipocytes, have been implicated in pore expansion. Dynamic contrast-enhanced MRI (DCE-MRI) is widely used in vessel detection in cardiovascular studies, but has not been applied to visualize vessels within cortical bone. In this study, we have developed a multimodal DCE-MRI and high resolution peripheral QCT (HR-pQCT) acquisition and image processing pipeline to detect vessel-filled cortical bone pores. Methods For this in vivo human study, 19 volunteers (10 males and 9 females; mean age =63±5) were recruited. Both distal and ultra-distal regions of the non-dominant tibia were imaged by HR-pQCT (82 µm nominal resolution) for bone structure segmentation and by 3T DCE-MRI (Gadavist; 9 min scan time; temporal resolution =30 sec; voxel size 230×230×500 µm3) for vessel visualization. The DCE-MRI was registered to the HR-pQCT volume and the voxels within the MRI cortical bone region were extracted. Features of the DCE data were calculated and voxels were categorized by a 2-stage hierarchical kmeans clustering algorithm to determine which voxels represent vessels. Vessel volume fraction (volume ratio of vessels to cortical bone), vessel density (average vessel count per cortical bone volume), and average vessel volume (mean volume of vessels) were calculated to quantify the status of vessel-filled pores in cortical bone. To examine spatial resolution and perform validation, a virtual phantom with 5 channel sizes and an applied pseudo enhancement curve was processed through the proposed image processing pipeline. Overlap volume ratio and Dice coefficient was calculated to measure the similarity between the detected vessel map and ground truth. Results In the human study, mean vessel volume fraction was 2.2%±1.0%, mean vessel density was 0.68±0.27 vessel/mm3, and mean average vessel volume was 0.032±0.012 mm3/vessel. Signal intensity for detected vessel voxels increased during the scan, while signal for non-vessel voxels within pores did not enhance. In the validation phantom, channels with diameter 250 µm or greater were detected successfully, with volume ratio equal to 1 and Dice coefficient above 0.6. Both statistics decreased dramatically for channel sizes less than 250 µm. Conclusions We have a developed a multi-modal image acquisition and processing pipeline that successfully detects vessels within cortical bone pores. The performance of this technique degrades for vessel diameters below the in-plane spatial resolution of the DCE-MRI acquisition. This approach can be applied to investigate the biological systems associated with cortical pore expansion.
Collapse
Affiliation(s)
- Po-Hung Wu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Matthew Gibbons
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Sarah C Foreman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jing Liu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| |
Collapse
|
38
|
Hostetler ZS, Stitzel JD, Weaver AA. Comparing rib cortical thickness measurements from computed tomography (CT) and Micro-CT. Comput Biol Med 2019; 111:103330. [PMID: 31276944 DOI: 10.1016/j.compbiomed.2019.103330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of this study was to compare cortical thickness of rib specimens scanned with clinical computed tomography (clinical-CT) at 0.5 and 1.0 mm slice thickness versus micro-CT at 0.05 mm slice thickness. Cortical thickness variation and accuracy was explored by anatomical region (anterior vs. lateral) and cross-sectional quadrants (superior, interior, inferior, and exterior). METHODS A validated cortical thickness algorithm was applied to clinical-CT and micro-CT scans of 17 rib specimens from six male post mortem human subjects aged 42-81 years. Each rib specimen was segmented and the thickness measurements were partitioned into cross-sectional quadrants in the anterior and lateral regions of the rib. Within each rib quadrant, the following were calculated: average thickness ± standard deviation, mean thickness difference between clinical-CT and micro-CT, and a thickness ratio between clinical-CT and micro-CT. Correlations from linear regression and paired-t tests were determined for paired clinical-CT and micro-CT results. RESULTS On average, the 0.5 mm clinical-CT underestimated the micro-CT thickness by 0.005 mm, while the 1.0 mm clinical-CT overestimated the micro-CT thickness by 0.149 mm. Thickness derived from 0.5 mm clinical-CT showed greater significant linear correlations (p < 0.05) with micro-CT thickness compared to 1.0 mm clinical-CT. CONCLUSIONS The small mean differences and thickness ratios near 1 show validation for the cortical thickness algorithm when applied to rib clinical-CT scans. Using clinical-CT scans as way to accurately measure rib cortical thickness offers a non-invasive way to analyze millions of CT scans collected each year from males and females of all ages.
