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Ghasem-Zadeh A, Bui M, Seeman E, Boyd SK, Iuliano S, Jaipurwala R, Mount PF, Toussaint ND, Chiang C. Bone microarchitecture and estimated failure load are deteriorated whether patients with chronic kidney disease have normal bone mineral density, osteopenia or osteoporosis. Bone 2022; 154:116260. [PMID: 34801763 DOI: 10.1016/j.bone.2021.116260] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Measurement of bone mineral density (BMD) is recommended in patients with chronic kidney disease (CKD). However, most persons in the community and most patients with CKD have osteopenia, suggesting fracture risk is low. Bone loss compromises bone microarchitecture which increases fragility disproportionate to modest deficits in BMD. We therefore hypothesized that patients with CKD have reduced estimated failure load due to deterioration in microarchitecture irrespective of whether they have normal femoral neck (FN) BMD, osteopenia or osteoporosis. METHODS We measured distal tibial and distal radial microarchitecture in 128 patients with CKD and 275 age- and sex-matched controls using high resolution peripheral quantitative computed tomography, FN-BMD using bone densitometry and estimated failure load at the distal appendicular sites using finite element analysis. RESULTS Patients versus controls respectively had: lower tibial cortical area 219 (40.7) vs. 237 (35.3) mm2, p = 0.002, lower cortical volumetric BMD 543 (80.7) vs. 642 (81.7) mgHA/cm3 due to higher porosity 69.6 (6.19) vs. 61.9 (6.48)% and lower matrix mineral density 64.2 (0.62) vs. 65.1 (1.28)%, lower trabecular vBMD 92.2 (41.1) vs. 149 (43.0) mgHA/cm3 due to fewer and spatially disrupted trabeculae, lower FN-BMD 0.78 (0.12) vs. 0.94 (0.14) g/cm2 and reduced estimated failure load 3825 (1152) vs. 5778 (1467) N, all p < 0.001. Deterioration in microarchitecture and estimated failure load was most severe in patients and controls with osteoporosis. Patients with CKD with osteopenia and normal FN-BMD had more deteriorated tibial microarchitecture and estimated failure load than controls with BMD in the same category. In univariate analyses, microarchitecture and FN-BMD were both associated with estimated failure load. In multivariable analyses, only microarchitecture was independently associated with estimated failure load and accounted for 87% of the variance. CONCLUSIONS Bone fragility is likely to be present in patients with CKD despite them having osteopenia or normal BMD. Measuring microarchitecture may assist in targeting therapy to those at risk of fracture.
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Affiliation(s)
- Ali Ghasem-Zadeh
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Depts of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, Australia.
| | - Minh Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Ego Seeman
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Depts of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - Sandra Iuliano
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Depts of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Rizwan Jaipurwala
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Depts of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Peter F Mount
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Dept of Nephrology, Austin Health, The University of Melbourne, Melbourne, Australia
| | - Nigel D Toussaint
- Dept of Nephrology, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Cherie Chiang
- Dept of Medicine, Austin Health, The University of Melbourne, Melbourne, Australia; Depts of Medicine and Endocrinology, Austin Health, The University of Melbourne, Melbourne, Australia
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Florance J, Hemke R, Chang CY, Torriani M, Bredella MA. Effects of intra-articular corticosteroid injections on lumbar trabecular density. Skeletal Radiol 2020; 49:787-793. [PMID: 31834434 DOI: 10.1007/s00256-019-03362-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/27/2019] [Accepted: 12/05/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the effect of intra-articular corticosteroid injections on lumbar spine trabecular density. MATERIALS AND METHODS This retrospective study was IRB-approved and HIPAA-compliant. We identified 50 patients (26 F, 24 M, mean age 69 ± 14 years) who had undergone at least three medium or large joint corticosteroid injections using insoluble corticosteroids and a subsequent non-contrast abdominal CT within 5 years of the first injection. About 126 age- and sex-matched controls without history of prior corticosteroid use who had undergone non-contrast abdominal CT were identified. Cumulative corticosteroid dose was calculated. Density measurements (HU) of trabecular bone of L1 to L4 were performed, and measurements of L1 were compared to established normative data. Groups were compared using a two-sided paired t-test or a chi-squared test. Linear regression analysis between cumulative corticosteroid dose and trabecular density was performed. RESULTS Patients underwent a mean of 4 corticosteroid injections (range 3 to 11) with a mean cumulative corticosteroid dose of 232 ± 100 mg triamcinolone equivalent (range 120 mg to 480 mg). There was no significant difference in trabecular density of L1 to L4 between cases and controls, and there was no significant difference in trabecular density at L1 compared to normative data (p > 0.2). There was no association between cumulative intra-articular corticosteroid dose and mean lumbar trabecular density (p > 0.3). CONCLUSION Patients who underwent repetitive intra-articular insoluble corticosteroid injections showed no increased risk of bone loss compared to controls. Cumulative intra-articular corticosteroid dose was not associated with lumbar trabecular density.
