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Oza C, Antani M, Mondkar SA, Kajale N, Ojha V, Goel P, Khadilkar V, Khadilkar AV. BoneXpert-derived bone health index reference curves constructed on healthy Indian children and adolescents. Pediatr Radiol 2024; 54:127-135. [PMID: 38099931 DOI: 10.1007/s00247-023-05824-1] [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: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Artificial intelligence (AI)-based applications for the assessment of the paediatric musculoskeletal system like BoneXpert are not only useful to assess bone age (BA) but also to provide a bone health index (BHI) and a standard deviation score (SDS) for both. This allows comparison of the BHI with age- and sex-matched healthy Caucasian children. OBJECTIVE We conducted this study with the objective of generating BHI curves using BoneXpert in healthy Indian children with BA between 2 and 17 years. METHOD We retrospectively reviewed anthropometric parameters, BHI, and BHI SDS data of digitalized left-hand radiographs (joint photographic experts group [jpg] format) of a cohort of 788 paediatric patients from a previous study to which they were recruited to compare various methods of BA assessment. The recruited children represented all age groups for both sexes. The corrected BHI for jpg images was calculated using the formula corrected BHI=BHI*(stature/(avL*50))^0.33333 where stature is height of subject and avL is average length of metacarpal bones. The reference Indian BHI curves and centiles were generated using the Lambda-Mu-Sigma method. RESULT The mean BHI and BHI SDS of the study group were 4.02±0.57 and -1.73±1.09, respectively. The average increase in median BHI from each age group was between 2.5% and 3% in both sexes up to age of 14 years after which it increased to 4.5% to 5%. The mean BHI of Indian children was lower than that of Caucasian children with maximum differences noted in boys at 16 years (21.7%) and girls at 14 years (16%). We report 8.4% SD of BHI for our study sample. Reference percentile curves for BHI according to BA were derived separately for boys and girls. CONCLUSION Reference data has been provided for the screening of bone health status of Indian children and adolescents.
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Affiliation(s)
- Chirantap Oza
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Endogrow Paediatric and Adolescent Endocrine Centre, Ahmedabad, India
- Department of Paediatrics, Narendra Modi Medical College, Ahmedabad, India
| | - Misha Antani
- Department of Pathology, B. J. Medical College, Ahmedabad, India
| | - Shruti A Mondkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
| | - Neha Kajale
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
| | - Vikas Ojha
- Department of Radiology, Jehangir Hospital, Pune, India
| | - Pranay Goel
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Vaman Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India
- Jehangir Hospital, Pune, India
| | - Anuradha V Khadilkar
- Department of Paediatric Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Old Building Basement, Jehangir Hospital, 32, Sassoon Road, Pune, Maharashtra, 411001, India.
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, India.
- Jehangir Hospital, Pune, India.
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Rosendahl K, Lundestad A, Bjørlykke JA, Lein RK, Angenete O, Augdal TA, Müller LSO, Jaramillo D. Revisiting the radiographic assessment of osteoporosis-Osteopenia in children 0-2 years of age. A systematic review. PLoS One 2020; 15:e0241635. [PMID: 33137162 PMCID: PMC7605664 DOI: 10.1371/journal.pone.0241635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 10/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Imaging for osteoporosis has two major aims, first, to identify the presence of low bone mass (osteopenia), and second, to quantify bone mass using semiquantitative (conventional radiography) or quantitative (densitometry) methods. In young children, densitometry is hampered by the lack of reference values, and high-quality radiographs still play a role although the evaluation of osteopenia as a marker for osteoporosis is subjective and based on personal experience. Medical experts questioned in court over child abuse, often refer to the literature and state that 20-40% loss of bone mass is warranted before osteopenia becomes evident on radiographs. In our systematic review, we aimed at identifying evidence underpinning this statement. A secondary outcome was identifying normal references for cortical thickness of the skeleton in infants born term, < 2 years of age. METHODS We undertook systematic searches in Medline, Embase and Svemed+, covering 1946-2020. Unpublished material was searched in Clinical trials and International Clinical Trials Registry Platform (ICTRP). Both relevant subject headings and free text words were used for the following concepts: osteoporosis or osteopenia, radiography, children up to 6 years. RESULTS A total 5592 publications were identified, of which none met the inclusion criteria for the primary outcome; the degree of bone loss warranted before osteopenia becomes visible radiographically. As for the secondary outcome, 21 studies were identified. None of the studies was true population based and none covered the pre-defined age range from 0-2 years. However, four studies of which three having a crossectional and one a longitudinal design, included newborns while one study included children 0-2 years. CONCLUSIONS Despite an extensive literature search, we did not find any studies supporting the assumption that a 20-40% bone loss is required before osteopenia becomes visible on radiographs. Reference values for cortical thickness were sparse. Further studies addressing this important topic are warranted.
