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Beynon RA, Saunders FR, Ebsim R, Frysz M, Faber BG, Gregory JS, Lindner C, Sarmanova A, Aspden RM, Harvey NC, Cootes T, Tobias JH. Dual-energy X-ray absorptiometry derived knee shape may provide a useful imaging biomarker for predicting total knee replacement: Findings from a study of 37,843 people in UK Biobank. Osteoarthr Cartil Open 2024; 6:100468. [PMID: 38655015 PMCID: PMC11035060 DOI: 10.1016/j.ocarto.2024.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024] Open
Abstract
Objective We aimed to create an imaging biomarker for knee shape using knee dual-energy x-ray absorptiometry (DXA) scans and investigate its potential association with subsequent total knee replacement (TKR), independently of radiographic features of knee osteoarthritis and established risk factors. Methods Using a 129-point statistical shape model, knee shape (expressed as a B-score) and minimum joint space width (mJSW) of the medial joint compartment (binarized as above or below the first quartile) were derived. Osteophytes were manually graded in a subset of images and an overall score was assigned. Cox proportional hazards models were used to examine the associations of B-score, mJSW and osteophyte score with TKR risk, adjusting for age, sex, height and weight. Results The analysis included 37,843 individuals (mean age 63.7 years). In adjusted models, B-score was associated with TKR: each unit increase in B-score, reflecting one standard deviation from the mean healthy shape, corresponded to a hazard ratio (HR) of 2.25 (2.08, 2.43), while a lower mJSW had a HR of 2.28 (1.88, 2.77). Among the 6719 images scored for osteophytes, mJSW was replaced by osteophyte score in the most strongly predictive model for TKR. In ROC analyses, a model combining B-score, osteophyte score, and demographics outperformed a model including demographics alone (AUC = 0.87 vs 0.73). Conclusions Using statistical shape modelling, we derived a DXA-based imaging biomarker for knee shape that was associated with kOA progression. When combined with osteophytes and demographic data, this biomarker may help identify individuals at high risk of TKR, facilitating targeted interventions.
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Affiliation(s)
- Rhona A. Beynon
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
| | - Fiona R. Saunders
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Raja Ebsim
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Monika Frysz
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
| | - Benjamin G. Faber
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
| | - Jennifer S. Gregory
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Claudia Lindner
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Aliya Sarmanova
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
| | - Richard M. Aspden
- University of Aberdeen, Centre for Arthritis and Musculoskeletal Health, Aberdeen, United Kingdom
| | - Nicholas C. Harvey
- University of Southampton, MRC Lifecourse Epidemiology Centre, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Timothy Cootes
- The University of Manchester, Division of Informatics, Imaging & Data Sciences, Manchester, United Kingdom
| | - Jonathan H. Tobias
- University of Bristol, Musculoskeletal Research Unit, Bristol Medical School, Bristol, United Kingdom
- University of Bristol, Medical Research Council Integrative Epidemiology Unit, Bristol, United Kingdom
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Staines KA, Saunders FR, Ireland A, Aspden RM, Gregory JS, Hardy RJ, Cooper R. Associations between life course longitudinal growth and hip shapes at ages 60-64 years: evidence from the MRC National Survey of Health and Development. RMD Open 2024; 10:e003816. [PMID: 38599656 PMCID: PMC11015210 DOI: 10.1136/rmdopen-2023-003816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/21/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE We sought to examine associations between height gain across childhood and adolescence with hip shape in individuals aged 60-64 years from the Medical Research Council National Survey of Health and Development, a nationally representative British birth cohort. METHODS Height was measured at ages 2, 4, 6, 7, 11 and 15 years, and self-reported at age 20 years. 10 modes of variation in hip shape (HM1-10), described by statistical shape models, were previously ascertained from DXA images taken at ages 60-64 years. Associations between (1) height at each age; (2) Super-Imposition by Translation And Rotation (SITAR) growth curve variables of height size, tempo and velocity; and (3) height gain during specific periods of childhood and adolescence, and HM1-10 were tested. RESULTS Faster growth velocity was associated with a wider, flatter femoral head and neck, as described by positive scores for HM6 (regression coefficient 0.014; 95% CI 0.08 to 0.019; p<0.001) and HM7 (regression coefficient 0.07; 95% CI 0.002 to 0.013; p=0.009), and negative scores for HM10 (regression coefficient -0.006; 95% CI -0.011 to 0.00, p=0.04) and HM2 (males only, regression coefficient -0.017; 95% CI -0.026 to -0.09; p<0.001). Similar associations were observed with greater height size and later height tempo. Examination of height gains during specific periods of childhood and adolescence identified those during the adolescence period as being most consistently associated. CONCLUSION Our analyses suggest that individual growth patterns, particularly in the adolescent period, are associated with modest variations in hip shape at 60-64 years, which are consistent with features seen in osteoarthritis.
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Affiliation(s)
- Katherine Ann Staines
- Centre for Lifelong Health, School of Applied Sciences, University of Brighton, Brighton, UK
| | - Fiona R Saunders
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Alex Ireland
- Department of Life Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, UK
| | - Richard M Aspden
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Jennifer S Gregory
- Centre for Arthritis & Musculoskeletal Health, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Institute of Medical Sciences, Aberdeen, UK
| | - Rebecca J Hardy
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Rachel Cooper
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne NHS Foundation Trust, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Newcastle, UK
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Heppenstall SV, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH, Frysz M, Faber BG. Hip geometric parameters are associated with radiographic and clinical hip osteoarthritis: Findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2023; 31:1627-1635. [PMID: 37704099 PMCID: PMC7615936 DOI: 10.1016/j.joca.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To examine the extent to which geometric parameters derived from dual-energy x-ray absorptiometry (DXA) scans in the UK Biobank study are related to hip osteoarthritis (HOA) independently of sex, age and body size. DESIGN Femoral neck width (FNW), diameter of the femoral head (DFH) and hip axis length (HAL) were derived automatically from left hip DXA scans in UK Biobank using outline points placed around the hip by a machine-learning program. Correlations were calculated between geometric parameters, age, height, and weight. Logistic regression was used to examine the relationship of geometric parameters with radiographic HOA, hospital diagnosed HOA (HESOA), and Cox proportional hazards model to evaluate the relationship with total hip replacement (THR). Analyses were adjusted for sex, age, height, weight, and geometric parameters. RESULTS The study consisted of 40,312 participants. In age and sex-adjusted analyses, FNW, HAL and DFH were related to increased risk of radiographic HOA. In a model adjusted for age, sex, height, weight and other geometric parameters, both FNW and HAL retained independent relationships with radiographic HOA [FNW: odds ratios 2.38 (2.18-2.59), HAL: 1.25 (1.15-1.36)], while DFH was now protective [0.55 (0.50-0.61)]. Only FNW was independently related to HESOA [2.20 (1.80-2.68)] and THR [hazard ratios 2.51 (1.89-3.32)]. CONCLUSION Greater FNW and HAL were independently related to an increased risk of radiographic HOA, whereas greater DFH appeared to be protective. Greater FNW was independently associated with HESOA and THR. These results suggest that DXA-derived geometric parameters, particularly FNW, could help determine HOA and THR risk.
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Affiliation(s)
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
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Zheng J, Frysz M, Faber BG, Lin H, Ebsim R, Ge J, Yong Y, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Jiang BH, Cootes T, Lindner C, Gao X, Wang S, Tobias JH. Comparison between UK Biobank and Shanghai Changfeng suggests distinct hip morphology may contribute to ethnic differences in the prevalence of hip osteoarthritis. Osteoarthritis Cartilage 2023:S1063-4584(23)00958-5. [PMID: 37935324 DOI: 10.1016/j.joca.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
OBJECTS Joint morphology is a risk factor for hip osteoarthritis (HOA) and could explain ethnic differences in HOA prevalence. Therefore, we aimed to compare the prevalence of radiographic HOA (rHOA) and hip morphology between the predominantly White UK Biobank (UKB) and exclusively Chinese Shanghai Changfeng (SC) cohorts. METHODS Left hip iDXA scans were used to quantify rHOA, from a combination of osteophytes (grade ≥1) and joint space narrowing (grade ≥1), and hip morphology. Using an 85-point Statistical Shape Model (SSM) we evaluated cam (alpha angle ≥60°) and pincer (lateral centre-edge angle (LCEA) ≥45°) morphology and acetabular dysplasia (LCEA <25°). Diameter of femoral head (DFH), femoral neck width (FNW), and hip axis length (HAL) were also obtained from these points. Results were adjusted for differences in age, height, and weight and stratified by sex. RESULTS Complete data were available for 5924 SC and 39,020 White UKB participants with mean ages of 63.4 and 63.7 years old. rHOA prevalence was considerably lower in female (2.2% versus 13.1%) and male (12.0% and 25.1%) SC compared to UKB participants. Cam morphology, rarely seen in females, was less common in SC compared with UKB males (6.3% versus 16.5%). Composite SSM modes, scaled to the same overall size, revealed SC participants to have a wider femoral head compared to UKB participants. FNW and HAL were smaller in SC compared to UKB, whereas DFH/FNW ratio was higher in SC. CONCLUSIONS rHOA prevalence is lower in Chinese compared with White individuals. Several differences in hip shape were observed, including frequency of cam morphology, FNW, and DFH/FNW ratio. These characteristics have previously been identified as risk factors for HOA and may contribute to observed ethnic differences in HOA prevalence.
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Affiliation(s)
- Jiayi Zheng
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Jieyu Ge
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yanling Yong
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bing-Hua Jiang
- Academy of Medical Science, Zhengzhou University, Zhengzhou, China
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhongshan Hospital, Fudan University, Shanghai, China; Fudan Institute for Metabolic Diseases, Shanghai, China.
| | - Sijia Wang
- CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
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5
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Faber BG, Frysz M, Boer CG, Evans DS, Ebsim R, Flynn KA, Lundberg M, Southam L, Hartley A, Saunders FR, Lindner C, Gregory JS, Aspden RM, Lane NE, Harvey NC, Evans DM, Zeggini E, Davey Smith G, Cootes T, Van Meurs J, Kemp JP, Tobias JH. The identification of distinct protective and susceptibility mechanisms for hip osteoarthritis: findings from a genome-wide association study meta-analysis of minimum joint space width and Mendelian randomisation cluster analyses. EBioMedicine 2023; 95:104759. [PMID: 37619450 PMCID: PMC10470292 DOI: 10.1016/j.ebiom.2023.104759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Hip minimum joint space width (mJSW) provides a proxy for cartilage thickness. This study aimed to conduct a genome-wide association study (GWAS) of mJSW to (i) identify new genetic determinants of mJSW and (ii) identify which mJSW loci convey hip osteoarthritis (HOA) risk and would therefore be of therapeutic interest. METHODS GWAS meta-analysis of hip mJSW derived from plain X-rays and DXA was performed, stratified by sex and adjusted for age and ancestry principal components. Mendelian randomisation (MR) and cluster analyses were used to examine causal effect of mJSW on HOA. FINDINGS 50,745 individuals were included in the meta-analysis. 42 SNPs, which mapped to 39 loci, were identified. Mendelian randomisation (MR) revealed little evidence of a causal effect of mJSW on HOA (ORIVW 0.98 [95% CI 0.82-1.18]). However, MR-Clust analysis suggested the null MR estimates reflected the net effect of two distinct causal mechanisms cancelling each other out, one of which was protective, whereas the other increased HOA susceptibility. For the latter mechanism, all loci were positively associated with height, suggesting mechanisms leading to greater height and mJSW increase the risk of HOA in later life. INTERPRETATIONS One group of mJSW loci reduce HOA risk via increased mJSW, suggesting possible utility as targets for chondroprotective therapies. The second group of mJSW loci increased HOA risk, despite increasing mJSW, but were also positively related to height, suggesting they contribute to HOA risk via a growth-related mechanism. FUNDING Primarily funded by the Medical Research Council and Wellcome Trust.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK.