Collapse
Affiliation(s)
- Zachary S Hostetler
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
| | - Joel D Stitzel
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
| | - Ashley A Weaver
- Wake Forest University School of Medicine, Biomedical Engineering, 575 N. Patterson Ave., Winston-Salem, NC, 27101, USA.
| |
Collapse
|
39
|
Carballido-Gamio J, Yu A, Wang L, Su Y, Burghardt AJ, Lang TF, Cheng X. Hip Fracture Discrimination Based on Statistical Multi-parametric Modeling (SMPM). Ann Biomed Eng 2019; 47:2199-2212. [PMID: 31240508 DOI: 10.1007/s10439-019-02298-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023]
Abstract
Studies using quantitative computed tomography (QCT) and data-driven image analysis techniques have shown that trabecular and cortical volumetric bone mineral density (vBMD) can improve the hip fracture prediction of dual-energy X-ray absorptiometry areal BMD (aBMD). Here, we hypothesize that (1) QCT imaging features of shape, density and structure derived from data-driven image analysis techniques can improve the hip fracture discrimination of classification models based on mean femoral neck aBMD (Neck.aBMD), and (2) that data-driven cortical bone thickness (Ct.Th) features can improve the hip fracture discrimination of vBMD models. We tested our hypotheses using statistical multi-parametric modeling (SMPM) in a QCT study of acute hip fracture of 50 controls and 93 fragility fracture cases. SMPM was used to extract features of shape, vBMD, Ct.Th, cortical vBMD, and vBMD in a layer adjacent to the endosteal surface to develop hip fracture classification models with machine learning logistic LASSO. The performance of these classification models was evaluated in two aspects: (1) their hip fracture classification capability without Neck.aBMD, and (2) their capability to improve the hip fracture classification of the Neck.aBMD model. Assessments were done with 10-fold cross-validation, areas under the receiver operating characteristic curve (AUCs), differences of AUCs, and the integrated discrimination improvement (IDI) index. All LASSO models including SMPM-vBMD features, and the majority of models including SMPM-Ct.Th features performed significantly better than the Neck.aBMD model; and all SMPM features significantly improved the hip fracture discrimination of the Neck.aBMD model (Hypothesis 1). An interesting finding was that SMPM-features of vBMD also captured Ct.Th patterns, potentially explaining the superior classification performance of models based on SMPM-vBMD features (Hypothesis 2). Age, height and weight had a small impact on model performances, and the model of shape, vBMD and Ct.Th consistently yielded better performances than the Neck.aBMD models. Results of this study clearly support the relevance of bone density and quality on the assessment of hip fracture, and demonstrate their potential on patient and healthcare cost benefits.
Collapse
Affiliation(s)
- Julio Carballido-Gamio
- Department of Radiology, University of Colorado Anschutz Medical Campus, 12700 E 19th Ave, Room 1208, Mail Stop C278, Aurora, CO, 80045, USA.
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas F Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| |
Collapse
|
40
|
Wang Y, Li J, Yang J, Dong J. Regional characteristics of cortical bone quality in the proximal humerus of postmenopausal women: a preliminary study. J Shoulder Elbow Surg 2019; 28:685-691. [PMID: 30527884 DOI: 10.1016/j.jse.2018.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/04/2018] [Accepted: 09/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures represent the third most common fragility fracture treated in osteoporotic populations, after hip and distal radial fractures. The purpose of this study was to characterize the spatial variability in cortical geometry in the proximal humerus in postmenopausal women. METHODS The proximal humeri in 43 healthy postmenopausal women were imaged by computed tomography. Cortical bone mapping was applied to create color 3-dimensional thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and endocortical trabecular density, were measured over the humeral head and metaphyseal region after 15 regions of interest (ROIs) were defined. RESULTS In the humeral head region, significant differences in CTh and CM values were detected between the anterior, lateral, and posterior walls (P < .05). The highest CTh and CM were found in the anterior wall in each plane (P < .05). Regarding the endocortical trabecular density, no significant findings were noted in the 3 planes (P > .05). In the metaphyseal region, the cortical structure in the medial column had higher CTh and CM values in ROI 10 compared with the lateral column (P < .05). The highest CTh and CM values of compact bone were seen in ROI 10 of the medial column (ROIs 10-12) (P < .05). CONCLUSION Our results showed significant regional variation of cortical bone in the humeral head region in postmenopausal women. Similar conditions were seen in the medial column in the metaphyseal region. This finding provides discriminatory information for stronger fixation of implants.