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Affiliation(s)
- Karen Rosendahl
- Faculty of Health Sciences, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
- * E-mail:
| | | | - John Asle Bjørlykke
- Section of Paediatric Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Oskar Angenete
- Department of Radiology and Nuclear Medicine, St Olav Hospital, Trondheim, Norway
- Department of Circulation and Medical imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Angell Augdal
- Faculty of Health Sciences, Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
- Section of Paediatric Radiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Diego Jaramillo
- Columbia University Medical Center, New York, New York, United States of America
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Slavcheva-Prodanova O, Konstantinova M, Tsakova A, Savova R, Archinkova M. Bone Health Index and bone turnover in pediatric patients with type 1 diabetes mellitus and poor metabolic control. Pediatr Diabetes 2020; 21:88-97. [PMID: 31599085 DOI: 10.1111/pedi.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/23/2019] [Accepted: 09/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is a need for a non-invasive, affordable, and reliable method for bone health screening in pediatric patients at risk. OBJECTIVE To assess Bone Health Index (BHI) in pediatric patients with type 1 diabetes (T1D) and its relation to bone metabolism, age at onset, duration, control, and insulin dose. SUBJECTS AND METHODS Left-hand radiographs were obtained from 65 patients with T1D, mean age 11.23 ± 3.89 years, mean disease duration 5.23 ± 3.76 years and mean glycosylated hemoglobin (HbA1c)-83 mmol/mol (9.7%). Blood and 24 hours urine samples were collected for bone and mineral metabolism assessment. BoneXpert was used to determine BHI, Bone Health Index standard deviation score (BHI SDS), and bone age. RESULTS Mean BHI SDS was -1.15 ± 1.19 (n = 54). In 20.37% (n = 11) BHI SDS was < -2SD with mean value -2.82 ± 0. 69, P < .001. These patients had lower levels of beta cross laps (0.77 ± 0.33 ng/mL vs 1.17 ± 0.47 ng/mL), osteocalcin (47.20 ± 14.07 ng/mL vs 75.91 ± 32.08 ng/mL), serum magnesium (0.79 ± 0.05 mmol/L vs 0.83 ± 0.06 mmol/L) and phosphorus (1.48 ± 0.29 mmol/L vs 1.71 ± 0.28 mmol/L) but higher ionized calcium (1.29 ± 0.04 mmol/L vs 1.26 ± 0.05 mmol/L), P < .05, compared to patients with BHI SDS in the normal range. We found a positive correlation between BHI SDS and age at manifestation (r = 0.307, P = 0.024) and a negative one with disease duration (r = -0.284, P = .038). No correlations were found with HbA1c, insulin dose, height, weight, BMI. CONCLUSIONS To the best of our knowledge, this is the first study to assess bone health in pediatric patients with T1D using BHI. We found significantly decreased cortical bone density and bone turnover in 20.37%. Earlier age at onset and diabetes duration may have a negative impact on cortical bone density in patients with poor control. Longitudinal studies are needed to follow changes or to assess future interventions.