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Cindy G Boer
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, USA
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Kaitlyn A Flynn
- Mater Research Institute, The University of Queensland, Woolloongabba, Australia; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Mischa Lundberg
- UQ Frazer Institute, The University of Queensland, Woolloongabba, Australia
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Centre for Environmental Health, Neuherberg, Germany
| | - April Hartley
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California Davis, Sacramento, USA
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, UK
| | - David M Evans
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia; UQ Frazer Institute, The University of Queensland, Woolloongabba, Australia
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Centre for Environmental Health, Neuherberg, Germany; Technical University of Munich and Klinikum Rechts der Isar, TUM School of Medicine, Germany
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - Joyce Van Meurs
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - John P Kemp
- Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK; Mater Research Institute, The University of Queensland, Woolloongabba, Australia; Institute for Molecular Bioscience, The University of Queensland, St Lucia, Australia
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit at the University of Bristol, UK
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Faber BG, Frysz M, Hartley AE, Ebsim R, Boer CG, Saunders FR, Gregory JS, Aspden RM, Harvey NC, Southam L, Giles W, Le Maitre CL, Wilkinson JM, van Meurs JBJ, Zeggini E, Cootes T, Lindner C, Kemp JP, Davey Smith G, Tobias JH. A Genome-Wide Association Study Meta-Analysis of Alpha Angle Suggests Cam-Type Morphology May Be a Specific Feature of Hip Osteoarthritis in Older Adults. Arthritis Rheumatol 2023; 75:900-909. [PMID: 36662418 PMCID: PMC10374163 DOI: 10.1002/art.42451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/08/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine the genetic architecture of cam morphology using alpha angle (AA) as a proxy measure and conduct an AA genome-wide association study (GWAS) followed by Mendelian randomization (MR) to evaluate its causal relationship with hip osteoarthritis (OA). METHODS Observational analyses examined associations between AA measurements derived from hip dual x-ray absorptiometry (DXA) scans from the UK Biobank study and radiographic hip OA outcomes and subsequent total hip replacement. Following these analyses, an AA GWAS meta-analysis was performed (N = 44,214) using AA measurements previously derived in the Rotterdam Study. Linkage disequilibrium score regression assessed the genetic correlation between AA and hip OA. Genetic associations considered significant (P < 5 × 10-8 ) were used as AA genetic instrument for 2-sample MR analysis. RESULTS DXA-derived AA showed expected associations between AA and radiographic hip OA (adjusted odds ratio [OR] 1.63 [95% confidence interval (95% CI) 1.58, 1.67]) and between AA and total hip replacement (adjusted hazard ratio 1.45 [95% CI 1.33, 1.59]) in the UK Biobank study cohort. The heritability of AA was 10%, and AA had a moderate genetic correlation with hip OA (rg = 0.26 [95% CI 0.10, 0.43]). Eight independent genetic signals were associated with AA. Two-sample MR provided weak evidence of causal effects of AA on hip OA risk (inverse variance weighted OR 1.84 [95% CI 1.14, 2.96], P = 0.01). In contrast, genetic predisposition for hip OA had stronger evidence of a causal effect on increased AA (inverse variance weighted β = 0.09 [95% CI 0.04, 0.13], P = 4.58 × 10-5 ). CONCLUSION Expected observational associations between AA and related clinical outcomes provided face validity for the DXA-derived AA measurements. Evidence of bidirectional associations between AA and hip OA, particularly for risk of hip OA on AA, suggests that hip shape modeling secondary to a genetic predisposition to hip OA contributes to the well-established relationship between hip OA and cam morphology in older adults.
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Affiliation(s)
- Benjamin G. Faber
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - April E. Hartley
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - Cindy G. Boer
- Department of Internal Medicine, Erasmus MCUniversity Medical CenterRotterdamThe Netherlands
| | - Fiona R. Saunders
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenUK
| | | | - Richard M. Aspden
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenUK
| | - Nicholas C. Harvey
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, UK, and NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustUK
| | - Lorraine Southam
- Institute of Translational Genomics, Helmholtz Zentrum München–German Research Center for Environmental HealthNeuherbergGermany
| | - William Giles
- Department of Oncology and MetabolismThe University of SheffieldUK
| | | | | | - Joyce B. J. van Meurs
- Department of Internal Medicine and Department of Orthopaedics & Sports Medicine, Erasmus MCRotterdamThe Netherlands
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München–German Research Center for Environmental Health, Neuherberg, Germany, and TUM School of MedicineTechnical University of Munich and Klinikum Rechts der IsarGermany
| | - Timothy Cootes
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data ScienceThe University of ManchesterUK
| | - John P. Kemp
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, UK, and The University of Queensland Diamantina Institute and Institute for Molecular Bioscience, The University of QueenslandQueenslandAustralia
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
| | - Jonathan H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, and Medical Research Council Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical SchoolUniversity of BristolUK
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7
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Frysz M, Faber BG, Ebsim R, Saunders FR, Lindner C, Gregory JS, Aspden RM, Harvey NC, Cootes T, Tobias JH. Machine Learning-Derived Acetabular Dysplasia and Cam Morphology Are Features of Severe Hip Osteoarthritis: Findings From UK Biobank. J Bone Miner Res 2022; 37:1720-1732. [PMID: 35811326 PMCID: PMC9545366 DOI: 10.1002/jbmr.4649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/15/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
The contribution of shape changes to hip osteoarthritis (HOA) remains unclear, as is the extent to which these vary according to HOA severity. In the present study, we used statistical shape modeling (SSM) to evaluate relationships between hip shape and HOA of different severities using UK Biobank DXA images. We performed a cross-sectional study in individuals with left hip dual-energy X-ray absorptiometry (DXA) scans. Statistical shape modeling (SSM) was used to quantify hip shape. Radiographic HOA (rHOA) was classified using osteophyte size and number and joint space narrowing. HOA outcomes ranged in severity from moderate (grade 2) to severe (grade ≥3) rHOA, hospital-diagnosed HOA, and subsequent total hip replacement (THR). Confounder-adjusted logistic regression between the top 10 hip shape modes (HSMs) and OA outcomes was performed. Further models adjusted for alpha angle (AA) and lateral center-edge angle (LCEA), reflecting acetabular dysplasia and cam morphology, respectively. Composite HSM figures were produced combining HSMs associated with separate OA outcomes. A total of 40,311 individuals were included (mean 63.7 years, 47.8% male), of whom 5.7% had grade 2 rHOA, 1.7% grade ≥3 rHOA, 1.3% hospital-diagnosed HOA, and 0.6% underwent THR. Composite HSM figures for grade 2 rHOA revealed femoral neck widening, increased acetabular coverage, and enlarged lesser and greater trochanters. In contrast, grade ≥3 rHOA, hospital-diagnosed HOA, and THR were suggestive of cam morphology and reduced acetabular coverage. Associations between HSMs depicting cam morphology and reduced acetabular coverage and more severe HOA were attenuated by AA and LCEA adjustment, respectively. Relationships between hip shape and HOA differed according to severity. Notably, cam morphology and acetabular dysplasia were features of severe HOA, but unrelated to moderate disease, suggesting possible prognostic utility. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Benjamin G Faber
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - Raja Ebsim
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal HealthUniversity of AberdeenAberdeenUK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospitals Southampton NHS Foundation TrustSouthamptonUK
| | - Tim Cootes
- Division of Informatics, Imaging and Data SciencesThe University of ManchesterManchesterUK
| | - Jon H Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
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8
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Davey Smith G, Cootes T, Tobias JH. A novel semi-automated classifier of hip osteoarthritis on DXA images shows expected relationships with clinical outcomes in UK Biobank. Rheumatology (Oxford) 2022; 61:3586-3595. [PMID: 34919677 PMCID: PMC9434243 DOI: 10.1093/rheumatology/keab927] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Conventional scoring methods for radiographic hip OA (rHOA) are subjective and show inconsistent relationships with clinical outcomes. To provide a more objective rHOA scoring method, we aimed to develop a semi-automated classifier based on DXA images and confirm its relationships with clinical outcomes. METHODS Hip DXAs in UK Biobank (UKB) were marked up for osteophyte area from which acetabular, superior and inferior femoral head osteophyte grades were derived. Joint space narrowing (JSN) grade was obtained automatically from minimum joint space width (mJSW) measures. Clinical outcomes related to rHOA comprised hip pain, hospital diagnosed OA (HES OA) and total hip replacement. Logistic regression and Cox proportional hazard modelling were used to examine associations between overall rHOA grade (0-4; derived from combining osteophyte and JSN grades) and the clinical outcomes. RESULTS A toal of 40 340 individuals were included in the study (mean age 63.7), of whom 81.2% had no evidence of rHOA, while 18.8% had grade ≥1 rHOA. Grade ≥1 osteophytes at each location and JSN were associated with hip pain, HES OA and total hip replacement. Associations with all three clinical outcomes increased progressively according to rHOA grade, with grade 4 rHOA and total hip replacement showing the strongest association [57.70 (38.08-87.44)]. CONCLUSIONS Our novel semi-automated tool provides a useful means for classifying rHOA on hip DXAs, given its strong and progressive relationships with clinical outcomes. These findings suggest DXA scanning can be used to classify rHOA in large DXA-based cohort studies supporting further research, with the future potential for population-based screening.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Monika Frysz
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, The University of Manchester, Manchester
| | - Jonathan H Tobias
- Musculoskeletal Research Unit
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol
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9
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Smith GD, Cootes T, Tobias JH. OA20 Radiographic hip osteoarthritis classified semi-automatically on dual-energy x-ray absorptiometry scans is strongly predictive of total hip replacement: findings from UK Biobank. Rheumatology (Oxford) 2022. [DOI: 10.1093/rheumatology/keac132.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Aims
Radiographic hip osteoarthritis (rHOA) is traditionally defined on hip x-rays, using subjective methods such as Kellgren-Lawrence scoring. Associations between subjective rHOA measures and symptoms are inconsistent. Applying digital tools to high-resolution dual-energy X-ray absorptiometry (DXA) scans, we aimed to develop a novel semi-automated classifier for rHOA and evaluate the face validity of the classifier based on relationships with hip pain, hospital diagnosed OA (HES OA), and risk of total hip replacement (THR).
Methods
Using hip DXAs in UK Biobank, osteophyte grades 0-3 were assigned based on manually measured osteophyte area. Minimum joint space width (mJSW) was automatically measured using outline points placed by a machine learning-based algorithm and then used to categorise individuals into joint space narrowing (JSN) grades 0-3. Osteophyte and JSN grades were combined, using a novel system giving greater to weight to osteophytes, to categorise individuals into rHOA grades 0-4. Logistic regression giving odds ratios (OR) was used to examine associations between rHOA grade and hip pain, and HES OA. Cox proportional hazard models giving hazard ratios (HR) were used to examine associations between rHOA grade and subsequent THR. Our adjusted model included age, sex, height and weight as covariates.
Results
40,340 individuals were included in the study (mean age 63.7 [range 44-82], 19294/21046 male/female). 32758 (81.2%) had rHOA grade 0, 4565 (11.3%) grade 1, 2317 (5.7%) grade 2, 543 (1.3%) grade 3, 157 (0.4%) grade 4, with all features of rHOA being more common in males than females. rHOA grades ≥2 were associated with all three clinical outcomes in both unadjusted and adjusted models, a clear dose-response relationship was seen with each increase in grade showing a large rise in OR/HRs (Table 1). Grade 4 rHOA was strongly predictive of THR (HR 57.70 [95%CI 38.08-87.44]).
Conclusion
We successfully applied a novel semi-automated classifier to over 40,000 individuals from UKB. The validity of our classifier was supported by the strong and progressive relationships observed between rHOA and hip pain, and HES OA and risk of THR. We conclude that hip DXAs provide a promising means of defining rHOA, with potential screening applications in the clinic.