Collapse
Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|
41
|
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.
Collapse
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.
| |
Collapse
|
42
|
Kersh ME, Martelli S, Zebaze R, Seeman E, Pandy MG. Mechanical Loading of the Femoral Neck in Human Locomotion. J Bone Miner Res 2018; 33:1999-2006. [PMID: 29920773 DOI: 10.1002/jbmr.3529] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/30/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022]
Abstract
Advancing age and reduced loading are associated with a reduction in bone formation. Conversely, loading increases periosteal apposition and may reduce remodeling imbalance and slow age-related bone loss, an important outcome for the proximal femur, which is a common site of fracture. The ability to take advantage of bone's adaptive response to increase bone strength has been hampered by a lack of knowledge of which exercises and specific leg muscles load the superior femoral neck: a common region of microcrack initiation and progression following a sideways fall. We used an in vivo method of quantifying focal strains within the femoral neck in postmenopausal women during walking, stair ambulation, and jumping. Relative to walking, stair ambulation and jumping induced significantly higher strains in the anterior and superior aspects of the femoral neck, common regions of microcrack initiation and progression following a fall. The gluteus maximus, a hip extensor muscle, induced strains in the femoral neck during stair ambulation and jumping, in contrast to walking which induced strains via the iliopsoas, a hip flexor. The ground reaction force was closely associated with the level of strain during each task, providing a surrogate indicator of the potential for a given exercise to load the femoral neck. The gluteal muscles combined with an increased ground reaction force relative to walking induce high focal strains within the anterosuperior region of the femoral neck and therefore provide a target for exercise regimens designed to slow bone loss and maintain or improve microstructural strength. Model files used for calculating femoral neck strains are available at uitbl.mechse.illinois.edu/downloads © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Saulo Martelli
- Medical Device Research Institute, College of Science and Engineering Flinders University, Tonsley, SA, Australia
| | - Roger Zebaze
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Heidelberg West, VIC, Australia
| | - Ego Seeman
- Departments of Medicine and Endocrinology, Austin Health, University of Melbourne, Heidelberg West, VIC, Australia.,Mary Mackillop Institute for Health Research, Australian Catholic University, Fitzroy, VIC, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, VIC, Australia
| |
Collapse
|
43
|
Marques EA, Carballido-Gamio J, Gudnason V, Sigurdsson G, Sigurdsson S, Aspelund T, Siggeirsdottir K, Launer L, Eiriksdottir G, Lang T, Harris TB. Sex differences in the spatial distribution of bone in relation to incident hip fracture: Findings from the AGES-Reykjavik study. Bone 2018; 114:72-80. [PMID: 29777918 PMCID: PMC6137723 DOI: 10.1016/j.bone.2018.05.016] [Citation(s) in RCA: 10] [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: 12/27/2017] [Revised: 04/11/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
In this case-cohort study, we used data-driven computational anatomy approaches to assess within and between sex spatial differences in proximal femoral bone characteristics in relation to incident hip fracture. One hundred male and 234 female incident hip fracture cases, and 1047 randomly selected noncase subcohort participants (562 female) were chosen from the population-based AGES-Reykjavik study (mean age of 77 years). The baseline -i.e. before hip fracture- hip quantitative computed tomography scans of these subjects were analyzed using voxel-based morphometry, tensor-based morphometry, and surface-based statistical parametric mapping to assess the spatial distribution of volumetric bone mineral density (vBMD), internal structure, and cortical bone properties (thickness, vBMD and trabecular vBMD adjacent to the endosteal surface) of the proximal femur, respectively, in relation to incident hip fracture. Results showed that in both men and women: 1) the superior aspect of the femoral neck and the trochanteric region (except for cortical bone thickness) were consistently identified as being associated with incident hip fracture, and 2) differences in bone properties between noncases and incident hip fracture cases followed similar trends, were located at compatible regions, and manifested heterogeneity in the spatial distribution of their magnitude with focal regions showing larger differences. With respect to sex differences, most of the regions with a significant interaction between fracture group and sex showed: 1) differences of greater magnitude in men between noncases and incident hip fracture cases with different spatial distributions for all bone properties with the exception of cortical bone thickness, and 2) that while most of these regions showed better bone quality in male cases than in female cases, female cases showed higher vBMD in the principal compressive group and higher endotrabecular vBMD at several regions including the anterior, posterior, and lateral aspects of the proximal femur. These findings indicate the value of these image analysis techniques by providing unique information about the specific patterns of bone deterioration associated with incident hip fracture and their sex differences, highlighting the importance of looking to men and women separately in the assessment of hip fracture risk.