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Affiliation(s)
- Olga Slavcheva-Prodanova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Maia Konstantinova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Adelina Tsakova
- Central Clinical Laboratory, Alexandrovska Hospital, Medical University - Sofia, Bulgaria
| | - Radka Savova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
| | - Margarita Archinkova
- Department of Endocrinology, Diabetes and Genetics, University Children's Hospital, Medical University - Sofia, Bulgaria
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Schündeln MM, Marschke L, Bauer JJ, Hauffa PK, Schweiger B, Führer-Sakel D, Lahner H, Poeppel TD, Kiewert C, Hauffa BP, Grasemann C. A Piece of the Puzzle: The Bone Health Index of the BoneXpert Software Reflects Cortical Bone Mineral Density in Pediatric and Adolescent Patients. PLoS One 2016; 11:e0151936. [PMID: 27014874 PMCID: PMC4807844 DOI: 10.1371/journal.pone.0151936] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/07/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Suspected osteopathology in chronically ill children often necessitates the assessment of bone mineral density. The most frequently used methods are dual-energy X-ray-absorption (DXA) and peripheral quantitative computed tomography (pQCT). The BoneXpert software provides an automated radiogrammatic method to assess skeletal age from digitalized X-rays of the left hand. Furthermore, the program calculates the Bone Health Index (BHI), a measure of cortical thickness and mineralization, which is obtained from indices of three metacarpal bones. In our study, we analyzed the manner in which BHI information provided by BoneXpert compares with DXA or pQCT measurements in youths. STUDY DESIGN The BHI was retrospectively obtained using digitalized X-rays of the left hand and compared with the results of 203 corresponding DXA readings (Lunar Prodigy, GE Healthcare) of the lumbar vertebrae and femur as well as 117 pQCT readings (XCT 900, Stratec) of the distal radius. RESULTS The BHI values showed a strong positive correlation with the DXA readings at each and all lumbar vertebrae (L1 -L4: r = 0.73; P < 0.0001). The age-adjusted Z-score of L1 -L4 and the height-adjusted score showed a positive correlation with the BHI-SDS (standard deviation score, r = 0.23; P < 0.002 and r = 0.27; P < 0.001, respectively). Total bone mineral density, as assessed via pQCT, also positively correlated with the BHI (r = 0.39; P < 0.0001), but the trabecular values displayed only a weak correlation. CONCLUSIONS The BHI obtained using BoneXpert can be a useful parameter in the assessment of bone health in children in most cases. This technique provides observer-independent information on cortical thickness and mineralization based on X-ray imaging of the hands.
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Affiliation(s)
- Michael M. Schündeln
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Laura Marschke
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Jens J. Bauer
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Pia K. Hauffa
- Pediatric Hematology and Oncology, Kinderklinik III, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Bernd Schweiger
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer-Sakel
- Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Harald Lahner
- Department of Endocrinology and Metabolism, Medical Center, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Thorsten D. Poeppel
- Clinik for Nuclear Medicine, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Cordula Kiewert
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Berthold P. Hauffa
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
| | - Corinna Grasemann
- Pediatric Endocrinology and Diabetology, Kinderklinik II, Universitätsklinikum-Essen and the University of Duisburg-Essen, Essen, Germany
- * E-mail:
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Renz DM, Malich A, Ulrich A, Pfeil A, Mentzel HJ, Streitparth F, Maurer MH, Teichgräber UK, Böttcher J. Reference values for digital X-ray radiogrammetry parameters in children and adolescents in comparison to estimates in patients with distal radius fractures. J Bone Miner Metab 2016; 34:55-64. [PMID: 25687428 DOI: 10.1007/s00774-014-0641-3] [Citation(s) in RCA: 3] [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: 07/14/2014] [Accepted: 11/06/2014] [Indexed: 10/24/2022]
Abstract
The first objective of this study was to determine normative digital X-ray radiogrammetry (DXR) values, based on original digital images, in a pediatric population (aged 6-18 years). The second aim was to compare these reference data with patients suffering from distal radius fractures, whereas both cohorts originated from the same geographical region and were evaluated using the same technical parameters as well as inclusion and exclusion criteria. DXR-BMD and DXR-MCI of the metacarpal bones II-IV were assessed on standardized digital hand radiographs, without printing or scanning procedures. DXR parameters were estimated separately by gender and among six age groups; values in the fracture group were compared to age- and gender-matched normative data using Student's t tests and Z scores. In the reference cohort (150 boys, 138 girls), gender differences were found in bone mineral density (DXR-BMD), with higher values for girls from 11 to 14 years and for boys from 15 to 18 years (p < 0.05). Girls had higher normative metacarpal index (DXR-MCI) values than boys, with significant differences at 11-14 years (p < 0.05). In the case-control investigation, the fracture group (95 boys, 69 girls) presented lower DXR-BMD at 15-18 years in boys and 13-16 years in girls vs. the reference cohort (p < 0.05); DXR-MCI was lower at 11-18 years in boys and 11-16 years in girls (p < 0.05). Mean Z scores in the fracture group for DXR-BMD were -0.42 (boys) and -0.46 (girls), and for DXR-MCI were -0.51 (boys) and -0.53 (girls). These findings indicate that the fully digital DXR technique can be accurately applied in pediatric populations ≥ 6 years of age. The lower DXR-BMD and DXR-MCI values in the fracture group suggest promising early identification of individuals with increased fracture risk, without the need for additional radiation exposure, enabling the initiation of prevention strategies to possibly reduce the incidence of osteoporosis later in life.
