1
|
Raphael J, D'Erasmo G, Nieves J, Iyer S, Breighner R, Dash A, Billings E, Song J, Kim HJ, Qureshi S, Cunningham M, Stein E. Psoas muscle cross sectional area relates to bone density and microarchitecture in candidates for spine fusion surgery. Bone 2024; 189:117259. [PMID: 39303932 DOI: 10.1016/j.bone.2024.117259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/11/2024] [Accepted: 09/15/2024] [Indexed: 09/22/2024]
Abstract
Prior studies demonstrate that muscle and bone health are integrally related, and both independently impact orthopedic surgery outcomes. However, relationships between bone density, in vivo microarchitecture, and muscle area have not been previously investigated in orthopedic surgery patients. This study assessed associations between psoas cross sectional area (CSA), bone mineral density (BMD), and microstructure in a cohort undergoing spine fusion. Pre-operatively, bilateral psoas CSA was measured on axial lumbar spine CT in the L3-L4 disc space. To adjust for body size, Psoas Muscle Index (PMI) was calculated (CSA divided by the square of patient height). High resolution peripheral quantitative CT (HR-pQCT, XtremeCT2) assessed volumetric BMD (vBMD), cortical (Ct) and trabecular (Tb) microarchitecture at the distal radius and tibia. Areal BMD (aBMD) was measured by DXA at the lumbar spine (LS), total hip (TH), femoral neck (FN), and the 1/3 radius (1/3R). Pearson correlations related psoas CSA and bone imaging parameters before and after correcting for height and weight. Among 88 patients included, mean age was 63 ± 12 years, BMI was 28 ± 7 kg/m2, 47 (53 %) were female. Larger psoas CSA was associated with higher vBMD, greater Ct thickness and better Tb microarchitecture (higher Tb number and lower Tb separation) at the tibia and radius. Larger psoas CSA was also associated with greater aBMD at TH and FN bilaterally and 1/3R (r 0.33 to 0.61; p < 0.002 for all comparisons). Psoas CSA was not associated with aBMD at the LS. Similar results were observed when relating PMI, and adjusting for age, height and weight to HR-pQCT and DXA measurements. Investigation of subgroups by sex demonstrated that relationships were similar magnitude among women but not the men. Patients who underwent primary compared to revision spine surgery had similar associations. Our results demonstrate a link between psoas muscle size and peripheral bone microarchitecture among patients undergoing posterior lumbar spinal fusion. Given the importance of both muscle and skeletal integrity to the success of spine surgery, further study regarding the associations between measurements of psoas muscle, bone microarchitecture, and surgical outcomes is warranted.
Collapse
Affiliation(s)
- Joseph Raphael
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Giavanna D'Erasmo
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Jeri Nieves
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sravisht Iyer
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Ryan Breighner
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Alexander Dash
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Emma Billings
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Junho Song
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Han Jo Kim
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sheeraz Qureshi
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Matthew Cunningham
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Emily Stein
- Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America.
| |
Collapse
|
2
|
Agarwal S, Germosen C, Rosillo I, Bucovsky M, Colon I, Kil N, Wang Z, Dinescu A, Guo XDE, Walker M. Fractures in women with type 2 diabetes are associated with marked deficits in cortical parameters and trabecular plates. J Bone Miner Res 2024; 39:1083-1093. [PMID: 38861455 PMCID: PMC11337576 DOI: 10.1093/jbmr/zjae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/14/2024] [Accepted: 06/10/2024] [Indexed: 06/13/2024]
Abstract
The basis for increased fracture risk in type 2 diabetes (T2DM) is not well understood. In this multi-ethnic, population-based study (n = 565), we investigated bone microstructure, trabecular plate/rod morphology, and mineralization in women with T2DM (n = 175) with and without fracture using a second-generation HRpQCT and individual trabecula segmentation and mineralization (ITS; ITM). Covariate-adjusted aBMD was 3.0%-6.5% higher at all sites (all p<.005) in T2DM vs controls. By HRpQCT, T2DM had higher covariate-adjusted trabecular vBMD (5.3%-6.4%) and number (3.8%-5.1%) and greater cortical area at the radius and tibia. Covariate-adjusted cortical porosity was 10.0% higher at the tibia only in T2DM vs controls, but failure load did not differ. Among women with T2DM, those with adult atraumatic fracture (n = 59) had 5.2%-8.5% lower adjusted aBMD at all sites by DXA compared with those without fracture (n = 103). By HRpQCT, those with fracture had lower adjusted total vBMD and smaller cortical area (10.2%-16.1%), lower cortical thickness (10.5-15.8%) and lower cortical vBMD associated with 18.1 and 17.2% lower failure load at the radius and tibia, respectively (all p<.05); plate volume and thickness were 5.7% and 4.7% lower, respectively, (p<.05) while rod volume fraction was 12.8% higher in the fracture group at the tibia only. Sodium glucose cotransporter 2 inhibitor users (SGLT2i; n = 19), tended to have lower radial rod tissue mineral density by ITS (p=.06). GLP1 agonist users (n = 19) had trabecular deficits at both sites and higher cortical porosity and larger pores at the distal tibia. In summary, T2DM is associated with increased cortical porosity while those with T2DM and fracture have more marked cortical deficits and fewer trabecular plates associated with lower failure load.
Collapse
Affiliation(s)
- Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Carmen Germosen
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Isabella Rosillo
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Ivelisse Colon
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Nayoung Kil
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Zexi Wang
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States
| | - Andreea Dinescu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY 10027, United States
| | - Marcella Walker
- Division of Endocrinology, Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
| |
Collapse
|
3
|
Bugbird AR, Whittier DE, Boyd SK. Transferability of bone phenotyping and fracture risk assessment by μFRAC from first-generation high-resolution peripheral quantitative computed tomography to second-generation scan data. J Bone Miner Res 2024; 39:571-579. [PMID: 38477766 PMCID: PMC11262140 DOI: 10.1093/jbmr/zjae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/02/2024] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION The continued development of high-resolution peripheral quantitative computed tomography (HR-pQCT) has led to a second-generation scanner with higher resolution and longer scan region. However, large multicenter prospective cohorts were collected with first-generation HR-pQCT and have been used to develop bone phenotyping and fracture risk prediction (μFRAC) models. This study establishes whether there is sufficient universality of these first-generation trained models for use with second-generation scan data. METHODS HR-pQCT data were collected for a cohort of 60 individuals, who had been scanned on both first- and second-generation scanners on the same day to establish the universality of the HR-pQCT models. These data were each used as input to first-generation trained bone microarchitecture models for bone phenotyping and fracture risk prediction, and their outputs were compared for each study participant. Reproducibility of the models were assessed using same-day repeat scans obtained from first-generation (n = 37) and second-generation (n = 74) scanners. RESULTS Across scanner generations, the bone phenotyping model performed with an accuracy of 93.1%. Similarly, the 5-year fracture risk assessment by μFRAC was well correlated with a Pearson's (r) correlation coefficient of r > 0.83 for the three variations of μFRAC (varying inclusion of clinical risk factors, finite element analysis, and dual X-ray absorptiometry). The first-generation reproducibility cohort performed with an accuracy for categorical assignment of 100% (bone phenotyping) and a correlation coefficient of 0.99 (μFRAC), whereas the second-generation reproducibility cohort performed with an accuracy of 96.4% (bone phenotyping) and a correlation coefficient of 0.99 (μFRAC). CONCLUSION We demonstrated that bone microarchitecture models trained using first-generation scan data generalize well to second-generation scans, performing with a high level of accuracy and reproducibility. Less than 4% of individuals' estimated fracture risk led to a change in treatment threshold, and in general, these dissimilar outcomes using second-generation data tended to be more conservative.
Collapse
Affiliation(s)
- Annabel R Bugbird
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Danielle E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
- Department of Cell Biology and Anatomy, Cumming School of Medicine, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
| |
Collapse
|
4
|
Das L, Laway BA, Sahoo J, Dhiman V, Singh P, Rao SD, Korbonits M, Bhadada SK, Dutta P. Bone mineral density, turnover, and microarchitecture assessed by second-generation high-resolution peripheral quantitative computed tomography in patients with Sheehan's syndrome. Osteoporos Int 2024; 35:919-927. [PMID: 38507080 DOI: 10.1007/s00198-024-07062-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/07/2024] [Indexed: 03/22/2024]
Abstract
Sheehan's syndrome (SS) is a rare but well-characterized cause of hypopituitarism. Data on skeletal health is limited and on microarchitecture is lacking in SS patients. PURPOSE We aimed to explore skeletal health in SS with bone mineral density (BMD), turnover, and microarchitecture. METHODS Thirty-five patients with SS on stable replacement therapy for respective hormone deficiencies and 35 age- and BMI-matched controls were recruited. Hormonal profile and bone turnover markers (BTMs) were measured using electrochemiluminescence assay. Areal BMD and trabecular bone score were evaluated using DXA. Bone microarchitecture was assessed using a second-generation high-resolution peripheral quantitative computed tomography. RESULTS The mean age of the patients was 45.5 ± 9.3 years with a lag of 8.3 ± 7.2 years prior to diagnosis. Patients were on glucocorticoid (94%), levothyroxine (94%), and estrogen-progestin replacement (58%). None had received prior growth hormone (GH) replacement. BTMs (P1NP and CTX) were not significantly different between patients and controls. Osteoporosis (26% vs. 16%, p = 0.01) and osteopenia (52% vs. 39%, p = 0.007) at the lumbar spine and femoral neck (osteoporosis, 23% vs. 10%, p = 0.001; osteopenia, 58% vs. 29%, p = 0.001) were present in greater proportion in SS patients than matched controls. Bone microarchitecture analysis revealed significantly lower cortical volumetric BMD (vBMD) (p = 0.02) at the tibia, with relative preservation of the other parameters. CONCLUSION Low areal BMD (aBMD) is highly prevalent in SS as compared to age- and BMI-matched controls. However, there were no significant differences in bone microarchitectural measurements, except for tibial cortical vBMD, which was lower in adequately treated SS patients.
Collapse
Affiliation(s)
- Liza Das
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
- Department of Telemedicine, PGIMER, Chandigarh, India
| | - Bashir Ahmad Laway
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Jayaprakash Sahoo
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vandana Dhiman
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | | | - Sudhaker Dhanwada Rao
- Division of Endocrinology, Metabolism and Bone and Mineral Disorders, and Bone and Mineral Research Laboratory, Henry Ford Health, Detroit, MI, USA
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Márta Korbonits
- Department of Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Sanjay Kumar Bhadada
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pinaki Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| |
Collapse
|
5
|
Kuker AP, Agarwal S, Shane E, Bicca J, Geer EB, Cremers S, Dworakowski E, Cohen A, Nickolas TL, Stein EM, Freda PU. Long-term Pegvisomant Therapy of Acromegaly: Effects on Bone Density, Turnover and Microstructure Using HRpQCT. J Endocr Soc 2024; 8:bvae079. [PMID: 38715589 PMCID: PMC11074588 DOI: 10.1210/jendso/bvae079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 07/12/2024] Open
Abstract
Context Fracture rate is increased in patients with active acromegaly and those in remission. Abnormalities of bone microstructure are present in patients with active disease and persist despite biochemical control after surgery. Effects of treatment with the GH receptor antagonist pegvisomant on bone microstructure were unknown. Methods We studied 25 patients with acromegaly (15 men, 10 women). In 20, we evaluated areal bone mineral density (BMD) by dual-energy X-ray absorptiometry and bone turnover markers (BTMs) longitudinally, before and during pegvisomant treatment. After long-term pegvisomant in 17, we cross-sectionally assessed volumetric BMD, microarchitecture, stiffness, and failure load of the distal radius and tibia using high-resolution peripheral quantitative computed tomography (HRpQCT) and compared these results to those of healthy controls and 2 comparison groups of nonpegvisomant-treated acromegaly patients, remission, and active disease, matched for other therapies and characteristics. Results In the longitudinal study, areal BMD improved at the lumbar spine but decreased at the hip in men after a median ∼7 years of pegvisomant. In the cross-sectional study, patients on a median ∼9 years of pegvisomant had significantly larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to healthy controls. Microstructure was similar in the pegvisomant and acromegaly comparison groups. BTMs were lowered, then stable over time. Conclusion In this, the first study to examine bone microstructure in pegvisomant-treated acromegaly, we found deficits in volumetric BMD and microarchitecture of the peripheral skeleton. BTM levels remained stable with long-term therapy. Deficits in bone quality identified by HRpQCT may play a role in the pathogenesis of fragility in treated acromegaly.