Collapse
Affiliation(s)
- Elisa A Marques
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA.
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland
| | - Gunnar Sigurdsson
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; University of Iceland, Reykjavik, Iceland; Landspitalinn University Hospital, Reykjavik, Iceland
| | | | - Thor Aspelund
- Icelandic Heart Association Research Institute, Kópavogur, Iceland; Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kristin Siggeirsdottir
- Department of Radiology, School of Medicine, University of Colorado Denver, Denver, CO, USA
| | - Lenore Launer
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
| | | | - Thomas Lang
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Tamara B Harris
- National Institute on Aging, Intramural Research Program, Laboratory of Epidemiology and Population Sciences, Bethesda, MD, USA
| |
Collapse
|
44
|
Power J, Loveridge N, Kröger H, Parker M, Reeve J. Femoral neck cortical bone in female and male hip fracture cases: Differential contrasts in cortical width and sub-periosteal porosity in 112 cases and controls. Bone 2018; 114:81-89. [PMID: 29807138 DOI: 10.1016/j.bone.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/17/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To quantitate differences between cases of hip fracture and controls in cortical width around the mid-femoral neck in men and women. METHODS Over 5 years, 64 (14 male) participants over age 55 (mean 79) years, who had never taken bone-active drugs and suffered intra-capsular hip fracture treated by arthroplasty, donated their routinely discarded distal intra-capsular femoral neck bone for histomorphometry. After embedding, complete femoral neck cross sections from the cut surface near the narrowest part of the neck were stained with von Kossa and cortical width was measured radially every 5 degrees of arc. Control material (n = 48, 25 male) was available through consented post mortems prior to the year 2000. Cortical widths were averaged for circumferential octants, each representing 45 degrees of arc. Divergence of individual cortical widths from their means was also examined. RESULTS Because sections were required to have a complete cortex, sampling was biased towards cases with sub-capital versus trans-cervical fractures. Compared to sex- and age matched controls, male cases showed larger relative differences in cortical widths than female cases. Unexpectedly, cortical widths in female but not male cases also showed marked over-representation of extremely narrow (<0.1 mm) cortical widths, located mainly posteriorly. The numbers of these very narrow cortical widths observed per subject retrospectively predicted female fracture status in logistic regression independently of mean cortical width values. Together with mean cortical width differences, the numbers of measured cortical widths <0.1 mm (out of 72 measured) raised the sensitivity of predicting fracture status in women from 48 to 80% at 80% specificity. In almost all cases, very narrow cortical widths were identified in regions enclosing a cortical pore roofed on its endosteal surface by thin structural bone defined a priori as trabecular. CONCLUSIONS Cortical widths <0.1 mm probably reflect zones where endosteal cortex has been trabecularised through expansion of an un-refilled sub-endosteal canal close to the periosteum. Persistent cortical defects occurring near the periosteal surface, where mechanical loading exerts its greatest stresses, are likely to result in extremes of localized concentrations of stress during a fall, unknown in young normal fallers. Such defects have the potential to help explain the excess of hip fractures among elderly women. Prevention of sub-periosteal tunnelling by osteoclasts might explain in part the additional benefits, beyond an increase in bone density, of treatments that reduce excessive bone resorption or else stimulate new bone formation on previously resorbed surfaces.