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Affiliation(s)
- Diane M Renz
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Ansgar Malich
- Institute of Diagnostic Radiology, Suedharz Clinic Nordhausen, Dr. Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - Andreas Ulrich
- Institute of Diagnostic Radiology, Suedharz Clinic Nordhausen, Dr. Robert-Koch-Str. 39, 99734, Nordhausen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Hans-Joachim Mentzel
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Florian Streitparth
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin H Maurer
- Department of Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ulf K Teichgräber
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller-University, Erlanger Allee 101, 07740, Jena, Germany
| | - Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, SRH Clinic Gera, Str. des Friedens 122, 07548, Gera, Germany
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Martin DD, Heckmann C, Neuhof J, Jenni OG, Ranke MB, Binder G. Comparison of radiogrammetrical metacarpal indices in children and reference data from the First Zurich Longitudinal Study. Pediatr Radiol 2012; 42:982-91. [PMID: 22669456 PMCID: PMC3414699 DOI: 10.1007/s00247-012-2390-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 12/17/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND A number of radiogrammetrical metacarpal indices are in use, some of which have been adapted for children. OBJECTIVE The purpose of this study was to compare four known indices-bone mineral density (BMD), relative cortical area, Exton-Smith index, bending breaking resistance index-and the more recently defined pediatric bone index (PBI) according to the two criteria of minimum height dependence and minimum variability in children of equal bone age. MATERIALS AND METHODS A total of 3,121 left-hand radiographs from 231 healthy Caucasian children ranging in age from 3 to 19 years old were analysed using BoneXpert®, a programme for automatic analysis of hand radiographs and assessment of bone age. RESULTS Dependence on height for chronological age or bone age and the mean relative standard deviation were lowest in the PBI for both genders pooled. The differences in height dependence were statistically significant and are shown to be clinically relevant. Reference data for PBI are presented. CONCLUSION PBI may be a better indicator than BMD for bone health in children; however, verification in a clinical group is needed.
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Affiliation(s)
- David D Martin
- Pediatric Endocrinology and Diabetology, University Children's Hospital Tübingen, Hoppe-Seyler-Str 1, 72076 Tuebingen, Germany.
