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Hollensteiner M, Traweger A, Augat P. Anatomic variability of the human femur and its implications for the use of artificial bones in biomechanical testing. BIOMED ENG-BIOMED TE 2024; 0:bmt-2024-0158. [PMID: 38997222 DOI: 10.1515/bmt-2024-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
Aside from human bones, epoxy-based synthetic bones are regarded as the gold standard for biomechanical testing os osteosyntheses. There is a significant discrepancy in biomechanical testing between the determination of fracture stability due to implant treatment in experimental methods and their ability to predict the outcome of stability and fracture healing in a patient. One possible explanation for this disparity is the absence of population-specific variables such as age, gender, and ethnicity in artificial bone, which may influence the geometry and mechanical properties of bone. The goal of this review was to determine whether commercially available artificial bones adequately represent human anatomical variability for mechanical testing of femoral osteosyntheses. To summarize, the availability of suitable bone surrogates currently limits the validity of mechanical evaluations of implant-bone constructs. The currently available synthetic bones neither accurately reflect the local mechanical properties of human bone, nor adequately represent the necessary variability between various populations, limiting their generalized clinical relevance.
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Affiliation(s)
- Marianne Hollensteiner
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andreas Traweger
- Institute of Tendon and Bone Regeneration, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Paracelsus Medical University Salzburg, Salzburg, Austria
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2
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Jepsen KJ, Bigelow EMR, Goulet RW, Nolan BT, Casden MA, Kennedy K, Hertz S, Kadur C, Clines GA, Leis AM, Karvonen-Gutierrez CA, Bredbenner TL. Structural differences contributing to sex-specific associations between FN BMD and whole-bone strength for adult White women and men. JBMR Plus 2024; 8:ziae013. [PMID: 38523663 PMCID: PMC10958990 DOI: 10.1093/jbmrpl/ziae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 03/26/2024] Open
Abstract
Hip areal BMD (aBMD) is widely used to identify individuals with increased fracture risk. Low aBMD indicates low strength, but this association differs by sex with men showing greater strength for a given aBMD than women. To better understand the structural basis giving rise to this sex-specific discrepancy, cadaveric proximal femurs from White female and male donors were imaged using nano-CT and loaded in a sideways fall configuration to assess strength. FN pseudoDXA images were generated to identify associations among structure, aBMD, and strength that differ by sex. Strength correlated significantly with pseudoDXA aBMD for females (R2 = 0.468, P < .001) and males (R2 = 0.393, P < .001), but the elevations (y-intercepts) of the linear regressions differed between sexes (P < .001). Male proximal femurs were 1045 N stronger than females for a given pseudoDXA aBMD. However, strength correlated with pseudoDXA BMC for females (R2 = 0.433, P < .001) and males (R2 = 0.443, P < .001) but without significant slope (P = .431) or elevation (P = .058) differences. Dividing pseudoDXA BMC by FN-width, total cross-sectional area, or FN-volume led to significantly different associations between strength and the size-adjusted BMC measures for women and men. Three structural differences were identified that differentially affected aBMD and strength for women and men: First, men had more bone mass per unit volume than women; second, different cross-sectional shapes resulted in larger proportions of bone mass orthogonal to the DXA image for men than women; and third, men and women had different proportions of cortical and trabecular bone relative to BMC. Thus, the proximal femurs of women were not smaller versions of men but were constructed in fundamentally different manners. Dividing BMC by a bone size measure was responsible for the sex-specific associations between hip aBMD and strength. Thus, a new approach for adjusting measures of bone mass for bone size and stature is warranted.
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Affiliation(s)
- Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Erin M R Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Bonnie T Nolan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Michael A Casden
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Kathryn Kennedy
- Biomedical Engineering, Marquette University, Milwaukee, WI 53201 United States
| | - Samantha Hertz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Chandan Kadur
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
- Biomedical Laboratory R&D, VA Medical Center, Ann Arbor, MI 48105 United States
| | - Gregory A Clines
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Aleda M Leis
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | | | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado Springs, CO 80918 United States
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Binney N. Reference-Class Problems Are Real: Health-Adjusted Reference Classes and Low Bone Mineral Density. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:128-146. [PMID: 38418083 PMCID: PMC10938540 DOI: 10.1093/jmp/jhae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
Elselijn Kingma argues that Christopher Boorse's biostatistical theory (the BST) does not show how the reference classes it uses are objective and naturalistic. Recently, philosophers of medicine have attempted to rebut Kingma's concerns. I argue that these rebuttals are theoretically unconvincing, and that there are clear examples of physicians adjusting their reference classes according to their prior knowledge of health and disease. I focus on the use of age-adjusted reference classes to diagnose low bone mineral density in children. In addition to using the BST's age, sex, and species, physicians also choose to use other factors to define reference classes, such as pubertal status, bone age, body size, and muscle mass. I show that physicians calibrate the reference classes they use according to their prior knowledge of health and disease. Reference classes are also chosen for pragmatic reasons, such as to predict fragility fractures.
