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Collins CJ, Atkins PR, Ohs N, Blauth M, Lippuner K, Müller R. Clinical observation of diminished bone quality and quantity through longitudinal HR-pQCT-derived remodeling and mechanoregulation. Sci Rep 2022; 12:17960. [PMID: 36289391 PMCID: PMC9606273 DOI: 10.1038/s41598-022-22678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
High resolution peripheral quantitative computed tomography (HR-pQCT) provides methods for quantifying volumetric bone mineral density and microarchitecture necessary for early diagnosis of bone disease. When combined with a longitudinal imaging protocol and finite element analysis, HR-pQCT can be used to assess bone formation and resorption (i.e., remodeling) and the relationship between this remodeling and mechanical loading (i.e., mechanoregulation) at the tissue level. Herein, 25 patients with a contralateral distal radius fracture were imaged with HR-pQCT at baseline and 9-12 months follow-up: 16 patients were prescribed vitamin D3 with/without calcium supplement based on a blood biomarker measures of bone metabolism and dual-energy X-ray absorptiometry image-based measures of normative bone quantity which indicated diminishing (n = 9) or poor (n = 7) bone quantity and 9 were not. To evaluate the sensitivity of this imaging protocol to microstructural changes, HR-pQCT images were registered for quantification of bone remodeling and image-based micro-finite element analysis was then used to predict local bone strains and derive rules for mechanoregulation. Remodeling volume fractions were predicted by both average values of trabecular and cortical thickness and bone mineral density (R2 > 0.8), whereas mechanoregulation was affected by dominance of the arm and group classification (p < 0.05). Overall, longitudinal, extended HR-pQCT analysis enabled the identification of changes in bone quantity and quality too subtle for traditional measures.
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Affiliation(s)
- Caitlyn J. Collins
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland ,grid.438526.e0000 0001 0694 4940Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA USA
| | - Penny R. Atkins
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland ,grid.5734.50000 0001 0726 5157Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.223827.e0000 0001 2193 0096Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT USA
| | - Nicholas Ohs
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Michael Blauth
- grid.5361.10000 0000 8853 2677Department of Orthopedics and Trauma Surgery, Medical University of Innsbruck, Innsbruck, Austria ,Clinical Medical Department DePuy Synthes, Zuchwil, Switzerland
| | - Kurt Lippuner
- grid.5734.50000 0001 0726 5157Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ralph Müller
- grid.5801.c0000 0001 2156 2780Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
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Tsuji K, Kitamura M, Chiba K, Muta K, Yokota K, Okazaki N, Osaki M, Mukae H, Nishino T. Comparison of bone microstructures via high-resolution peripheral quantitative computed tomography in patients with different stages of chronic kidney disease before and after starting hemodialysis. Ren Fail 2022; 44:381-391. [PMID: 35220856 PMCID: PMC8890516 DOI: 10.1080/0886022x.2022.2043375] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic kidney disease (CKD) negatively affects bone strength; however, the osteoporotic conditions in patients with CKD are not fully understood. Moreover, the changes in bone microstructure between pre-dialysis and dialysis are unknown. High-resolution peripheral quantitative computed tomography (HR-pQCT) reveals the three-dimensional microstructures of the bone. We aimed to evaluate bone microstructures in patients with different stages of CKD. This study included 119 healthy men and 40 men admitted to Nagasaki University Hospital for inpatient education or the initiation of hemodialysis. The distal radius and tibia were scanned with HR-pQCT. Patient clinical characteristics and bone microstructures were evaluated within 3 months of initiation of hemodialysis (in patients with CKD stage 5 D), patients with CKD stage 4–5, and healthy volunteers. Cortical bone parameters were lower in the CKD group than in healthy controls. Tibial cortical and trabecular bone parameters (cortical thickness, cortical area, trabecular volumetric bone mineral density, trabecular-bone volume fraction, and trabecular thickness) differed between patients with CKD stage 5 D and those with CKD stage 4–5 (p < 0.01). These differences were also observed between patients with CKD stage 5 and those with CKD stage 5 D (p < 0.017), but not between patients with CKD stage 4 and those with CKD stage 5, suggesting that the bone microstructure rapidly changed at the start of hemodialysis. Patients with CKD stage 5 D exhibited tibial microstructural impairment compared with those with CKD stage 4–5. HR-pQCT is useful for elucidation of the pathology of bone microstructures in patients with renal failure.