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Thodberg HH, van Rijn RR, Tanaka T, Martin DD, Kreiborg S. A paediatric bone index derived by automated radiogrammetry. Osteoporos Int 2010; 21:1391-400. [PMID: 19937229 PMCID: PMC2895878 DOI: 10.1007/s00198-009-1085-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Accepted: 09/11/2009] [Indexed: 11/28/2022]
Abstract
SUMMARY Hand radiographs are obtained routinely to determine bone age of children. This paper presents a method that determines a Paediatric Bone Index automatically from such radiographs. The Paediatric Bone Index is designed to have minimal relative standard deviation (7.5%), and the precision is determined to be 1.42%. INTRODUCTION We present a computerised method to determine bone mass of children based on hand radiographs, including a reference database for normal Caucasian children. METHODS Normal Danish subjects (1,867), of ages 7-17, and 531 normal Dutch subjects of ages 5-19 were included. Historically, three different indices of bone mass have been used in radiogrammetry all based on A = piTW(1 - T/W), where T is the cortical thickness and W the bone width. The indices are the metacarpal index A/W(2), DXR-BMD = A/W, and Exton-Smith's index A/(WL), where L is the length of the bone. These indices are compared with new indices of the form A/(W(a) L(b)), and it is argued that the preferred index has minimal SD relative to the mean value at each bone age and sex. Finally, longitudinal series of X-rays of 20 Japanese children are used to derive the precision of the measurements. RESULTS The preferred index is A/(W(1.33) L(0.33)), which is named the Paediatric Bone Index, PBI. It has mean relative SD 7.5% and precision 1.42%. CONCLUSIONS As part of the BoneXpert method for automated bone age determination, our method facilitates retrospective research studies involving validation of the proposed index against fracture incidence and adult bone mineral density.
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Affiliation(s)
- H H Thodberg
- Visiana, Søllerødvej 57 C, 2840, Holte, Denmark.
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Abstract
Metacarpal morphometry and radiogrammetry are the oldest methods for quantitative assessment of the skeleton. The historical aspects of these measurements are reviewed. Although they were inexpensive and widely available and provided useful research and epidemiologic information, they were labor intensive and imprecise. They were replaced with the current established methods of bone mineral densitometry. With the application of modern computer vision techniques, metacarpal morphometric analysis has been rejuvenated, with improvement in precision and evidence that the method can be applied to studies in adults and children. Evidence for limited normal reference data and the ability to predict future fractures in osteoporosis and reflect activity and predict outcomes in rheumatoid arthritis are presented.
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van Rijn R, Van Kuijk C. Of small bones and big mistakes; bone densitometry in children revisited. Eur J Radiol 2009; 71:432-9. [DOI: 10.1016/j.ejrad.2008.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 12/18/2022]
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Kalichman L, Malkin I, Bigman G, Matias R, Seibel MJ, Kobyliansky E, Livshits G. Age-Related Changes in Bone-Strength-Associated Geometry Indices in Naive Human Population. Anat Rec (Hoboken) 2008; 291:835-44. [DOI: 10.1002/ar.20707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Goerres GW, Frey D, Hany TF, Seifert B, Häuselmann HJ, Studer A, Hauser D, Zilic N, Michel BA, Hans D, Uebelhart D. Digital X-ray radiogrammetry better identifies osteoarthritis patients with a low bone mineral density than quantitative ultrasound. Eur Radiol 2006; 17:965-74. [PMID: 16953374 DOI: 10.1007/s00330-006-0382-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 05/29/2006] [Accepted: 06/23/2006] [Indexed: 01/01/2023]
Abstract
This study assessed the ability of quantitative ultrasound (QUS) and digital X-ray radiogrammetry (DXR) to identify osteopenia and osteoporosis in patients with knee osteoarthritis (OA). One hundred and sixty-one patients with painful knee OA (81 men, 80 women; age 62.6+/-9.2 years, range 40-82 years) were included in this cross-sectional study and underwent dual-energy X-ray absorptiometry (DXA) of both hips and the lumbar spine, QUS of the phalanges and calcanei of both hands and heels, and DXR using radiographs of both hands. Unpaired t-test, Mann-Whitney U test, ROC analysis and Spearman's rank correlation were used for comparisons and correlation of methods. Using DXA as the reference standard, we defined a low bone mineral density (BMD) as a T-score < or =-1.0 at the lumbar spine or proximal femur. In contrast to phalangeal or calcaneal QUS, DXR was able to discriminate patients with a low BMD at the lumbar spine (p<0.0001) or hips (p<0.0001). ROC analysis showed that DXR had an acceptable predictive power in identifying OA patients a low hip BMD (sensitivity 70%, specificity 71%). Therefore, DXR used as a screening tool could help in identifying patients with knee OA for DXA.
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Affiliation(s)
- Gerhard W Goerres
- Institute of Diagnostic Radiology, Department of Medical Radiology, University Hospital Zurich, Raemistr. 100, CH-8091, Zurich, Switzerland.