Collapse
Affiliation(s)
- Adriana P Kuker
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Sanchita Agarwal
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Elizabeth Shane
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | | | - Eliza B Geer
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Serge Cremers
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
- Department of Pathology and Cell Biology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Elzbieta Dworakowski
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Adi Cohen
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Thomas L Nickolas
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Diseases, Hospital for Special Surgery, New York, NY 10021, USA
| | - Pamela U Freda
- Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA
| |
Collapse
|
6
|
Dash AS, Billings E, Vlastaris K, Kim HJ, Cunningham ME, Raphael J, Lovecchio F, Carrino JA, Lebl D, McMahon D, Stein EM. Pre-operative bone quality deficits and risk of complications following spine fusion surgery among postmenopausal women. Osteoporos Int 2024; 35:551-560. [PMID: 37932510 DOI: 10.1007/s00198-023-06963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023]
Abstract
Poor bone quality is a risk factor for complications after spinal fusion surgery. This study investigated pre-operative bone quality in postmenopausal women undergoing spine fusion and found that those with small bones, thinner cortices and surgeries involving more vertebral levels were at highest risk for complications. PURPOSE Spinal fusion is one of the most common surgeries performed worldwide. While skeletal complications are common, underlying skeletal deficits are often missed by pre-operative DXA due to artifact from spinal pathology. This prospective cohort study investigated pre-operative bone quality using high resolution peripheral CT (HRpQCT) and its relation to post-operative outcomes in postmenopausal women, a population that may be at particular risk for skeletal complications. We hypothesized that women with low volumetric BMD (vBMD) and abnormal microarchitecture would have higher rates of post-operative complications. METHODS Pre-operative imaging included areal BMD (aBMD) by DXA, cortical and trabecular vBMD and microarchitecture of the radius and tibia by high resolution peripheral CT. Intra-operative bone quality was subjectively graded based on resistance to pedicle screw insertion. Post-operative complications were assessed by radiographs and CTs. RESULTS Among 50 women enrolled (age 65 years), mean spine aBMD was normal and 35% had osteoporosis by DXA at any site. Low aBMD and vBMD were associated with "poor" subjective intra-operative quality. Skeletal complications occurred in 46% over a median follow-up of 15 months. In Cox proportional models, complications were associated with greater number of surgical levels (HR 1.19 95% CI 1.06-1.34), smaller tibia total area (HR 1.67 95% CI1.16-2.44) and lower tibial cortical thickness (HR 1.35 95% CI 1.05-1.75; model p < 0.01). CONCLUSION Women with smaller bones, thinner cortices and procedures involving a greater number of vertebrae were at highest risk for post-operative complications, providing insights into surgical and skeletal risk factors for complications in this population.
Collapse
Affiliation(s)
- Alexander S Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Billings
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Katelyn Vlastaris
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | | | - Joseph Raphael
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | | | - John A Carrino
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - Darren Lebl
- Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Donald McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| |
Collapse
|
7
|
Dinescu AT, Zhou B, Hu YJ, Agarwal S, Shane E, Guo XDE. Individual trabecula segmentation validation in first- and second-generation high-resolution peripheral computed tomography compared to micro-computed tomography in the distal radius and tibia. JBMR Plus 2024; 8:ziae007. [PMID: 38505220 PMCID: PMC10945717 DOI: 10.1093/jbmrpl/ziae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/07/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024] Open
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) has been used for in vivo 3D visualization of trabecular microstructure. Second-generation HR-pQCT (HR-pQCT II) has been shown to have good agreement with first generation HR-pQCT (HR-pQCT I). Advanced Individual Trabecula Segmentation (ITS) decomposes the trabecula network into individual plates and rods. ITS based on HR-pQCT I showed a strong correlation to ITS based on micro-computed tomography (μCT) and identified trabecular changes in metabolic bone diseases. ITS based on HR-pQCT II has new potential because of the enhanced resolution but has yet to be validated. The objective of this study was to assess the agreement between ITS based on HR-pQCT I, HR-pQCT II, and μCT to assess the capability of ITS on HR-pQCT images as a tool for studying bone structure. Freshly frozen tibia and radius bones were scanned in the distal region using HR-pQCT I at 82 μm, HR-pQCT II at 60.7 μm, and μCT at 37 μm. Images were registered, binarized, and ITS analysis was performed. Bone volume fraction (pBV/TV, rBV/TV), number density (pTb.N, rTb.N), thickness (pTb.Th, rTb.Th), and plate-to-rod (PR) ratio (pBV/rBV) of trabecular plates and rods were obtained. Paired Student's t-tests with post hoc Bonferroni analysis were used to examine the differences. Linear regression was used to determine the correlation coefficient. The HR-pQCT I parameters were different from the μCT measurements. The HR-pQCT II parameters were different from the μCT measurements except for rTb.N, and the HR-pQCT I parameters were different from the HR-pQCT II measurements except for pTb.Th. The strong correlation between HR-pQCT II and μCT microstructural analysis (R2 = 0.55-0.94) suggests that HR-pQCT II can be used to assess changes in plate and rod microstructure and that values from HR-pQCT I can be corrected.
Collapse
Affiliation(s)
- Andreea Teodora Dinescu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, 10027, United States
| | - Bin Zhou
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, 10027, United States
| | - Yizhong Jenny Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, 10027, United States
| | - Sanchita Agarwal
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, 10032, United States
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, Columbia University, New York, NY, 10032, United States
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, 10027, United States
| |
Collapse
|
8
|
Gabel L, Kent K, Hosseinitabatabaei S, Burghardt AJ, Leonard MB, Rauch F, Willie BM. Recommendations for High-resolution Peripheral Quantitative Computed Tomography Assessment of Bone Density, Microarchitecture, and Strength in Pediatric Populations. Curr Osteoporos Rep 2023; 21:609-623. [PMID: 37428435 PMCID: PMC10543577 DOI: 10.1007/s11914-023-00811-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize current approaches and provide recommendations for imaging bone in pediatric populations using high-resolution peripheral quantitative computed tomography (HR-pQCT). RECENT FINDINGS Imaging the growing skeleton is challenging and HR-pQCT protocols are not standardized across centers. Adopting a single-imaging protocol for all studies is unrealistic; thus, we present three established protocols for HR-pQCT imaging in children and adolescents and share advantages and disadvantages of each. Limiting protocol variation will enhance the uniformity of results and increase our ability to compare study results between different research groups. We outline special cases along with tips and tricks for acquiring and processing scans to minimize motion artifacts and account for growing bone. The recommendations in this review are intended to help researchers perform HR-pQCT imaging in pediatric populations and extend our collective knowledge of bone structure, architecture, and strength during the growing years.
Collapse
Affiliation(s)
- L Gabel
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
| | - K Kent
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - S Hosseinitabatabaei
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - M B Leonard
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - F Rauch
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Pediatrics, McGill University, Montreal, Canada
| | - B M Willie
- Research Centre, Shriners Hospital for Children-Canada, Montreal, Canada
- Department of Biomedical Engineering, McGill University, Montreal, Canada
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Canada
| |
Collapse
|
9
|
Gazzotti S, Aparisi Gómez MP, Schileo E, Taddei F, Sangiorgi L, Fusaro M, Miceli M, Guglielmi G, Bazzocchi A. High-resolution peripheral quantitative computed tomography: research or clinical practice? Br J Radiol 2023; 96:20221016. [PMID: 37195008 PMCID: PMC10546468 DOI: 10.1259/bjr.20221016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/18/2023] Open
Abstract
High-resolution peripheral quantitative CT (HR-pQCT) is a low-dose three-dimensional imaging technique, originally developed for in vivo assessment of bone microarchitecture at the distal radius and tibia in osteoporosis. HR-pQCT has the ability to discriminate trabecular and cortical bone compartments, providing densitometric and structural parameters. At present, HR-pQCT is mostly used in research settings, despite evidence showing that it may be a valuable tool in osteoporosis and other diseases. This review summarizes the main applications of HR-pQCT and addresses the limitations that currently prevent its integration into routine clinical practice. In particular, the focus is on the use of HR-pQCT in primary and secondary osteoporosis, chronic kidney disease (CKD), endocrine disorders affecting bone, and rare diseases. A section on novel potential applications of HR-pQCT is also present, including assessment of rheumatic diseases, knee osteoarthritis, distal radius/scaphoid fractures, vascular calcifications, effect of medications, and skeletal muscle. The reviewed literature seems to suggest that a more widespread implementation of HR-pQCT in clinical practice would offer notable opportunities. For instance, HR-pQCT can improve the prediction of incident fractures beyond areal bone mineral density provided by dual-energy X-ray absorptiometry. In addition, HR-pQCT may be used for the monitoring of anti-osteoporotic therapy or for the assessment of mineral and bone disorder associated with CKD. Nevertheless, several obstacles currently prevent a broader use of HR-pQCT and would need to be targeted, such as the small number of installed machines worldwide, the uncertain cost-effectiveness, the need for improved reproducibility, and the limited availability of reference normative data sets.
Collapse
Affiliation(s)
- Silvia Gazzotti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Enrico Schileo
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Sangiorgi
- Department of Medical Genetics and Rare Orthopaedic Diseases, and CLIBI Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Marco Miceli
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| |
Collapse
|
10
|
Kuker AP, Agarwal S, Shane E, Cohen A, Nickolas TL, Stein EM, Reid TJ, Hans D, Cremers S, Bruce JN, Freda PU. Persistent Deficits in Bone Quality in Treated Acromegaly: Evidence From Assessments of Microstructure. J Endocr Soc 2023; 7:bvad121. [PMID: 37809053 PMCID: PMC10553518 DOI: 10.1210/jendso/bvad121] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose Fractures are increased in patients with acromegaly, both before and after successful acromegaly treatment. Abnormalities of bone microstructure, which may underlie this fragility, are present in active acromegaly but to what extent these improve with acromegaly treatment or persist despite biochemical remission remains unclear. To examine these questions, we studied the effects of acromegaly treatment and remission on bone quality. Methods Sixty-five women and men with acromegaly were studied. Subgroups underwent assessments of areal bone mineral density by dual x-ray absorptiometry, trabecular bone score (TBS), and volumetric bone mineral density, microarchitecture, stiffness and failure load of the distal radius and tibia by high-resolution peripheral quantitative tomography in a longitudinal study before and after acromegaly treatment and in a cross-sectional study in which patients were compared to sex-, age-, and body mass index-matched healthy controls. Results In the longitudinal study, significant increases in total, cortical, and trabecular densities at the radius and tibia and increased stiffness and failure load of the tibia occurred with acromegaly treatment. In the cross-sectional study, patients in biochemical remission after surgery had larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to controls. TBS did not change with acromegaly treatment but correlated with some microstructural parameters. Conclusion We show, for the first time, that volumetric bone mineral density and microarchitecture of the peripheral skeleton improve with acromegaly treatment but remain abnormal in patients in remission after surgery compared to controls. These abnormalities, known to be associated with fractures in other populations, may play a role in the pathogenesis of persistent fragility in treated acromegaly.
Collapse
Affiliation(s)
- Adriana P Kuker
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Sanchita Agarwal
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Elizabeth Shane
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Adi Cohen
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Thomas L Nickolas
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Diseases, Hospital for Special Surgery, New York, NY 10032, USA
| | - Tirissa J Reid
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Didier Hans
- Center for Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne 1011, Switzerland
| | - Serge Cremers
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
- Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Jeffrey N Bruce
- Neurosurgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | - Pamela U Freda
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| |
Collapse
|
11
|
Heilbronner AK, Koff MF, Breighner R, Kim HJ, Cunningham M, Lebl DR, Dash A, Clare S, Blumberg O, Zaworski C, McMahon DJ, Nieves JW, Stein EM. Opportunistic Evaluation of Trabecular Bone Texture by MRI Reflects Bone Mineral Density and Microarchitecture. J Clin Endocrinol Metab 2023; 108:e557-e566. [PMID: 36800234 PMCID: PMC10516518 DOI: 10.1210/clinem/dgad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
CONTEXT Many individuals at high risk for fracture are never evaluated for osteoporosis and subsequently do not receive necessary treatment. Utilization of magnetic resonance imaging (MRI) is burgeoning, providing an ideal opportunity to use MRI to identify individuals with skeletal deficits. We previously reported that MRI-based bone texture was more heterogeneous in postmenopausal women with a history of fracture compared to controls. OBJECTIVE The present study aimed to identify the microstructural characteristics that underlie trabecular texture features. METHODS In a prospective cohort, we measured spine volumetric bone mineral density (vBMD) by quantitative computed tomography (QCT), peripheral vBMD and microarchitecture by high-resolution peripheral QCT (HRpQCT), and areal BMD (aBMD) by dual-energy x-ray absorptiometry. Vertebral trabecular bone texture was analyzed using T1-weighted MRIs. A gray level co-occurrence matrix was used to characterize the distribution and spatial organization of voxelar intensities and derive the following texture features: contrast (variability), entropy (disorder), angular second moment (ASM; uniformity), and inverse difference moment (IDM; local homogeneity). RESULTS Among 46 patients (mean age 64, 54% women), lower peripheral vBMD and worse trabecular microarchitecture by HRpQCT were associated with greater texture heterogeneity by MRI-higher contrast and entropy (r ∼ -0.3 to 0.4, P < .05), lower ASM and IDM (r ∼ +0.3 to 0.4, P < .05). Lower spine vBMD by QCT was associated with higher contrast and entropy (r ∼ -0.5, P < .001), lower ASM and IDM (r ∼ +0.5, P < .001). Relationships with aBMD were less pronounced. CONCLUSION MRI-based measurements of trabecular bone texture relate to vBMD and microarchitecture, suggesting that this method reflects underlying microstructural properties of trabecular bone. Further investigation is required to validate this methodology, which could greatly improve identification of patients with skeletal fragility.