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Affiliation(s)
- Jonathon Florance
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Robert Hemke
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Movement Sciences (AMS), Meibergdreef 9, 1105, Amsterdam, AZ, Netherlands
| | - Connie Y Chang
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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Duckham RL, Bialo SR, Machan J, Kriz P, Gordon CM. A case-control pilot study of stress fracture in adolescent girls: the discriminative ability of two imaging technologies to classify at-risk athletes. Osteoporos Int 2019; 30:1573-1580. [PMID: 31143993 DOI: 10.1007/s00198-019-05001-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/06/2018] [Accepted: 04/22/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED Since stress fractures are common among adolescent athletes, it is important to identify bone assessment tools that accurately identify risk. We investigated the discriminative ability of two imaging technologies to classify at-risk athletes. Findings suggested that peripheral quantitative computed tomography (pQCT) has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. INTRODUCTION Given the high stress fracture (SFX) prevalence among adolescent girls, an understanding of the most informative assessment tools to identify SFX risks are required. We investigated the discriminative ability of pQCT vs. dual-energy X-ray absorptiometry (DXA) to classify athletes with or without SFX. METHODS Twelve adolescent athletes diagnosed with a lower-extremity SFX were compared with 12 matched controls. DXA measured areal bone mineral density (aBMD) and content of the total body, and lumbar spine. Bilateral tibiae were assessed with pQCT. At the metaphysis (3%), total density (ToD), trabecular density (TrD), trabecular area (TrA), and estimated bone strength in compression (BSIc), and at the diaphysis (38% and 66%), total bone area (ToA), cortical density (CoD), cortical area (CoA), estimated bone strength in torsion (SSIp), and peri- and endocortical and muscle area (MuA) were obtained. Cortical bone mass/density around the center of mass and marrow density (estimate of adiposity) were calculated using ImageJ software. General estimated equations adjusting for multiple comparisons (Holm-Bonferroni method) were used to compare means between (1) injured limb of the case athletes vs. uninjured limb of the control athletes and (2) uninjured limb of the case athletes vs. uninjured limbs of the controls and injured vs. uninjured limb of case athletes with a SFX. RESULTS aBMD and content showed no significant differences between cases and controls. When comparing the injured vs. uninjured leg in the case athletes by pQCT at the 3% tibia, unadjusted TrD, total density, and BSIc were significantly lower (p < 0.05) in the injured vs. uninjured leg. Marrow density at the 66% site was 1% (p < 0.05) lower in the injured vs. uninjured leg. CONCLUSIONS These preliminary data in athletes with SFX suggest that pQCT has the ability to distinguish differences in bone structure in injured vs. uninjured limbs. No discriminative bone parameter classifications were identified between adolescent athletes with or without SFX.
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Affiliation(s)
- R L Duckham
- Institute for Physical Activity and Nutrition (IPAN) School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
| | - S R Bialo
- Division of Pediatric Endocrinology, Rhode Island Hospital/Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - J Machan
- Division of Biostatistics, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - P Kriz
- Division of Sports Medicine, Departments of Orthopedics and Pediatrics, Warren Alpert Medical School Rhode Island Hospital/Hasbro Children's Hospital, Brown University, Providence, RI, USA
| | - C M Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
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