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Böttcher J, Pfeil A, Schäfer ML, Petrovitch A, Seidl BE, Mentzel HJ, Lehmann G, Malich A, Heyne JP, Hein G, Wolf G, Kaiser WA. Normative data for digital X-ray radiogrammetry from a female and male German cohort. J Clin Densitom 2006; 9:341-50. [PMID: 16931354 DOI: 10.1016/j.jocd.2006.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2006] [Revised: 05/22/2006] [Accepted: 06/03/2006] [Indexed: 01/01/2023]
Abstract
This study presents German reference data for digital X-ray radiogrammetry (DXR) differentiated by males as well as females, and quantifies for gender-specific and age-related differences including all DXR parameters. This study also documents the effects of different X-ray settings (e.g., radiographs of the wrist or the hand) on DXR measurements. There were 2085 patients who were prospectively enrolled (954 females and 1131 males) from a data pool of 11,915 patients with radiographs of the nondominant hand or wrist. All patients underwent measurements of bone mineral density (BMD), cortical thickness, bone width, and the metacarpal index (MCI) using DXR technology. These data showed a continuous age-related increase of the DXR parameters to the point of peak bone mass, then a continuous decline beyond the peak bone mass with accentuated age-related cortical bone loss in women. Peak bone mass is reached at approximately 30-34 yr for women and 45-49 yr for men. In addition, men had a significantly higher DXR BMD (mean: +12.8%) compared with woman in all age groups. Regarding the impact of various X-ray settings (e.g., X-ray(wrist) vs. X-ray(hand)), no significant difference was observed between both groups, men as well as women. The development of digital imaging technology has enabled more precise measurements of several radio-geometric features. The present study estimated normative reference values for DXR in German Caucasian women and men. Based on this reference data, a valid and reliable quantification of disease-related demineralization based on measurements of DXR BMD and MCI is now available for the Caucasian ethnic group.
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Affiliation(s)
- Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Jena, Germany.
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15
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Mentzel HJ, Blume J, Boettcher J, Lehmann G, Tuchscherer D, Pfeil A, Kramer A, Malich A, Kauf E, Hein G, Kaiser WA. The potential of digital X-ray radiogrammetry (DXR) in the assessment of osteopenia in children with chronic inflammatory bowel disease. Pediatr Radiol 2006; 36:415-20. [PMID: 16506029 DOI: 10.1007/s00247-005-0093-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 11/15/2005] [Accepted: 12/04/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Loss of bone mass is a known complication of chronic inflammatory bowel disease (IBD) in children. The gold standard in the evaluation of bone mineral density (BMD) is dual energy X-ray absorptiometry (DXA). OBJECTIVE In this preliminary study we evaluated digital X-ray radiogrammetry (DXR) which estimates BMD (DXR-BMD) from hand radiographs in children with IBD. MATERIALS AND METHODS A total of 26 children with IBD (10 girls, 16 boys; age range 10-18 years) underwent DXR for the calculation of DXR-BMD and metacarpal index (DXR-MCI) using the Pronosco X-posure system. The results were compared with a local reference database and correlated with the results of DXA. RESULTS DXR-BMD was 0.36-0.56 g/cm(2) (median 0.46 g/cm(2)) in Crohn disease patients and 0.38-0.63 g/cm(2) (median 0.48 g/cm(2)) in ulcerative colitis patients. DXR-MCI was 0.29-0.49 in Crohn disease patients and 0.28-0.53 in ulcerative colitis patients. The Z-scores were reduced to <-1 SD in five Crohn disease patients and in six ulcerative colitis patients. The coefficients (r) for the correlations between DXR-BMD and DXA-BMD were 0.78 for the lumbar spine and 0.61 for the proximal femur (P<0.01), and between DXR-MCI and DXA-BMD were 0.78 for the lumbar spine and 0.51 for the proximal femur (P<0.01). CONCLUSIONS DXR seems to be able to estimate cortical osteopenia in children with chronic IBD. The DXR results showed a positive correlation with DXA results.