Collapse
Affiliation(s)
- Alison K Heilbronner
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Matthew F Koff
- Department of Radiology and Imaging—MRI, Hospital for Special Surgery, New York, NY 10021, USA
| | - Ryan Breighner
- Department of Radiology and Imaging—MRI, Hospital for Special Surgery, New York, NY 10021, USA
| | - Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY 10021, USA
| | | | - Darren R Lebl
- Spine Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Alexander Dash
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Shannon Clare
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Olivia Blumberg
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Caroline Zaworski
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Donald J McMahon
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| | - Jeri W Nieves
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
- Mailman School of Public Health and Institute of Human Nutrition, Columbia University, New York, NY 10032, USA
| | - Emily M Stein
- Division of Endocrinology/Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY 10021, USA
| |
Collapse
|
12
|
Sadoughi S, Subramanian A, Ramil G, Burghardt AJ, Kazakia GJ. A Laplace-Hamming Binarization Approach for Second-Generation HR-pQCT Rescues Fine Feature Segmentation. J Bone Miner Res 2023; 38:1006-1014. [PMID: 37102793 PMCID: PMC10524566 DOI: 10.1002/jbmr.4819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/27/2023] [Accepted: 04/25/2023] [Indexed: 04/28/2023]
Abstract
Although second-generation high-resolution peripheral quantitative computed tomography (XCTII) provides the highest-resolution in vivo bone microstructure assessment, the manufacturer's standard image processing protocol omits fine features in both trabecular and cortical compartments. To optimize fine structure segmentation, we implemented a binarization approach based on a Laplace-Hamming (LH) segmentation and documented the reproducibility and accuracy of XCTII structure segmentation using both the standard Gaussian-based binarization and the proposed LH segmentation approach. To evaluate reproducibility, 20 volunteers (9 women, 11 men; aged 23-75 years) were recruited, and three repeat scans of the radii and tibias were acquired using the manufacturer's standard in vivo protocol. To evaluate accuracy, cadaveric structure phantoms (14 radii, 6 tibias) were scanned on XCTII using the same standard in vivo protocol and on μCT at 24.5 μm resolution. XCTII images were analyzed twice-first, with the manufacturer's standard patient evaluation protocol and, second, with the proposed LH segmentation approach. The LH approach rescued fine features evident in the grayscale images but omitted or overrepresented (thickened) by the standard approach. The LH approach significantly reduced error in trabecular volume fraction (BV/TV) and thickness (Tb.Th) compared with the standard approach; however, higher error was introduced for trabecular separation (Tb.Sp). The LH approach improved the correlation between XCTII and μCT for cortical porosity (Ct.Po) and significantly reduced error in cortical pore diameter (Ct.Po.Dm) compared with the standard approach. The LH approach resulted in improved precision compared with the standard approach for BV/TV, Tb.Th, Ct.Po, and Ct.Po.Dm at the radius and for Ct.Po at the tibia. Our results suggest that the proposed LH approach produces substantially improved binary masks, reduces proportional bias, and provides greater accuracy and reproducibility in important outcome metrics, all due to more accurate segmentation of the fine features in both trabecular and cortical compartments. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Saghi Sadoughi
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Aditya Subramanian
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Gabby Ramil
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Andrew J Burghardt
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Galateia J Kazakia
- Bone Quality Research Lab, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| |
Collapse
|
13
|
Heilbronner AK, Dash A, Straight BE, Snyder LJ, Ganesan S, Adu KB, Jae A, Clare S, Billings E, Kim HJ, Cunningham M, Lebl DR, Donnelly E, Stein EM. Peripheral cortical bone density predicts vertebral bone mineral properties in spine fusion surgery patients. Bone 2023; 169:116678. [PMID: 36646265 PMCID: PMC10081687 DOI: 10.1016/j.bone.2023.116678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Spine fusion surgery is one of the most common orthopedic procedures, with over 400,000 performed annually to correct deformities and pain. However, complications occur in approximately one third of cases. While many of these complications may be related to poor bone quality, it is difficult to detect bone abnormalities prior to surgery. Areal BMD (aBMD) assessed by DXA may be artifactually high in patients with spine pathology, leading to missed diagnosis of deficits. In this study, we related preoperative imaging characteristics of both central and peripheral sites to direct measurements of bone quality in vertebral biopsies. We hypothesized that pre-operative imaging outcomes would relate to vertebral bone mineralization and collagen properties. Pre-operative assessments included DXA measurements of aBMD of the spine, hip, and forearm, central quantitative computed tomography (QCT) of volumetric BMD (vBMD) at the lumbar spine, and high resolution peripheral quantitative computed tomography (HRpQCT; Xtreme CT2) measurements of vBMD and microarchitecture at the distal radius and tibia. Bone samples were collected intraoperatively from the lumbar vertebrae and analyzed using Fourier-transform Infrared (FTIR) spectroscopy. Bone samples were obtained from 23 postmenopausal women (mean age 67 ± 7 years, BMI 28 ± 8 kg/m2). We found that patients with more mature bone by FTIR, measured as lower acid phosphate content and carbonate to phosphate ratio, and greater collagen maturity and mineral maturity/crystallinity (MMC), had greater cortical vBMD at the tibia and greater aBMD at the lumbar spine and one-third radius. Our data suggests that bone quality at peripheral sites may predict bone quality at the spine. As bone quality at the spine is challenging to assess prior to surgery, there is a great need for additional screening tools. Pre-operative peripheral bone imaging may provide important insight into vertebral bone quality and may foster identification of patients with bone quality deficits.
Collapse
Affiliation(s)
- Alison K Heilbronner
- Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Alexander Dash
- Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Beth E Straight
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America
| | - Leah J Snyder
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America
| | - Sandhya Ganesan
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America
| | - Kobby B Adu
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America
| | - Andy Jae
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America
| | - Shannon Clare
- Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Emma Billings
- Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Matthew Cunningham
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Darren R Lebl
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Eve Donnelly
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, United States of America; Research Institute, Hospital for Special Surgery, New York, NY, United States of America
| | - Emily M Stein
- Division of Endocrinology, Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
| |
Collapse
|
14
|
Agarwal S, McMahon DJ, Chen J, Brossfield A, Fernando J, Bilezikian JP, Cusano NE, Rubin MR. The Clinical and Skeletal Effects of Long-Term Therapy of Hypoparathyroidism With rhPTH(1-84). J Bone Miner Res 2023; 38:480-492. [PMID: 36726204 PMCID: PMC10101915 DOI: 10.1002/jbmr.4780] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/16/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
Hypoparathyroidism (HypoPT) is a disorder characterized by hypocalcemia, low or absent parathyroid hormone (PTH) levels, reduced bone remodeling, and high areal bone mineral density (aBMD). PTH is a therapeutic option, yet data on the prolonged clinical and skeletal effects of PTH treatment are limited. We tracked annual daily doses of calcium and active vitamin D supplements, calciotropic biochemistries, estimated glomerular filtration rate (eGFR), and aBMD measurements in 27 HypoPT patients (16 postsurgical, 11 nonsurgical) who were treated with recombinant human PTH(1-84) [rhPTH(1-84)] for at least 8 (n = 27) and up to 12 (n = 14) years. We also performed high-resolution-peripheral quantitative computed tomography (HRpQCT) imaging and report results at baseline, 5, 8, and 12 years of rhPTH(1-84) treatment. With prolonged use of rhPTH, reductions in the need for supplemental calcium and active vitamin D were maintained. The eGFR did not decline. Serum calcium was maintained within the lower limit of the normal range. aBMD by dual-energy X-ray absorptiometry (DXA) showed an increase at the lumbar spine and a decrease at the distal 1/3 radius. By HRpQCT, cortical volumetric BMD (vBMD) at the tibia decreased at year 5: -20.0% ± 1.5%. The magnitude of this reduction was mitigated in year 8: -8.5% ± 1.6% and in year 12: -10.3% ± 2.2% but all were significantly below the mean baseline value (p < 0.001). A similar pattern of decline was observed at the radius. Cortical porosity progressively increased at the tibia in year 5: 17.4% ± 10% (p < 0.05), year 8: 55.2% ± 11% (p < 0.001), and year 12: 83.5% ± 14% (p < 0.001). A similar pattern of increase was observed at the radius. Failure load, which was higher than normal at baseline, decreased but remained above normal at year 12. This is the longest experience, to date, with PTH therapy in HypoPT. These results demonstrate sustained biochemical stability but overall decreases in bone mass. © 2023 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Sanchita Agarwal
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Donald J. McMahon
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Juliet Chen
- Sophie Davis Program for Biomedical Education, CUNY School of Medicine, New York, NY
| | - Aiden Brossfield
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Jason Fernando
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - John P. Bilezikian
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | | | - Mishaela R. Rubin
- Metabolic Bone Disease Unit, Department of Medicine, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| |
Collapse
|
15
|
Agarwal S, Shiau S, Kamanda-Kosseh M, Bucovsky M, Kil N, Lappe JM, Stubby J, Recker RR, Guo XE, Shane E, Cohen A. Teriparatide Followed by Denosumab in Premenopausal Idiopathic Osteoporosis: Bone Microstructure and Strength by HR-pQCT. J Bone Miner Res 2023; 38:35-47. [PMID: 36335582 DOI: 10.1002/jbmr.4739] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/07/2022]
Abstract
Premenopausal women with idiopathic osteoporosis (PreMenIOP) have marked deficits in skeletal microstructure. We have reported that sequential treatment with teriparatide and denosumab improves central skeletal bone mineral density (BMD) by dual-energy X-ray absorptiometry and central QCT in PreMenIOP. We conducted preplanned analyses of high-resolution peripheral quantitative computed tomography (HR-pQCT) scans from teriparatide and denosumab extension studies to measure effects on volumetric BMD (vBMD), microarchitecture, and estimated strength at the distal radius and tibia. Of 41 women enrolled in the parent teriparatide study (20 mcg daily), 34 enrolled in the HR-pQCT study. HR-pQCT participants initially received teriparatide (N = 24) or placebo (N = 10) for 6 months; all then received teriparatide for 24 months. After teriparatide, 26 enrolled in the phase 2B denosumab extension (60 mg q6M) for 24 months. Primary outcomes were percentage change in vBMD, microstructure, and stiffness after teriparatide and after denosumab. Changes after sequential teriparatide and denosumab were secondary outcomes. After teriparatide, significant improvements were seen in tibial trabecular number (3.3%, p = 0.01), cortical area and thickness (both 2.7%, p < 0.001), and radial trabecular microarchitecture (number: 6.8%, thickness: 2.2%, separation: -5.1%, all p < 0.02). Despite increases in cortical porosity and decreases in cortical density, whole-bone stiffness and failure load increased at both sites. After denosumab, increases in total (3.5%, p < 0.001 and 3.3%, p = 0.02) and cortical vBMD (1.7% and 3.2%; both p < 0.01), and failure load (1.1% and 3.6%; both p < 0.05) were seen at tibia and radius, respectively. Trabecular density (3.5%, p < 0.001) and number (2.4%, p = 0.03) increased at the tibia, while thickness (3.0%, p = 0.02) increased at the radius. After 48 months of sequential treatment, significant increases in total vBMD (tibia: p < 0.001; radius: p = 0.01), trabecular microstructure (p < 0.05), cortical thickness (tibia: p < 0.001; radius: p = 0.02), and whole bone strength (p < 0.02) were seen at both sites. Significant increases in total vBMD and bone strength parameters after sequential treatment with teriparatide followed by denosumab support the use of this regimen in PreMenIOP. © 2022 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Sanchita Agarwal
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Stephanie Shiau
- Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Piscataway, NY, USA
| | - Mafo Kamanda-Kosseh
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Mariana Bucovsky
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Nayoung Kil
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Joan M Lappe
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Julie Stubby
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - Robert R Recker
- Department of Medicine, Creighton University Medical Center, Omaha, NE, USA
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Elizabeth Shane
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| | - Adi Cohen
- Department of Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA
| |
Collapse
|
16
|
Pichone A, Gomes CP, Lima LFC, Moreira CA, Paranhos-Neto FDP, Madeira M, Lopes RT, Farias MLF, Leite Jr. M. Assessment of trabecular and cortical parameters using high-resolution peripheral quantitative computed tomography, histomorphometry and microCT of iliac crest bone core in hemodialysis patients. Bone Rep 2022; 16:101173. [PMID: 35198659 PMCID: PMC8850668 DOI: 10.1016/j.bonr.2022.101173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022] Open
Abstract
Patients with end-stage renal disease develop changes in bone quality and quantity, which can be assessed using different methods. This study aimed to compare and to correlate bone parameters obtained in vivo using high-resolution peripheral quantitative computed tomography (HR-pQCT) with those obtained by bone biopsy using histomorphometry and microcomputed tomography (microCT) analysis of the iliac crest core, and to evaluate if HR-pQCT is helpful in aiding with categorization of those with high turnover. Twenty hemodialysis patients, 13 females (7 postmenopausal), underwent bone biopsy from 2018 to 2020. The mean age was 48.5 ± 10.6 years, and the mean hemodialysis vintage was 15 years. Histomorphometry identified mineralization defects, low turnover, and high turnover in 65%, 45%, and 35% of the patients, respectively. The highest values of trabecular bone volume (BV/TV) were obtained by histomorphometry, while the highest values of cortical thickness (Ct.Th) were obtained by HR-pQCT at the distal tibia. Moderate correlations were found between BV/TV values obtained by microCT of the bone core and HR-pQCT at the distal radius (r = 0.531, p = 0.016) and at the distal tibia (r = 0.536, p = 0.015). BV/TV values obtained from the bone core by histomorphometry and microCT were also significantly correlated (r = 0.475, p = 0.04). Regarding Ct.Th, there was a strong correlation between the radius and tibia HR-pQCT (r = 0.800, p < 0.001), between bone core microCT and the distal radius HR-pQCT (r = 0.610, p < 0.01), as between histomorphometry and microCT (r = 0.899, p < 0.01). In groups classified by bone turnover, patients with high turnover presented lower BV/TV, Tb.N, Tb.Th, and Ct.Th than those with low turnover in peripheral sites using HR-pQCT. By this method, it was possible to identify low turnover from tibia BV/TV > 12,4% plus Tb.Sp ≤ 0.667 mm (AUC 0.810, 95% CI 0.575 to 0.948) and high turnover from total bone mineral density (BMD) ≤ 154.2 mg HA/cm3 (AUC 0.860, 95% CI 0.633 to 0.982, p < 0.001) and cortical BMD ≤ 691.6 mg HA/cm3 (AUC 0.840, 95% CI 0.609 to 0.963, p < 0.001). In conclusion, HR-pQCT had significant correlation with iliac crest bone in BV/TV and Ct.Th, which are known to provide bone strength. This method is quick and non-invasive and may be helpful in categorizing those with high versus low turnover in hemodialysis patients. Bone structure in hemodialysis patients can be assessed using different methods. There was correlation of BV/TV and Ct.Th between histomorphometry and bone core microCT. BV/TV and Ct.Th values obtained by radius HR-pQCT and bone core microCT were correlated. High turnover patients had lower BV/TV, Tb.N, Tb.Th, and Ct.Th by HR-pQCT. HR-pQCT was able to discriminate low and high turnover in hemodialysis patients.