Collapse
Affiliation(s)
- Jon Power
- Department of Biological Sciences, University of Chester, Chester CH1 4BJ, UK
| | - Nigel Loveridge
- Division of Trauma and Orthopaedic Surgery, University of Cambridge, Box 180, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, P.O.BOX 100, FIN-70029 KYS Kuopio, Finland
| | - Martyn Parker
- Trauma and Orthopaedics, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough PE3 9GZ, UK
| | - Jonathan Reeve
- NIHR Biomedical Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK.
| |
Collapse
|
45
|
Józsa G, Szegeczki V, Pálfi A, Kiss T, Helyes Z, Fülöp B, Cserháti C, Daróczi L, Tamás A, Zákány R, Reglődi D, Juhász T. Signalling Alterations in Bones of Pituitary Adenylate Cyclase Activating Polypeptide (PACAP) Gene Deficient Mice. Int J Mol Sci 2018; 19:ijms19092538. [PMID: 30150589 PMCID: PMC6163297 DOI: 10.3390/ijms19092538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/10/2018] [Accepted: 08/24/2018] [Indexed: 12/15/2022] Open
Abstract
Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide with diverse developmental roles, including differentiation of skeletal elements. It is a positive regulatory factor of chondrogenesis and osteogenic differentiation in vitro, but little is known about its in vivo role in bone formation. In our experiments, diaphyses of long bones from hind limbs of PACAP gene-deficient mice showed changes in thickness and increased staining intensity. Our main goal was to perform a detailed morphological and molecular biological analysis of femurs from PACAP knockout (KO) and wild type (WT) mice. Transverse diameter and anterior cortical bone thickness of KO femurs showed significant alterations with disturbed Ca2+ accumulation and collagen type I expression. Higher expression and activity of alkaline phosphatase were also observed, accompanied by increased fragility PACAP KO femurs. Increased expression of the elements of bone morphogenic protein (BMP) and hedgehog signalling was also observed, and are possibly responsible for the compensation mechanism accounting for the slight morphological changes. In summary, our results show that lack of PACAP influences molecular and biomechanical properties of bone matrix, activating various signalling cascade changes in a compensatory fashion. The increased fragility of PACAP KO femur further supports the role of endogenous PACAP in in vivo bone formation.
Collapse
Affiliation(s)
- Gergő Józsa
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Vince Szegeczki
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Nagyerdeikrt. 98, H-4032 Debrecen, Hungary.
| | - Andrea Pálfi
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Nagyerdeikrt. 98, H-4032 Debrecen, Hungary.
| | - Tamás Kiss
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Balázs Fülöp
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Csaba Cserháti
- Department of Solid State Physics, University of Debrecen, Bem tér 18/b, H-4026 Debrecen, Hungary.
| | - Lajos Daróczi
- Department of Solid State Physics, University of Debrecen, Bem tér 18/b, H-4026 Debrecen, Hungary.
| | - Andrea Tamás
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Róza Zákány
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Nagyerdeikrt. 98, H-4032 Debrecen, Hungary.
| | - Dóra Reglődi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Szigeti út 12, H-7624 Pécs, Hungary.
| | - Tamás Juhász
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Nagyerdeikrt. 98, H-4032 Debrecen, Hungary.