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Affiliation(s)
- Hans-Joachim Mentzel
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Bachstrasse 18, 07740, Jena, Germany.
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16
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van Rijn RR, Boot A, Wittenberg R, van der Sluis IM, van den Heuvel-Eibrink MM, Lequin MH, de MuinckKeizer-Schrama SMPF, Van Kuijk C. Direct X-ray radiogrammetry versus dual-energy X-ray absorptiometry: assessment of bone density in children treated for acute lymphoblastic leukaemia and growth hormone deficiency. Pediatr Radiol 2006; 36:227-32. [PMID: 16432701 DOI: 10.1007/s00247-005-0080-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 11/13/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND In recent years interest in bone densitometry in children has increased. OBJECTIVE To evaluate the clinical application of digital X-ray radiogrammetry (DXR) and compare the results with those of dual-energy X-ray absorptiometry (DXA). MATERIALS AND METHODS A total of 41 children with acute lymphoblastic leukaemia (ALL) and 26 children with growth hormone deficiency (GHD) were included in this longitudinal study. Radiographs of the left hand were obtained and used for DXR. DXA of the total body and of the lumbar spine was performed. RESULTS In both study populations significant correlations between DXR and DXA were found, and, with the exception of the correlation between DXR bone mineral density (DXR-BMD) and bone mineral apparent density in the GHD population, all correlations had a P-value of <0.001. During treatment a change in DXR-BMD was found in children with GHD. CONCLUSIONS Our study showed that DXR in a paediatric population shows a strong correlation with DXA of the lumbar spine and total body and that it is able to detect a change in BMD during treatment.
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Affiliation(s)
- Rick R van Rijn
- Department of Radiology, Academic Medical Centre Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam Zuid-Oost, The Netherlands.
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Toledo VAM, Jergas M. Age-related changes in cortical bone mass: data from a German female cohort. Eur Radiol 2005; 16:811-7. [PMID: 16215737 DOI: 10.1007/s00330-005-0013-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 07/22/2005] [Accepted: 08/19/2005] [Indexed: 01/01/2023]
Abstract
To describe data from digital radiogrammetry (DXR) in an unselected German female cohort over a wide age range. Using a retrospective study design we analyzed radiographs of the hand from 540 German women (aged 5-96 years) using an automated assessment of cortical thickness, metacarpal index (MCI), and estimated cortical bone mineral density (DXR-BMD) on digitized radiographs. Both hands were radiographed in 97 women. In this group DXR-BMD and cortical thickness were significantly higher in the right metacarpals while there was no significant difference in MCI. To study the association with age we differentiated young (<20 years), middle-aged (20-45 years), and an older patients (>45 years). In young women all parameters increased significantly with age in a linear fashion (r=0.8 for DXR-BMD, r=0.7 for MCI). In those aged 25-45 years DXR-BMD and MCI were highest (peak bone mass). In women aged 45 or older all parameters decreased with age in an almost linear fashion with an annual change ranging from 0.7% to 0.9%. Our results for an unselected German female cohort indicate that DXR is a reliable, widely available osteodensitometric technique based on the refinement of conventional radiogrammetry. These findings are comparable to those from other studies and represent a valid resource for clinical application and for comparisons with other ethnic groups.
