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Chen H, Zhu X, Zhou Q, Pu X, Wang B, Lin H, Zhu Z, Qiu Y, Sun X. Utility of MRI-based vertebral bone quality scores and CT-based Hounsfield unit values in vertebral bone mineral density assessment for patients with diffuse idiopathic skeletal hyperostosis. Osteoporos Int 2024; 35:705-715. [PMID: 38148381 DOI: 10.1007/s00198-023-06999-x] [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: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023]
Abstract
This study investigated bone mineral density assessment for patients with DISH. DXA-based T-scores overestimated bone quality, while MRI-based VBQ scores and CT-based HU values provided accurate assessments, particularly for advanced degenerative cases. This enhances accurate evaluation of BMD, crucial for clinical decision-making. PURPOSE To investigate the diagnostic effectiveness of DXA, MRI, and CT in assessing bone mineral density (BMD) for diffuse idiopathic skeletal hyperostosis (DISH) patients. METHODS Retrospective analysis of 105 DISH patients and 116 age-matched controls with lumbar spinal stenosis was conducted. BMD was evaluated using DXA-based T-scores, MRI-based vertebral bone quality (VBQ) scores, and CT-based Hounsfield unit (HU) values. Patients were categorized into three BMD subgroups. Lumbar osteophyte categories were determined by Mata score. Demographics, clinical data, T-scores, VBQ scores, and HU values were collected. Receiver operating characteristic (ROC) analysis identified VBQ and HU thresholds for diagnosing normal BMD using DXA in controls. Correlations between VBQ, HU, and lumbar T-score were analyzed. RESULTS Age, gender, and BMI showed no significant differences between DISH and control groups. DISH patients had higher T-score (L1-4), the lowest T-score, and Mata scores. VBQ and HU did not significantly differ between groups. In controls, VBQ and HU effectively diagnosed normal BMD (AUC = 0.857 and 0.910, respectively) with cutoffs of 3.0 for VBQ and 104.3 for HU. DISH had higher normal BMD prevalence using T-scores (69.5% vs. 58.6%, P < 0.05), but no significant differences using VBQ (57.1% vs. 56.2%, P > 0.05) and HU (58.1% vs. 57.8%, P > 0.05). Correlations revealed moderate correlations between HU and T-scores (L1-4) in DISH (r = 0.642, P < 0.001) and strong in controls (r = 0.846, P < 0.001). Moderate negative correlations were observed between VBQ and T-scores (L1-4) in DISH (r = - 0.450, P < 0.001) and strong in controls (r = - 0.813, P < 0.001). CONCLUSION DXA-based T-scores may overestimate BMD in DISH. VBQ scores and HU values could effectively complement BMD assessment, particularly in DISH patients or those with advanced lumbar degeneration.
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Affiliation(s)
- Haojie Chen
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xiufen Zhu
- Department of Orthopedic Surgery, Osteoporosis and Metabolic Bone Disease Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Qingshuang Zhou
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Drum Tower Hospital Clinical College of Jiangsu University, Nanjing, China
| | - Xiaojiang Pu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Wang
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Hua Lin
- Department of Orthopedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zezhang Zhu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yong Qiu
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xu Sun
- Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
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Wan K, Li L, Jia D, Gao S, Qian W, Wu Y, Lin H, Mu X, Gao X, Wang S, Wu F, Zhuang X. Multi-target landmark detection with incomplete images via reinforcement learning and shape prior embedding. Med Image Anal 2023; 89:102875. [PMID: 37441881 DOI: 10.1016/j.media.2023.102875] [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] [Received: 01/10/2023] [Revised: 05/05/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023]
Abstract
Medical images are generally acquired with limited field-of-view (FOV), which could lead to incomplete regions of interest (ROI), and thus impose a great challenge on medical image analysis. This is particularly evident for the learning-based multi-target landmark detection, where algorithms could be misleading to learn primarily the variation of background due to the varying FOV, failing the detection of targets. Based on learning a navigation policy, instead of predicting targets directly, reinforcement learning (RL)-based methods have the potential to tackle this challenge in an efficient manner. Inspired by this, in this work we propose a multi-agent RL framework for simultaneous multi-target landmark detection. This framework is aimed to learn from incomplete or (and) complete images to form an implicit knowledge of global structure, which is consolidated during the training stage for the detection of targets from either complete or incomplete test images. To further explicitly exploit the global structural information from incomplete images, we propose to embed a shape model into the RL process. With this prior knowledge, the proposed RL model can not only localize dozens of targets simultaneously, but also work effectively and robustly in the presence of incomplete images. We validated the applicability and efficacy of the proposed method on various multi-target detection tasks with incomplete images from practical clinics, using body dual-energy X-ray absorptiometry (DXA), cardiac MRI and head CT datasets. Results showed that our method could predict whole set of landmarks with incomplete training images up to 80% missing proportion (average distance error 2.29 cm on body DXA), and could detect unseen landmarks in regions with missing image information outside FOV of target images (average distance error 6.84 mm on 3D half-head CT). Our code will be released via https://zmiclab.github.io/projects.html.