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Golding PH. Dual-energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) for diagnosis of osteoporosis - experimental data from artificial vertebrae confirms significant dependence on bone size. Bone Rep 2022; 17:101607. [PMID: 35937936 PMCID: PMC9352459 DOI: 10.1016/j.bonr.2022.101607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/13/2022] [Accepted: 07/21/2022] [Indexed: 10/24/2022] Open
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Rosengren BE, Rempe J, Jehpsson L, Dencker M, Karlsson MK. Physical Activity at Growth Induces Bone Mass Benefits Into Adulthood – A Fifteen‐Year Prospective Controlled Study. JBMR Plus 2021; 6:e10566. [PMID: 35079677 PMCID: PMC8770997 DOI: 10.1002/jbm4.10566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/29/2021] [Indexed: 12/17/2022] Open
Abstract
Daily school physical activity (PA) improves musculoskeletal traits. Whether or not benefits remain in adulthood is debated. We included in this study 131 children that took part in an intervention with 40 minutes of PA per school day (200 minutes per week) from age 6 to 9 years (grade one) to age 14 to 16 years (grade nine), whereas 78 children continued with national recommended school physical education of 60 minutes per week. Measurements were done with dual‐energy X‐ray absorptiometry (bone mineral content [BMC], bone mineral density [BMD], and bone area), and a computerized knee dynamometer (peak torque muscle strength) at study start, at the end of the intervention, and 7 years after the intervention. Group differences from study start and end of the intervention to 7 years thereafter were estimated by analyses of covariance (adjusted for sex and follow‐up time). Musculoskeletal gains from study start to 7 years after termination of the intervention were higher in the intervention group (total body less head BMC +182.5 g [95% confidence interval {CI}, 55.1–309.9] and BMD +0.03 g/cm2 [95% CI, 0.003–0.05], femoral neck area + 0.2 cm2 [95% CI, 0.1–0.4], and knee flexion peak torque muscle strength at 60 degrees per second +9.2 Nm [95% CI, 2.9–15.5]). There was no attenuation during the 7 years that followed termination of the intervention (all group comparisons p > 0.05). Benefits in musculoskeletal gains remain 7 years after termination of a daily school‐based PA program, without attenuation after termination of the program. Daily school PA may counteract low bone mass and inferior muscle strength in adulthood. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Jakob Rempe
- Department of Orthopedics, Helsingborg Hospital Lund University Helsingborg Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus Dencker
- Department of Physiology and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skane University Hospital Malmo Lund University Malmo Sweden
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Valero C, Olmos JM, Humbert L, Castillo J, Hernández JL, Martínez J, Macías JG. 3D analysis of bone mineral density in a cohort: age- and sex-related differences. Arch Osteoporos 2021; 16:80. [PMID: 34076788 DOI: 10.1007/s11657-021-00921-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/08/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Women have lower areal BMD (g/cm2) than men; however, the women have smaller-size bones. Our study showed that women ≤ 59 years have a hip volumetric BMD by DXA 3D similar to that of men of the same age. This makes us think about the importance of taking into account bone size at the time of analyzing the sex-related differences in bone mass. PURPOSE Women have lower areal BMD (g/cm2) than men; however, these studies do not take into account that women have smaller-size bones. Recently, three-dimensional (3D) modeling methods were proposed to analyze volumetric BMD (vBMD). We want to determine the values of vBMD at the hip by DXA-based 3D modeling in a cohort of people in order to know the age- and sex-related differences. METHODS A total of 2647 people of both sexes (65% women) were recruited from a large cohort (Camargo cohort, Santander, Spain). 3D-SHAPER® software (version 2.8, Galgo Medical, Barcelona, Spain) was used to derive 3D analysis from the hip DXA scans at baseline RESULTS: The differences were less pronounced for vBMD (cortical sBMD 9.3%, trabecular vBMD 6.4%, integral vBMD 2.2%) compared to aBMD (FN aBMD 11.4% and TH aBMD 13.3%). After stratifying by age (≤ 59 years, 60-69 years, 70-79 years, and ≥ 80 years), we observed in ≤ 59 years that aBMD was lower in women compared to men, at FN (0.758 [0.114] g/cm2 vs. 0.833 [0.117] g/cm2; p = 1.4 × 10-20) and TH (0.878 [0.117] g/cm2 vs. 0.990 [0.119] g/cm2; p = 4.1 × 10-40). Nevertheless, no statistically significant difference was observed for integral vBMD (331 [58] mg/cm3 in women and 326 [51] mg/cm3 in men; p = 0.19) and trabecular vBMD (190 [41] mg/cm3 in women and 195 [39] mg/cm3 in men; p = 0.20). CONCLUSION Our results make us think about the importance of taking into account bone size at the time of analyzing the sex-related differences in bone mass.
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Affiliation(s)
- Carmen Valero
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain. .,University of Cantabria, IDIVAL, Santander, Spain.
| | - José Manuel Olmos
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | | | - Jesús Castillo
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - José Luis Hernández
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - Josefina Martínez
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
| | - Jesús González Macías
- Department of Internal Medicine, University Hospital Marqués de Valdecilla, Santander, Spain.,University of Cantabria, IDIVAL, Santander, Spain
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7
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Lindgren E, Rosengren BE, Karlsson MK. Does peak bone mass correlate with peak bone strength? Cross-sectional normative dual energy X-ray absorptiometry data in 1052 men aged 18-28 years. BMC Musculoskelet Disord 2019; 20:404. [PMID: 31484522 PMCID: PMC6727506 DOI: 10.1186/s12891-019-2785-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background Areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. However, as aBMD is calculated as bone mineral content (BMC) divided by the scanned area, aBMD displays an inverse relationship with bone size. In a skeleton that is increasing in size, this is a problem, as bone size is an independent factor that determines bone strength. It could therefore be questioned whether peak aBMD is the period with greatest bone strength, a period that in the hip then would occur in ages 16–19. The aim of this study was to evaluate whether there are changes in bone size in men after age 18 that may influence peak bone strength. Another aim was to provide updated normative DXA data. Methods We scanned left femoral neck by DXA in a cross-sectional study with a population-based selection of 1052 men aged 18–28, and then registered bone mineral content (BMC, gram), aBMD (gram/cm2) and bone area (cm2) in each one-year age group. We performed analyses of variance (ANOVA) to evaluate whether there were differences in these traits between the age groups. We then used Pearson’s correlation analyses to test for trends with ageing after peak bone mass was reached. Results We found the highest absolute femoral neck aBMD at age 19, with statistically significant differences between the one-year age groups in BMC, aBMD, and bone area (all p < 0.05). From peak bone mass onwards (n = 962), there are negative correlations between age and BMC (r = − 0.07; p < 0.05) and age and aBMD (r = − 0.12; p < 0.001), and positive correlation between age and bone area (r = 0.06; p < 0.05). Conclusion As femoral neck bone size in young adult men becomes larger after peak bone mass, it could be questioned whether DXA estimated peak aBMD correlates with peak bone strength. We infer that aBMD must be interpreted with care in individuals with a growing skeleton, since skeletal strength may then increase, in spite of decreasing aBMD. This should be taken into account when performing DXA measurements in these ages.
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Affiliation(s)
- Erik Lindgren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skane University Hospital, SE-205 02, Malmo, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skane University Hospital, SE-205 02, Malmo, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopaedics and Clinical Sciences, Lund University, Skane University Hospital, SE-205 02, Malmo, Sweden.
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8
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Osteoporose – Epidemiologie und Versorgungsqualität. Z Gerontol Geriatr 2019; 52:408-413. [DOI: 10.1007/s00391-019-01559-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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9
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Lee Y, Ogihara N, Lee T. Assessment of finite element models for prediction of osteoporotic fracture. J Mech Behav Biomed Mater 2019; 97:312-320. [PMID: 31151004 DOI: 10.1016/j.jmbbm.2019.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/05/2019] [Accepted: 05/09/2019] [Indexed: 12/16/2022]
Abstract
With increasing life expectancy and mortality rates, the burden of osteoporotic hip fractures is continually on an upward trend. In terms of prevention, there are several osteoporosis treatment strategies such as anti-resorptive drug treatments, which attempt to retard the rate of bone resorption, while promoting the rate of formation. With respect to prediction, several studies have provided insights into obtaining bone strength by non-invasive means through the application of FE analysis. However, what valuable information can we obtain from FE studies that have focused on osteoporosis research, with respect to the prediction of osteoporotic fractures? This paper aims to fine studies that have used FE analysis to predict fractures in the proximal femur through a systematic search of literature using PUBMED, with the main objective of supporting the diagnosis of osteoporosis. The focus of these FE studies is first discussed, and the methodological aspects are summarized, by mainly comparing and contrasting their meshing properties, material properties, and boundary conditions. The implications of these methodological differences in FE modelling processes and propositions with the aim of consolidating or minimalizing these differences are further discussed. We proved that studies need to start converging in terms of their input parameters to make the FE method applicable to clinical settings. This, in turn, will decrease the time needed for in vitro tests. Current advancements in FE analysis need to be consolidated before any further steps can be taken to implement engineering analysis into the clinical scenario.