Disclosure
B.G. Faber: None. R. Ebsim: None. F.R. Saunders: None. M. Frysz: None. C. Lindner: None. J.S. Gregory: None. R.M. Aspden: None. N.C. Harvey: None. G. Davey Smith: None. T. Cootes: None. J.H. Tobias: None.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UNITED KINGDOM
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UNITED KINGDOM
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UNITED KINGDOM
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UNITED KINGDOM
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UNITED KINGDOM
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10
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Gupta A, Maslen C, Vindlacheruvu M, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, McCloskey E, Ward KA, Poole KE. Digital health interventions for osteoporosis and post-fragility fracture care. Ther Adv Musculoskelet Dis 2022; 14:1759720X221083523. [PMID: 35368375 PMCID: PMC8966117 DOI: 10.1177/1759720x221083523] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The growing burden from osteoporosis and fragility fractures highlights a need to improve osteoporosis management across healthcare systems. Sub-optimal management of osteoporosis is an area suitable for digital health interventions. While fracture liaison services (FLSs) are proven to greatly improve care for people with osteoporosis, such services might benefit from technologies that enhance automation. The term 'Digital Health' covers a variety of different tools including clinical decision support systems, electronic medical record tools, patient decision aids, patient apps, education tools, and novel artificial intelligence (AI) algorithms. Within the scope of this review are AI solutions that use algorithms within health system registries to target interventions. Clinician-targeted, patient-targeted, or system-targeted digital health interventions could be used to improve management and prevent fragility fractures. This review was commissioned by The Royal Osteoporosis Society and Bone Research Academy during the production of the 2020 Research Roadmap (https://theros.org.uk), with the intention of identifying gaps where targeted research funding could lead to improved patient health. We explore potential uses of digital technology in the general management of osteoporosis. Evidence suggests that digital technologies can support multidisciplinary teams to provide the best possible patient care based on current evidence and to support patients in self-management. However, robust randomised controlled studies are still needed to assess the effectiveness and cost-effectiveness of these technologies.
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Affiliation(s)
- Amit Gupta
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | | | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | | | | | | | | | - Kenneth E.S. Poole
- University of Cambridge School of Clinical Medicine, CB2 0QQ Cambridge, UK
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11
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Faber BG, Ebsim R, Saunders FR, Frysz M, Lindner C, Gregory JS, Aspden RM, Harvey NC, Smith GD, Cootes T, Tobias JH. Osteophyte size and location on hip DXA scans are associated with hip pain: Findings from a cross sectional study in UK Biobank. Bone 2021; 153:116146. [PMID: 34389476 PMCID: PMC8503366 DOI: 10.1016/j.bone.2021.116146] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE It remains unclear how the different features of radiographic hip osteoarthritis (rHOA) contribute to hip pain. We examined the relationship between rHOA, including its individual components, and hip pain using a novel dual-energy x-ray absorptiometry (DXA)-based method. METHODS Hip DXAs were obtained from UK Biobank. A novel automated method obtained minimum joint space width (mJSW) from points placed around the femoral head and acetabulum. Osteophyte areas at the lateral acetabulum, superior and inferior femoral head were derived manually. Semi-quantitative measures of osteophytes and joint space narrowing (JSN) were combined to define rHOA. Logistic regression was used to examine the relationships between these variables and hip pain, obtained via questionnaires. RESULTS 6807 hip DXAs were examined. rHOA was present in 353 (5.2%) individuals and was associated with hip pain [OR 2.42 (1.78-3.29)] and hospital diagnosed OA [6.01 (2.98-12.16)]. Total osteophyte area but not mJSW was associated with hip pain in mutually adjusted models [1.31 (1.23-1.39), 0.95 (0.87-1.04) respectively]. On the other hand, JSN as a categorical variable showed weak associations between grade ≥ 1 and grade ≥ 2 JSN with hip pain [1.30 (1.06-1.60), 1.80 (1.34-2.42) respectively]. Acetabular, superior and inferior femoral osteophyte areas were all independently associated with hip pain [1.13 (1.06-1.20), 1.13 (1.05-1.24), 1.10 (1.03-1.17) respectively]. CONCLUSION In this cohort, the relationship between rHOA and prevalent hip pain was explained by 2-dimensional osteophyte area, but not by the apparent mJSW. Osteophytes at different locations showed important, potentially independent, associations with hip pain, possibly reflecting the contribution of distinct biomechanical pathways.
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Affiliation(s)
- Benjamin G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
| | - Raja Ebsim
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Fiona R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - Claudia Lindner
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Jennifer S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Richard M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - Nicholas C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - Timothy Cootes
- Division of Informatics, Imaging and Data Science, University of Manchester, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
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12
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Faber BG, Ebsim R, Saunders FR, Frysz M, Gregory JS, Aspden RM, Harvey NC, Davey Smith G, Cootes T, Lindner C, Tobias JH. Cam morphology but neither acetabular dysplasia nor pincer morphology is associated with osteophytosis throughout the hip: findings from a cross-sectional study in UK Biobank. Osteoarthritis Cartilage 2021; 29:1521-1529. [PMID: 34419604 PMCID: PMC8547486 DOI: 10.1016/j.joca.2021.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine whether acetabular dysplasia (AD), cam and/or pincer morphology are associated with radiographic hip osteoarthritis (rHOA) and hip pain in UK Biobank (UKB) and, if so, what distribution of osteophytes is observed. DESIGN Participants from UKB with a left hip dual-energy X-ray absorptiometry (DXA) scan had alpha angle (AA), lateral centre-edge angle (LCEA) and joint space narrowing (JSN) derived automatically. Cam and pincer morphology, and AD were defined using AA and LCEA. Osteophytes were measured manually and rHOA grades were calculated from JSN and osteophyte measures. Logistic regression was used to examine the relationships between these hip morphologies and rHOA, osteophytes, JSN, and hip pain. RESULTS 6,807 individuals were selected (mean age: 62.7; 3382/3425 males/females). Cam morphology was more prevalent in males than females (15.4% and 1.8% respectively). In males, cam morphology was associated with rHOA [OR 3.20 (95% CI 2.41-4.25)], JSN [1.53 (1.24-1.88)], and acetabular [1.87 (1.48-2.36)], superior [1.94 (1.45-2.57)] and inferior [4.75 (3.44-6.57)] femoral osteophytes, and hip pain [1.48 (1.05-2.09)]. Broadly similar associations were seen in females, but with weaker statistical evidence. Neither pincer morphology nor AD showed any associations with rHOA or hip pain. CONCLUSIONS Cam morphology was predominantly seen in males in whom it was associated with rHOA and hip pain. In males and females, cam morphology was associated with inferior femoral head osteophytes more strongly than those at the superior femoral head and acetabulum. Further studies are justified to characterise the biomechanical disturbances associated with cam morphology, underlying the observed osteophyte distribution.
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Affiliation(s)
- B G Faber
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK.
| | - R Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - F R Saunders
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - M Frysz
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - J S Gregory
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - R M Aspden
- Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, UK
| | - G Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
| | - T Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - C Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, UK; Medical Research Council Integrative Epidemiology Unit, University of Bristol, UK
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13
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Aggarwal V, Maslen C, Abel RL, Bhattacharya P, Bromiley PA, Clark EM, Compston JE, Crabtree N, Gregory JS, Kariki EP, Harvey NC, Ward KA, Poole KES. Opportunistic diagnosis of osteoporosis, fragile bone strength and vertebral fractures from routine CT scans; a review of approved technology systems and pathways to implementation. Ther Adv Musculoskelet Dis 2021; 13:1759720X211024029. [PMID: 34290831 PMCID: PMC8274099 DOI: 10.1177/1759720x211024029] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Osteoporosis causes bones to become weak, porous and fracture more easily. While a vertebral fracture is the archetypal fracture of osteoporosis, it is also the most difficult to diagnose clinically. Patients often suffer further spine or other fractures, deformity, height loss and pain before diagnosis. There were an estimated 520,000 fragility fractures in the United Kingdom (UK) in 2017 (costing £4.5 billion), a figure set to increase 30% by 2030. One way to improve both vertebral fracture identification and the diagnosis of osteoporosis is to assess a patient's spine or hips during routine computed tomography (CT) scans. Patients attend routine CT for diagnosis and monitoring of various medical conditions, but the skeleton can be overlooked as radiologists concentrate on the primary reason for scanning. More than half a million CT scans done each year in the National Health Service (NHS) could potentially be screened for osteoporosis (increasing 5% annually). If CT-based screening became embedded in practice, then the technique could have a positive clinical impact in the identification of fragility fracture and/or low bone density. Several companies have developed software methods to diagnose osteoporosis/fragile bone strength and/or identify vertebral fractures in CT datasets, using various methods that include image processing, computational modelling, artificial intelligence and biomechanical engineering concepts. Technology to evaluate Hounsfield units is used to calculate bone density, but not necessarily bone strength. In this rapid evidence review, we summarise the current literature underpinning approved technologies for opportunistic screening of routine CT images to identify fractures, bone density or strength information. We highlight how other new software technologies have become embedded in NHS clinical practice (having overcome barriers to implementation) and highlight how the novel osteoporosis technologies could follow suit. We define the key unanswered questions where further research is needed to enable the adoption of these technologies for maximal patient benefit.
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Affiliation(s)
- Veena Aggarwal
- Kingston Hospital NHS Foundation Trust, Kingston Upon Thames, UK
| | | | | | | | | | | | | | - Nicola Crabtree
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | - Jennifer S. Gregory
- University of Aberdeen School of Medicine Medical Sciences and Nutrition, Aberdeen, UK
| | | | | | - Kate A. Ward
- University of Southampton, Southampton, Hampshire, UK
| | - Kenneth E. S. Poole
- University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, CB2 0QQ, UK
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14
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Saunders FR, Gregory JS, Pavlova AV, Muthuri SG, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R, Ireland A. Motor development in infancy and spine shape in early old age: Findings from a British birth cohort study. J Orthop Res 2020; 38:2740-2748. [PMID: 32162719 PMCID: PMC8641380 DOI: 10.1002/jor.24656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/21/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Spine shape changes dramatically in early life, influenced by attainment of developmental milestones such as independent walking. Whether these associations persist across life is unknown. Therefore, we investigated associations between developmental milestones and spine shape, as determined using statistical shape models (SSMs) of lumbar spine from dual-energy X-ray absorptiometry scans in 1327 individuals (688 female) at 60 to 64 years in the MRC National Survey of Health and Development. Lumbar lordosis angle (L4 inferior endplate to T12 superior endplate) was measured using the two-line Cobb method. In analyses adjusted for sex, height, lean and fat mass, socioeconomic position, and birthweight, later walking age was associated with greater lordosis described by SSM1 (regression coefficient, 0.023; 95% CI, 0.000-0.047; P = .05) and direct angle measurement. Modest associations between walking age and less variation in anterior-posterior vertebral size caudally (SSM6) were also observed (0.021; 95% CI, -0.002 to 0.044; P = .07). Sex interactions showed that later walking was associated with larger relative vertebral anterior-posterior dimensions in men (SSM3; -0.043; 95% CI, -0.075 to 0.01; P = .01) but not women (0.018; 95% CI, -0.0007 to 0.043; P = .17). Similar associations were observed between age at independent standing and SSMs but there was little evidence of association between sitting age and spine shape. Unadjusted associations between walking age and SSMs 1 and 6 remained similar after adjustment for potential confounders and mediators. This suggests that these associations may be explained by altered mechanical loading of the spine during childhood growth, although other factors could contribute. Early life motor development, particularly walking, may have a lasting effect on the features of spine morphology with clinical significance.