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Affiliation(s)
- Kaiwen Wan
- School of Data Science, Fudan University, Shanghai, 200433, China
| | - Lei Li
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Dengqiang Jia
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China; Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Shangqi Gao
- School of Data Science, Fudan University, Shanghai, 200433, China
| | - Wei Qian
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yingzhi Wu
- Department of Plastic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Huandong Lin
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, 200032 Shanghai, China
| | - Xiongzheng Mu
- Department of Plastic Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xin Gao
- Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, 200032 Shanghai, China
| | - Sijia Wang
- Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Fuping Wu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xiahai Zhuang
- School of Data Science, Fudan University, Shanghai, 200433, China.
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Sarraj M, Saidahmed A, Thornley P, Koziarz F, Khamis RA, Jentzsch T, Bhanot K, Oitment C. Secondary Osteoporosis with Normal Bone Mineral Density: A Case of Compression Fracture and Spinal Cord Injury in Cushing's Disease. Spine Surg Relat Res 2023; 7:406-409. [PMID: 37636149 PMCID: PMC10447193 DOI: 10.22603/ssrr.2022-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/04/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Mohamed Sarraj
- McMaster University, Division of Orthopedic Surgery, Department of Surgery, Hamilton General Hospital, Ontario, Canada
| | - Ahmed Saidahmed
- McMaster University, Division of Orthopedic Surgery, Department of Surgery, Hamilton General Hospital, Ontario, Canada
| | - Patrick Thornley
- Division of Orthopedic Surgery, Western University, Ontario, Canada
| | - Frank Koziarz
- McMaster University, Department of Health Research Methods, Evidence and Impact, Ontario, Canada
| | - Rami Abou Khamis
- McMaster University, Department of Internal Medicine, Hamilton General Hospital, Ontario, Canada
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Kunal Bhanot
- Division of Orthopaedic Surgery, St. Michael's Hospital, Ontario, Canada
| | - Colby Oitment
- McMaster University, Division of Orthopedic Surgery, Department of Surgery, Hamilton General Hospital, Ontario, Canada
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Age Prediction from Low Resolution, Dual-Energy X-ray Images Using Convolutional Neural Networks. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12136608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Age prediction from X-rays is an interesting research topic important for clinical applications such as biological maturity assessment. It is also useful in many other practical applications, including sports or forensic investigations for age verification purposes. Research on these issues is usually carried out using high-resolution X-ray scans of parts of the body, such as images of the hands or images of the chest. In this study, we used low-resolution, dual-energy, full-body X-ray absorptiometry images to train deep learning models to predict age. In particular, we proposed a preprocessing framework and adapted many partially pretrained convolutional neural network (CNN) models to predict the age of children and young adults. We used a new dataset of 910 multispectral images that were weakly annotated by specialists. The experimental results showed that the proposed preprocessing techniques and the adapted approach to the CNN model achieved a discrepancy between chronological age and predicted age of around 15.56 months for low-resolution whole-body X-rays. Furthermore, we found that the main factor that influenced age prediction scores was spatial features, not multispectral features.