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Affiliation(s)
- Yeokyeong Lee
- Department of Architectural Engineering, Ewha Womans University, Republic of Korea
| | | | - Taeyong Lee
- Division of Mechanical and Biomedical Engineering, Ewha Womans University, Republic of Korea.
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10
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Yang XJ, Sang HX, Bai B, Ma XY, Xu C, Lei W, Zhang Y. Ex Vivo Evaluation of Hip Fracture Risk by Proximal Femur Geometry and Bone Mineral Density in Elderly Chinese Women. Med Sci Monit 2018; 24:7438-7443. [PMID: 30334549 PMCID: PMC6392087 DOI: 10.12659/msm.910876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The incidence of hip fracture is steadily increasing. We aimed to establish a creative approach to precisely estimate the risk of hip fracture by exploring the relationship between hip fracture and bone mineral density (BMD)/femur geometry. Material/Methods Sixteen samples of cadaveric female proximal femora were randomly selected. Experiments were performed experimental measurement of the femoral neck BMD and geometric parameters (including neck length, neck diameter, head diameter, and neck-shaft angle). In addition, the experimental measurements contain the failure load, which represents the mechanical strength of the femoral neck, and we calculated the correlation coefficient among BMD, geometric parameters, and failure load. Results Significant correlations were discovered between femoral mechanical properties and femoral neck BMD (r=0.792, r2=0.628, P<0.001), trochanteric BMD (r=0.749, r2=0.560, P=0.001), and head diameter (r=0.706, r2=0.499, P=0.002). Multiple linear regression analyses indicated that the best predictor of hip fracture was the combination of femoral neck BMD, head diameter, and neck diameter (r2=0.844, P<0.001). Conclusions The results confirmed that, compared with BMD alone, the combination of BMD and geometric parameters of proximal femur is a better estimation of hip fracture. The geometry of the proximal femur played an important role in assessing the biomechanical strength of femur. This method greatly assists in predicting the risk of hip fracture in clinical trials and will assist studies on why the incidence of hip fracture varies among races.
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Affiliation(s)
- Xiao-Jiang Yang
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Hong-Xun Sang
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Bo Bai
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Xiang-Yu Ma
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Chao Xu
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Wei Lei
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland).,Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China (mainland)
| | - Yang Zhang
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
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11
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Adams AL, Fischer H, Kopperdahl DL, Lee DC, Black DM, Bouxsein ML, Fatemi S, Khosla S, Orwoll ES, Siris ES, Keaveny TM. Osteoporosis and Hip Fracture Risk From Routine Computed Tomography Scans: The Fracture, Osteoporosis, and CT Utilization Study (FOCUS). J Bone Miner Res 2018; 33:1291-1301. [PMID: 29665068 PMCID: PMC6155990 DOI: 10.1002/jbmr.3423] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/19/2018] [Accepted: 03/06/2018] [Indexed: 01/22/2023]
Abstract
Methods now exist for analyzing previously taken clinical computed tomography (CT) scans to measure a dual-energy X-ray absorptiometry (DXA)-equivalent bone mineral density (BMD) at the hip and a finite element analysis-derived femoral strength. We assessed the efficacy of this "biomechanical CT" (BCT) approach for identifying patients at high risk of incident hip fracture in a large clinical setting. Using a case-cohort design sampled from 111,694 women and men aged 65 or older who had a prior hip CT scan, a DXA within 3 years of the CT, and no prior hip fracture, we compared those with subsequent hip fracture (n = 1959) with randomly selected sex-stratified controls (n = 1979) and analyzed their CT scans blinded to all other data. We found that the age-, race-, and body mass index (BMI)-adjusted hazard ratio (HR; per standard deviation) for femoral strength was significant before (women: HR = 2.8, 95% confidence interval [CI] 2.2-3.5; men: 2.8, 2.1-3.7) and after adjusting also for the (lowest) hip BMD T-score by BCT (women: 2.1, 1.4-3.2; men: 2.7, 1.6-4.6). The hazard ratio for the hip BMD T-score was similar between BCT and DXA for both sexes (women: 2.1, 1.8-2.5 BCT versus 2.1, 1.7-2.5 DXA; men: 2.8, 2.1-3.8 BCT versus 2.5, 2.0-3.2 DXA) and was higher than for the (lowest) spine/hip BMD T-score by DXA (women: 1.6, 1.4-1.9; men: 2.1, 1.6-2.7). Compared with the latter as a clinical-practice reference and using both femoral strength and the hip BMD T-score from BCT, sensitivity for predicting hip fracture was higher for BCT (women: 0.66 versus 0.59; men: 0.56 versus 0.48), with comparable respective specificity (women: 0.66 versus 0.67; men: 0.76 versus 0.78). We conclude that BCT analysis of previously acquired routine abdominal or pelvic CT scans is at least as effective as DXA testing for identifying patients at high risk of hip fracture. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Annette L Adams
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Heidi Fischer
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Dennis M Black
- Departments of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Mary L Bouxsein
- Orthopedic Biomechanics Laboratory, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Shireen Fatemi
- Department of Endocrinology, Kaiser Permanente Southern California, Panorama City, CA, USA
| | - Sundeep Khosla
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - Ethel S Siris
- Toni Stabile Osteoporosis Center, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Tony M Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California, Berkeley, CA, USA
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Curtis EM, Moon RJ, Harvey NC, Cooper C. The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Bone 2017; 104:29-38. [PMID: 28119181 PMCID: PMC5420448 DOI: 10.1016/j.bone.2017.01.024] [Citation(s) in RCA: 166] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 02/08/2023]
Abstract
Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority among health measures considered by policy makers. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above the threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford OX3 7LD, UK.