| |
Collapse
|
46
|
Stephens NB, Kivell TL, Pahr DH, Hublin JJ, Skinner MM. Trabecular bone patterning across the human hand. J Hum Evol 2018; 123:1-23. [PMID: 30072187 DOI: 10.1016/j.jhevol.2018.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023]
Abstract
Hand bone morphology is regularly used to link particular hominin species with behaviors relevant to cognitive/technological progress. Debates about the functional significance of differing hominin hand bone morphologies tend to rely on establishing phylogenetic relationships and/or inferring behavior from epigenetic variation arising from mechanical loading and adaptive bone modeling. Most research focuses on variation in cortical bone structure, but additional information about hand function may be provided through the analysis of internal trabecular structure. While primate hand bone trabecular structure is known to vary in ways that are consistent with expected joint loading differences during manipulation and locomotion, no study exists that has documented this variation across the numerous bones of the hand. We quantify the trabecular structure in 22 bones of the human hand (early/extant modern Homo sapiens) and compare structural variation between two groups associated with post-agricultural/industrial (post-Neolithic) and foraging/hunter-gatherer (forager) subsistence strategies. We (1) establish trabecular bone volume fraction (BV/TV), modulus (E), degree of anisotropy (DA), mean trabecular thickness (Tb.Th) and spacing (Tb.Sp); (2) visualize the average distribution of site-specific BV/TV for each bone; and (3) examine if the variation in trabecular structure is consistent with expected joint loading differences among the regions of the hand and between the groups. Results indicate similar distributions of trabecular bone in both groups, with those of the forager sample presenting higher BV/TV, E, and lower DA, suggesting greater and more variable loading during manipulation. We find indications of higher loading along the ulnar side of the forager sample hand, with high site-specific BV/TV distributions among the carpals that are suggestive of high loading while the wrist moves through the 'dart-thrower's' motion. These results support the use of trabecular structure to infer behavior and have direct implications for refining our understanding of human hand evolution and fossil hominin hand use.
Collapse
Affiliation(s)
- Nicholas B Stephens
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany.
| | - Tracy L Kivell
- Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury CT2 7NZ, United Kingdom; Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - Dieter H Pahr
- Institute for Lightweight Design and Structural Biomechanics, Vienna University of Technology, Getreidemarkt 9, A-1060 Vienna, Austria
| | - Jean-Jacques Hublin
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| | - Matthew M Skinner
- Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury CT2 7NZ, United Kingdom; Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Deutscher Platz 6, 04103 Leipzig, Germany
| |
Collapse
|
47
|
Wang Y, Li J, Yang J, Dong J. Regional variations of cortical bone in the humeral head region: A preliminary study. Bone 2018; 110:194-198. [PMID: 29458122 DOI: 10.1016/j.bone.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Incidence of proximal humeral fractures dramatically increased over the last decade due to demographic changes. The goal of this study was to analyze regional characteristics of cortical bone in the humeral head region using cortical bone mapping (CBM) technique. METHODS The proximal humerus of 103 healthy volunteers was imaged by clinical computed tomography (CT) scans. Three groups of volunteers were identified according to age: group A (20-39years), group B (40-59years), and group C (>60years). CBM was applied to create color 3D thickness maps for each proximal humerus. Cortical parameters, including the cortical thickness (CTh), cortical mass surface density (CM), and the endocortical trabecular density (ECTD) were measured over humeral head region after nine regions of interest (ROI) were defined. RESULTS Cortical bone structure of the humeral head region varied dramatically in cross-section independent of age, with significant cortical thinning at the posterior wall. Particularly, notable cortical thinning was also found in the distal end of lateral wall at 60years of age or older. The degree of regional variability of cortical properties within lateral wall tended to diminish with age. CONCLUSION Substantial regional variations in cortical bone structure at humeral head region were observed quantitatively in this study. These morphologic data provided useful information on clinical medicine such as surgical fixation.
Collapse
Affiliation(s)
- Yeming Wang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China.