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Affiliation(s)
- Kiyokazu Tsuji
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuaki Yokota
- 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
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Frank M, Reisinger AG, Pahr DH, Thurner PJ. Effects of Osteoporosis on Bone Morphometry and Material Properties of Individual Human Trabeculae in the Femoral Head. JBMR Plus 2021; 5:e10503. [PMID: 34189388 PMCID: PMC8216141 DOI: 10.1002/jbm4.10503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/30/2021] [Accepted: 04/10/2021] [Indexed: 12/02/2022] Open
Abstract
Osteoporosis is the most common bone disease and is conventionally classified as a decrease of total bone mass. Current diagnosis of osteoporosis is based on clinical risk factors and dual energy X‐ray absorptiometry (DEXA) scans, but changes in bone quantity (bone mass) and quality (trabecular structure, material properties, and tissue composition) are not distinguished. Yet, osteoporosis is known to cause a deterioration of the trabecular network, which might be related to changes at the tissue scale—the material properties. The goal of the current study was to use a previously established test method to perform a thorough characterization of the material properties of individual human trabeculae from femoral heads in cyclic tensile tests in a close to physiologic, wet environment. A previously developed rheological model was used to extract elastic, viscous, and plastic aspects of material behavior. Bone morphometry and tissue mineralization were determined with a density calibrated micro‐computed tomography (μCT) set‐up. Osteoporotic trabeculae neither showed a significantly changed material or mechanical behavior nor changes in tissue mineralization, compared with age‐matched healthy controls. However, donors with osteopenia indicated significantly reduced apparent yield strain and elastic work with respect to osteoporosis, suggesting possible initial differences at disease onset. Bone morphometry indicated a lower bone volume to total volume for osteoporotic donors, caused by a smaller trabecular number and a larger trabecular separation. A correlation of age with tissue properties and bone morphometry revealed a similar behavior as in osteoporotic bone. In the range studied, age does affect morphometry but not material properties, except for moderately increased tissue strength in healthy donors and moderately increased hardening exponent in osteoporotic donors. Taken together, the distinct changes of trabecular bone quality in the femoral head caused by osteoporosis and aging could not be linked to suspected relevant changes in material properties or tissue mineralization. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Martin Frank
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria
| | - Andreas G Reisinger
- Department of Anatomy and Biomechanics, Division Biomechanics Karl Landsteiner University of Health Sciences Dr. Karl-Dorrek-Straße 30 Krems 3500 Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria.,Department of Anatomy and Biomechanics, Division Biomechanics Karl Landsteiner University of Health Sciences Dr. Karl-Dorrek-Straße 30 Krems 3500 Austria
| | - Philipp J Thurner
- Institute of Lightweight Design and Structural Biomechanics TU Wien Gumpendorfer Straße 7 Vienna 1060 Austria
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Daniels AM, Wyers CE, Janzing HMJ, Sassen S, Loeffen D, Kaarsemaker S, van Rietbergen B, Hannemann PFW, Poeze M, van den Bergh JP. The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT. Bone Joint J 2020; 102-B:478-484. [DOI: 10.1302/0301-620x.102b4.bjj-2019-0632.r3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Besides conventional radiographs, the use of MRI, CT, and bone scintigraphy is frequent in the diagnosis of a fracture of the scaphoid. However, which techniques give the best results remain unknown. The investigation of a new imaging technique initially requires an analysis of its precision. The primary aim of this study was to investigate the interobserver agreement of high-resolution peripheral quantitative CT (HR-pQCT) in the diagnosis of a scaphoid fracture. A secondary aim was to investigate the interobserver agreement for the presence of other fractures and for the classification of scaphoid fracture. Methods Two radiologists and two orthopaedic trauma surgeons evaluated HR-pQCT scans of 31 patients with a clinically-suspected scaphoid fracture. The observers were asked to determine the presence of a scaphoid or other fracture and to classify the scaphoid fracture based on the Herbert classification system. Fleiss kappa statistics were used to calculate the interobserver agreement for the diagnosis of a fracture. Intraclass correlation coefficients (ICCs) were used to assess the agreement for the classification of scaphoid fracture. Results A total of nine (29%) scaphoid fractures and 12 (39%) other fractures were diagnosed in 20 patients (65%) using HR-pQCT across the four observers. The interobserver agreement was 91% for the identification of a scaphoid fracture (95% confidence interval (CI) 0.76 to 1.00) and 80% for other fractures (95% CI 0.72 to 0.87). The mean ICC for the classification of a scaphoid fracture in the seven patients diagnosed with scaphoid fracture by all four observers was 73% (95% CI 0.42 to 0.94). Conclusion We conclude that the diagnosis of scaphoid and other fractures is reliable when using HR-pQCT in patients with a clinically-suspected fracture. Cite this article: Bone Joint J 2020;102-B(4):478–484.