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Wang L, Khoo BCC, Cheng XG, Brown K, Lewis JR, Su YB, Guo Z, Li K, Prince RL. Differences in femoral neck structure between elderly Caucasian and Chinese populations: a cross-sectional study of Perth-Beijing cohorts. Arch Osteoporos 2017; 12:72. [PMID: 28812206 DOI: 10.1007/s11657-017-0366-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/31/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Structural skeletal differences of the femoral neck of older Beijing-Chinese and Perth-Caucasian women were compared; adjusting for frame size-related differences, Beijing-Chinese have lower periosteal width; however, indices of internal bone distribution suggest that Beijing-Chinese may exhibit increased resistance to fracture that may relate to the reduced hip fracture incidence. INTRODUCTION Ethnic differences in skeletal structure may relate to differences in hip fracture risk in Chinese and Caucasian populations. 2D mass, size, and structural biomechanics were compared in the two populations. METHODS Quantitative computed tomography-derived geometric variables were compared in age-matched community-derived female populations, 196 Beijing-Chinese 76.5 ± 4.8 (mean ± SD) years and 237 Perth-Caucasians 77.1 ± 5.0 years. These included scanned area (A), periosteal width (W), bone mineral content (BMC), aBMD, bone cross-sectional area (bCSA), section modulus (Z) and buckling ratio (BR). Assumption-free measures included sigma (σ), related to the distribution of bone in the scanned image previously identified as a predictor of hip fracture, and delta (δ), the center-of-mass displacement from the geometric center. RESULTS Compared to Beijing-Chinese, Perth-Caucasians were heavier (Beijing-Chinese 58.7 ± 11.8; Perth-Caucasians 66.1 ± 11.0 kg), taller (154.9 ± 16.7 vs 158.9 ± 6.0 cm), and had higher BMC, A, and W. After adjustment for frame size, BMC was not significantly different but W remained higher in Perth-Caucasians. Differences in variables aBMD, Z, BR, and σ favored higher resistance to failure with Beijing-Chinese before and after adjustment for frame size. δ was similar in both populations; bCSA was higher in Beijing-Chinese before adjustment for frame size but not after. CONCLUSIONS Bone mass differences in two populations were related to frame size differences. However, femoral neck width remained smaller in Beijing-Chinese suggesting effects of local genetic and environmental factors. In Beijing-Chinese participants compared to Perth-Caucasians, internal bone distribution suggests increased resistance to deformation if exposed to same force that may, in-part, relate to reduced incidence of hip fracture in Beijing-Chinese.
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Affiliation(s)
- L Wang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - B C C Khoo
- Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, Perth, WA, Australia.,School of Physics, University of Western Australia, Nedlands, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia
| | - X G Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - J R Lewis
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Y B Su
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Z Guo
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Li
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - R L Prince
- School of Medicine and Pharmacology, University of Western Australia, Nedlands, WA, Australia. .,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
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14
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Curtis EM, Moon RJ, Harvey NC, Cooper C. Reprint of: The impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Int J Orthop Trauma Nurs 2017; 26:7-17. [PMID: 28578992 PMCID: PMC5480618 DOI: 10.1016/j.ijotn.2017.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Osteoporosis constitutes a major public health problem, through its association with age-related fractures, particularly of the hip, vertebrae, distal forearm and humerus. Substantial geographic variation has been noted in the incidence of osteoporotic fractures worldwide, with Western populations (North America, Europe and Oceania), reporting increases in hip fracture throughout the second half of the 20th century, with a stabilisation or decline in the last two decades. In developing populations however, particularly in Asia, the rates of osteoporotic fracture appears to be increasing. The massive global burden consequent to osteoporosis means that fracture risk assessment should be a high priority amongst health measures considered by policy makers. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), has been used globally since the mid-1990s. However, although this definition identifies those at greatest individual risk of fracture, in the population overall a greater total number of fractures occur in individuals with BMD values above threshold for osteoporosis diagnosis. A number of web-based tools to enable the inclusion of clinical risk factors, with or without BMD, in fracture prediction algorithms have been developed to improve the identification of individuals at high fracture risk, the most commonly used globally being FRAX®. Access to DXA, osteoporosis risk assessment, case finding and treatment varies worldwide, but despite such advances studies indicate that a minority of men and women at high fracture risk receive treatment. Importantly, research is ongoing to demonstrate the clinical efficacy and cost-effectiveness of osteoporosis case finding and risk assessment strategies worldwide. The huge burden caused by osteoporosis related fractures to individuals, healthcare systems and societies should provide a clear impetus for the progression of such approaches.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
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15
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Wang L, Cheng XG, Su YB, Brown K, Xu L, Li K, Zhang CX, Zhang Y, Duanmu YY, Wu XB, Wang MY. Sex-related variations in cortical and trabecular bone of the femoral neck in an elderly Chinese population. Osteoporos Int 2017; 28:2391-2399. [PMID: 28405730 DOI: 10.1007/s00198-017-4043-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) was used to investigate sex-related variations in cortical and trabecular bone of the femoral neck. Cortical bone thickness of women in the superior quadrant was thinner than that of men, and the cortex in all four quadrants was negatively associated with age in women. INTRODUCTION This cross-sectional study aimed to investigate sex-related similarities and differences in femoral neck structure in an elderly Chinese population by QCT bone investigational toolkit (BIT) analysis. METHODS This study included 207 male (67.9 ± 7.7 years; range, 55-87 years) and 400 female subjects (68.0 ± 8.7 years; range, 55-96 years). BIT module was used to measure cortical and trabecular bone in anatomic quadrants of the femoral neck. Measurements of cortical thickness (Ct.Th), cortical vBMD (Ct.vBMD), trabecular vBMD (Tb.vBMD), and integral vBMD (It.vBMD) at the femoral neck were determined in four anatomical sectors. RESULTS The greatest difference between sexes, after adjusting for age, height, and weight, was in Ct.Th of Quadrant Supero-anterior (SA), which was 27.4% lower in women (p<0.001). Ct.Th of Quadrant Supero-posterior (SP) was 15.1% lower in women (p = 0.027). Ct.Th and Tb.vBMD in all four quadrants appeared to be negatively associated with age in females, whereas no significant relationship was observed in males, except Ct.Th of Quadrant SP. CONCLUSIONS The superior femoral neck geometry between males and females was significantly different, even after adjustment for body size and age, and the sub-regional cortical and trabecular bone negatively age-related changes in women indicated that women apparently have a more vulnerable geometrical outcome with age for fractures than men.