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Affiliation(s)
- Fiona R. Saunders
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Jennifer S. Gregory
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Anastasia V. Pavlova
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,School of Health SciencesRobert Gordon UniversityAberdeenUK
| | | | - Rebecca J. Hardy
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK,Cohort and Longitudinal Studies Enhancement Resources (CLOSER)UCL Institute of EducationLondonUK
| | - Kathryn R. Martin
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK,Medicines Monitoring Unit (MEMO), School of Medicine, Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical SchoolUniversity of DundeeDundeeUK
| | - Judith E. Adams
- Manchester Academic Health Science Centre and Radiology, Manchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation Trust and University of ManchesterManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- School of Medicine, Medical Sciences and Nutrition, Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical SciencesUniversity of AberdeenAberdeenUK
| | - Rachel Cooper
- Department of Sport and Exercise Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
| | - Alex Ireland
- Department of Life Sciences, Research Centre for Musculoskeletal Science and Sports MedicineManchester Metropolitan UniversityManchesterUK
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15
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Gregory JS, Barr RJ, Yoshida K, Alesci S, Reid DM, Aspden RM. Statistical shape modelling provides a responsive measure of morphological change in knee osteoarthritis over 12 months. Rheumatology (Oxford) 2020; 59:2419-2426. [PMID: 31943121 DOI: 10.1093/rheumatology/kez610] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 11/02/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Responsive biomarkers are needed to assess the progression of OA and their lack has hampered previous clinical trials. Statistical shape modelling (SSM) from radiographic images identifies those at greatest risk of fast-progression or joint replacement, but its sensitivity to change has not previously been measured. This study evaluates the responsiveness of SSM in knee OA in a 12-month observational study. METHODS A total of 109 people were recruited who had undergone knee radiographs in the previous 12 months, and were grouped based on severity of radiographic OA (Kellgren-Lawrence grading). An SSM was built from three dual-energy X-ray absorptiometry scans at 6-month intervals. Change-over-time and OA were assessed using generalized estimating equations, standardized response means (SRM) and reliable change indices. RESULTS Mode 1 showed typical features of radiographic OA and had a strong link with Kellgren-Lawrence grading but did not change significantly during the study. Mode 3 showed asymmetrical changes consistent with medial cartilage loss, osteophytes and joint malalignment, and was responsive to change, with a 12-month SRM of 0.63. The greatest change was observed in the moderate radiographic OA group (SRM 0.92) compared with the controls (SRM 0.21), and the reliable change index identified 14% of this group whose progression was clinically significant. CONCLUSION Shape changes linked the progression of osteophytosis with increasing malalignment within the joint. Modelling of the whole joint enabled quantification of change beyond the point where bone-to-bone contact has been made. The knee SSM is, therefore, a responsive biomarker for radiographic change in knees over 12 months.
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Affiliation(s)
- Jennifer S Gregory
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Rebecca J Barr
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Aberdeen, UK
| | - Kanako Yoshida
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | | | - David M Reid
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Richard M Aspden
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
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Deane JA, Pavlova AV, Lim AKP, Gregory JS, Aspden RM, McGregor AH. Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study. BMC Musculoskelet Disord 2020; 21:433. [PMID: 32620099 PMCID: PMC7334848 DOI: 10.1186/s12891-020-03346-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 05/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background Lumbar disc degeneration (LDD) is a condition associated with recurrent low back pain (LBP). Knowledge regarding effective management is limited. As a step towards the identification of risk, prognostic or potentially modifiable factors in LDD patients, the aim of this study was to explore the hypothesis that intrinsic lumbar spine shape is associated with LDD and clinical outcomes in symptomatic adults. Methods 3 T MRI was used to acquire T2-weighted sagittal images (L1-S1) from 70 healthy controls and LDD patients (mean age 49 years, SD 11, range 31–71 years). Statistical Shape Modelling (SSM) was used to describe lumbar spine shape. SSM identified variations in lumbar shape as ‘modes’ of variation and quantified deviation from the mean. Intrinsic shape differences were determined between LDD groups using analysis of variance with post-hoc comparisons. The relationship between intrinsic shape and self-reported function, mental health and quality of life were also examined. Results The first 7 modes of variation explained 91% of variance in lumbar shape. Higher LDD sum scores correlated with a larger lumbar lordosis (Mode 1 (55% variance), P = 0.02), even lumbar curve distribution (Mode 2 (12% variance), P = 0.05), larger anterior-posterior (A-P) vertebral diameter (Mode 3 (10% variance), P = 0.007) and smaller L4-S1 disc spaces (Mode 7 (2% variance), P ≤ 0.001). In the presence of recurrent LBP, LDD was associated with a larger A-P vertebral diameter (Mode 3) and a more even lumbar curvature with smaller L5/S1 disc spaces (Mode 4), which was significantly associated with patient quality of life (P = 0.002–0.04, rp = 0.43–0.61)). Conclusions This exploratory study provides new evidence that intrinsic shape phenotypes are associated with LDD and quality of life in patients. Longitudinal studies are required to establish the potential role of these risk or prognostic shape phenotypes.
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Affiliation(s)
- Janet A Deane
- Sackler MSK LAB, Sir Michael Uren Hub, Imperial College London, White City Campus, 86 Wood Lane, London, W12 0BZ, UK. .,Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Adrian K P Lim
- Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alison H McGregor
- Sackler MSK LAB, Sir Michael Uren Hub, Imperial College London, White City Campus, 86 Wood Lane, London, W12 0BZ, UK
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17
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Frysz M, Gregory JS, Aspden RM, Paternoster L, Tobias JH. The effect of pubertal timing, as reflected by height tempo, on proximal femur shape: Findings from a population-based study in adolescents. Bone 2020; 131:115179. [PMID: 31794847 PMCID: PMC6961111 DOI: 10.1016/j.bone.2019.115179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/05/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine the relationship between pubertal timing (using measures of height tempo) and proximal femur shape in a large adolescent cohort. METHODS Hip DXA scans were obtained in offspring from the Avon Longitudinal Study of Parents and Children. To quantify hip morphology, the images were analyzed using Shape software based on a 53-point statistical shape model and independent modes of variation (hip shape mode (HSM) scores) for each image were generated. Height tempo (which corresponds to age at peak height velocity (aPHV)) was estimated from serial height measurements collected between age 5-20 years. Multivariable linear regression was used to examine cross-sectional associations between height tempo and the top ten HSMs at age 14 and 18, adjusting for sex and fat mass index (FMI). RESULTS Complete outcome and covariate data were available from 3827 and 3507 participants at age 14 and 18 years, respectively. Mean aPHV was 13.5 and 11.8 years for males and females, respectively. At age 14, height tempo was associated with a majority of modes, except for HSM4 and there was strong evidence of interaction by sex. In males, all modes showed evidence of an association with tempo, independent of FMI, with the strongest observed for HSM8 (adjusted β 0.38 (0.33, 0.43) p = 4.1 × 10-50). Compared with males, the associations were generally weaker in females, with the strongest effect observed for HSM8 (adjusted β 0.10 (0.05, 0.14) p = 1.6 × 10-5). The overall effect of later pubertal timing on proximal femur shape in males was a narrower femoral neck and larger superolateral head, whereas in females these changes were hard to discern. When assessed at age 18, there was little relationship between tempo and proximal femur shape in either sex. CONCLUSION Our results indicate that significant changes in hip shape occur during puberty, including aspects of shape which may be related to future risk of hip OA and/or fracture. However, puberty timing per se does not appear to exert long lasting effects on proximal femur shape.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Lavinia Paternoster
- Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Medical Research Council Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
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18
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Hernandez Cordero AI, Gonzales NM, Parker CC, Sokoloff G, Vandenbergh DJ, Cheng R, Abney M, Skol A, Douglas A, Palmer AA, Gregory JS, Lionikas A. Genome-wide Associations Reveal Human-Mouse Genetic Convergence and Modifiers of Myogenesis, CPNE1 and STC2. Am J Hum Genet 2020; 106:138. [PMID: 31901248 DOI: 10.1016/j.ajhg.2019.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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19
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Frysz M, Tobias JH, Lawlor DA, Aspden RM, Gregory JS, Ireland A. Associations between prenatal indicators of mechanical loading and proximal femur shape: findings from a population-based study in ALSPAC offspring. J Musculoskelet Neuronal Interact 2020; 20:301-313. [PMID: 32877967 PMCID: PMC7493447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Hip development is influenced by mechanical loading, but associations between prenatal loading and hip shape in later life remain unexplored. METHODS We examined associations between prenatal loading indicators (gestation length, oligohydramnios (OH) and breech) obtained from obstetric records and hip shape modes (HSMs) generated using dual-energy X-ray absorptiometry images taken at age 14- and 18-years in participants from the UK Avon Longitudinal Study of Parents and Children (ALSPAC). These associations were examined in 2453 (30 OH, 105 breech) and 2330 (27 OH, 95 breech) participants with complete data at age 14- and 18-years respectively using confounder-adjusted models. RESULTS At 14 years HSM2 was 0.59SD lower in OH males, and HSM5 (-0.31SD) and HSM9 (-0.32SD) were lower in OH in both sexes. At 18 years HSM1 (-0.44SD) and HSM2 (-0.71SD) were lower and HSM6 (0.61SD) and HSM8 (1.06SD) were higher in OH males, whilst HSM5 was lower in OH in both sexes. OH appeared to be associated with a wider femoral neck and head, and larger lesser/greater trochanters. Only weak associations were observed between gestation length/breech and HSMs. CONCLUSIONS These results suggest that prenatal skeletal loading, in particular oligohydramnios, may influence adolescent joint shape with associations generally stronger in males.
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Affiliation(s)
- Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK,MRC Integrative Epidemiology Unit at the University of Bristol, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, UK,MRC Integrative Epidemiology Unit at the University of Bristol, UK
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, UK,Population Health Science, Bristol Medical School, Bristol University, UK,Bristol NIHR Biomedical Research Centre, Medical Sciences and Nutrition, Medical Sciences and Nutrition, University of Aberdeen
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen
| | - Alex Ireland
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Life Sciences, Manchester Metropolitan University, Manchester, UK
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20
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Hernandez Cordero AI, Gonzales NM, Parker CC, Sokolof G, Vandenbergh DJ, Cheng R, Abney M, Sko A, Douglas A, Palmer AA, Gregory JS, Lionikas A. Genome-wide Associations Reveal Human-Mouse Genetic Convergence and Modifiers of Myogenesis, CPNE1 and STC2. Am J Hum Genet 2019; 105:1222-1236. [PMID: 31761296 PMCID: PMC6904802 DOI: 10.1016/j.ajhg.2019.10.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/28/2019] [Indexed: 12/11/2022] Open
Abstract
Muscle bulk in adult healthy humans is highly variable even after height, age, and sex are accounted for. Low muscle mass, due to fewer and/or smaller constituent muscle fibers, would exacerbate the impact of muscle loss occurring in aging or disease. Genetic variability substantially influences muscle mass differences, but causative genes remain largely unknown. In a genome-wide association study (GWAS) on appendicular lean mass (ALM) in a population of 85,750 middle-aged (aged 38-49 years) individuals from the UK Biobank (UKB), we found 182 loci associated with ALM (p < 5 × 10-8). We replicated associations for 78% of these loci (p < 5 × 10-8) with ALM in a population of 181,862 elderly (aged 60-74 years) individuals from UKB. We also conducted a GWAS on hindlimb skeletal muscle mass of 1,867 mice from an advanced intercross between two inbred strains (LG/J and SM/J); this GWAS identified 23 quantitative trait loci. Thirty-eight positional candidates distributed across five loci overlapped between the two species. In vitro studies of positional candidates confirmed CPNE1 and STC2 as modifiers of myogenesis. Collectively, these findings shed light on the genetics of muscle mass variability in humans and identify targets for the development of interventions for treatment of muscle loss. The overlapping results between humans and the mouse model GWAS point to shared genetic mechanisms across species.
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Affiliation(s)
- Ana I Hernandez Cordero
- School of Medicine, Medical Sciences, and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK AB24 3FX, UK
| | - Natalia M Gonzales
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Clarissa C Parker
- Department of Psychology, Middlebury College, Middlebury, VT 05753, USA; Program in Neuroscience, Middlebury College, Middlebury, VT, 05753, USA
| | - Greta Sokolof
- Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA 52242, USA
| | - David J Vandenbergh
- Department of Biobehavioral Health, Penn State Institute for the Neurosciences, and Molecular, Cellular, and Integrative Sciences Program, Pennsylvania State University, University Park, PA 16802, USA
| | - Riyan Cheng
- Department of Health Sciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Mark Abney
- Department of Human Genetics, University of Chicago, Chicago, IL 60637, USA
| | - Andrew Sko
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Alex Douglas
- Institute of Biological and Environmental Sciences, University of Aberdeen, Aberdeen, AB24 3FX, UK
| | - Abraham A Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA 92093, USA; Institute for Genomic Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Jennifer S Gregory
- School of Medicine, Medical Sciences, and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK AB24 3FX, UK
| | - Arimantas Lionikas
- School of Medicine, Medical Sciences, and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK AB24 3FX, UK.