Collapse
Affiliation(s)
- Alinie Pichone
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Corresponding author at: Hospital Universitario Clementino Fraga Filho – Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255/Serviço de nefrologia - sétimo andar, Rio de Janeiro, RJ 21941-617, Brazil.
| | - Carlos Perez Gomes
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Felipe Cardoso Lima
- Laboratory of Nuclear Instrumentation, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carolina Aguiar Moreira
- Division of Endocrinology (SEMPR), Internal Medicine Department of Federal University of Parana & Academic Research Center of Pro Renal Institute, Curitiba, Brazil
| | | | - Miguel Madeira
- Division of Endocrinology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo Tadeu Lopes
- Laboratory of Nuclear Instrumentation, COPPE, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Maurilo Leite Jr.
- Division of Nephrology, HUCFF, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
17
|
Simon M, Indermaur M, Schenk D, Hosseinitabatabaei S, Willie BM, Zysset P. Fabric-elasticity relationships of tibial trabecular bone are similar in osteogenesis imperfecta and healthy individuals. Bone 2022; 155:116282. [PMID: 34896360 DOI: 10.1016/j.bone.2021.116282] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/02/2022]
Abstract
Osteogenesis Imperfecta (OI) is an inherited form of bone fragility characterised by impaired synthesis of type I collagen, altered trabecular bone architecture and reduced bone mass. High resolution peripheral computed tomography (HR-pQCT) is a powerful method to investigate bone morphology at peripheral sites including the weight-bearing distal tibia. The resulting 3D reconstructions can be used as a basis of micro-finite element (FE) or homogenized finite element (hFE) models for bone strength estimation. The hFE scheme uses homogenized local bone volume fraction (BV/TV) and anisotropy information (fabric) to compute healthy bone strength within a reasonable computation time using fabric-elasticity relationships. However, it is unclear if these relationships quantified previously for healthy controls are valid for trabecular bone from OI patients. Thus, the aim of this study is to investigate fabric-elasticity relationships in OI trabecular bone compared to healthy controls. In the present study, the morphology of distal tibiae from 50 adults with OI were compared to 120 healthy controls using second generation HR-pQCT. Six cubic regions of interest (ROIs) were selected per individual in a common anatomical region. A first matching between OI and healthy control group was performed by selecting similar individuals to obtain identical mean and median age and sex distribution. It allowed us to perform a first morphometric analysis and compare the outcome with literature. Then, stiffness tensors of the ROIs were computed using μFE and multiple linear regressions were performed with the Zysset-Curnier orthotropic fabric-elasticity model. An initial fit was performed on both the OI group and the healthy control group using all extracted ROIs. Then, data was filtered according to a fixed threshold for a defined coefficient of variation (CV) assessing ROI heterogeneity and additional linear regressions were performed on these filtered data sets. These full and filtered data were in turn compared with previous results from μCT reconstructions obtained in other anatomical locations. Finally, the ROIs of both groups were matched according to their BV/TV and degree of anisotropy (DA). Linear regressions were performed using these matched data to detect statistical differences between the two groups. Compared to healthy controls, we found the OI samples to have significantly lower BV/TV and trabecular number (Tb.N.), significantly higher CV, trabecular separation (Tb.Sp.) and trabecular separation standard deviation (Tb.Sp.SD), but no differences in trabecular thickness (Tb.Th.). These results are in agreement with previous studies. The stiffnesses of highly heterogeneous ROIs were randomly lower with respect to the fabric-elasticity relationships, which reflects the limit of validity of the computational homogenisation methodology. This limitation does not challenge the fabric-elasticity relationship, which extrapolation to heterogeneous ROIs is probably reasonable but can simply not be evaluated with the employed homogenisation methodology. Moreover, due to their low BV/TV, the potential (unknown) errors on these heterogeneous ROIs would have negligible influence on whole bone stiffness in comparison to homogeneous ROIs which are orders of magnitude stiffer. The filtering of highly heterogeneous ROIs removed these low stiffness ROIs and led to similar correlation coefficients for both OI and healthy groups. Finally, the BV/TV and DA matched data revealed no significant differences in fabric-elasticity parameters between OI and healthy individuals. Moreover, the filtering step did not exclude a particular OI type. Compared to previous studies, the stiffness constants from the 61 μm resolution HR-pQCT ROIs were lower than for the 36 μm resolution μCT ROIs. In conclusion, OI trabecular bone of the distal tibia was shown to be significantly more heterogeneous and have a lower BV/TV than healthy controls. Despite the reduced linear regression parameters found for HR-pQCT images, the fabric-elasticity relationships between OI and healthy individuals are similar when the trabecular bone ROIs are sufficiently homogeneous to perform the computational stiffness analysis. Accordingly, the elastic properties used for FEA of healthy bones are also valid for OI bones.
Collapse
Affiliation(s)
- Mathieu Simon
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Michael Indermaur
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Denis Schenk
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Seyedmahdi Hosseinitabatabaei
- Research Centre, Shriners Hospital for Children, Montreal, Canada; Department of Pediatric Surgery, McGill University, Montreal, Canada; Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Bettina M Willie
- Research Centre, Shriners Hospital for Children, Montreal, Canada; Department of Pediatric Surgery, McGill University, Montreal, Canada; Department of Biomedical Engineering, McGill University, Montreal, Canada
| | - Philippe Zysset
- ARTORG Centre for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| |
Collapse
|
18
|
Hu YJ, Chines A, Shi Y, Seeman E, Guo XE. The effect of denosumab and alendronate on trabecular plate and rod microstructure at the distal tibia and radius: A post-hoc HR-pQCT study. Bone 2022; 154:116187. [PMID: 34530172 DOI: 10.1016/j.bone.2021.116187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Age-related trabecular microstructural deterioration and conversion from plate-like trabeculae to rod-like trabeculae occur because of unbalanced rapid remodeling. As denosumab achieves greater remodeling suppression and lower cortical porosity than alendronate, we hypothesized that denosumab might also preserve trabecular plate microstructure, bone stiffness and strength more effectively than alendronate. METHODS In this post hoc analysis of a phase 2 study, postmenopausal women randomized to placebo (P, n = 74), denosumab (D, n = 72), or alendronate (A, n = 68). HR-pQCT scans of the distal radius and tibia were performed at baseline and Month-12 (M12). Trabecular compartment was subjected to Individual Trabecula Segmentation while finite element analysis was performed to estimate stiffness and strength. Percent change from baseline at M12 of each parameter was compared between patient groups. RESULTS At the distal tibia, in the placebo group, plate surface area (pTb.S, -1.3%) decreased while rod bone volume fraction (rBV/TV, +4.5%) and number (rTb.N, +2.1%) increased. These changes were prevented by denosumab but persisted despite alendronate therapy (pTb.S: -1.7%; rBV/TV: +6.9%; rTb.N: +3.0%). Both treatments improved whole bone stiffness (D: +3.1%; A: +1.8%) and failure load (D: +3.0%; A: +2.2%); improvements using denosumab was significant compared to placebo (stiffness: p = 0.004; failure load: p = 0.003). At the distal radius, denosumab increased total trabecular bone volume fraction (BV/TV, +3.4%) and whole bone failure load (+4.0%), significantly different from placebo (BV/TV: p = 0.044; failure load: p = 0.046). Significantly different effects of either drug on plate and rod microstructure were not detected. CONCLUSIONS Denosumab preserved trabecular plate microstructure. Alendronate did not. However, estimated strength did not differ between denosumab and alendronate treated groups.
Collapse
Affiliation(s)
- Yizhong Jenny Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | | | | | - Ego Seeman
- Departments of Endocrinology and Medicine, Austin Health, University of Melbourne, Melbourne, Australia; Mary MacKillop Institute of Healthy Aging, Australian Catholic University, Melbourne, Australia
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA.
| |
Collapse
|
19
|
Kumar J, Perwad F. Adverse Consequences of Chronic Kidney Disease on Bone Health in Children. Semin Nephrol 2021; 41:439-445. [PMID: 34916005 DOI: 10.1016/j.semnephrol.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Chronic kidney disease (CKD) mineral bone disorder has long-term effects on skeletal integrity and growth. Abnormalities in serum markers of mineral metabolism are evident early in pediatric CKD. Bone deformities, poor linear growth, and high rates of fractures are common in children with CKD. Newer imaging modalities such as high-resolution peripheral quantitative computed tomography shows promise in assessing bone mineral density more comprehensively and predicting incident fractures. A lack of large-scale studies that provide a comprehensive assessment of bone histology and correlations with serum biomarkers has contributed to the absence of evidence-based guidelines and suboptimal management of CKD mineral bone disorder in children with CKD.
Collapse
Affiliation(s)
- Juhi Kumar
- Department of Pediatrics and Population Health Sciences, Weill Cornell Medicine, New York, NY.
| | - Farzana Perwad
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| |
Collapse
|
20
|
Plett RM, Kemp TD, Burt LA, Billington EO, Hanley DA, Boyd SK. Using 3D image registration to maximize the reproducibility of longitudinal bone strength assessment by HR-pQCT and finite element analysis. Osteoporos Int 2021; 32:1849-1857. [PMID: 33624139 DOI: 10.1007/s00198-021-05896-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022]
Abstract
UNLABELLED We developed and validated a finite element (FE) approach for longitudinal high-resolution peripheral quantitative computed tomography (HR-pQCT) studies using 3D image registration to account for misalignment between images. This reduced variability in longitudinal FE estimates and improved our ability to measure in vivo changes in HR-pQCT studies of bone strength. INTRODUCTION We developed and validated a finite element (FE) approach for longitudinal high-resolution peripheral quantitative computed tomography (HR-pQCT) studies using 3D rigid-body registration (3DR) to maximize reproducibility by accounting for misalignment between images. METHODS In our proposed approach, we used the full common bone volume defined by 3DR to estimate standard FE parameters. Using standard HR-pQCT imaging protocols, we validated the 3DR approach with ex vivo samples of the distal radius (n = 10, four repeat scans) by assessing whether 3DR can reduce measurement variability from repositioning error. We used in vivo data (n = 40, five longitudinal scans) to assess the sensitivity of 3DR to detect changes in bone strength at the distal radius by the standard deviation of the rate of change (σ), where the ideal value of σ is minimized to define true change. FE estimates by 3DR were compared to estimates by no registration (NR) and slice-matching (SM). RESULTS Group-wise comparisons of ex vivo variation (CVRMS, %) found that FE measurement precision was improved by SM (CVRMS < 0.80%) and 3DR (CVRMS < 0.62%) compared to NR (CVRMS~2%), and 3DR was advantageous as repositioning error increased. Longitudinal in vivo reproducibility was minimized by 3DR for failure load estimates (σ = 0.008 kN/month). CONCLUSION Although 3D registration cannot negate motion artifacts, it plays an important role in detecting and reducing variability in FE estimates for longitudinal HR-pQCT data and is well suited for estimating effects of interventions in in vivo longitudinal studies of bone strength.
Collapse
Affiliation(s)
- R M Plett
- Biomedical Engineering Graduate Program, Faculty of Graduate Studies, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - T D Kemp
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Canada
| | - L A Burt
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - E O Billington
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - D A Hanley
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Canada.
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| |
Collapse
|
21
|
van den Bergh JP, Szulc P, Cheung AM, Bouxsein M, Engelke K, Chapurlat R. The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions. Osteoporos Int 2021; 32:1465-1485. [PMID: 34023944 PMCID: PMC8376700 DOI: 10.1007/s00198-021-05999-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity; (2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.