| | - Jian Li
- Department of Radiology, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianhua Yang
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingming Dong
- Department of Orthopedics, Tianjin Hospital, Tianjin University, Tianjin, China
| |
Collapse
|
48
|
Schoell SL, Weaver AA, Beavers DP, Lenchik L, Marsh AP, Rejeski WJ, Stitzel JD, Beavers KM. Development of Subject-Specific Proximal Femur Finite Element Models Of Older Adults with Obesity to Evaluate the Effects of Weight Loss on Bone Strength. ACTA ACUST UNITED AC 2018; 6. [PMID: 29683141 PMCID: PMC5909834 DOI: 10.4172/2329-9509.1000213] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Study background Recommendation of intentional weight loss in older adults remains controversial, due in part to the loss of bone mineral density (BMD) known to accompany weight loss. While finite element (FE) models have been used to assess bone strength, these methods have not been used to study the effects of weight loss. The purpose of this study is to develop subject-specific FE models of the proximal femur and study the effect of intentional weight loss on bone strength. Methods Computed tomography (CT) scans of the proximal femur of 25 overweight and obese (mean BMI=29.7 ± 4.0 kg/m2), older adults (mean age=65.6 ± 4.1 years) undergoing an 18-month intentional weight loss intervention were obtained at baseline and post-intervention. Measures of volumetric BMD (vBMD) and variable cortical thickness were derived from each subject CT scan and directly mapped to baseline and post-intervention models. Subject-specific FE models were developed using morphing techniques. Bone strength was estimated through simulation of a single-limb stance and sideways fall configuration. Results After weight loss intervention, there were significant decreases from baseline to 18 months in vBMD (total hip: -0.024 ± 0.013 g/cm3; femoral neck: -0.012 ± 0.014 g/cm3), cortical thickness (total hip: -0.044 ± 0.032 mm; femoral neck: -0.026 ± 0.039 mm), and estimated strength (stance: -0.15 ± 0.12 kN; fall: -0.04 ± 0.06 kN). Adjusting for baseline bone measures, body mass, and gender, correlations were found between weight change and change in total hip and femoral neck cortical thickness (all p<0.05). For every 1 kilogram of body mass lost cortical thickness in the total hip and femoral neck decreased by 0.003 mm and 0.004 mm, respectively. No significant correlations were present for the vBMD or strength data. Conclusion The developed subject-specific FE models could be used to better understand the effects of intentional weight loss on bone health.
Collapse
Affiliation(s)
- S L Schoell
- Department of Biomedical Engineering, Wake Forest School of Medicine, USA
| | - A A Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, USA
| | - D P Beavers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, USA
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, USA
| | - A P Marsh
- Department of Health and Exercise Science, Wake Forest University, USA
| | - W J Rejeski
- Department of Health and Exercise Science, Wake Forest University, USA
| | - J D Stitzel
- Department of Biomedical Engineering, Wake Forest School of Medicine, USA
| | - K M Beavers
- Department of Health and Exercise Science, Wake Forest University, USA
| |
Collapse
|
49
|
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.
Collapse
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.
| |
Collapse
|
50
|
Narra N, Abe S, Dimitrov V, Nikander R, Kouhia R, Sievänen H, Hyttinen J. Ricci-flow based conformal mapping of the proximal femur to identify exercise loading effects. Sci Rep 2018; 8:4823. [PMID: 29555952 PMCID: PMC5859094 DOI: 10.1038/s41598-018-23248-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/07/2018] [Indexed: 11/26/2022] Open
Abstract
The causal relationship between habitual loading and adaptive response in bone morphology is commonly explored by analysing the spatial distribution of mechanically relevant features. In this study, 3D distribution of features in the proximal femur of 91 female athletes (5 exercise loading groups representing habitual loading) is contrasted with 20 controls. A femur specific Ricci-flow based conformal mapping procedure was developed for establishing correspondence among the periosteal surfaces. The procedure leverages the invariance of the conformal mapping method to isometric shape differences to align surfaces in the 2D parametric domain, to produce dense correspondences across an isotopological set of surfaces. This is implemented through a multi-parametrisation approach to detect surface features and to overcome the issue of inconsistency in the anatomical extent present in the data. Subsequently, the group-wise distribution of two mechanically relevant features was studied – cortical thickness and surface principal strains (simulation results of a sideways fall). Statistical inferences over the surfaces were made by contrasting the athlete groups with the controls through statistical parametric mapping. With the aid of group-wise and composite-group maps, proximal femur regions affected by specific loading groups were identified with a high degree of spatial localisation.
Collapse
Affiliation(s)
- Nathaniel Narra
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland.
| | - Shinya Abe
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland
| | - Vassil Dimitrov
- Department of Electrical and Computer Engineering, University of Calgary, Calgary, Canada.,Geometric Energy Corporation, Calgary, Canada
| | - Riku Nikander
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland.,Jyväskylä Central Hospital, Jyväskylä, Finland
| | - Reijo Kouhia
- Laboratory of Civil Engineering, Tampere University of Technology, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Hyttinen
- BioMediTech Institute and Faculty of Biomedical Sciences and Engineering, Tampere University of Technology, Tampere, Finland
| |
Collapse
|