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Affiliation(s)
- L Wang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X G Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China.
| | - Y B Su
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Brown
- Mindways Software, Austin, TX, USA
| | - L Xu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - K Li
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - C X Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Y Y Duanmu
- Department of Radiology, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - X B Wu
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - M Y Wang
- Department of Traumatology and Orthopedic Surgery, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
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16
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Abstract
Bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is the most commonly used method to assess fracture risk. DXA utilizes two different energy X-rays to calculate BMD and, by comparison to a young normative database, the T-score. In 1994, the World Health Organization defined osteoporosis based on T-score, changing the paradigm of the field and forever placing DXA measurements in the center of osteoporosis diagnosis. Since then, many large studies have demonstrated the predictive value of BMD by DXA-for every standard deviation decline in BMD, there is a relative risk of 1.5-2.5 for fracture. This predictive ability is similar to how blood pressure can predict myocardial infarction. Limitations of DXA are also important to consider. While BMD by DXA can identify those at risk, there is a significant overlap in the BMD of patients who will and will not fracture. Special considerations are also needed in men and ethnic minority groups. These groups may have different bone size, thus affecting the normative range of BMD, and/or distinct bone structure that affect the association between BMD and fractures. Finally, BMD can be affected by positioning errors or artifacts, including osteoarthritis, fracture, and jewelry. Of course, DXA has tremendous strengths as well-namely its wide availability, its low radiation exposure, and a large body of evidence that relate DXA measurements to fracture risk. For these reasons, DXA remains the cornerstone of fracture assessment now and for the foreseeable future.
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Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; Department of Medicine, Section of Diabetes, Metabolism, and Endocrinology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637
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Bachmann KN, Schorr M, Bruno AG, Bredella MA, Lawson EA, Gill CM, Singhal V, Meenaghan E, Gerweck AV, Slattery M, Eddy KT, Ebrahimi S, Koman SL, Greenblatt JM, Keane RJ, Weigel T, Misra M, Bouxsein ML, Klibanski A, Miller KK. Vertebral Volumetric Bone Density and Strength Are Impaired in Women With Low-Weight and Atypical Anorexia Nervosa. J Clin Endocrinol Metab 2017; 102:57-68. [PMID: 27732336 PMCID: PMC5413107 DOI: 10.1210/jc.2016-2099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Areal bone mineral density (BMD) is lower, particularly at the spine, in low-weight women with anorexia nervosa (AN). However, little is known about vertebral integral volumetric BMD (Int.vBMD) or vertebral strength across the AN weight spectrum, including "atypical" AN [body mass index (BMI) ≥18.5 kg/m2]. OBJECTIVE To investigate Int.vBMD and vertebral strength, and their determinants, across the AN weight spectrum. DESIGN Cross-sectional observational study. SETTING Clinical research center. PARTICIPANTS 153 women (age 18 to 45): 64 with low-weight AN (BMI <18.5 kg/m2; 58% amenorrheic), 44 with atypical AN (18.5≤BMI<23 kg/m2; 30% amenorrheic), 45 eumenorrheic controls (19.2≤BMI<25 kg/m2). MEASURES Int.vBMD and cross-sectional area (CSA) by quantitative computed tomography of L4; estimated vertebral strength (derived from Int.vBMD and CSA). RESULTS Int.vBMD and estimated vertebral strength were lowest in low-weight AN, intermediate in atypical AN, and highest in controls. CSA did not differ between groups; thus, vertebral strength (calculated using Int.vBMD and CSA) was driven by Int.vBMD. In AN, Int.vBMD and vertebral strength were associated positively with current BMI and nadir lifetime BMI (independent of current BMI). Int.vBMD and vertebral strength were lower in AN with current amenorrhea and longer lifetime amenorrhea duration. Among amenorrheic AN, Int.vBMD and vertebral strength were associated positively with testosterone. CONCLUSIONS Int.vBMD and estimated vertebral strength (driven by Int.vBMD) are impaired across the AN weight spectrum and are associated with low BMI and endocrine dysfunction, both current and previous. Women with atypical AN experience diminished vertebral strength, partially due to prior low-weight and/or amenorrhea. Lack of current low-weight or amenorrhea in atypical AN does not preclude compromise of vertebral strength.
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Affiliation(s)
| | | | - Alexander G. Bruno
- Harvard–Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139;
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215
| | | | | | | | - Vibha Singhal
- Neuroendocrine Unit,
- Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | - Anu V. Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | | | - Seda Ebrahimi
- Cambridge Eating Disorders Center, Cambridge, Massachusetts, 02138;
| | | | | | | | - Thomas Weigel
- Klarman Center, McLean Hospital, and Harvard Medical School, Belmont, Massachusetts, 02478; and
| | - Madhusmita Misra
- Neuroendocrine Unit,
- Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114
| | - Mary L. Bouxsein
- Harvard–Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139;
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215
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18
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Fratini A, Bonci T, Bull AMJ. Whole Body Vibration Treatments in Postmenopausal Women Can Improve Bone Mineral Density: Results of a Stimulus Focussed Meta-Analysis. PLoS One 2016; 11:e0166774. [PMID: 27907000 PMCID: PMC5132247 DOI: 10.1371/journal.pone.0166774] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 11/03/2016] [Indexed: 11/18/2022] Open
Abstract
Whole body vibration treatment is a non-pharmacological intervention intended to stimulate muscular response and increase bone mineral density, particularly for postmenopausal women. The literature related to this topic is controversial, heterogeneous, and unclear despite the prospect of a major clinical effect.The aim of this study was to identify and systematically review the literature to assess the effect of whole body vibration treatments on bone mineral density (BMD) in postmenopausal women with a specific focus on the experimental factors that influence the stimulus. Nine studies fulfilled the inclusion criteria, including 527 postmenopausal women and different vibration delivery designs. Cumulative dose, amplitudes and frequency of treatments as well as subject posture during treatment vary widely among studies. Some of the studies included an associated exercise training regime. Both randomized and controlled clinical trials were included. Whole body vibration was shown to produce significant BMD improvements on the hip and spine when compared to no intervention. Conversely, treatment associated with exercise training resulted in negligible outcomes when compared to exercise training or to placebo. Moreover, side-alternating platforms were more effective in improving BMD values than synchronous platforms and mechanical oscillations of magnitude higher than 3 g and/or frequency lower than 25 Hz were also found to be effective. Treatments with a cumulative dose over 1000 minutes in the follow-up period were correlated to positive outcomes.Our conclusion is that whole body vibration treatments in elderly women can reduce BMD decline.However, many factors (e.g., amplitude, frequency and subject posture) affect the capacity of the vibrations to propagate to the target site; the adequate level of stimulation required to produce these effects has not yet been defined. Further biomechanical analyses to predict the propagation of the vibration waves along the body and assess the stimulation levels are required.