Collapse
Affiliation(s)
- J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
- Faculty of Medicine, Hasselt University, Hasselt, Belgium.
| | - P Szulc
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
| | - A M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network; and Department of Medicine and Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - M Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
| |
Collapse
|
22
|
Ng Tang Fui M, Hoermann R, Bracken K, Handelsman DJ, Inder WJ, Stuckey BGA, Yeap BB, Ghasem-Zadeh A, Robledo KP, Jesudason D, Zajac JD, Wittert GA, Grossmann M. Effect of Testosterone Treatment on Bone Microarchitecture and Bone Mineral Density in Men: A 2-Year RCT. J Clin Endocrinol Metab 2021; 106:e3143-e3158. [PMID: 33693907 DOI: 10.1210/clinem/dgab149] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Indexed: 01/16/2023]
Abstract
CONTEXT Testosterone treatment increases bone mineral density (BMD) in hypogonadal men. Effects on bone microarchitecture, a determinant of fracture risk, are unknown. OBJECTIVE We aimed to determine the effect of testosterone treatment on bone microarchitecture using high resolution-peripheral quantitative computed tomography (HR-pQCT). METHODS Men ≥ 50 years of age were recruited from 6 Australian centers and were randomized to receive injectable testosterone undecanoate or placebo over 2 years on the background of a community-based lifestyle program. The primary endpoint was cortical volumetric BMD (vBMD) at the distal tibia, measured using HR-pQCT in 177 men (1 center). Secondary endpoints included other HR-pQCT parameters and bone remodeling markers. Areal BMD (aBMD) was measured by dual-energy x-ray absorptiometry (DXA) in 601 men (5 centers). Using a linear mixed model for repeated measures, the mean adjusted differences (95% CI) at 12 and 24 months between groups are reported as treatment effect. RESULTS Over 24 months, testosterone treatment, versus placebo, increased tibial cortical vBMD, 9.33 mg hydroxyapatite (HA)/cm3) (3.96, 14.71), P < 0.001 or 3.1% (1.2, 5.0); radial cortical vBMD, 8.96 mg HA/cm3 (3.30, 14.62), P = 0.005 or 2.9% (1.0, 4.9); total tibial vBMD, 4.16 mg HA/cm3 (2.14, 6.19), P < 0.001 or 1.3% (0.6, 1.9); and total radial vBMD, 4.42 mg HA/cm3 (1.67, 7.16), P = 0.002 or 1.8% (0.4, 2.0). Testosterone also significantly increased cortical area and thickness at both sites. Effects on trabecular architecture were minor. Testosterone reduced bone remodeling markers CTX, -48.1 ng/L [-81.1, -15.1], P < 0.001 and P1NP, -6.8 μg/L[-10.9, -2.7], P < 0.001. Testosterone significantly increased aBMD at the lumbar spine, 0.04 g/cm2 (0.03, 0.05), P < 0.001 and the total hip, 0.01 g/cm2 (0.01, 0.02), P < 0.001. CONCLUSION In men ≥ 50 years of age, testosterone treatment for 2 years increased volumetric bone density, predominantly via effects on cortical bone. Implications for fracture risk reduction require further study.
Collapse
Affiliation(s)
- Mark Ng Tang Fui
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
| | - Karen Bracken
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, 2050, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney New South Wales, 2139, Australia
| | - Warrick J Inder
- Princess Alexandra Hospital and the University of Queensland, Queensland, 4102, Australia
| | - Bronwyn G A Stuckey
- Keogh Institute for Medical Research, Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital and University of Western Australia, Western Australia, 6009, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia and Department of Endocrinology and Diabetes, Freemantle & Fiona Stanley Hospital, Perth, Western Australia, 6150, Australia
| | - Ali Ghasem-Zadeh
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
| | - Kristy P Robledo
- NHMRC Clinical Trials Centre, University of Sydney, New South Wales, 2050, Australia
| | - David Jesudason
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, 5000, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
| | - Gary A Wittert
- Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, South Australia, Australia, and The Queen Elizabeth Hospital, South Australia, 5000, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Victoria, 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, 3084, Australia
| |
Collapse
|
23
|
Chiba K, Okazaki N, Isobe Y, Miyazaki S, Yonekura A, Tomita M, Osaki M. Precision of 3D Registration Analysis for Longitudinal Study of Second-Generation HR-pQCT. J Clin Densitom 2021; 24:319-329. [PMID: 33172803 DOI: 10.1016/j.jocd.2020.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of this research was to develop 3D registration analysis method in longitudinal studies of high-resolution peripheral quantitative computed tomography (HR-pQCT), to analyze ranges of bone microstructure parameters in addition to standard parameters, and to test the precision of these measurements. METHODS Scans of HR-pQCT and analysis of bone microstructure were performed at 3 times in 15 subjects. The 3 images were matched 3-dimensionally, and bone microstructures were analyzed in the common region. In addition to standard measurement parameters of geometry, bone mineral density (BMD), trabecular bone, and cortical bone, parameters showing plate to rod-like structure, connectivity, cavity formation of trabecular bone, and bending stability of cortical bone were also measured. Precision was evaluated with the root mean square percent coefficient variance (RMS%CV). RESULTS RMS%CV was 0.1%-1.3% for geometry, 0.6%-1.9% for BMD, 0.8%-3.3% for trabecular bone, 2.1%-9.8% for additionally measured trabecular bone, 1.0%-3.4% for cortical bone excluding Ct.Po, 6.0%-6.1% for Ct.Po, and 0.8%-1.5% for additionally measured cortical bone. Precision was higher for 3D registration than for 2D registration in geometry, BV/TV, and Ct.Po. CONCLUSIONS 3D registration analysis of a range of bone microstructural parameters in longitudinal analysis of HR-pQCT showed good precision, offering potential for contributing to future research on osteoporosis and bone metabolic diseases.
Collapse
Affiliation(s)
- Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan.
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | | | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masato Tomita
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
24
|
Krez A, Agarwal S, Bucovsky M, McMahon DJ, Hu Y, Bessler M, Schrope B, Carrelli A, Clare S, Guo XDE, Silverberg SJ, Stein EM. Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women. J Clin Endocrinol Metab 2021; 106:e1868-e1879. [PMID: 33098299 PMCID: PMC8502471 DOI: 10.1210/clinem/dgaa654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN Four-year prospective cohort study. PATIENTS African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.
Collapse
Affiliation(s)
- Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mariana Bucovsky
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Beth Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Carrelli
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shannon Clare
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Shonni J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Correspondence and Reprint Requests: Emily M. Stein, MD, MS, Director of Research, Metabolic Bone Service, Hospital for Special Surgery, Associate Professor of Medicine, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021. E-mail:
| |
Collapse
|
25
|
Miller T, Ying MTC, Hung VWY, Tsang CSL, Ouyang H, Chung RCK, Qin L, Pang MYC. Determinants of estimated failure load in the distal radius after stroke: An HR-pQCT study. Bone 2021; 144:115831. [PMID: 33359893 DOI: 10.1016/j.bone.2020.115831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/30/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Bone health is often compromised after stroke and the distal radius is a common site of fragility fractures. The macro- and mircoproperties of bone tissue after stroke and their clinical correlates are understudied. The objectives of the study were to use High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) to investigate the bone properties at the distal radius, and to identify the correlates of estimated failure load for the distal radius in people with chronic stroke. This was a cross-sectional study of 64 people with stroke (age: 60.8 ± 7.7 years, stroke duration: 5.7 ± 3.9 years) and 64 age- and sex-matched controls. Bilateral bone structural, densitometric, geometric and strength parameters of the distal radius were measured using HR-pQCT. The architecture, stiffness and echo intensity of the bilateral biceps brachii muscle and brachial artery blood flow were evaluated using diagnostic ultrasound. Other outcomes included the Fugl-Meyer Motor Assessment (FMA), Motor Activity Log (MAL), and Composite Spasticity Scale (CSS). The results revealed a significant side (paretic vs non-paretic for the stroke group, non-dominant vs dominant for controls) by group (stroke vs control) interaction effect for estimated failure load, cortical area, cortical thickness, trabecular number and trabecular separation, and all volumetric density parameters. Post-hoc analysis showed percent side-to-side differences in bone outcomes were greater in the stroke group than the control group, with the exception of trabecular thickness and intracortical porosity. Among the HR-pQCT variables, percent side-to-side difference in trabecular volumetric bone mineral density contributed the most to the percent side-to-side difference in estimated failure load in the stroke group (R2 change = 0.334, β = 1.106). Stroke-related impairments (FMA, MAL, CSS) were found to be significant determinants of the percent side-to-side difference in estimated failure load (R2 change = 0.233, β = -0.480). This was the first study to examine bone microstructure post-stroke. We found that the paretic distal radius had compromised bone structural properties and lower estimated failure load compared to the non-paretic side. Motor impairment was a determinant of estimated bone strength at the distal radius and may be a potential intervention target for improving bone health post-stroke.
Collapse
Affiliation(s)
- Tiev Miller
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Michael T C Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong
| | - Vivian W Y Hung
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Charlotte S L Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Raymond C K Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ling Qin
- Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| |
Collapse
|
26
|
Kim HJ, Dash A, Cunningham M, Schwab F, Dowdell J, Harrison J, Zaworski C, Krez A, Lafage V, Agarwal S, Carlson B, McMahon DJ, Stein EM. Patients with abnormal microarchitecture have an increased risk of early complications after spinal fusion surgery. Bone 2021; 143:115731. [PMID: 33157283 PMCID: PMC9518007 DOI: 10.1016/j.bone.2020.115731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 12/12/2022]
Abstract
Spine fusion is one of the most common orthopedic surgeries, with more than 400,000 cases performed annually. While these procedures correct debilitating pain and deformities, complications occur in up to 45%. As successful fusion rests upon early stability of hardware in bone, patients with structural skeletal deficits may be at particular risk for complications. Few studies have investigated this relationship, and none have used higher order imaging to evaluate microstructural mechanisms for complications. Standard DXA measurements are subject to artifact in patients with spinal disease and therefore provide limited information. The goal of this prospective study was to investigate pre-operative bone quality as a risk factor for early post-operative complications using high resolution peripheral QCT (HR-pQCT) measurements of volumetric BMD (vBMD) and microarchitecture. We hypothesized that patients with low vBMD and abnormal microarchitecture at baseline would have more skeletal complications post-operatively. Conversely, we hypothesized that pre-operative DXA measurements would not be predictive of complications. Fifty-four subjects (mean age 63 years, BMI 27 kg/m2) were enrolled pre-operatively and followed for 6 months after multi-level lumbar spine fusion. Skeletal complications occurred in 14 patients. Patients who developed complications were of similar age and BMI to those who did not. Baseline areal BMD and Trabecular Bone Score by DXA did not differ. In contrast, HR-pQCT revealed that patients who developed complications had lower trabecular vBMD, fewer and thinner trabeculae at both the radius and tibia, and thinner tibial cortices. In summary, abnormalities of both trabecular and cortical microarchitecture were associated the development of complications within the first six months following spine fusion surgery. Our results suggest a mechanism for early skeletal complications after fusion. Given the burgeoning number of fusion surgeries, further studies are necessary to investigate strategies that may improve bone quality and lower the risk of post-operative complications.
Collapse
Affiliation(s)
- Han Jo Kim
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Alexander Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Matthew Cunningham
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Frank Schwab
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - James Dowdell
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Jonathan Harrison
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Caroline Zaworski
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Virginie Lafage
- Spine Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States of America
| | - Brandon Carlson
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, United States of America.
| |
Collapse
|
27
|
Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius. Arch Orthop Trauma Surg 2021; 141:1909-1918. [PMID: 33128608 PMCID: PMC8497288 DOI: 10.1007/s00402-020-03658-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters. MATERIALS AND METHODS Dorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up. Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients. OUTCOME Characteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27-212.86), p = 0.008], total [OR 0.16 (95% CI 0.04-0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05-0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02-0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures. CONCLUSIONS In conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.
Collapse
|
28
|
Ohs N, Collins CJ, Atkins PR. Validation of HR-pQCT against micro-CT for morphometric and biomechanical analyses: A review. Bone Rep 2020; 13:100711. [PMID: 33392364 PMCID: PMC7772687 DOI: 10.1016/j.bonr.2020.100711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 12/26/2022] Open
Abstract
High-resolution peripheral quantitative computed-tomography (HR-pQCT) has the potential to become a powerful clinical assessment and diagnostic tool. Given the recent improvements in image resolution, from 82 to 61 μm, this technology may be used to accurately quantify in vivo bone microarchitecture, a key biomarker of degenerative bone diseases. However, computational methods to assess bone microarchitecture were developed for micro computed tomography (micro-CT), a higher-resolution technology only available for ex vivo studies, and validation of these computational analysis techniques against the gold-standard micro-CT has been inconsistent and incomplete. Herein, we review methods for segmentation of bone compartments and microstructure, quantification of bone morphology, and estimation of mechanical strength using finite-element analysis, highlighting the need throughout for improved standardization across the field. Studies have relied on homogenous datasets for validation, which does not allow for robust comparisons between methods. Consequently, the adaptation and validation of novel segmentation approaches has been slow to non-existent, with most studies still using the manufacturer's segmentation for morphometric analysis despite the existence of better performing alternative approaches. The promising accuracy of HR-pQCT for capturing morphometric indices is overshadowed by considerable variability in outcomes between studies. For finite element analysis (FEA) methods, the use of disparate material models and FEA tools has led to a fragmented ability to assess mechanical bone strength with HR-pQCT. Further, the scarcity of studies comparing 62 μm HR-pQCT to the gold standard micro-CT leaves the validation of this imaging modality incomplete. This review revealed that without standardization, the capabilities of HR-pQCT cannot be adequately assessed. The need for a public, extendable, heterogeneous dataset of HR-pQCT and corresponding gold-standard micro-CT images, which would allow HR-pQCT users to benchmark existing and novel methods and select optimal methods depending on the scientific question and data at hand, is now evident. With more recent advancements in HR-pQCT, the community must learn from its past and provide properly validated technologies to ensure that HR-pQCT can truly provide value in patient diagnosis and care.