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Zhao C, Herbst M, Weber T, Luckner C, Vogt S, Ritschl L, Kappler S, Siewerdsen JH, Zbijewski W. Slot-scan dual-energy bone densitometry using motorized X-ray systems. Med Phys 2021; 48:6673-6695. [PMID: 34628651 DOI: 10.1002/mp.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/31/2021] [Accepted: 09/24/2021] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We investigate the feasibility of slot-scan dual-energy (DE) bone densitometry on motorized radiographic equipment. This approach will enable fast quantitative measurements of areal bone mineral density (aBMD) for opportunistic evaluation of osteoporosis. METHODS We investigated DE slot-scan protocols to obtain aBMD measurements at the lumbar spine (L-spine) and hip using a motorized x-ray platform capable of synchronized translation of the x-ray source and flat-panel detector (FPD). The slot dimension was 5 × 20 cm2 . The DE slot views were processed as follows: (1) convolution kernel-based scatter correction, (2) unfiltered backprojection to tile the slots into long-length radiographs, and (3) projection-domain DE decomposition, consisting of an initial adipose-water decomposition in a bone-free region followed by water-CaHA decomposition with adjustment for adipose content. The accuracy and reproducibility of slot-scan aBMD measurements were investigated using a high-fidelity simulator of a robotic x-ray system (Siemens Multitom Rax) in a total of 48 body phantom realizations: four average bone density settings (cortical bone mass fraction: 10-40%), four body sizes (waist circumference, WC = 70-106 cm), and three lateral shifts of the body within the slot field of view (FOV) (centered and ±1 cm off-center). Experimental validations included: (1) x-ray test-bench feasibility study of adipose-water decomposition and (2) initial demonstration of slot-scan DE bone densitometry on the robotic x-ray system using the European Spine Phantom (ESP) with added attenuation (polymethyl methacrylate [PMMA] slabs) ranging 2 to 6 cm thick. RESULTS For the L-spine, the mean aBMD error across all WC settings ranged from 0.08 g/cm2 for phantoms with average cortical bone fraction wcortical = 10% to ∼0.01 g/cm2 for phantoms with wcortical = 40%. The L-spine aBMD measurements were fairly robust to changes in body size and positioning, e.g., coefficient of variation (CV) for L1 with wcortical = 30% was ∼0.034 for various WC and ∼0.02 for an obese patient (WC = 106 cm) changing lateral shift. For the hip, the mean aBMD error across all phantom configurations was about 0.07 g/cm2 for a centered patient. The reproducibility of hip aBMD was slightly worse than in the L-spine (e.g., in the femoral neck, the CV with respect to changing WC was ∼0.13 for phantom realizations with wcortical = 30%) due to more challenging scatter estimation in the presence of an air-tissue interface within the slot FOV. The aBMD of the hip was therefore sensitive to lateral positioning of the patient, especially for obese patients: e.g., the CV with respect to patient lateral shift for femoral neck with WC = 106 cm and wcortical = 30% was 0.14. Empirical evaluations confirmed substantial reduction in aBMD errors with the proposed adipose estimation procedure and demonstrated robust aBMD measurements on the robotic x-ray system, with aBMD errors of ∼0.1 g/cm2 across all three simulated ESP vertebrae and all added PMMA attenuator settings. CONCLUSIONS We demonstrated that accurate aBMD measurements can be obtained on a motorized FPD-based x-ray system using DE slot-scans with kernel-based scatter correction, backprojection-based slot view tiling, and DE decomposition with adipose correction.