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Affiliation(s)
- Antonio Fratini
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
- * E-mail:
| | - Tecla Bonci
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Anthony M. J. Bull
- Department of Bioengineering, Imperial College London, London, United Kingdom
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Nasiri M, Luo Y. Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling. Bone 2016; 90:90-8. [PMID: 27292653 DOI: 10.1016/j.bone.2016.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 05/25/2016] [Accepted: 06/07/2016] [Indexed: 11/17/2022]
Abstract
There is controversy about whether or not body parameters affect hip fracture in men and women in the same way. In addition, although bone mineral density (BMD) is currently the most important single discriminator of hip fracture, it is unclear if BMD alone is equally effective for men and women. The objective of this study was to quantify and compare the associations of hip fracture risk with BMD and body parameters in men and women using our recently developed two-level biomechanical model that combines a whole-body dynamics model with a proximal-femur finite element model. Sideways fall induced impact force of 130 Chinese clinical cases, including 50 males and 80 females, were determined by subject-specific dynamics modeling. Then, a DXA-based finite element model was used to simulate the femur bone under the fall-induced loading conditions and calculate the hip fracture risk. Body weight, body height, body mass index, trochanteric soft tissue thickness, and hip bone mineral density were determined for each subject and their associations with impact force and hip fracture risk were quantified. Results showed that the association between impact force and hip fracture risk was not strong enough in both men (r=-0.31,p<0.05) and women (r=0.42,p<0.001) to consider the force as a sole indicator of hip fracture risk. The correlation between hip BMD and hip fracture risk in men (r=-0.83,p<0.001) was notably stronger than that in women (r=-0.68,p<0.001). Increased body mass index was not a protective factor against hip fracture in men (r=-0.13,p>0.05), but it can be considered as a protective factor among women (r=-0.28,p<0.05). In contrast to men, trochanteric soft tissue thickness can be considered as a protective factor against hip fracture in women (r=-0.50,p<0.001). This study suggested that the biomechanical risk/protective factors for hip fracture are sex-specific. Therefore, the effect of body parameters should be considered differently for men and women in hip fracture risk assessment tools. These findings support further exploration of sex-specific preventive and protective measurements to reduce the incidence of hip fractures.
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Affiliation(s)
- Masoud Nasiri
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, Canada
| | - Yunhua Luo
- Department of Mechanical Engineering, Faculty of Engineering, University of Manitoba, Canada; Department of Biomedical Engineering, Faculty of Engineering, University of Manitoba, Canada.
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20
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Fast and easy preoperative estimation of cancellous bone mineral density in patients with proximal femur fractures. Arch Orthop Trauma Surg 2015; 135:1683-9. [PMID: 26476721 DOI: 10.1007/s00402-015-2340-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Postoperative complications after hip fractures in osteoporotic bone such as implant cutout can be reduced by the use of specially designed implants or additional cement augmentation. It is not yet clear at which degree of osteoporosis, patients will profit from implant augmentation or specially designed implants for geriatric patients. As the surgeon ideally should obtain information on local bone quality at the site of implant anchorage already preoperatively, the aim of the study was to develop an easily applicable radiographic method to estimate bone quality in those patients. MATERIALS AND METHODS 75 patients with unilateral hip fracture were included. Preoperatively, a CT scan with a calibration device was conducted. Postoperatively, DXA scans were performed. The proposed method measures local cancellous bone mineral density in the contralateral and uninjured femoral head. As a control, 15 young and healthy non-osteoporotic subjects were included. Inter- and intraobserver reliability was investigated for a subgroup of 20 patients. RESULTS Study group patients had a mean BMD measured by CT scans of 194.2 mg/cm(3) (SD 40.4). There was a statistically significant correlation with data from DXA scans (r = 0.706, p < 0.001). The control group was significantly younger and showed a significantly higher BMD when compared to the study group (p < 0.001). Reliability evaluation showed no statistically significant difference in inter- and intraobserver measurements. Interclass correlation proved to be very high. CONCLUSION The proposed method is an easily applicable, reliable and useful tool to estimate bone quality preoperatively using the contralateral hip as a reference. Obtained data may facilitate the decision-making towards the use of further therapeutic measures to improve implant anchorage in osteoporotic bone such as bone cement augmentation. Thus, our method allows for a more individualized surgical treatment of hip fracture patients adapted to the estimated cancellous bone quality of the patient.
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Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, Shepherd JA, Schousboe JT. Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part I. J Clin Densitom 2015; 18:338-58. [PMID: 26277851 DOI: 10.1016/j.jocd.2015.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/21/2022]
Abstract
The International Society for Clinical Densitometry (ISCD) has developed new official positions for the clinical use of quantitative computed tomography of the hip. The ISCD task force for quantitative computed tomography reviewed the evidence for clinical applications and presented a report with recommendations at the 2015 ISCD Position Development Conference. Here, we discuss the agreed on ISCD official positions with supporting medical evidence, rationale, controversy, and suggestions for further study. Parts II and III address the advanced techniques of finite element analysis applied to computed tomography scans and the clinical feasibility of existing techniques for opportunistic screening of osteoporosis using computed tomography scans obtained for other diagnosis such as colonography was addressed.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Germany; Bioclinica, Hamburg, Germany.
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - Sundeep Khosla
- Center for Clinical and Translational Science, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, China
| | - Philippe Zysset
- Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - John T Schousboe
- Park Nicollet Clinic/HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Zysset P, Qin L, Lang T, Khosla S, Leslie WD, Shepherd JA, Schousboe JT, Engelke K. Clinical Use of Quantitative Computed Tomography-Based Finite Element Analysis of the Hip and Spine in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part II. J Clin Densitom 2015; 18:359-92. [PMID: 26277852 DOI: 10.1016/j.jocd.2015.06.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 01/19/2023]
Abstract
The International Society for Clinical Densitometry (ISCD) has developed new official positions for the clinical use of quantitative computed tomography (QCT)-based finite element analysis of the spine and hip. The ISCD task force for QCT reviewed the evidence for clinical applications and presented a report with recommendations at the 2015 ISCD Position Development Conference. Here we discuss the agreed upon ISCD official positions with supporting medical evidence, rationale, controversy, and suggestions for further study. Parts I and III address the clinical use of QCT of the hip, and the clinical feasibility of existing techniques for opportunistic screening of osteoporosis using CT scans obtained for other diagnosis such as colonography was addressed.
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Affiliation(s)
- Philippe Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas Lang
- Center for Clinical and Translational Science, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sundeep Khosla
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - John T Schousboe
- Park Nicollet Clinic/HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Bioclinica, Hamburg, Germany.