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21
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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22
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Baird DA, Evans DS, Kamanu FK, Gregory JS, Saunders FR, Giuraniuc CV, Barr RJ, Aspden RM, Jenkins D, Kiel DP, Orwoll ES, Cummings SR, Lane NE, Mullin BH, Williams FMK, Richards JB, Wilson SG, Spector TD, Faber BG, Lawlor DA, Grundberg E, Ohlsson C, Pettersson‐Kymmer U, Capellini TD, Richard D, Beck TJ, Evans DM, Paternoster L, Karasik D, Tobias JH. Identification of Novel Loci Associated With Hip Shape: A Meta-Analysis of Genomewide Association Studies. J Bone Miner Res 2019; 34:241-251. [PMID: 30320955 PMCID: PMC6375741 DOI: 10.1002/jbmr.3605] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/30/2018] [Accepted: 10/06/2018] [Indexed: 02/05/2023]
Abstract
We aimed to report the first genomewide association study (GWAS) meta-analysis of dual-energy X-ray absorptiometry (DXA)-derived hip shape, which is thought to be related to the risk of both hip osteoarthritis and hip fracture. Ten hip shape modes (HSMs) were derived by statistical shape modeling using SHAPE software, from hip DXA scans in the Avon Longitudinal Study of Parents and Children (ALSPAC; adult females), TwinsUK (mixed sex), Framingham Osteoporosis Study (FOS; mixed), Osteoporotic Fractures in Men study (MrOS), and Study of Osteoporotic Fractures (SOF; females) (total N = 15,934). Associations were adjusted for age, sex, and ancestry. Five genomewide significant (p < 5 × 10-9 , adjusted for 10 independent outcomes) single-nucleotide polymorphisms (SNPs) were associated with HSM1, and three SNPs with HSM2. One SNP, in high linkage disequilibrium with rs2158915 associated with HSM1, was associated with HSM5 at genomewide significance. In a look-up of previous GWASs, three of the identified SNPs were associated with hip osteoarthritis, one with hip fracture, and five with height. Seven SNPs were within 200 kb of genes involved in endochondral bone formation, namely SOX9, PTHrP, RUNX1, NKX3-2, FGFR4, DICER1, and HHIP. The SNP adjacent to DICER1 also showed osteoblast cis-regulatory activity of GSC, in which mutations have previously been reported to cause hip dysplasia. For three of the lead SNPs, SNPs in high LD (r2 > 0.5) were identified, which intersected with open chromatin sites as detected by ATAC-seq performed on embryonic mouse proximal femora. In conclusion, we identified eight SNPs independently associated with hip shape, most of which were associated with height and/or mapped close to endochondral bone formation genes, consistent with a contribution of processes involved in limb growth to hip shape and pathological sequelae. These findings raise the possibility that genetic studies of hip shape might help in understanding potential pathways involved in hip osteoarthritis and hip fracture. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Denis A Baird
- Musculoskeletal Research UnitUniversity of BristolBristolUK
| | - Daniel S Evans
- California Pacific Medical Center Research InstituteSan FranciscoCAUSA
| | - Frederick K Kamanu
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
| | | | - Fiona R Saunders
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
| | | | - Rebecca J Barr
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
- MEMO ResearchUniversity of DundeeDundeeUK
| | - Richard M Aspden
- Arthritis and Musculoskeletal MedicineUniversity of AberdeenAberdeenUK
| | | | - Douglas P Kiel
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
- Broad Institute of MIT and HarvardBostonMAUSA
| | - Eric S Orwoll
- School of MedicineOregon Health and Science UniversityPortlandORUSA
| | - Steven R Cummings
- California Pacific Medical Center Research InstituteSan FranciscoCAUSA
| | - Nancy E Lane
- University of California at DavisSacramentoCAUSA
| | - Benjamin H Mullin
- Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
- School of Biomedical SciencesUniversity of Western AustraliaPerthAustralia
| | - Frances MK Williams
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | - J Brent Richards
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
- Departments of Medicine, Human Genetics, Epidemiology, and BiostatisticsJewish General HospitalMcGill UniversityMontrealCanada
| | - Scott G Wilson
- Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
- School of Biomedical SciencesUniversity of Western AustraliaPerthAustralia
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | - Tim D Spector
- Department of Twin Research and Genetic EpidemiologyKing's College LondonLondonUK
| | | | | | - Elin Grundberg
- Department of Human GeneticsMcGill UniversityMontrealCanada
| | - Claes Ohlsson
- Centre for Bone and Arthritis ResearchInstitute of MedicineUniversity of GothenburgGothenburgSweden
| | | | - Terence D Capellini
- Broad Institute of MIT and HarvardBostonMAUSA
- Human Evolutionary BiologyHarvard UniversityBostonMAUSA
| | | | | | - David M Evans
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
- University of Queensland Diamantina InstituteTranslational Research InstituteBrisbaneAustralia
| | | | - David Karasik
- Institute for Aging ResearchHebrew SeniorLifeDepartment of MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
- Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Jonathan H Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- MRC Integrative Epidemiology UnitUniversity of BristolBristolUK
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23
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Hernandez Cordero AI, Carbonetto P, Riboni Verri G, Gregory JS, Vandenbergh DJ, P Gyekis J, Blizard DA, Lionikas A. Replication and discovery of musculoskeletal QTLs in LG/J and SM/J advanced intercross lines. Physiol Rep 2019; 6. [PMID: 29479840 PMCID: PMC6430048 DOI: 10.14814/phy2.13561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 12/14/2022] Open
Abstract
The genetics underlying variation in health‐related musculoskeletal phenotypes can be investigated in a mouse model. Quantitative trait loci (QTLs) affecting musculoskeletal traits in the LG/J and SM/J strain lineage remain to be refined and corroborated. The aim of this study was to map muscle and bone traits in males (n = 506) of the 50th filial generation of advanced intercross lines (LG/SM AIL) derived from the two strains. Genetic contribution to variation in all musculoskeletal traits was confirmed; the SNP heritability of muscle mass ranged between 0.46 and 0.56; and the SNP heritability of tibia length was 0.40. We used two analytical software, GEMMA and QTLRel, to map the underlying QTLs. GEMMA required substantially less computation and recovered all the QTLs identified by QTLRel. Seven significant QTLs were identified for muscle weight (Chr 1, 7, 11, 12, 13, 15, and 16), and two for tibia length, (Chr 1 and 13). Each QTL explained 4–5% of phenotypic variation. One muscle and both bone loci replicated previous findings; the remaining six were novel. Positional candidates for the replicated QTLs were prioritized based on in silico analyses and gene expression in muscle tissue. In summary, we replicated existing QTLs and identified novel QTLs affecting muscle weight, and replicated bone length QTLs in LG/SM AIL males. Heritability estimates substantially exceed the cumulative effect of the QTLs, hence a richer genetic architecture contributing to muscle and bone variability could be uncovered with a larger sample size.
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Affiliation(s)
- Ana I Hernandez Cordero
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter Carbonetto
- Research Computing Center and Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Gioia Riboni Verri
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Jennifer S Gregory
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - David J Vandenbergh
- Department of Biobehavioral Health, The Penn State Institute for the Neurosciences, Molecular and Cellular Integrative Biosciences Program, The Pennsylvania State University, University Park, Pennsylvania
| | - Joseph P Gyekis
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, Pennsylvania
| | - David A Blizard
- Department of Biobehavioral Health, The Penn State Institute for the Neurosciences, Molecular and Cellular Integrative Biosciences Program, The Pennsylvania State University, University Park, Pennsylvania
| | - Arimantas Lionikas
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
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24
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Gonzales NM, Seo J, Hernandez Cordero AI, St Pierre CL, Gregory JS, Distler MG, Abney M, Canzar S, Lionikas A, Palmer AA. Genome wide association analysis in a mouse advanced intercross line. Nat Commun 2018; 9:5162. [PMID: 30514929 PMCID: PMC6279738 DOI: 10.1038/s41467-018-07642-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
The LG/J x SM/J advanced intercross line of mice (LG x SM AIL) is a multigenerational outbred population. High minor allele frequencies, a simple genetic background, and the fully sequenced LG and SM genomes make it a powerful population for genome-wide association studies. Here we use 1,063 AIL mice to identify 126 significant associations for 50 traits relevant to human health and disease. We also identify thousands of cis- and trans-eQTLs in the hippocampus, striatum, and prefrontal cortex of ~200 mice. We replicate an association between locomotor activity and Csmd1, which we identified in an earlier generation of this AIL, and show that Csmd1 mutant mice recapitulate the locomotor phenotype. Our results demonstrate the utility of the LG x SM AIL as a mapping population, identify numerous novel associations, and shed light on the genetic architecture of mammalian behavior.
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Affiliation(s)
- Natalia M Gonzales
- Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA
| | - Jungkyun Seo
- Center for Genomic & Computational Biology, Duke University, Durham, NC, 27708, USA
- Graduate Program in Computational Biology and Bioinformatics, Duke University, Durham, NC, 27708, USA
| | - Ana I Hernandez Cordero
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Celine L St Pierre
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, 63108, USA
| | - Jennifer S Gregory
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Margaret G Distler
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Mark Abney
- Department of Human Genetics, University of Chicago, Chicago, IL, 60637, USA
| | - Stefan Canzar
- Gene Center, Ludwig-Maximilians-Universität München, 81377, Munich, Germany
| | - Arimantas Lionikas
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Abraham A Palmer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, 92093, USA.
- Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
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Baird DA, Paternoster L, Gregory JS, Faber BG, Saunders FR, Giuraniuc CV, Barr RJ, Lawlor DA, Aspden RM, Tobias JH. Investigation of the Relationship Between Susceptibility Loci for Hip Osteoarthritis and Dual X‐Ray Absorptiometry–Derived Hip Shape in a Population‐Based Cohort of Perimenopausal Women. Arthritis Rheumatol 2018; 70:1984-1993. [DOI: 10.1002/art.40584] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 06/05/2018] [Indexed: 11/06/2022]
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Barr RJ, Gregory JS, Yoshida K, Alesci S, Aspden RM, Reid DM. Significant morphological change in osteoarthritic hips identified over 6-12 months using statistical shape modelling. Osteoarthritis Cartilage 2018; 26:783-789. [PMID: 29673866 DOI: 10.1016/j.joca.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 03/29/2018] [Accepted: 04/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Predicting who will develop osteoarthritis, assessing how rapidly their disease will progress and monitoring early responses to treatment are key to the development of therapeutic agents able to treat this crippling disease and to their future clinical use. Statistical Shape Modelling (SSM) enables quantification of variations in multiple geometric measures describing the whole hip joint to be considered in concert. This prospective study evaluates the responsiveness of SSM to changes in hip-shape within 1 year. METHODS Sixty-two people, mean age 67.1 yrs, were recruited. Dual-energy X-ray Absorptiometry images were taken at three timepoints (baseline, 6 and 12 months). Based on Kellgren-Lawrence grading (KLG) of their baseline images, subjects were classified into control/doubtful OA: KLG < 1 in both hips; moderate OA: KLG = 2; and severe OA: KLG ≥ 3 in their most severe hip. Morphology was quantified using SSM and changes in shape were assessed using generalised estimating equations. Standardized response means (SRMs) were calculated for the first and second 6 month periods, then the full 12 months. RESULTS Disease severity ranged from KLG0-KLG4 in the 124 hips assessed at baseline. Three SSM modes (Modes 1, 3 and 4) were associated with OA severity. Across the whole cohort, SRM magnitudes ranged from 0.16 to 0.63. The greatest subgroup SRM (magnitude 0.91) was observed over 12 months in those subjects with moderate OA (KLG2). CONCLUSIONS We have demonstrated that SSM can capture changes in hip shape over 6 and 12 months across the entire hip joint providing a sensitive measure of hip OA progression.
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Affiliation(s)
- R J Barr
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK; Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, UK.
| | - J S Gregory
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - K Yoshida
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - S Alesci
- Takeda Pharmaceuticals, Washington, DC, USA.
| | - R M Aspden
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
| | - D M Reid
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.