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Affiliation(s)
- Anne M. Daniels
- Department of Surgery, ViCuri Medical Centre, Venlo, The Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sander Sassen
- Department of Radiology, ViCuri Medical Centre, Venlo, The Netherlands
| | - Daan Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sjoerd Kaarsemaker
- Department of Orthopaedic Surgery, ViCuri Medical Centre, Venlo, The Netherlands
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pascal F. W. Hannemann
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Poeze
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Surgery and Trauma Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Subdivision of Endocrinology, ViCuri Medical Centre, Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
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Alcântara ACS, Assis I, Prada D, Mehle K, Schwan S, Costa-Paiva L, Skaf MS, Wrobel LC, Sollero P. Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis-A Survey. MATERIALS (BASEL, SWITZERLAND) 2019; 13:E106. [PMID: 31878356 PMCID: PMC6981613 DOI: 10.3390/ma13010106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/26/2022]
Abstract
This paper provides a starting point for researchers and practitioners from biology, medicine, physics and engineering who can benefit from an up-to-date literature survey on patient-specific bone fracture modelling, simulation and risk analysis. This survey hints at a framework for devising realistic patient-specific bone fracture simulations. This paper has 18 sections: Section 1 presents the main interested parties; Section 2 explains the organzation of the text; Section 3 motivates further work on patient-specific bone fracture simulation; Section 4 motivates this survey; Section 5 concerns the collection of bibliographical references; Section 6 motivates the physico-mathematical approach to bone fracture; Section 7 presents the modelling of bone as a continuum; Section 8 categorizes the surveyed literature into a continuum mechanics framework; Section 9 concerns the computational modelling of bone geometry; Section 10 concerns the estimation of bone mechanical properties; Section 11 concerns the selection of boundary conditions representative of bone trauma; Section 12 concerns bone fracture simulation; Section 13 presents the multiscale structure of bone; Section 14 concerns the multiscale mathematical modelling of bone; Section 15 concerns the experimental validation of bone fracture simulations; Section 16 concerns bone fracture risk assessment. Lastly, glossaries for symbols, acronyms, and physico-mathematical terms are provided.
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Affiliation(s)
- Amadeus C. S. Alcântara
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Israel Assis
- Department of Integrated Systems, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Daniel Prada
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
| | - Konrad Mehle
- Department of Engineering and Natural Sciences, University of Applied Sciences Merseburg, 06217 Merseburg, Germany;
| | - Stefan Schwan
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, 06120 Halle/Saale, Germany;
| | - Lúcia Costa-Paiva
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-887, Brazil;
| | - Munir S. Skaf
- Institute of Chemistry and Center for Computing in Engineering and Sciences, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil;
| | - Luiz C. Wrobel
- Institute of Materials and Manufacturing, Brunel University London, Uxbridge UB8 3PH, UK;
- Department of Civil and Environmental Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro 22451-900, Brazil
| | - Paulo Sollero
- Department of Computational Mechanics, School of Mechanical Engineering, University of Campinas—UNICAMP, Campinas, Sao Paulo 13083-860, Brazil; (A.C.S.A.); (D.P.)
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Rice PE, Needle AR, Leicht ZS, Zwetsloot KA, McBride JM. Bone health, muscle properties and stretch-shortening cycle function of young and elderly males. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2019; 19:389-395. [PMID: 31789290 PMCID: PMC6944796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine bone, muscle, strength and stretch-shortening cycle (SSC) performance in young and elderly individuals with an ankle model to elucidate potential effects of ageing that have been suggested to influence fall risk. Moderately active young (n=10; age=22.3±1.3 yrs) and elderly (n=8; age=67.5±3.3 yrs) males completed a peripheral quantitative computed tomography scan on the dominant lower leg, maximal voluntary isometric plantarflexions (MVIP) and SSC tasks: a countermovement hop and drop hops from three different heights. Bone stress-strain index at 14% of the lower leg and muscle density, muscle cross-sectional area and muscle+bone cross-sectional area at 66% of the lower leg were all significantly greater (p≤0.05) in younger males than elderly males. Younger males also had significantly greater rate of force development and peak force during the MVIP when compared to the elderly. Younger males achieved significantly higher forces, velocities and hop heights during all SSC tasks than elderly males. Such information provides support for greater specificity in exercise interventions that prevent lower leg morphological and functional decrements in the ageing population.
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Affiliation(s)
- Paige E. Rice
- Centre for Exercise and Sports Science Research, Edith Cowan University, Joondalup, Australia,Neuromuscular & Biomechanics Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone USA,Corresponding author: Paige E. Rice, MS, School of Medical and Health Sciences, Centre for Exercise and Sport Science Research, Edith Cowan University, Joondalup, WA, AUS 6027 E-mail:
| | - Alan R. Needle
- Neuromuscular & Biomechanics Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone USA
| | - Zachary S. Leicht
- Neuromuscular & Biomechanics Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone USA
| | - Kevin A. Zwetsloot
- Neuromuscular & Biomechanics Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone USA
| | - Jeffrey M. McBride
- Neuromuscular & Biomechanics Laboratory, Department of Health and Exercise Science, Appalachian State University, Boone USA
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