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Dendere R, Potgieter JH, Steiner S, Whiley SP, Douglas TS. Dual-Energy X-Ray Absorptiometry for Measurement of Phalangeal Bone Mineral Density on a Slot-Scanning Digital Radiography System. IEEE Trans Biomed Eng 2015; 62:2850-9. [PMID: 26099139 DOI: 10.1109/tbme.2015.2447575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this paper, we assess the feasibility of using two detectors in a slot-scanning digital radiography system to acquire images for measuring bone mineral density (BMD) of the middle phalanx of the middle finger using dual-energy X-ray absorptiometry (DXA). METHODS Simulations were used to evaluate the spectral separation of the low- and high-energy spectra and detective quantum efficiency was used for assessing image quality. Scan parameters were chosen to optimize spectral separation, image quality, and radiation dose. We introduce the measurement of volumetric BMD (vBMD) using basis material decomposition. We assess the accuracy of our methods by comparing measurements taken using bone images against reference data derived from subsequent incineration of the bones. In vivo scans were conducted to evaluate the system precision (repeatability) and agreement with a clinical densitometer. RESULTS Average errors for bone mineral content (BMC), areal BMD (aBMD), and vBMD were 4.85%, 5.49%, and 12.77%, respectively. Our system had good agreement with a clinical densitometer based on concordance correlation coefficient values of 0.92 and 0.98 for aBMD and BMC, respectively. Precision studies yielded coefficient of variation (CV) values of 1.35% for aBMD, 1.48% for BMC, and 1.80% for vBMD. The CV values of all measurements were within 2%, indicating that the methods have clinically acceptable precision. CONCLUSION We conclude that our techniques yield bone measurements with high accuracy, clinically acceptable precision, and good agreement with a clinical densitometer. SIGNIFICANCE We have shown the clinical potential of phalangeal DXA measurements of aBMD and vBMD on a slot-scanning digital radiography system.
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Abstract
Osteoporosis becomes common with aging in both sexes, but is often ignored in men. The 2013 International Society for Clinical Densitometry consensus conference endorsed a Caucasian female referent database for T-score calculation in men. This recommendation has generated controversy and concern. Accumulating data indicate that at the same DXA-measured body mineral density (BMD) (g/cm(2)), men and women are at approximately the same fracture risk. With this point in mind, using the same database to derive the T-score in men and women is reasonable. As a result, a greater proportion of men who sustain a fragility fracture will have T-scores that are higher than they would if a male database were used; in fact, many men will fracture at T-scores that are "normal." This highlights the importance of diagnosing osteoporosis not just by T-score, but also by the presence of fragility fracture and/or by estimations of fracture risk as generated by tools such as the FRAX calculator. The practical consequences of this change in densitometric definition of osteoporosis in men should be monitored, including the proportion of men at risk identified and treated as well as defining the response to treatment in those assessed by this more comprehensive approach.
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Affiliation(s)
- Neil Binkley
- University of Wisconsin Osteoporosis Clinical Research Program, 2870 University Avenue, Suite 100, Madison, WI 53705. Phone: 608.265.6410 Fax: 608.265.6409
| | - Robert Adler
- Endocrinology Section, McGuire Veterans Affairs Medical Center, 1201 Broad Rock Boulevard, Richmond, VA, 23249. Phone 804 675 5424; Fax 804 675 5425
| | - John P. Bilezikian
- College of Physicians and Surgeons, Department of Medicine, Division of Endocrinology, 630 W. 168 Street, New York, NY 10032 Phone: 212.305.6238; Fax: 212.305.6486
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Laurent M, Antonio L, Sinnesael M, Dubois V, Gielen E, Classens F, Vanderschueren D. Androgens and estrogens in skeletal sexual dimorphism. Asian J Androl 2014; 16:213-22. [PMID: 24385015 PMCID: PMC3955330 DOI: 10.4103/1008-682x.122356] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone is an endocrine tissue expressing androgen and estrogen receptors as well as steroid metabolizing enzymes. The bioactivity of circulating sex steroids is modulated by sex hormone-binding globulin and local conversion in bone tissue, for example, from testosterone (T) to estradiol (E2) by aromatase, or to dihydrotestosterone by 5α-reductase enzymes. Our understanding of the structural basis for gender differences in bone strength has advanced considerably over recent years due to increasing use of (high resolution) peripheral computed tomography. These microarchitectural insights form the basis to understand sex steroid influences on male peak bone mass and turnover in cortical vs trabecular bone. Recent studies using Cre/LoxP technology have further refined our mechanistic insights from global knockout mice into the direct contributions of sex steroids and their respective nuclear receptors in osteoblasts, osteoclasts, osteocytes, and other cells to male osteoporosis. At the same time, these studies have reinforced the notion that androgen and estrogen deficiency have both direct and pleiotropic effects via interaction with, for example, insulin-like growth factor 1, inflammation, oxidative stress, central nervous system control of bone metabolism, adaptation to mechanical loading, etc., This review will summarize recent advances on these issues in the field of sex steroid actions in male bone homeostasis.
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Affiliation(s)
- Michaël Laurent
- Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine; Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven; Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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Osteoporosis in men: a review. Bone Res 2014; 2:14001. [PMID: 26273515 PMCID: PMC4472130 DOI: 10.1038/boneres.2014.1] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 01/20/2014] [Accepted: 01/24/2014] [Indexed: 01/12/2023] Open
Abstract
Osteoporosis and consequent fracture are not limited to postmenopausal women. There is increasing attention being paid to osteoporosis in older men. Men suffer osteoporotic fractures about 10 years later in life than women, but life expectancy is increasing faster in men than women. Thus, men are living long enough to fracture, and when they do the consequences are greater than in women, with men having about twice the 1-year fatality rate after hip fracture, compared to women. Men at high risk for fracture include those men who have already had a fragility fracture, men on oral glucocorticoids or those men being treated for prostate cancer with androgen deprivation therapy. Beyond these high risk men, there are many other risk factors and secondary causes of osteoporosis in men. Evaluation includes careful history and physical examination to reveal potential secondary causes, including many medications, a short list of laboratory tests, and bone mineral density testing by dual energy X-ray absorptiometry (DXA) of spine and hip. Recently, international organizations have advocated a single normative database for interpreting DXA testing in men and women. The consequences of this change need to be determined. There are several choices of therapy for osteoporosis in men, with most fracture reduction estimation based on studies in women.
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Torres-del-Pliego E, Vilaplana L, Güerri-Fernández R, Diez-Pérez A. Measuring bone quality. Curr Rheumatol Rep 2014; 15:373. [PMID: 24072603 DOI: 10.1007/s11926-013-0373-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Osteoporosis is defined as a reduction in bone mass and impairment of bone quality that lead to bone fragility and fracture risk. Bone quality includes a hierarchy of properties from macroscopic to nanoscale level. Several techniques have been developed in an attempt to measure these non-density properties. Densitometry, high-resolution images (radiography, CT scan), and MRI can measure the geometry and microarchitecture of bone. Tissue mineralization and composition can be assessed by use of microradiography, Fourier-transform infrared spectroscopy, or Raman microspectroscopy. Finite-element analysis is an image-based method that enables calculation of bone strength. More recently, microindentation has enabled direct estimation of bone material strength, measured in the cortical bone of the tibia. Most of these techniques are of limited use to clinics, although finite-element analysis and microindentation have high potential for clinical use and can enable more comprehensive and accurate evaluation of bone fragility and fracture susceptibility.