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Muthuri SG, Saunders FR, Hardy RJ, Pavlova AV, Martin KR, Gregory JS, Barr RJ, Adams JE, Kuh D, Aspden RM, Cooper R. Associations between body mass index across adult life and hip shapes at age 60 to 64: Evidence from the 1946 British birth cohort. Bone 2017; 105:115-121. [PMID: 28842363 PMCID: PMC5658512 DOI: 10.1016/j.bone.2017.08.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/10/2017] [Accepted: 08/19/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the associations of body mass index (BMI) across adulthood with hip shapes at age 60-64years. METHODS Up to 1633 men and women from the MRC National Survey of Health and Development with repeat measures of BMI across adulthood and posterior-anterior dual-energy X-ray absorptiometry bone mineral density images of the proximal femur recorded at age 60-64 were included in analyses. Statistical shape modelling was applied to quantify independent variations in hip mode (HM), of which the first 6 were examined in relation to: i) BMI at each age of assessment; ii) BMI gain during different phases of adulthood; iii) age first overweight. RESULTS Higher BMI at all ages (i.e. 15 to 60-64) and greater gains in BMI were associated with higher HM2 scores in both sexes (with positive HM2 values representing a shorter femoral neck and a wider and flatter femoral head). Similarly, younger age first overweight was associated with higher HM2 scores but only in men once current BMI was accounted for. In men, higher BMI at all ages was also associated with lower HM4 scores (with negative HM4 values representing a flatter femoral head, a wider neck and smaller neck shaft angle) but no associations with BMI gain or prolonged exposure to high BMI were found. Less consistent evidence of associations was found between BMI and the other four HMs. CONCLUSION These results suggest that BMI across adulthood may be associated with specific variations in hip shapes in early old age.
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Affiliation(s)
- Stella G Muthuri
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK.
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rebecca J Hardy
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
| | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rebecca J Barr
- Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Mailbox 2 Level 7, Ninewells Hospital & Medical School, Dundee DD1 9SY, UK
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, 33 Bedford Place, London WC1B 5JU, UK
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Ahedi HG, Aspden RM, Blizzard LC, Saunders FR, Cicuttini FM, Aitken DA, Jones G, Gregory JS. Hip Shape as a Predictor of Osteoarthritis Progression in a Prospective Population Cohort. Arthritis Care Res (Hoboken) 2017; 69:1566-1573. [DOI: 10.1002/acr.23166] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 11/18/2016] [Accepted: 12/06/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Harbeer G. Ahedi
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
| | - Leigh C. Blizzard
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Fiona R. Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
| | | | - Dawn A. Aitken
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania; Hobart Tasmania Australia
| | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Institute of Medical Sciences, University of Aberdeen; Aberdeen UK
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29
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Pavlova AV, Saunders FR, Muthuri SG, Gregory JS, Barr RJ, Martin KR, Hardy RJ, Cooper R, Adams JE, Kuh D, Aspden RM. Statistical shape modelling of hip and lumbar spine morphology and their relationship in the MRC National Survey of Health and Development. J Anat 2017; 231:248-259. [PMID: 28561274 PMCID: PMC5522893 DOI: 10.1111/joa.12631] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 12/23/2022] Open
Abstract
The anatomical shape of bones and joints is important for their proper function but quantifying this, and detecting pathological variations, is difficult to do. Numerical descriptions would also enable correlations between joint shapes to be explored. Statistical shape modelling (SSM) is a method of image analysis employing pattern recognition statistics to describe and quantify such shapes from images; it uses principal components analysis to generate modes of variation describing each image in terms of a set of numerical scores after removing global size variation. We used SSM to quantify the shapes of the hip and the lumbar spine in dual-energy x-ray absorptiometry (DXA) images from 1511 individuals in the MRC National Survey of Health and Development at ages 60-64 years. We compared shapes of both joints in men and women and hypothesised that hip and spine shape would be strongly correlated. We also investigated associations with height, weight, body mass index (BMI) and local (hip or lumber spine) bone mineral density. In the hip, all except one of the first 10 modes differed between men and women. Men had a wider femoral neck, smaller neck-shaft angle, increased presence of osteophytes and a loss of the femoral head/neck curvature compared with women. Women presented with a flattening of the femoral head and greater acetabular coverage of the femoral head. Greater weight was associated with a shorter, wider femoral neck and larger greater and lesser trochanters. Taller height was accompanied by a flattening of the curve between superior head and neck and a larger lesser trochanter. Four of the first eight modes describing lumbar spine shape differed between men and women. Women tended to have a more lordotic spine than men with relatively smaller but caudally increasing anterior-posterior (a-p) vertebral diameters. Men were more likely to have a straighter spine with larger vertebral a-p diameters relative to vertebral height than women, increasing cranially. A weak correlation was found between body weight and a-p vertebral diameter. No correlations were found between shape modes and height in men, whereas in women there was a weak positive correlation between height and evenness of spinal curvature. Linear relationships between hip and spine shapes were weak and inconsistent in both sexes, thereby offering little support for our hypothesis. In conclusion, men and women entering their seventh decade have small but statistically significant differences in the shapes of their hips and their spines. Associations with height, weight, BMI and BMD are small and correspond to subtle variations whose anatomical significance is not yet clear. Correlations between hip and spine shapes are small.
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Affiliation(s)
- Anastasia V. Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Fiona R. Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Jennifer S. Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | - Rebecca J. Barr
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
- Present address:
Medicines Monitoring Unit (MEMO)Division of Molecular & Clinical MedicineSchool of Medicine Ninewells Hospital & Medical SchoolUniversity of DundeeMailbox 2, Level 7Dundee DD1 9SYUK
| | - Kathryn R. Martin
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
| | | | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Judith E. Adams
- Manchester Academic Health Science CentreManchester Royal InfirmaryCentral Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCLLondonUK
| | - Richard M. Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal HealthSchool of MedicineMedical Sciences and NutritionUniversity of AberdeenAberdeenUK
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Nelson AE, Golightly YM, Lateef S, Renner JB, Jordan JM, Aspden RM, Hillstrom H, Gregory JS. Cross-sectional associations between variations in ankle shape by statistical shape modeling, injury history, and race: the Johnston County Osteoarthritis Project. J Foot Ankle Res 2017; 10:34. [PMID: 28770007 PMCID: PMC5530536 DOI: 10.1186/s13047-017-0216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Injury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease. Joint shape is linked to OA, but the interplay of injury and joint shape and their combined role in OA, particularly at the ankle, is not well known. Therefore, we explored cross-sectional associations between ankle shape and injury in a large community-based cohort. Methods Ankles without radiographic OA were selected from the current data collection of the Johnston County OA Project. Ankles with self-reported prior injury were included as injury cases (n = 108) along with 1:1 randomly selected non-injured ankles. To define ankle shape, a 68 point model on weight-bearing lateral ankle radiographs was entered into a statistical shape model, producing a mean shape and a set of continuous variables (modes) representing variation in that shape. Nineteen modes, explaining 80% of shape variance, were simultaneously included in a logistic regression model with injury status as the dependent variable, adjusted for intra-person correlation, sex, race, body mass index (BMI), baseline OA radiographic grade, and baseline symptoms. Results A total of 194 participants (213 ankles) were included; mean age 71 years, BMI 30 kg/m2, 67% white and 71% women. Injured ankles were more often symptomatic and from whites. In a model adjusted only for intra-person correlation, associations were seen between injury status and modes 1, 6, 13, and 19. In a fully adjusted model, race strongly affected the estimate for mode 1 (which was no longer statistically significant). Conclusions This study showed variations in ankle shape and history of injury as well as with race. These novel findings may indicate a change in ankle morphology following injury, or that ankle morphology predisposes to injury, and suggest that ankle shape is a potentially important factor in the development of ankle OA.
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Affiliation(s)
- Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Injury Prevention Research Center University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Shahmeer Lateef
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Richard M Aspden
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Howard Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York City, NY USA
| | - Jennifer S Gregory
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Nicod J, Davies RW, Cai N, Hassett C, Goodstadt L, Cosgrove C, Yee BK, Lionikaite V, McIntyre RE, Remme CA, Lodder EM, Gregory JS, Hough T, Joynson R, Phelps H, Nell B, Rowe C, Wood J, Walling A, Bopp N, Bhomra A, Hernandez-Pliego P, Callebert J, Aspden RM, Talbot NP, Robbins PA, Harrison M, Fray M, Launay JM, Pinto YM, Blizard DA, Bezzina CR, Adams DJ, Franken P, Weaver T, Wells S, Brown SDM, Potter PK, Klenerman P, Lionikas A, Mott R, Flint J. Genome-wide association of multiple complex traits in outbred mice by ultra-low-coverage sequencing. Nat Genet 2016; 48:912-8. [PMID: 27376238 PMCID: PMC4966644 DOI: 10.1038/ng.3595] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 05/24/2016] [Indexed: 12/13/2022]
Abstract
Two bottlenecks impeding the genetic analysis of complex traits in rodents are access to mapping populations able to deliver gene-level mapping resolution, and the need for population specific genotyping arrays and haplotype reference panels. Here we combine low coverage sequencing (0.15X) with a novel method to impute the ancestral haplotype space in 1,887 commercially available outbred mice. We mapped 156 unique quantitative trait loci for 92 phenotypes at 5% false discovery rate. Gene-level mapping resolution was achieved at about a fifth of loci, implicating Unc13c and Pgc1-alpha at loci for the quality of sleep, Adarb2 for home cage activity, Rtkn2 for intensity of reaction to startle, Bmp2 for wound healing, Il15 and Id2 for several T-cell measures and Prkca for bone mineral content. These findings have implications for diverse areas of mammalian biology and demonstrate how GWAS can be extended via low-coverage sequencing to species with highly recombinant outbred populations.
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Affiliation(s)
- Jérôme Nicod
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | | | - Na Cai
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Carl Hassett
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Leo Goodstadt
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | - Cormac Cosgrove
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benjamin K Yee
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Vikte Lionikaite
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | | | - Carol Ann Remme
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Elisabeth M Lodder
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Jennifer S Gregory
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Tertius Hough
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Russell Joynson
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Hayley Phelps
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Barbara Nell
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Clare Rowe
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Joe Wood
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Alison Walling
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Nasrin Bopp
- Wellcome Trust Centre for Human Genetics, Oxford, UK
| | | | | | - Jacques Callebert
- Department of Biochemistry, AP-HP, Hôpital Lariboisière, INSERM U942, Paris, France
| | - Richard M Aspden
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Nick P Talbot
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Peter A Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Mark Harrison
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Martin Fray
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Jean-Marie Launay
- Department of Biochemistry, AP-HP, Hôpital Lariboisière, INSERM U942, Paris, France
| | - Yigal M Pinto
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - David A Blizard
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Connie R Bezzina
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Paul Franken
- Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Tom Weaver
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Sara Wells
- Mary Lyon Centre, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Steve D M Brown
- Mammalian Genetics Unit, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Paul K Potter
- Mammalian Genetics Unit, MRC Harwell, Harwell Science and Innovation Campus, Harwell, UK
| | - Paul Klenerman
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Arimantas Lionikas
- School of Medicine, Medical Sciences and Nutrition, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | - Richard Mott
- Wellcome Trust Centre for Human Genetics, Oxford, UK.,UCL Genetics Institute, University College London, London, UK
| | - Jonathan Flint
- Wellcome Trust Centre for Human Genetics, Oxford, UK.,Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California, USA
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Neilly D, Khan SK, Gregory JS, Aspden RM, Hutchison JD, Deehan DJ. Can radiographs of hip fractures predict subsequent hip fractures? A shape modelling analysis. Injury 2016; 47:1543-6. [PMID: 27173091 DOI: 10.1016/j.injury.2016.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/18/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The geometrical shape of the proximal femur has previously been shown to predict primary hip fractures. Hip fractures are routinely diagnosed on plain radiographs of the pelvis, and these have both hips viewable. We have investigated if statistical shape modelling of the uninvolved hip on plain radiographs, at the time of the first hip fracture episode, could predict a subsequent 'second fracture' on that (uninvolved) side. MATERIALS AND METHODS 60 radiographs taken at the time of the index hip fracture were blinded and separated into two arms; patients sustaining one hip fracture only (n=30), and those who went on to sustain a second fracture (n=30), over the three-year follow-up period. Two separate shape models were used for these groups and compared using t-tests or Mann-Whitney U-tests, along with Cohen's d to measure the effect size of each measure. RESULTS We found no statistically significant difference in the shape of the femur between the first fracture and second fracture group (p>0.05) and no results reached a "medium" effect size (Cohen's d <0.5). CONCLUSIONS Shape modelling is feasible and can be applied in the routine clinical setting. However, we were unable to elucidate any predictive value in this relatively small sample. A reliable radiograph-based method of identifying patients at risk of second fracture would be of value in planning prevention, service provision, and cost analysis. Further work is required and a study with more patients might exclude the type 2 error in our work.