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Affiliation(s)
- Chumin Zhao
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | | | | | | | | | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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Malkovskiy AV, Van Wassenhove LD, Goltsev Y, Osei-Sarfo K, Chen CH, Efron B, Gudas LJ, Mochly-Rosen D, Rajadas J. The Effect of Ethanol Consumption on Composition and Morphology of Femur Cortical Bone in Wild-Type and ALDH2*2-Homozygous Mice. Calcif Tissue Int 2021; 108:265-276. [PMID: 33068139 PMCID: PMC8092984 DOI: 10.1007/s00223-020-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
ALDH2 inactivating mutation (ALDH2*2) is the most abundant mutation leading to bone morphological aberration. Osteoporosis has long been associated with changes in bone biomaterial in elderly populations. Such changes can be exacerbated with elevated ethanol consumption and in subjects with impaired ethanol metabolism, such as carriers of aldehyde dehydrogenase 2 (ALDH2)-deficient gene, ALDH2*2. So far, little is known about bone compositional changes besides a decrease in mineralization. Raman spectroscopic imaging has been utilized to study the changes in overall composition of C57BL/6 female femur bone sections, as well as in compound spatial distribution. Raman maps of bone sections were analyzed using multilinear regression with these four isolated components, resulting in maps of their relative distribution. A 15-week treatment of both wild-type (WT) and ALDH2*2/*2 mice with 20% ethanol in the drinking water resulted in a significantly lower mineral content (p < 0.05) in the bones. There was no significant change in mineral and collagen content due to the mutation alone (p > 0.4). Highly localized islets of elongated adipose tissue were observed on most maps. Elevated fat content was found in ALDH2*2 knock-in mice consuming ethanol (p < 0.0001) and this effect appeared cumulative. This work conclusively demonstrates that that osteocytes in femurs of older female mice accumulate fat, as has been previously theorized, and that fat accumulation is likely modulated by levels of acetaldehyde, the ethanol metabolite.
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Affiliation(s)
- Andrey V Malkovskiy
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford Medical School, Stanford, CA, 94305, USA.
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA.
| | - Lauren D Van Wassenhove
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Yury Goltsev
- Department of Microbiology and Immunology, Baxter Laboratory in Stem Cell Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Kwame Osei-Sarfo
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Bradley Efron
- Department of Biomedical Data Science, Stanford Medical School, Stanford, CA, 94305, USA
| | - Lorraine J Gudas
- Department of Pharmacology, Weill Cornell Medical College, New York, NY, 10065, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, Stanford Medical School, Stanford, CA, 94305, USA
| | - Jayakumar Rajadas
- Biomaterials and Advanced Drug Delivery Laboratory, Stanford Medical School, Stanford, CA, 94305, USA.
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Sutter T, Duboeuf F, Chapurlat R, Cortet B, Lespessailles E, Roux JP. DXA body composition corrective factors between Hologic Discovery models to conduct multicenter studies. Bone 2021; 142:115683. [PMID: 33045389 DOI: 10.1016/j.bone.2020.115683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dual X-ray absorptiometry body composition measurements are widely used for clinical and research settings. It is well known that measurements vary across instruments, needing caution for longitudinal monitoring or multicentric studies. This study was to quantify intra- and inter-center variability of bone mineral content, bone mineral density, fat and lean body composition measurements between Hologic Discovery models in order to calculate the corrective factors to be applied for multicenter research projects. MATERIALS AND METHODS A whole body phantom composed of materials representing the thickness and percentage of bone, lean and fat mass in the human physiological range was analyzed ten times in three different centers using dual energy X-ray absorptiometry scanners (Two Hologic Discovery QDR A and one QDR W). In addition, we used a morphometric vertebral phantom to monitor stability and a three steps block phantom to check accuracy. RESULTS We found a good long-term stability and accuracy for the three devices. Intra-center coefficients of variation were within the range of the manufacturer acceptable values (bone mineral density: 1.40%, bone mineral content: 1%, area: 1.50%, fat mass: 0.89%, lean mass: 0.76%, total mass: 0.12%). Whereas the inter-center coefficient of variation exceeded 8% (bone mineral density: 8.18%, bone mineral content: 3.03%, area: 8.63%: fat mass: 3,92%, lean mass: 7.89%, total mass: 2.85%). CONCLUSION Our study showed that the discrepancies across centers remain a major concern, particularly with regard to body composition results. Our study highlight the need of cross calibration between densitometers and proposes corrective factors evaluated from a whole body phantom to lead multicentric studies adjustment.