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Affiliation(s)
- Elisa Torres-del-Pliego
- Department of Medicine, Hospital del Mar-IMIM, Universitat Autònoma de Barcelona, RETICEF, Instituto Carlos III, Catalonia, Spain,
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Bruno AG, Broe KE, Zhang X, Samelson EJ, Meng CA, Manoharan R, D'Agostino J, Cupples LA, Kiel DP, Bouxsein ML. Vertebral size, bone density, and strength in men and women matched for age and areal spine BMD. J Bone Miner Res 2014; 29:562-9. [PMID: 23955966 PMCID: PMC4149904 DOI: 10.1002/jbmr.2067] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/16/2013] [Accepted: 08/05/2013] [Indexed: 11/08/2022]
Abstract
To explore the possible mechanisms underlying sex-specific differences in skeletal fragility that may be obscured by two-dimensional areal bone mineral density (aBMD) measures, we compared quantitative computed tomography (QCT)-based vertebral bone measures among pairs of men and women from the Framingham Heart Study Multidetector Computed Tomography Study who were matched for age and spine aBMD. Measurements included vertebral body cross-sectional area (CSA, cm(2) ), trabecular volumetric BMD (Tb.vBMD, g/cm(3) ), integral volumetric BMD (Int.vBMD, g/cm(3) ), estimated vertebral compressive loading and strength (Newtons) at L3 , the factor-of-risk (load-to-strength ratio), and vertebral fracture prevalence. We identified 981 male-female pairs (1:1 matching) matched on age (± 1 year) and QCT-derived aBMD of L3 (± 1%), with an average age of 51 years (range 34 to 81 years). Matched for aBMD and age, men had 20% larger vertebral CSA, lower Int.vBMD (-8%) and Tb.vBMD (-9%), 10% greater vertebral compressive strength, 24% greater vertebral compressive loading, and 12% greater factor-of-risk than women (p < 0.0001 for all), as well as higher prevalence of vertebral fracture. After adjusting for height and weight, the differences in CSA and volumetric bone mineral density (vBMD) between men and women were attenuated but remained significant, whereas compressive strength was no longer different. In conclusion, vertebral size, morphology, and density differ significantly between men and women matched for age and spine aBMD, suggesting that men and women attain the same aBMD by different mechanisms. These results provide novel information regarding sex-specific differences in mechanisms that underlie vertebral fragility.
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Affiliation(s)
- Alexander G Bruno
- Harvard-MIT Health Sciences and Technology Program, Cambridge, MA, USA; Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Watts NB, Leslie WD, Foldes AJ, Miller PD. 2013 International Society for Clinical Densitometry Position Development Conference: Task Force on Normative Databases. J Clin Densitom 2013; 16:472-81. [PMID: 24076161 DOI: 10.1016/j.jocd.2013.08.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 08/06/2013] [Indexed: 01/13/2023]
Abstract
Following the standard protocol for development of Official Positions for the International Society for Clinical Densitometry, the Expert Panel heard the report and recommendations from the Task Force on Normative Databases; using the RAND methodology, agreement was reached on the following statements: 1. Manufacturers should continue to use their own databases for the lumbar spine as the reference standard for T-scores. 2. Manufacturers should continue to use National Health and Nutrition Examination Survey III data as the reference standard for femoral neck and total hip T-scores. 3. If local reference data are available, they should be used to calculate only Z-scores but not T-scores. 4. A uniform Caucasian (non-race adjusted) female reference database should be used to calculate T-scores for men of all ethnic groups.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.
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Laurent M, Gielen E, Claessens F, Boonen S, Vanderschueren D. Osteoporosis in older men: recent advances in pathophysiology and treatment. Best Pract Res Clin Endocrinol Metab 2013; 27:527-39. [PMID: 24054929 DOI: 10.1016/j.beem.2013.04.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Osteoporosis remains underrecognized and undertreated but more so in men, adding considerably to fracture burden and costs. Fracture-related morbidity and mortality is higher in men, partly due to greater frailty. Improved peak bone mass, geometry and turn-over contribute to lower fracture incidence in men. Bioavailable androgens and oestrogens regulate these aspects of musculoskeletal sexual dimorphism, yet the direct cellular and molecular targets of sex steroids in bone remain incompletely understood. Screening with clinical risk factors and dual energy X-ray absorptiometry are advised in men from age 70 (or 50 with additional risk factors). We now have compelling evidence that osteoporosis drugs are equally effective in men and women, not only to increase bone density but also to prevent osteoporotic fractures. The use of testosterone or selective androgen receptor modulators for osteoporosis, sarcopenia, frailty and falls in men with late-onset hypogonadism requires further investigation.
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Affiliation(s)
- Michaël Laurent
- Geriatric Medicine, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Sinclair KD, Farnsworth RW, Pham TX, Knight AN, Bloebaum RD, Skedros JG. The artiodactyl calcaneus as a potential ‘control bone’ cautions against simple interpretations of trabecular bone adaptation in the anthropoid femoral neck. J Hum Evol 2013; 64:366-79. [DOI: 10.1016/j.jhevol.2013.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 12/08/2012] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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Abstract
Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA.
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Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 2012; 23:2239-56. [PMID: 22419370 PMCID: PMC3421108 DOI: 10.1007/s00198-012-1964-3] [Citation(s) in RCA: 946] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 12/15/2022]
Abstract
UNLABELLED The country-specific risk of hip fracture and the 10-year probability of a major osteoporotic fracture were determined on a worldwide basis from a systematic review of literature. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. INTRODUCTION The present study aimed to update the available information base available on the heterogeneity in the risk of hip fracture on a worldwide basis. An additional aim was to document variations in major fracture probability as determined from the available FRAX models. METHODS Studies on hip fracture risk were identified from 1950 to November 2011 by a Medline OVID search. Evaluable studies in each country were reviewed for quality and representativeness and a study (studies) chosen to represent that country. Age-specific incidence rates were age-standardised to the world population in 2010 in men, women and both sexes combined. The 10-year probability of a major osteoporotic fracture for a specific clinical scenario was computed in those countries for which a FRAX model was available. RESULTS Following quality evaluation, age-standardised rates of hip fracture were available for 63 countries and 45 FRAX models available in 40 countries to determine fracture probability. There was a greater than 10-fold variation in hip fracture risk and fracture probability between countries. CONCLUSIONS Worldwide, there are marked variations in hip fracture rates and in the 10-year probability of major osteoporotic fractures. The variation is sufficiently large that these cannot be explained by the often multiple sources of error in the ascertainment of cases or the catchment population. Understanding the reasons for this heterogeneity may lead to global strategies for the prevention of fractures.
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Affiliation(s)
- J A Kanis
- WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
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