Collapse
Affiliation(s)
- Nicholas Ohs
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | | | - Penny R. Atkins
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Osteoporosis, Inselspital, Bern, Switzerland
| |
Collapse
|
29
|
Yu F, Xu Y, Hou Y, Lin Y, Jiajue R, Jiang Y, Wang O, Li M, Xing X, Zhang L, Qin L, Hsieh E, Xia W. Age-, Site-, and Sex-Specific Normative Centile Curves for HR-pQCT-Derived Microarchitectural and Bone Strength Parameters in a Chinese Mainland Population. J Bone Miner Res 2020; 35:2159-2170. [PMID: 32564403 PMCID: PMC9719438 DOI: 10.1002/jbmr.4116] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 12/18/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is an advanced 3D imaging technology that has the potential to contribute to fracture risk assessment and early diagnosis of osteoporosis. However, to date no studies have sought to establish normative reference ranges for HR-pQCT measures among individuals from the Chinese mainland, significantly restricting its use. In this study, we collected HR-pQCT scans from 863 healthy Chinese men and women aged 20 to 80 years using the latest-generation scanner (Scanco XtremeCT II, Scanco Medical AG, Brüttisellen, Switzerland). Parameters including volumetric bone mineral density, bone geometry, bone microarchitecture, and bone strength were evaluated. Age-, site-, and sex-specific centile curves were established using generalized additive models for location, scale, and shape with age as the only explanatory variable. Based on established models, age-related variations for different parameters were also quantified. For clinical purposes, the expected values of HR-pQCT parameters for a defined age and a defined percentile or Z-score were provided. We found that the majority of trabecular and bone strength parameters reached their peak at 20 years of age, regardless of sex and site, then declined steadily thereafter. However, most of the cortical bone loss was observed after the age of 50 years. Among the measures, cortical porosity changed most dramatically, and overall, changes were more notable at the radius than the tibia and among women compared with men. Establishing such normative HR-pQCT reference data will provide an important basis for clinical and research applications in mainland China aimed at elucidating microstructural bone damage driven by different disease states or nutritional status. © 2020 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Fan Yu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yuping Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yanfang Hou
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yuanyuan Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Li Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| |
Collapse
|
30
|
Whittier DE, Burt LA, Hanley DA, Boyd SK. Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT. J Bone Miner Res 2020; 35:2151-2158. [PMID: 33314359 DOI: 10.1002/jbmr.4114] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 11/11/2022]
Abstract
There are currently no population-based reference data sets available for volumetric bone mineral density and microarchitecture parameters measured using the second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT), yet the technology is rapidly becoming a standard for studies of bone microarchitecture. Although cross-calibrated data sets from the first-generation HR-pQCT have been reported, they are not suitable for second-generation bone microarchitecture properties because of fundamental differences between scanner generations. This study provides site- and sex-specific centile curves across the adult life span for second-generation HR-pQCT properties. A total of 1236 adult participants (768 female and 468 male) from the Calgary area between the ages of 18 and 90 years were scanned at the distal tibia and radius using the second-generation HR-pQCT. Bone densities, microarchitectural properties, and failure load estimated using finite element analysis were determined using standard in vivo protocol. Site- and sex-specific centile curves were generated using the generalized additive models for location, scale, and shape (GAMLSS) method. These data provide reference curves appropriate for predominantly white male and female adults, which can be used as a tool to assess patient- or cohort-specific bone health. © 2020 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - David A Hanley
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
31
|
Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:1607-1627. [PMID: 32458029 PMCID: PMC7429313 DOI: 10.1007/s00198-020-05438-5] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems. METHODS A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document. RESULTS An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems. CONCLUSION This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.
Collapse
Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J Paccou
- Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - A Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Bioclinica, Inc., Hamburg, Germany
| | - M L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
32
|
Narla RR, Ott SM. Structural and Metabolic Assessment of Bone. Handb Exp Pharmacol 2020; 262:369-396. [PMID: 32885312 DOI: 10.1007/164_2020_376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The assessment of bone structure and metabolism should focus on the bone strength. Many factors are involved, and although bone density is an important component, it is not the same as bone strength. Other aspects of bone quality include bone volume, micro-architecture, material composition, and ability to repair damage. This chapter briefly reviews some of the methods that can be used to assess both density and quality of bone. Non-invasive measurements of density or structure include dual X-ray absorptiometry (DXA), quantitative computed tomography, ultrasound, and magnetic resonance imaging. DXA is most widely used and has advantages of safety and accessibility, but there are limitations in the interpretation of the results, and in clinical practice positioning errors are frequently seen. Invasive methods are used primarily for research. Samples of bone can be used to measure structure by histology as well as micro-computed tomography and infra-red spectroscopy or backscattered electron microscopy. Force can be directly applied to bone samples to measure the bones strength. Impact microindentation is a new minimally invasive technique that measures bone hardness. Metabolic assessment includes blood and urine tests that reflect diseases that cause bone loss, particularly problems with mineral metabolism. Tetracycline-labelled bone biopsies are the standard for measuring bone formation. Non-invasive biochemical tests of bone formation and resorption can evaluate a patient's skeletal physiology.
Collapse
Affiliation(s)
- Radhika R Narla
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington, Seattle, WA, USA.
| |
Collapse
|
33
|
Mata-Mbemba D, Rohringer T, Ibrahim A, Adams-Webberc T, Moineddin R, Doria AS, Vali R. HR-pQCT imaging in children, adolescents and young adults: Systematic review and subgroup meta-analysis of normative data. PLoS One 2019; 14:e0225663. [PMID: 31834887 PMCID: PMC6910691 DOI: 10.1371/journal.pone.0225663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the methodologies on image acquisition of normative data of high-resolution peripheral quantitative computed tomography (HR-pQCT) in children, adolescents and/or young adults (up to 25 years) and to determine their normative data based on available literature. A literature search was conducted in MEDLINE, EMBASE and Web of Science from 1947 to July 2019. Quality of articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and Modified Newcastle-Ottawa scale (NOS). Articles which fitted the following criteria were combined to meta-analysis: age range (15 to 22.6 years), references at tibia (22.5mm) and/or radius (9.0 to 9.5mm). Eight articles were ultimately included in the systematic review and 4 of them that filled the criteria were summarised in meta-analysis. The results of random effects model of HR-pQCT parameters of the 4 articles were as follows: 1)Radius: bone volume fraction (BT/BV) [estimate 0.17:0.1229(lower)-0.2115 (upper); trabecular number (Tb_N):2.08(2.03–2.12); trabecular thickness (Tb.Th):0.07 (0.07–0.0.08); trabecular separation (Tb.Sp):0.41 (0.38–0.42); cortical thickness (Ct.Th):0.85 (0.76–0.94); cortical porosity (Ct.Po):1.53 (0.63–2.44); total area (Tt.Ar):263.66(-385.3–912.6); total bone density (Tt-vBMD):280.5 (73.1–487.7); Trabecular density (Tb-vBMD):223.6 (47.1–400.09), and cortical density (CT.vBMD):765.9 (389.1–1142.8). 2)Tibia: BT/BV:0.18 (0.17–0.19); Tb_N:2.02 (1.83–2.2); Tb.Th:0.08 (0.80–0.09); Tb.Sp:0.40(0.36–0.44); Ct.Th:1.32(1.26–1.38); Ct.Po:3.15 (1.1–5.2); Tt.Ar:693.1(150.2–1235.8); Tt-vBMD:343.76 (335.5–352.1); Tb-vBMD:223.6 (213.37 (193.5–233.2), and CT.vBMD:894.3 (857.6–931.1). There is overall ‘fair’ evidence on reporting of results of normative data of HR-pQCT parameters in children, adolescents and/or young adults. However, data are scarce pointing out to the urgent need for standardization of acquisition parameters and guidelines on the use of HR-PQCT in these populations.
Collapse
Affiliation(s)
- Daddy Mata-Mbemba
- Department of Diagnostic Imaging, IWK Health Centre, and Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
- * E-mail:
| | | | - Ala Ibrahim
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Rahim Moineddin
- Departments of Family and Community Medicine (R.M.), University of Toronto, Toronto, Canada
| | - Andrea S. Doria
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| |
Collapse
|
34
|
Scott D, Shore-Lorenti C, Ebeling PR. Multiple vertebral compression fractures after sleeve gastrectomy and a subsequent pregnancy: a case report. Osteoporos Int 2019; 30:2151-2154. [PMID: 31273389 DOI: 10.1007/s00198-019-05073-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/25/2019] [Indexed: 11/29/2022]
Abstract
We report that a 33-year-old woman developed multiple compression fractures several years after a sleeve gastrectomy followed by pregnancy. Despite normal areal BMD values assessed by dual-energy X-ray absorptiometry and no family history of osteoporosis, the patient demonstrated low lumbar spine trabecular bone score, as well as low peripheral trabecular volumetric BMD and deterioration of trabecular microarchitecture assessed by high-resolution peripheral quantitative computed tomography. Women of reproductive age should be provided with lifestyle management targeting bone health following bariatric surgery.
Collapse
Affiliation(s)
- D Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3168, Australia.
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Victoria, Australia.
| | - C Shore-Lorenti
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3168, Australia
| | - P R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, 3168, Australia
| |
Collapse
|
35
|
Daniels AM, Theelen LMA, Wyers CE, Janzing HMJ, van Rietbergen B, Vranken L, van der Velde RY, Geusens PPMM, Kaarsemaker S, Poeze M, van den Bergh JP. Bone Microarchitecture and Distal Radius Fracture Pattern Complexity. J Orthop Res 2019; 37:1690-1697. [PMID: 30977554 PMCID: PMC6767516 DOI: 10.1002/jor.24306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/02/2019] [Accepted: 03/27/2019] [Indexed: 02/04/2023]
Abstract
Distal radius fractures (DRFs) occur in various complexity patterns among patients differing in age, gender, and bone mineral density (BMD). Our aim was to investigate the association of patient characteristics, BMD, bone microarchitecture, and bone strength with the pattern complexity of DRFs. In this study, 251 patients aged 50-90 years with a radiologically confirmed DRF who attended the Fracture Liaison Service of VieCuri Medical Centre, the Netherlands, between November 2013 and June 2016 were included. In all patients fracture risk factors and underling metabolic disorders were evaluated and BMD measurement with vertebral fractures assessment by dual-energy X-ray absorptiometry was performed. Radiographs of all DRFs were reviewed by two independent investigators to assess fracture pattern complexity according to the AO/OTA classification in extra-articular (A), partially articular (B), and complete articular (C) fractures. For this study, patients with A and C fractures were compared. Seventy-one patients were additionally assessed by high-resolution peripheral quantitative computed tomography. Compared to group A, mean age, the proportion of males, and current smokers were higher in group C, but BMD and prevalent vertebral fractures were not different. In univariate analyses, age, male gender, trabecular area, volumetric BMD (vBMD), and stiffness were associated with type C fractures. In multivariate analyses, only male gender (odds ratio (OR) 8.48 95% confidence interval (CI) 1.75-41.18, p = 0.008]) and age (OR 1.11 [95% CI 1.03-1.19, p = 0.007]) were significantly associated with DRF pattern complexity. In conclusion, our data demonstrate that age and gender, but not body mass index, BMD, bone microarchitecture, or strength were associated with pattern complexity of DRFs.© 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. J Orthop Res 37:1690-1697, 2019.