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Affiliation(s)
- Thibault Sutter
- EA 4708 I3MTO Laboratory, University of Orleans, Orleans, France
| | - François Duboeuf
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
| | - Roland Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Bernard Cortet
- Department of Rheumatology, University Hospital of Lille, EA4490, University of Lille, Lille, France
| | - Eric Lespessailles
- EA 4708 I3MTO Laboratory, University of Orleans, Orleans, France; Department of Rheumatology, Regional Hospital of Orleans, Orleans, France
| | - Jean-Paul Roux
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
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Majjad A, Ghassem MA, Toufik H, Sadni S, Debbarh Z, Djossou JH, El Ouardi N, Taoubane L, Abouqal R, Achemlal L, El Maghraoui A. Relationship between vertebral fracture prevalence and abdominal aortic calcification in women with rheumatoid arthritis. Bone 2020; 141:115599. [PMID: 32822872 DOI: 10.1016/j.bone.2020.115599] [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: 04/25/2020] [Revised: 07/21/2020] [Accepted: 08/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Vertebral fracture assessment (VFA)-detected abdominal aortic calcification (AAC) has been validated as an indicator of increased risk of vertebral fractures (VFs) in other populations but this relationship in rheumatoid arthritis (RA) is unclear. We assess the prevalence of AAC on VFA scans and its potential relationship with prevalent VFs in a cohort of RA women. METHODS We enrolled 250 women with RA. VFA images, and scans of the lumbar spine and proximal femur were obtained using dual-energy x-ray absorptiometry. The presence/severity of VFs and AAC were carried out using validated approaches. RESULTS AAC was detected in 95 of 250 (38%) eligible subjects and 83 (33.2%) had at least one VF. Significantly subjects with VFs had a higher AAC score (3.4 ± 3.8 versus 0.7 ± 1.4; p˂0.001) and higher prevalence of AAC than those without VFs (65% versus 26%; P˂0.001). The group with VFs tended to be older, had more menopausal women, and lower lumbar spine and total hip BMD than those without VF. They also had a long-standing disease and high DAS 28-CRP, a great steroid cumulative dose, and a high prevalence of rheumatoid factor (RF). In multivariate analyses, a significant association was noted between prevalent VFs and age of patients, RA disease activity, presence of densitometric osteoporosis, RF, and VFA-detected AAC, whereas there was no significant association with steroid cumulative dose and disease duration. CONCLUSION VFA is a convenient tool for the diagnosis of VFs and AAC. In this cohort, VFA-detected AAC was independently associated with prevalent VFs.
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Affiliation(s)
- Abderrahim Majjad
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco.
| | - Mohamed A Ghassem
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Hamza Toufik
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Siham Sadni
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Zineb Debbarh
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Julien H Djossou
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Najlae El Ouardi
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Laila Taoubane
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Lahcen Achemlal
- Department of Rheumatology, Military Hospital Mohammed V, Rabat, Morocco
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Assessment of paraspinal muscle characteristics, lumbar BMD, and their associations in routine multi-detector CT of patients with and without osteoporotic vertebral fractures. Eur J Radiol 2020; 125:108867. [PMID: 32065929 DOI: 10.1016/j.ejrad.2020.108867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/17/2020] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate paraspinal muscle characteristics and lumbar bone mineral density (BMD) and their associations in routine abdominal multi-detector computed tomography (MDCT) as well as the impact of osteoporotic vertebral fractures on such associations. METHOD 116 patients (69.7 ± 8.1 years, 72 males) who underwent routine abdominal MDCT (oncological staging and/or follow-up for tumor recurrence) were retrospectively included and assigned to a fracture and control group (age- and gender-matched), depending on the presence or absence of lumbar osteoporotic vertebral fractures. BMD was derived from lumbar vertebrae using a conversion equation, and the cross-sectional area (CSA), CSA ratio (CSA psoas muscles divided by CSA erector spinae muscles), and muscle attenuation were measured for the psoas and erector spinae muscles at the levels L2 and L4/5 without dedicated software. RESULTS Males showed significantly higher BMD, CSA, and CSA ratios at the levels L2 and L4/5, while females had decreased erector spinae muscle attenuation at L4/5 (p < 0.05). No significant differences between patients with versus without fractures were observed except for BMD (68.5 ± 37.2 mg/ml vs. 91.4 ± 26.8 mg/ml; p < 0.01). Age-adjusted partial correlation testing revealed significant correlations of BMD and the CSA ratio at level L4/5 (r = 0.20; p = 0.03), but not with muscle attenuation (p > 0.05). CONCLUSIONS Paraspinal muscle characteristics and lumbar BMD can be assessed seamlessly in routine abdominal MDCT without dedicated software. There are level-dependent interactions between paraspinal muscle characteristics as well as lumbar BMD. Vertebral fracture status was independent of paraspinal muscle characteristics.