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Affiliation(s)
- David Neilly
- North of Scotland Specialty Training Programme, United Kingdom; Division of Applied Medicine, University of Aberdeen, United Kingdom
| | - Sameer K Khan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom.
| | | | - Richard M Aspden
- Division of Applied Medicine, University of Aberdeen, United Kingdom
| | - James D Hutchison
- Division of Applied Medicine, University of Aberdeen, United Kingdom
| | - David J Deehan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom; Institute of Cellular Medicine, Newcastle University, United Kingdom
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Varzi D, Coupaud SAF, Purcell M, Allan DB, Gregory JS, Barr RJ. Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients. Bone 2015; 81:495-501. [PMID: 26341577 DOI: 10.1016/j.bone.2015.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/18/2015] [Accepted: 08/30/2015] [Indexed: 01/13/2023]
Abstract
After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. Decreases in bone mineral density (BMD) in the first year range from 1% (slow) to 40% (rapid). In chronic SCI, fragility fractures commonly occur around the knee, with significant associated morbidity. Osteoporosis treatments await full evaluation in SCI, but should be initiated early and targeted towards patients exhibiting rapid bone loss. The potential to predict rapid bone loss from a single bone scan within weeks of a SCI was investigated using statistical shape modelling (SSM) of bone morphology, hypothesis: baseline bone shape predicts bone loss at 12-months post-injury at fracture-prone sites. In this retrospective cohort study 25 SCI patients (median age, 33 years) were scanned at the distal femur and proximal tibia using peripheral Quantitative Computed Tomography at <5 weeks (baseline), 4, 8 and 12 months post-injury. An SSM was made for each bone. Links between the baseline shape-modes and 12-month total and trabecular BMD loss were analysed using multiple linear regression. One mode from each SSM significantly predicted bone loss (age-adjusted P<0.05 R(2)=0.37-0.61) at baseline. An elongated intercondylar femoral notch (femur mode 4, +1 SD from the mean) was associated with 8.2% additional loss of femoral trabecular BMD at 12-months. A more concave posterior tibial fossa (tibia mode 3, +1 SD) was associated with 9.4% additional 12-month tibial trabecular BMD loss. Baseline bone shape determined from a single bone scan is a valid imaging biomarker for the prediction of 12-month bone loss in SCI patients.
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Affiliation(s)
- Delaram Varzi
- Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK
| | - Sylvie A F Coupaud
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK; Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | - Mariel Purcell
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | - David B Allan
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, UK
| | - Jennifer S Gregory
- Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.
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Yoshida K, Barr RJ, Galea-Soler S, Aspden RM, Reid DM, Gregory JS. Reproducibility and Diagnostic Accuracy of Kellgren-Lawrence Grading for Osteoarthritis Using Radiographs and Dual-Energy X-ray Absorptiometry Images. J Clin Densitom 2015; 18:239-44. [PMID: 25304911 DOI: 10.1016/j.jocd.2014.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/29/2022]
Abstract
Advances in image quality from modern dual-energy X-ray absorptiometry (DXA) scanners now allow near radiograph-like quality images at a low radiation dose. This opens potential new applications for the use of DXA scanners to study other musculoskeletal conditions, such as osteoarthritis, which is often investigated by visual assessment of radiographs. Together, osteoporosis and osteoarthritis are the 2 most common musculoskeletal conditions, both of which primarily affect older people. The aim of this study was to determine whether Kellgren-Lawrence grading of DXA images can be used to grade hip osteoarthritis as effectively as radiographs. People who had attended for recent pelvic radiographs underwent DXA of hips (50 hips from 25 people) using a GE Healthcare iDXA scanner. Three observers assigned Kellgren-Lawrence grades to each image, and grading was repeated at least 1 week apart. Intraobserver and interobserver reliability for radiographs and DXA images were calculated using quadratic-weighted kappa (QWK). People were recalled 12 months later, and the tests were repeated with both the radiograph and DXA scans taken within 2 weeks of each other. Hip DXA intraobserver reproducibility achieved a QWK range of 0.88-0.95 and interobserver reproducibility of 0.85-0.88, similar to QWK from hip radiographs. Intraobserver reliability between subject-matched radiograph and iDXA images revealed QWK ranging between 0.80 and 0.88. Reproducibility of hip osteoarthritis grading using DXA was comparable with that of radiographs in this study and similar to repeatability scores previously published in literature. Given the lower radiation dose and the opportunity to simultaneously investigate osteoporosis, DXA presents an attractive imaging option for osteoarthritis.
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Affiliation(s)
- Kanako Yoshida
- Musculoskeletal Research Programme, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Musculoskeletal Research Programme, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Richard M Aspden
- Musculoskeletal Research Programme, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - David M Reid
- Musculoskeletal Research Programme, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Musculoskeletal Research Programme, Division of Applied Medicine, Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK.
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Merle C, Waldstein W, Gregory JS, Goodyear SR, Aspden RM, Aldinger PR, Murray DW, Gill HS. How many different types of femora are there in primary hip osteoarthritis? An active shape modeling study. J Orthop Res 2014; 32:413-22. [PMID: 24249665 DOI: 10.1002/jor.22518] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 10/15/2013] [Indexed: 02/04/2023]
Abstract
We assessed the variation in proximal femoral canal shape and its association with geometric and demographic parameters in primary hip OA. In a retrospective cohort study, the joint geometry of the proximal femur was evaluated on radiographs and corresponding CT scans of 345 consecutive patients with end-stage hip OA. Active shape modeling (ASM) was performed to assess the variation in endosteal shape of the proximal femur. To identify natural groupings of patients, hierarchical cluster analysis of the shape modes was used. ASM identified 10 independent shape modes accounting for >96% of the variation in proximal femoral canal shape within the dataset. Cluster analysis revealed 10 specific shape clusters. Significant differences in geometric and demographic parameters between the clusters were observed. ASM and subsequent cluster analysis have the potential to identify specific morphological patterns of the proximal femur despite the variability in proximal femoral anatomy. The study identified patterns of proximal femoral canal shape in hip OA that allow a comprehensive classification of variation in shape and its association with joint geometry. Our data may improve future stem designs that will optimize stem fit and simultaneously allow individual restoration of hip biomechanics.
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Affiliation(s)
- C Merle
- Department of Orthopaedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstr. 200 A 69118, Heidelberg, Germany; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Goodyear SR, Barr RJ, McCloskey E, Alesci S, Aspden RM, Reid DM, Gregory JS. Can we improve the prediction of hip fracture by assessing bone structure using shape and appearance modelling? Bone 2013; 53:188-93. [PMID: 23220597 DOI: 10.1016/j.bone.2012.11.042] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 10/19/2012] [Accepted: 11/28/2012] [Indexed: 01/07/2023]
Abstract
PURPOSE There is a continuing need to improve the prediction of hip fractures to identify those at highest risk, enabling cost-effective use of preventative therapies. METHODS The aim of this work was to validate an innovative imaging biomarker for hip fracture by modelling the shape and texture of the proximal femur assessed from dual energy X-ray absorptiometry (DXA) scans. Scans used were acquired at baseline from elderly patients participating in a prospective, placebo-controlled fracture prevention study of the bisphosphonate, clodronate. 182 subjects who subsequently suffered a hip fracture were age, weight and height matched with two controls who did not suffer a fracture during a median 4-year follow-up period. Logistic regression was used to test if variables were good predictors of fracture and adjust for bone mineral density (BMD). RESULTS Shape mode 2, reflecting variability in neck-shaft angle, neck width and the size of both trochanters (0.81 (OR), 0.68-0.97 (CI), 0.024 (P)), and appearance mode 6, recording grey-level contrast (1.33, 1.11-1.59, 0.002), were significant predictors of hip fracture and remained so after adjustment for BMD (shape mode 2 (0.77, 0.64-0.93, 0.006), appearance mode 6 (1.32, 1.10-1.59, 0.003)). Receiver Operating Curve analysis showed the combination of shape mode 2, appearance mode 6 and BMD was 3% better than any single predictor. CONCLUSION Variables derived from shape and appearance models gave a prediction of fracture comparable to BMD and in combination with BMD gave an improvement in the prediction of hip fracture that could predict an additional 2000 hip fracture cases per year in the UK, potentially saving more than £20 million per year and 10,000 cases in the US.
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Affiliation(s)
- S R Goodyear
- Musculoskeletal Research Programme, Institute of Medical Sciences and Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
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Ali AH, Cowan AB, Gregory JS, Aspden RM, Meakin JR. The accuracy of active shape modelling and end-plate measurements for characterising the shape of the lumbar spine in the sagittal plane. Comput Methods Biomech Biomed Engin 2012; 15:167-72. [DOI: 10.1080/10255842.2010.518962] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Miller NA, Gregory JS, Semple SIK, Aspden RM, Stollery PJ, Gilbert FJ. Relationships Between Vocal Structures, the Airway, and Craniocervical Posture Investigated Using Magnetic Resonance Imaging. J Voice 2012; 26:102-9. [PMID: 21236638 DOI: 10.1016/j.jvoice.2010.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 10/26/2010] [Indexed: 12/01/2022]
Affiliation(s)
- Nicola A Miller
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, Scotland, UK.
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Barr RJ, Gregory JS, Reid DM, Aspden RM, Yoshida K, Hosie G, Silman AJ, Alesci S, Macfarlane GJ. Predicting OA progression to total hip replacement: can we do better than risk factors alone using active shape modelling as an imaging biomarker? Rheumatology (Oxford) 2011; 51:562-70. [PMID: 22139532 DOI: 10.1093/rheumatology/ker382] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca J. Barr
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Jennifer S. Gregory
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - David M. Reid
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Richard M. Aspden
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Kanako Yoshida
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Gillian Hosie
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Alan J. Silman
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Salvatore Alesci
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
| | - Gary J. Macfarlane
- Musculoskeletal Research Programme, Division of Applied Medicine, University of Aberdeen, Foresterhill, Aberdeen, 2Primary Care Rheumatology Society, Northallerton, 3Arthritis Research UK, Chesterfield, UK, 4Merck, Women's Health and Endocrine, North Wales PA, USA and 5Aberdeen Pain Research Collaboration (Epidemiology Group), Institute of Applied Health Sciences, University of Aberdeen, Forester
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Miller NA, Gregory JS, Semple SIK, Aspden RM, Stollery PJ, Gilbert FJ. The effects of humming and pitch on craniofacial and craniocervical morphology measured using MRI. J Voice 2011; 26:90-101. [PMID: 21435837 DOI: 10.1016/j.jvoice.2010.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 10/26/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS Traditional voice research occurs within a phonetic context. Accordingly, pitch-related contributions are inseparable from those due to articulator input. In humming, articulator input is negligible. Using magnetic resonance imaging, we test the hypothesis that voice production is accompanied by pitch-related adjustments unrelated to articulatory or postural input. STUDY DESIGN/METHOD In this cross-sectional study, 10 healthy volunteers (five men, five women, aged 20-47 years, median 25 years), including singers (6 months to 10 years tuition, median 2 years) and non-singers, were assessed to establish the lowest and highest notes they could comfortably sustain while humming over 20 seconds. With head position stable, midsagittal images were acquired while volunteers hummed these predetermined low and high notes. Twenty-two craniocervical, angular, and linear dimensions defined on these images were compared using one-way repeated-measures analysis of variance. Correlations between variables were sought using Pearson correlation coefficient. RESULTS We found significant differences between low- and high-note conditions in six of 22 measures and widespread pitch-related correlations between variables (r≥0.63, P<0.05). Compared with low-note humming, high-note humming was accompanied by increased craniocervical angles opt/nsl and cvt/nsl (P=0.008 and 0.002, respectively); widening of the C3-menton distance (P=0.003), a rise of the larynx and hyoid in relation to the cranial base (P=0.012 and <0.001, respectively), and an increased sternum-hyoid distance (P<0.001). CONCLUSION Voice production is accompanied by pitch-related adjustments that are currently being masked by, or mistakenly attributed to, articulatory or postural input, identification of which could improve understanding of mechanisms underlying speech and song.