Collapse
Affiliation(s)
- Anne M. Daniels
- Department of SurgeryVieCuri Medical CentreVenloThe Netherlands,NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands
| | - Luuk M. A. Theelen
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands
| | | | - Bert van Rietbergen
- Department of Biomedical Engineering, Orthopaedic BiomechanicsEindhoven University of TechnologyEind hovenThe Netherlands,Department of Orthopaedic Surgery, Research School CAPHRIMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Lisanne Vranken
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Robert Y. van der Velde
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands
| | - Piet P. M. M. Geusens
- Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Surgery, Division of TraumasurgeryMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in MetabolismMaastricht UniversityMaastrichtThe Netherlands,Department of Internal MedicineVieCuri Medical CentreVenloThe Netherlands,Department of Internal MedicineMaastricht UniversityMaastrichtThe Netherlands,Faculty of Medicine, Division of Internal MedicineHasselt UniversityHasseltBelgium
| |
Collapse
|
36
|
Whittier DE, Manske SL, Boyd SK, Schneider PS. The Correction of Systematic Error due to Plaster and Fiberglass Casts on HR-pQCT Bone Parameters Measured In Vivo at the Distal Radius. J Clin Densitom 2019; 22:401-408. [PMID: 30658879 DOI: 10.1016/j.jocd.2018.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
Due to difficulty assessing healing of distal radius fractures using conventional radiography, there is interest in using high resolution peripheral quantitative computed tomography (HR-pQCT) to track healing at the microarchitectural level. Unfortunately, the plaster-of-Paris and fiberglass casts used to immobilize fractures affect HR-pQCT measurements due to beam hardening, and increased noise. The challenge is compounded because casts have variable thickness, and an individual patient will often have their cast changed 2-3 times during the course of treatment. This study quantifies the effect of casts within a clinically relevant range of thicknesses on measured bone parameters at the distal radius, and establishes conversion equations to correct for systematic error in due to cast presence. Eighteen nonfractured participants were scanned by HR-pQCT in three conditions: no cast, plaster-of-Paris cast, and fiberglass cast. Measured parameters were compared between the baseline scan (no cast) and each cast scan to evaluate if systematic error exists due to cast presence. A linear regression model was used to determine an appropriate conversion for parameters that were found to have systematic error. Plaster-of-Paris casts had a greater range of thicknesses (3.2-9.5 mm) than the fiberglass casts (3.0-5.4 mm), and induced a greater magnitude of systematic error overall. Key parameters of interest were bone mineral density (total, cortical, and trabecular) and trabecular bone volume fraction, all of which were found to have systematic error due to presence of either cast type. Linear correlations between baseline and cast scans for these parameters were excellent (R2 > 0.98), and appropriate conversions could be determined within a margin of error less than a ±6% for the plaster-of-Paris cast, and ±4% for the fiberglass cast. We have demonstrated the effects of cast presence on bone microarchitecture measurements, and presented a method to correct for systematic error, in support of future use of HR-pQCT to study fracture healing.
Collapse
Affiliation(s)
- Danielle E Whittier
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Sarah L Manske
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
| | - Prism S Schneider
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary AB, Canada; Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary AB, Canada.
| |
Collapse
|
37
|
Arias-Moreno AJ, Hosseini HS, Bevers M, Ito K, Zysset P, van Rietbergen B. Validation of distal radius failure load predictions by homogenized- and micro-finite element analyses based on second-generation high-resolution peripheral quantitative CT images. Osteoporos Int 2019; 30:1433-1443. [PMID: 30997546 PMCID: PMC6614386 DOI: 10.1007/s00198-019-04935-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 03/05/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED This study developed a well-standardized and reproducible approach for micro-finite element (mFE) and homogenized-FE (hFE) analyses that can accurately predict the distal radius failure load using either mFE or hFE models when using the approaches and parameters developed in this study. INTRODUCTION Micro-FE analyses based on high-resolution peripheral quantitative CT (HR-pQCT) images are frequently used to predict distal radius failure load. With the introduction of a second-generation HR-pQCT device, however, the default modelling approach no longer provides accurate results. The aim of this study was to develop a well-standardized and reproducible approach for mFE and hFE analyses that can provide precise and accurate results for distal radius failure load predictions based on second-generation HR-pQCT images. METHODS Second-generation HR-pQCT was used to scan the distal 20-mm section of 22 cadaver radii. The sections were excised and mechanically tested afterwards. For these sections, mFE and hFE models were made that were used to identify required material parameters by comparing predicted and measured results. Using these parameters, the models were cropped to represent the 10-mm region recommended for clinical studies to test their performance for failure load prediction. RESULTS After identification of material parameters, the measured failure load of the 20-mm segments was in good agreement with the results of mFE models (R2 = 0.969, slope = 1.035) and hFE models (R2 = 0.966, slope = 0.890). When the models were restricted to the clinical region, mFE still accurately predicted the measured failure load (R2 = 0.955, slope = 1.021), while hFE predictions were precise but tended to overpredict the failure load (R2 = 0.952, slope = 0.780). CONCLUSIONS It was concluded that it is possible to accurately predict the distal radius failure load using either mFE or hFE models when using the approaches and parameters developed in this study.
Collapse
Affiliation(s)
- A J Arias-Moreno
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Zaale, Groene Loper 15, 5612AP, Eindhoven, The Netherlands
- Department of Mechanics and Production, Autonomous University of Manizales, Antigua Estación del Ferrocarril, Manizales, Caldas, Colombia
| | - H S Hosseini
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
| | - M Bevers
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Zaale, Groene Loper 15, 5612AP, Eindhoven, The Netherlands
| | - K Ito
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Zaale, Groene Loper 15, 5612AP, Eindhoven, The Netherlands
| | - P Zysset
- Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland
| | - B van Rietbergen
- Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, De Zaale, Groene Loper 15, 5612AP, Eindhoven, The Netherlands.
| |
Collapse
|
38
|
Stein EM, Dash A, Bucovsky M, Agarwal S, Fu J, Lentzsch S, Shane E. Disrupted radial and tibial microarchitecture in patients with monoclonal gammopathy of undetermined significance. Osteoporos Int 2019; 30:629-635. [PMID: 30488275 PMCID: PMC10081445 DOI: 10.1007/s00198-018-4787-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/12/2018] [Accepted: 11/18/2018] [Indexed: 02/06/2023]
Abstract
UNLABELLED Patients with monoclonal gammopathy of undetermined significance (MGUS) had abnormalities in volumetric BMD (vBMD), microarchitecture, and stiffness at both the radius and tibia by high-resolution peripheral quantitative CT compared to matched controls. This is the first report demonstrating that patients with MGUS have microarchitectural deficits at multiple skeletal sites. INTRODUCTION Fracture risk is elevated in patients with monoclonal gammopathy of undetermined significance (MGUS). However, the pathogenesis of bone disease in these patients is poorly understood. Prior work using high-resolution peripheral CT (HRpQCT) demonstrated abnormal microarchitecture at the radius, with predominantly cortical abnormalities. We hypothesized that patients with MGUS have abnormal microarchitecture at both radius and tibia compared to controls, reflecting global skeletal effects of the disease. METHODS This case-control study enrolled 36 subjects; patients with MGUS (n = 12) were matched 1:2 by age, sex, and race to controls (n = 24). Areal BMD (aBMD) was measured by DXA, vBMD, and microarchitecture by HRpQCT, and whole bone stiffness by finite element analysis. Serum was drawn for markers of bone metabolism and inflammation. RESULTS By DXA, MGUS patients had lower aBMD at the lumbar spine, femoral neck, and 1/3 radius. Markers of bone metabolism and inflammation did not differ. By HRpQCT at the radius, MGUS patients had lower total, trabecular and cortical density, lower trabecular number, and greater trabecular separation and heterogeneity. At the tibia, MGUS patients had lower total and trabecular density, lower trabecular number, greater separation and heterogeneity, and lower whole bone stiffness. CONCLUSIONS Patients with MGUS had lower vBMD, cortical, and trabecular abnormalities at the radius compared to matched controls. At the tibia, trabecular abnormalities predominated. These results suggest that in addition to previously described cortical deficits, deterioration of trabecular bone may contribute to a generalized skeletal fragility in patients with MGUS.
Collapse
Affiliation(s)
- E M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - A Dash
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - M Bucovsky
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Agarwal
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J Fu
- Multiple Myeloma and Amyloidosis Service, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - S Lentzsch
- Multiple Myeloma and Amyloidosis Service, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - E Shane
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
39
|
Yin MT, RoyChoudhury A, Bucovsky M, Colon I, Ferris DC, Olender S, Agarwal S, Sharma A, Zeana C, Zingman B, Shane E. A Randomized Placebo-Controlled Trial of Low- Versus Moderate-Dose Vitamin D3 Supplementation on Bone Mineral Density in Postmenopausal Women With HIV. J Acquir Immune Defic Syndr 2019; 80:342-349. [PMID: 30531305 PMCID: PMC6375749 DOI: 10.1097/qai.0000000000001929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prevalence of osteoporosis and fracture is increased among older people with HIV. We compared the effects of low (1000 IU) vs moderate (3000 IU) vitamin D3 (VitD) supplementation on areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD) in African American and Hispanic postmenopausal women with HIV on antiretroviral therapy. METHODS We performed a 12-month prospective, randomized, double-blind, placebo-controlled study with primary outcomes of change in aBMD by dual-energy X-ray absorptiometry (DXA) and secondary outcomes of change in vBMD by quantitative computed tomography and bone turnover markers. An intent-to-treat analysis was performed on 85 randomized subjects (43 low and 42 moderate) for primary DXA outcomes, and complete case analysis was performed for secondary outcomes. RESULTS Mean age was 56 ± 5 years, median CD4 count was 722 cells/mm, and 74% had HIV RNA ≤ 50 copies/mL. Serum 25-OHD was higher in the moderate than low VitD group at 6 months (33.1 ± 10.3 vs 27.8 ± 8.1 ng/mL, P = 0.03) and 12 months, but parathyroid hormone levels remained similar. Percent change in aBMD, vBMD, and bone turnover markers did not differ between low and moderate VitD groups before or after adjustment for baseline aBMD. CONCLUSIONS VitD supplementation at 3000 IU daily increased mean total 25-OHD levels in postmenopausal women with HIV, but we did not find evidence of an effect on BMD beyond those observed with 1000 IU daily. Future studies are necessary to determine whether VitD supplementation is beneficial in this patient population, and if so, what dose is optimal for skeletal health.
Collapse
Affiliation(s)
- Michael T Yin
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Arindam RoyChoudhury
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, Cornell University, New York, NY
| | - Mariana Bucovsky
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Ivelisse Colon
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - David C Ferris
- Department of Medicine, Mt. Sinai St. Luke's and Mt. Sinai West, New York, NY
- Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY
| | - Susan Olender
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Sanchita Agarwal
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Anjali Sharma
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Cosmina Zeana
- Department of Medicine, Bronx-Lebanon Hospital Center, Bronx, NY
| | - Barry Zingman
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Elizabeth Shane
- Department of Medicine, Columbia University Medical Center, New York, NY
| |
Collapse
|
40
|
Baer TG, Agarwal S, Chen S, Chiuzan C, Sopher A, Tao R, Hassoun A, Shane E, Fennoy I, Oberfield SE, Vuguin PM. Deficits in Bone Geometry in Growth Hormone-Deficient Prepubertal Boys Revealed by High-Resolution Peripheral Quantitative Computed Tomography. Horm Res Paediatr 2019; 92:293-301. [PMID: 32224610 PMCID: PMC7192784 DOI: 10.1159/000506229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 01/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although growth hormone (GH) is essential for attainment of peak bone mass, bone health in prepubertal children with GH deficiency is not routinely evaluated. The objective of this study was to evaluate bone microarchitecture in GH-deficient (GHD) boys using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Fifteen control and fifteen GHD, GH naïve pre-pubertal boys were recruited for a case-control study at a major academic center. Subjects with panhypopituitarism, chromosomal pathology, chronic steroids, or stimulant use were excluded. Volumetric bone mineral density (vBMD; total, cortical, and trabecular), bone geometry (total, cortical and trabecular cross-sectional area, cortical perimeter), bone microarchitecture, and estimated bone strength of the distal radius and tibia were assessed by HR-pQCT. Areal BMD and body composition were assessed by DXA. Insulin-like growth factor 1 (IGF-1), osteocalcin, C telopeptide, and P1NP levels were measured. RESULTS GHD subjects had a significantly smaller cortical perimeter of the distal radius compared to controls (p < 0.001), with the difference in cortical perimeter persisting after adjusting for height z score, age, lean mass, and 25-hydroxyvitamin D level (p < 0.05).No significant differences were found in vBMD. No significant differences were found in microarchitecture, estimated strength, areal BMD, body composition, or bone turnover markers. Analysis showed significant positive correlations between IGF-1 levels and cortical parameters. DISCUSSION/CONCLUSIONS Prepubertal GHD boys had deficits in bone geometry not evident with DXA. Larger prospective/longitudinal HR-pQCT studies are needed to determine the extent of these deficits, the need for routine bone evaluation, and the timing of GH replacement for prevention or restoration of these deficits.