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Affiliation(s)
- V A Molina Toledo
- Department of Diagnostic and Interventional Radiology, St. Elisabeth-Krankenhaus, Cologne, Germany
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Mentzel HJ, John U, Boettcher J, Malich A, Pfeil A, Vollandt R, Misselwitz J, Kaiser WA. Evaluation of bone-mineral density by digital X-ray radiogrammetry (DXR) in pediatric renal transplant recipients. Pediatr Radiol 2005; 35:489-94. [PMID: 15624109 DOI: 10.1007/s00247-004-1381-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2004] [Revised: 10/26/2004] [Accepted: 11/01/2004] [Indexed: 01/01/2023]
Abstract
BACKGROUND Loss of bone mass and increased fracture risk are known complications after renal transplantation in adults. Risk factors include donor source, dialysis status prior to transplantation, aetiology of renal disease, transplant rejection and drug therapy, particularly steroids. OBJECTIVE In this preliminary study of quantification of bone loss in children after renal transplantion, we evaluated the applicability of digital X-ray radiogrammetry (DXR) of hand radiographs to estimate cortical bone mineral density (DXR-BMD). MATERIALS AND METHODS A total of 23 renal transplant recipients (9 girls, 14 boys; age 6.5-20 years, median 16.3 years) underwent DXR measurements for calculation of DXR-BMD and metacarpal index (DXR-MCI) using radiographs of the non-dominant left hand. The duration between transplantation and the DXR evaluation, the duration of dialysis and medication were considered. The results were compared to a local age-matched and gender-matched reference data base. RESULTS Our study revealed a significant decrease in bone mineral density compared to an age-matched and sex-matched normal population (P<0.05). In three patients the DXR-BMD was reduced more than -2.5 SD. In 12 patients the DXR-BMD was between -1 and -2.5 SD, and in 7 patients the DXR-BMD was in the normal range. In one patient, evaluation was not possible. Fractures were documented in three patients following transplantation. Reduced DXR-BMD was not significantly associated with immunosuppressive therapy or the duration of dialysis, and there was no significant correlation between DXR-BMD and the time between transplantation and DXR evaluation. CONCLUSIONS Paediatric renal transplant patients show reduced DXR-BMD. In this preliminary study we demonstrated that DXR-BMD seems to be a reliable technique for quantification of demineralisation following renal transplantation in children.
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Affiliation(s)
- Hans-J Mentzel
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Bachstrasse 18, 07740 Jena, Germany.
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Böttcher J, Pfeil A, Rosholm A, Malich A, Petrovitch A, Heinrich B, Lehmann G, Mentzel HJ, Hein G, Linss W, Kaiser WA. Influence of image-capturing parameters on digital X-ray radiogrammetry. J Clin Densitom 2005; 8:87-94. [PMID: 15722592 DOI: 10.1385/jcd:8:1:087] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Revised: 09/20/2004] [Accepted: 09/20/2004] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to evaluate the importance of different image-capturing conditions, which might influence the characteristics of radiographs and, consequently, impact calculations of bone mineral density (BMD) and Metacarpal Index (MCI) using digital X-ray radiogrammetry (DXR). Radiographs of the left hand of deceased males were acquired three times using systematically varied parameters: 4-8 miliamp seconds (mA); 40-52 kV; film-focus distance (FFD); 90-130 cm; film sensitivity, 200/400; and different image modalities (conventional vs original digital radiographs as well as digital printouts). Furthermore, the interradiograph reproducibility using both conventional equipment and printouts vs originals of digital images and the intraradiograph reproducibility (either conventional or digital printouts) were evaluated. All BMD and MCI measurements were obtained with the DXR technology. The interradiograph reproducibility of DXR-BMD using conventional images under standardized conditions (6 mAs; 42 kV; 1 m FFD; film sensitivity of 200) was calculated to be coefficient of variation (CV) = 0.49% for Agfa Curix film and CV = 0.33% for Kodak T-MAT-Plus film, whereas reproducibility error using digital images ranged from CV = 0.57% (digital printouts; Philips) to CV = 1.50% (original digital images; Siemens). The intraradiograph reproducibility error was observed to be CV = 0.13% (conventional; Kodak film) vs CV = 0.27% (digital printouts; Philips). The BMD calculation was not noticeably affected by changes of FFD, exposure level, or film sensitivity/film brand, but was influenced by tube voltage (CV = 0.99% for Kodak film to CV = 2.05% for Siemens digital printouts). No significant differences were observed between the BMD and MCI data. DXR provides measurements of MCI and BMD with high precision and reproducibility. The measurements are unaffected by all tested image-capturing conditions, with the exception of tube voltage. In addition, different digital image devices clearly have an effect on DXR reproducibility.
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Affiliation(s)
- Joachim Böttcher
- Institute of Diagnostic and Interventional Radiology Friedrich-Schiller-University Jena, Erlanger Allee 101, 07747 Jena, Germany.
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