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Affiliation(s)
- Nicola A Miller
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, Scotland, UK.
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Meakin JR, Gregory JS, Aspden RM, Smith FW, Gilbert FJ. The intrinsic shape of the human lumbar spine in the supine, standing and sitting postures: characterization using an active shape model. J Anat 2009; 215:206-11. [PMID: 19493187 DOI: 10.1111/j.1469-7580.2009.01102.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The shape of the lumbar spine in the sagittal plane varies between individuals and as a result of postural changes but it is not known how the shape in different postures is related. Sagittal images of the lumbar spines of 24 male volunteers were acquired using a positional magnetic resonance scanner. The subjects were imaged lying supine, standing and sitting. An active shape model was used to characterize shape in terms of independent modes of variation. Two modes were identified that described the total (mode 1) and distribution (mode 2) of the curvature. The spinal shape was found to be intercorrelated between the three postures for both modes, suggesting that the lumbar spine has an element of shape that is partially maintained despite postural alterations. Mode 1 values indicated that the spine was straightest when standing and curviest when sitting. Mode 2 values indicated that the distribution in the curvature was most even when sitting and least even when lying supine. Systematic differences in the behaviour of the spine, when changing posture, were found that suggest that the shape of the spine may affect its biomechanics.
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Affiliation(s)
- Judith R Meakin
- Bone and Musculoskeletal Programme, Division of Applied Medicine, University of Aberdeen, Aberdeen, UK.
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Gregory JS, Aspden RM. Femoral geometry as a risk factor for osteoporotic hip fracture in men and women. Med Eng Phys 2008; 30:1275-86. [PMID: 18976949 DOI: 10.1016/j.medengphy.2008.09.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Revised: 09/25/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
Osteoporotic hip fracture is associated with high mortality and morbidity and often results in a loss of mobility and independence. Osteoporosis is diagnosed by measuring Bone Mineral Density (BMD), a measure of the amount of mineral in a bone. Although BMD continues to serve well it does not fully account for bone strength and only partially accounts for the risk of hip fracture. The shape and structure of the proximal femur also help to determine how forces act in the hip in a fall and their measurement can aid the prediction of hip fracture. This review examines the link between simple geometrical measures of the proximal femur and hip fracture, or bone strength. It will explore how they relate to each other and to anthropometric factors such as sex, height, weight and age. Limitations in these measures will be identified and new methods of analysis reviewed that encompass many different aspects of the shape of the femur. These new methods show great promise for improving the prediction of fracture risk in the future.
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Affiliation(s)
- Jennifer S Gregory
- Bone and Musculoskeletal Programme, Division of Applied Medicine, University of Aberdeen, UK.
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Meakin JR, Gregory JS, Smith FW, Gilbert FJ, Aspden RM. EFFECTS OF LOADBEARING ON SPINAL SHAPE IN THE UPRIGHT STANCE USING ACTIVE SHAPE MODELLING. J Biomech 2008. [DOI: 10.1016/s0021-9290(08)70195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meakin JR, Gregory JS, Smith FW, Gilbert FJ, Aspden RM. THE INTRINSIC SHAPE OF THE LUMBAR SPINE AND THE EFFECTS OF POSTURE AND TIME OF DAY. J Biomech 2008. [DOI: 10.1016/s0021-9290(08)70198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gregory JS, Waarsing JH, Day J, Pols HA, Reijman M, Weinans H, Aspden RM. Early identification of radiographic osteoarthritis of the hip using an active shape model to quantify changes in bone morphometric features: can hip shape tell us anything about the progression of osteoarthritis? ACTA ACUST UNITED AC 2007; 56:3634-43. [PMID: 17968890 DOI: 10.1002/art.22982] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Few methods exist to measure the progression of osteoarthritis (OA) or to identify people at high risk of developing OA. Striking radiographic changes include deformation of the femoral head and osteophyte growth, which are usually measured semiquantitatively following visual assessment. In this study, an active shape model (ASM) of the proximal femur was used to determine whether morphologic changes to the bone could be quantified and used as a marker of hip OA. METHODS One hundred ten subjects who had no signs of radiographic hip OA at baseline (Kellgren/Lawrence [K/L] scores 0-1) were selected from the Rotterdam Study cohort of subjects ages > or = 55 years. To measure the progression of OA, subjects were followed up with radiographic assessment after 6 years. At the 6-year followup, 55 subjects had established OA (K/L score 3), and in 12 of these OA subjects, the progression of the disease required a total hip replacement (THR). Age- and sex-matched control subjects had a K/L score of 0 at followup. Using the ASM, subjects were assessed for shape changes in the femoral head and neck before, during, and after the development of radiographic OA. Scores of shape variance, or mode scores, were assigned for 10 modes of variation in each subject, and differences in mode scores were determined. RESULTS During followup, significant changes in shape of the proximal femur occurred within the OA group from baseline to followup (P < 0.0001 for mode 1 and P = 0.002 for mode 6) but not within the control group. At baseline (all subjects having K/L scores 0-1), there were significant differences in mode 6 between the OA group and the control group (P = 0.020), and in modes 3 and 6 between the OA subjects who underwent THR and the remaining OA subjects (P = 0.012 and P = 0.019, respectively). CONCLUSION Compared with traditional scoring methods, the ASM can be used more precisely to quantify the deforming effect of OA on the proximal femur and to identify, at an earlier stage of disease, those subjects at highest risk of developing radiographic OA or needing a THR. The ASM may therefore be useful as an imaging biomarker in the assessment of patients with hip OA.
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Gregory JS, Stewart A, Undrill PE, Reid DM, Aspden RM. Bone shape, structure, and density as determinants of osteoporotic hip fracture: a pilot study investigating the combination of risk factors. Invest Radiol 2006; 40:591-7. [PMID: 16118552 DOI: 10.1097/01.rli.0000174475.41342.42] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This article compares and combines methods for examining the external shape and the internal structure of the proximal femur with bone mineral density (BMD) to provide a classifier for hip fracture. MATERIALS AND METHODS Fifty standard pelvic radiographs were available from age-matched fracture and control groups of postmenopausal women. Femoral shape was measured using an active shape model, the trabecular structure by means of a Fourier transform. RESULTS Both the shape and various structure measures were independent of BMD (P=0.16 and >0.50, respectively). Calculating the area under the receiver operator characteristic (ROC) curve (Az), each of shape (Az=0.81), the best structure measure (Az=0.79-0.93), and BMD (Az=0.79), could partially classify the fracture and control groups. However, the combination achieved almost perfect separation (Az=0.99). CONCLUSIONS This pilot study shows how bone shape and structure can complement BMD measurements for investigations of fracture risk.
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Affiliation(s)
- Jennifer S Gregory
- Department of Orthopaedics, University of Aberdeen, Aberdeen, Scotland, U.K.
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Abstract
Spontaneous hemorrhage is a rare complication of lupus. We describe a 36-year old female with lupus who suffered spontaneous, nontraumatic hemorrhage from branches of the splenic artery with massive blood loss while being treated for a lupus flare. We compare this to the two other reported cases of similar lupus-associated splenic artery hemorrhage documented in the literature, both of which had significant pre-existing hemorrhagic risk factors. Spontaneous, nontraumatic hemorrhage of the splenic artery in the absence of risk factors, and in a patient with secondary antiphospholipid syndrome, has been previously undescribed in lupus.
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Affiliation(s)
- M W Itagaki
- University of Illinois, College of Medicine at Urbana-Champaign, Urbana, Illinois 61801, USA.
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Rahmatallah S, Li Y, Seton HC, Mackenzie IS, Gregory JS, Aspden RM. NMR detection and one-dimensional imaging using the inhomogeneous magnetic field of a portable single-sided magnet. J Magn Reson 2005; 173:23-28. [PMID: 15705508 DOI: 10.1016/j.jmr.2004.11.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 11/10/2004] [Indexed: 05/24/2023]
Abstract
A portable, nuclear magnetic resonance (NMR) probe is described which utilises the intrinsic inhomogeneity of the field produced by a single-sided magnet to provide spatial encoding of the NMR signal. The probe uses a longitudinally magnetized hollow cylinder, and a figure-8 radiofrequency (RF) surface coil. The system has been used to measure NMR relaxation times and one-dimensional NMR profiles of rubber phantoms.
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Affiliation(s)
- S Rahmatallah
- Department of Orthopaedics, IMS Building, Medical School, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
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Gregory JS, Stewart A, Undrill PE, Reid DM, Aspden RM. Identification of hip fracture patients from radiographs using Fourier analysis of the trabecular structure: a cross-sectional study. BMC Med Imaging 2004; 4:4. [PMID: 15469614 PMCID: PMC524177 DOI: 10.1186/1471-2342-4-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Accepted: 10/06/2004] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND: This study presents an analysis of trabecular bone structure in standard radiographs using Fourier transforms and principal components analysis (PCA) to identify contributions to hip fracture risk. METHODS: Radiographs were obtained from 26 hip fracture patients and 24 controls. They were digitised and five regions of interest (ROI) were identified from the femoral head and neck for analysis. The power spectrum was obtained from the Fourier transform of each region and three profiles were produced; a circular profile and profiles parallel and perpendicular to the preferred orientation of the trabeculae. PCA was used to generate a score from each profile, which we hypothesised could be used to discriminate between the fracture and control groups. The fractal dimension was also calculated for comparison. The area under the receiver operating characteristic curve (Az) discriminating the hip fracture cases from controls was calculated for each analysis. RESULTS: Texture analysis of standard radiographs using the fast Fourier transform yielded variables that were significantly associated with fracture and not significantly correlated with age, body mass index or femoral neck bone mineral density. The anisotropy of the trabecular structure was important; both the perpendicular and circular profiles were significantly better than the parallel-profile (P < 0.05). No significant differences resulted from using the various ROI within the proximal femur. For the best three groupings of profile (circular, parallel or perpendicular), method (PCA or fractal) and ROI (Az = 0.84 - 0.93), there were no significant correlations with femoral neck bone mineral density, age, or body mass index. PCA analysis was found to perform better than fractal analysis (P = 0.019). CONCLUSIONS: Both PCA and fractal analysis of the FFT data could discriminate successfully between the fracture and control groups, although PCA was significantly stronger than fractal dimension. This method appears to provide a powerful tool for the assessment of bone structure in vivo with advantages over standard fractal methods.
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Affiliation(s)
- Jennifer S Gregory
- Department of Orthopaedics, University of Aberdeen, Aberdeen, United Kingdom
| | - Alison Stewart
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom
| | - Peter E Undrill
- Department of Biomedical Physics and Bioengineering, University of Aberdeen, Aberdeen, United Kingdom
| | - David M Reid
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, United Kingdom
| | - Richard M Aspden
- Department of Orthopaedics, University of Aberdeen, Aberdeen, United Kingdom
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Shapiro SS, Davis JL, Lebach DE, Gregory JS. Measurement of the solar gravitational deflection of radio waves using geodetic very-long-baseline interferometry data, 1979-1999. Phys Rev Lett 2004; 92:121101. [PMID: 15089661 DOI: 10.1103/physrevlett.92.121101] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2003] [Revised: 01/20/2004] [Indexed: 05/24/2023]
Abstract
We used very-long-baseline interferometry (VLBI) to measure the deflection by the Sun of radio waves emanating from distant compact radio sources. This bending is characterized in the parametrized post-Newtonian formalism by gamma, which is unity in general relativity. Using a large geodetic VLBI data set, we obtained gamma=0.9998(3)+/-0.0004(5) (estimated standard error). We found no systematic biases from our analysis of subgroups of data.
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Affiliation(s)
- S S Shapiro
- Department of Physics, Guilford College, Greensboro, North Carolina 27410, USA.
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