Collapse
Affiliation(s)
- Tamar G. Baer
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Sanchita Agarwal
- Department of Medicine, Columbia University Irving Medical Center, New York (NY) USA
| | - Shaoxuan Chen
- Department of Biostatistics, Columbia University Irving Medical Center, New York (NY) USA
| | - Codruta Chiuzan
- Department of Biostatistics, Columbia University Irving Medical Center, New York (NY) USA
| | - Aviva Sopher
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Rachel Tao
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Abeer Hassoun
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Elizabeth Shane
- Department of Medicine, Columbia University Irving Medical Center, New York (NY) USA
| | - Ilene Fennoy
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Sharon E. Oberfield
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| | - Patricia M. Vuguin
- Department of Pediatrics, Columbia University Irving Medical Center, New York (NY) USA
| |
Collapse
|
41
|
Ramalho J, Marques IDB, Hans D, Dempster D, Zhou H, Patel P, Pereira RMR, Jorgetti V, Moyses RMA, Nickolas TL. The trabecular bone score: Relationships with trabecular and cortical microarchitecture measured by HR-pQCT and histomorphometry in patients with chronic kidney disease. Bone 2018; 116:215-220. [PMID: 30098418 DOI: 10.1016/j.bone.2018.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
Abstract
The trabecular bone score (TBS) is a novel tool using grayscale variograms of the lumbar spine bone mineral density (BMD) to assess trabecular bone microarchitecture. Studies in patients with chronic kidney disease (CKD) suggest it may be helpful in assessing fracture risk. However, TBS has not been validated as a measure of trabecular architecture against transiliac bone biopsy with histomorphometry in CKD patients. We hypothesized that TBS would reflect trabecular architecture at the iliac crest in CKD patients. We obtained tetracycline double labeled transiliac crest bone biopsy, areal BMD of the spine, total hip, femoral neck (FN) and spine TBS by dual energy X-ray absorptiometry (DXA), and cortical and trabecular volumetric density and microarchitecture by high resolution peripheral quantitative computed tomography (HR-pQCT) in CKD patients from two centers: twenty-two patients from Columbia University Medical Center, USA and thirty patients from Hospital das Clinicas - Universidade de São Paulo, Brazil. Two patients were excluded for outlier status. Univariate and multivariate relationships between TBS and measures from DXA, HR-pQCT and histomorphometry were determined. Patients were 50.2 ± 15.8 years old, 23 (46%) were men, and 33 (66%) were on dialysis. TBS was <1.31 in 21 (42%) patients and 22%, 14% and 10% had T-scores ≤ -2.5 at spine, FN and total hip respectively. In univariate regression, TBS was significantly associated with trabecular bone volume (BV/TV), trabecular width (Tb.Wi), trabecular spacing, cortical width but not with trabecular number or cortical porosity. FN Z-score and height were also associated with cancellous BV/TV and Tb.Wi, In multivariate analysis, TBS remained an independent predictor of BV/TV and Tb.Wi. There were no relationships between TBS and dynamic parameters from histomorphometry. These data suggest that TBS reflected trabecular microarchitecture and cortical width measured by bone biopsy in CKD patients. Future studies should address its utility in the identification of CKD patients who may benefit from fracture prevention strategies.
Collapse
Affiliation(s)
- J Ramalho
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - I D B Marques
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil
| | - Didier Hans
- Center of bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David Dempster
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA; Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, NY, USA
| | - Hua Zhou
- Regional Bone Center, Helen Hayes Hospital, West Haverstraw, New York, NY, USA
| | - Parth Patel
- Columbia University College of Physicians & Surgeons, New York, NY, USA
| | - R M R Pereira
- Bone Laboratory Metabolism, Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - V Jorgetti
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil; Hospital Samaritano Americas Serviços Médicos, Sao Paulo, SP, Brazil
| | - R M A Moyses
- Laboratório de Investigação Médica 16, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, SP, Brazil; Universidade Nove de Julho, São Paulo, SP, Brazil
| | - Thomas L Nickolas
- Department of Medicine, Columbia University Medical Center, New York, NY, USA.
| |
Collapse
|
42
|
Cauley JA, Burghardt AJ, Harrison SL, Cawthon PM, Schwartz AV, Connor EB, Ensrud KE, Langsetmo L, Majumdar S, Orwoll E. Accelerated Bone Loss in Older Men: Effects on Bone Microarchitecture and Strength. J Bone Miner Res 2018; 33:1859-1869. [PMID: 29750848 PMCID: PMC6330703 DOI: 10.1002/jbmr.3468] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 01/18/2023]
Abstract
Accelerated bone loss (ABL) shown on routine dual-energy X-ray absorptiometry (DXA) may be accompanied by microarchitectural changes, increased cortical porosity, and lower bone strength. To test this hypothesis, we performed a cross-sectional study and used high-resolution peripheral quantitative computed tomography (HR-pQCT) scans (Scanco Medical AG, Brüttisellen, Switzerland) to measure estimated bone strength and microarchitecture in the distal radius and distal and diaphyseal tibia. We studied 1628 men who attended the year 14 exam of the Osteoporotic Fractures in Men (MrOS) study. We retrospectively characterized areal bone mineral density (aBMD) change from the year 7 to year 14 exam in three categories: "accelerated" loss, ≥10% loss at either the total hip or femoral neck (n = 299, 18.4%); "expected" loss, <10% (n = 1061, 65.2%), and "maintained" BMD, ≥0% (n = 268, 16.5%). The ABL cut-off was a safety alert established for MrOS. We used regression models to calculate adjusted mean HR-pQCT parameters in men with ABL, expected loss, or maintained BMD. Men who experienced ABL were older and had a lower body mass index and aBMD and experienced greater weight loss compared with other men. Total volumetric BMD and trabecular and cortical volumetric BMD were lower in men with ABL compared with the expected or maintained group. Men with ABL had significantly lower trabecular bone volume fraction (BV/TV), fewer trabeculae, and greater trabecular separation at both the distal radius and tibia than men with expected loss or who maintained aBMD, all p trend <0.001. Men with ABL had lower cortical thickness and lower estimated bone strength, but there was no difference in cortical porosity except at the tibia diaphyseal site. In summary, men with ABL have lower estimated bone strength, poorer trabecular microarchitecture, and thinner cortices than men without ABL but have similar cortical porosity. These impairments may lead to an increased risk of fracture. © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Lisa Langsetmo
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Orwoll
- Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
43
|
Starr JF, Bandeira LC, Agarwal S, Shah AM, Nishiyama KK, Hu Y, McMahon DJ, Guo XE, Silverberg SJ, Rubin MR. Robust Trabecular Microstructure in Type 2 Diabetes Revealed by Individual Trabecula Segmentation Analysis of HR-pQCT Images. J Bone Miner Res 2018; 33:1665-1675. [PMID: 29750829 PMCID: PMC6119094 DOI: 10.1002/jbmr.3465] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 04/05/2018] [Accepted: 04/20/2018] [Indexed: 01/27/2023]
Abstract
Type 2 diabetes (T2D) patients have an increased fracture risk, which may be partly explained by compromised bone microarchitecture within the cortical bone compartment. Data on trabecular bone parameters in T2D are contradictory. By high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular microarchitecture is preserved, yet larger trabecular holes are detected in T2D by MRI and DXA-based trabecular bone scores are abnormal. To determine if there are differences in trabecular microstructure, connectivity, and alignment in postmenopausal women with T2D as compared with controls, we performed an individual trabecula segmentation (ITS) analysis on HR-pQCT scans of the distal radius and tibia in 92 women with (n = 42) and without (n = 50) T2D. Unadjusted analyses showed that T2D subjects had greater total trabecular bone volume, trabecular plate volume fraction, plate number density, plate junction density, and axial alignment at the radius and tibia, and increased plate tissue fraction, but decreased rod tissue fraction and rod length at the radius (p < 0.05 for all). After adjustments for clinical covariates, plate number density and plate junction density remained higher at the radius and tibia, whereas total trabecular bone volume was increased and trabecular rod length was decreased at the radius. These differences remained significant after adjustment for hip BMD and trabecular volumetric bone density. Notably, the increased plate-like ITS qualities were seen in those with T2D duration of <10 years, whereas ITS parameters in subjects with T2D duration ≥10 years did not differ from those of control subjects. In conclusion, postmenopausal women with early T2D had a greater plate-like and less rod-like trabecular network. This early advantage in trabecular plate quality does not explain the well-established increased fracture risk in these patients and does not persist in the later stage of T2D. © 2018 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Jessica F Starr
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Leonardo C Bandeira
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sanchita Agarwal
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ankit M Shah
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kyle K Nishiyama
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Donald J McMahon
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - X Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Shonni J Silverberg
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Mishaela R Rubin
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
44
|
Chiba K, Okazaki N, Kurogi A, Isobe Y, Yonekura A, Tomita M, Osaki M. Precision of Second-Generation High-Resolution Peripheral Quantitative Computed Tomography: Intra- and Intertester Reproducibilities and Factors Involved in the Reproducibility of Cortical Porosity. J Clin Densitom 2018; 21:295-302. [PMID: 28256308 DOI: 10.1016/j.jocd.2017.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/23/2017] [Indexed: 11/21/2022]
Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) was upgraded to a second generation in 2014 with higher spatial resolution, faster scan time, and a different measurement algorithm. The purpose of this study was to investigate the precision of the second-generation HR-pQCT. The distal radius and tibia of 15 healthy men and women (age range of 20-74 yr, 8 men and 7 women) were scanned by second-generation HR-pQCT, and their geometry, bone mineral density (BMD), and the microstructure of trabecular and cortical bones were evaluated. Scans and measurements were performed by tester 1 at baseline and at 1 and 4 wk to evaluate intratester reproducibility, and by testers 2 and 3 one time each to evaluate intertester reproducibility. Reproducibility was evaluated by root mean square percent coefficient of variance (RMS%CV). Factors involved in the reproducibility of cortical porosity (Ct.Po) were also investigated. The ranges of RMS%CV were 0.2%-2.5% for geometry, 0.6%-1.7% for BMD, 0.7%-2.4% for trabecular bone, and 1.1%-1.3% for cortical thickness, showing excellent reproducibility. The range of RMS%CV for Ct.Po was 11.0%-13.3%, relatively higher than those for the other parameters. There was no apparent difference between intra- and intertester reproducibilities. There was no clear correlation between the percent coefficient of variance of Ct.Po and the subjects' background characteristics, motion artifact, and cortical bone structure. The reproducibility of the second-generation HR-pQCT was excellent in geometry, BMD, trabecular bone, and cortical thickness, with no apparent difference between intra- and intertester reproducibilities. Compared with the first-generation HR-pQCT, the reproducibility of trabecular bone was improved. The reproducibility of Ct.Po was insufficient and needed to be improved, and factors that influence its reproducibility were not clear.
Collapse
Affiliation(s)
- Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ayako Kurogi
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yusaku Isobe
- Nagasaki University School of Medicine, Nagasaki, Japan
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masato Tomita
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| |
Collapse
|
45
|
Christen P, Müller R. In vivo Visualisation and Quantification of Bone Resorption and Bone Formation from Time-Lapse Imaging. Curr Osteoporos Rep 2017. [PMID: 28639146 DOI: 10.1007/s11914-017-0372-1] [Citation(s) in RCA: 21] [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] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Mechanoregulation of bone cells was proposed over a century ago, but only now can we visualise and quantify bone resorption and bone formation and its mechanoregulation. In this review, we show how the newest advances in imaging and computational methods paved the way for this breakthrough. RECENT FINDINGS Non-invasive in vivo assessment of bone resorption and bone formation was demonstrated by time-lapse micro-computed tomography in animals, and by high-resolution peripheral quantitative computed tomography in humans. Coupled with micro-finite element analysis, the relationships between sites of bone resorption and bone formation and low and high tissue loading, respectively, were shown. Time-lapse in vivo imaging and computational methods enabled visualising and quantifying bone resorption and bone formation as well as its mechanoregulation. Future research includes visualising and quantifying mechanoregulation of bone resorption and bone formation from molecular to organ scales, and translating the findings into medicine using personalised bone health prognosis.
Collapse
Affiliation(s)
- Patrik Christen
- ETH Zurich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland
| | - Ralph Müller
- ETH Zurich, Institute for Biomechanics, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland.
| |
Collapse
|
46
|
Manske SL, Davison EM, Burt LA, Raymond DA, Boyd SK. The Estimation of Second-Generation HR-pQCT From First-Generation HR-pQCT Using In Vivo Cross-Calibration. J Bone Miner Res 2017; 32:1514-1524. [PMID: 28294415 DOI: 10.1002/jbmr.3128] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 11/07/2022]
Abstract
Second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT) provides the highest resolution in vivo to assess bone density and microarchitecture in 3D. Although strong agreement of most outcomes measured with first- (XCTI) and second- (XCTII) generation HR-pQCT has been demonstrated, the ability to use the two systems interchangeably is unknown. From in vivo measurements, we determined the limits of estimating XCTII data from XCTI scans conducted in vivo and whether that estimation can be improved by linear cross-calibration equations. These data are crucial as the research field transitions to the new technology. Our study design established cross-calibration equations by scanning 62 individuals on both systems on the same day and then tested those cross-calibrations on the same cohort 6 months later so that estimated (denoted as XCTII*) and "true" XCTII parameters could be compared. We calculated the generalized least-significant change (GLSC) for those predictions. There was strong agreement between both systems for density (R2 > 0.94), macroarchitecture (R2 > 0.95), and most microarchitecture outcomes with the exception of trabecular thickness (Tb.Th, R2 = 0.51 to 0.67). Linear regression equations largely eliminated the systematic error between XCTII and XCTII* and produced a good estimation of most outcomes, with individual error estimates between 0.2% and 3.4%, with the exception of Tt.BMD. Between-system GLSC was similar to within-XCTI LSC (eg, 8.3 to 41.9 mg HA/cm3 for density outcomes). We found that differences between outcomes assessed with XCTI and XCTII can be largely eliminated by cross-calibration. Tb.Th is poorly estimated because it is measured more accurately by XCTII than XCTI. It may be possible to use cross-calibration for most outcomes when both scanner generations are used for multicenter and longitudinal studies. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Sarah L Manske
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Erin M Davison
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Lauren A Burt
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Duncan A Raymond
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Steven K Boyd
- McCaig Institute for Bone and Joint Health and Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|