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Sun HB, Jing XS, Liu YZ, Qi M, Wang XK, Hai Y. The Optimal Volume Fraction in Percutaneous Vertebroplasty Evaluated by Pain Relief, Cement Dispersion, and Cement Leakage: A Prospective Cohort Study of 130 Patients with Painful Osteoporotic Vertebral Compression Fracture in the Thoracolumbar Vertebra. World Neurosurg 2018; 114:e677-e688. [PMID: 29555612 DOI: 10.1016/j.wneu.2018.03.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/04/2018] [Accepted: 03/06/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To probe the relationship among cement volume/fraction, imaging features of cement distribution, and pain relief and then to evaluate the optimal volume during percutaneous vertebroplasty. METHODS From January 2014 to January 2017, a total of 130 patients eligible for inclusion criteria were enrolled in this prospective cohort study. According to the different degrees of pain relief, cement leakage, and cement distribution, all patients were allocated to 2 groups. Clinical and radiologic characteristics were assessed to identify independent factors influencing pain relief, cement leakage, and cement distribution, including age, sex, fracture age, bone mineral density, operation time, fracture level, fracture type, modified semiquantitative severity grade, intravertebral cleft, cortical disruption in the vertebral wall, endplate disruption, type of nutrient foramen, fractured vertebral body volume, intravertebral cement volume, and volume fraction. A receiver operating characteristic curve was used to analyze the diagnostic value of the cement volume/fraction and then to obtain the optional cut-off value. RESULTS The preoperative visual analog scale scores in the responders versus nonresponders patient groups were 7.37 ± 0.61 versus 7.87 ± 0.92 and the postoperative VAS scores in the responders versus nonresponders were 2.04 ± 0.61 versus 4.33 ± 0.49 at 1 week. There were no independent factors influencing pain relief. There were 95 (73.08%) patients who experienced cement leakage, and cortical disruption in the vertebral wall and cement fraction percentage were identified as independent risk factors by binary logistic regression analysis (adjusted odds ratio [OR] 2.935, 95% confidence interval [95% CI] 1.214-7.092, P = 0.017); (adjusted OR 1.134, 95% CI 1.026-1.254, P = 0.014). The area under the receiver-operating characteristic curve of volume fraction (VF%) was 0.658 (95% CI 0.549-0.768, P = 0.006 < 0.05). The cut-off value of VF% for cement leakage was 21.545%, with a sensitivity of 69.50% and a specificity of 60.00%. The incidence of favorable cement distribution was 74.62% (97/130), and VF% were identified as independent protective factors (adjusted OR 1.185, 95% CI 1.067-1.317, P = 0.002) The area under the receiver-operating characteristic curve of VF% was 0.686 (95% CI 0.571-0.802, P = 0.001 < 0.05). The cut-off value of VF% to reach a favorable cement distribution was 19.78%, with a sensitivity of 86.60% and a specificity of 51.50%. CONCLUSIONS In osteoporotic vertebral compression fracture with mild/moderate fracture severity at the single thoracolumbar level, the intravertebral cement volume of 4-6 mL could relieve pain rapidly. The optimal VF% was 19.78%, which could achieve satisfactory cement distribution. With the increase of VF%, the incidence of cement leakage would also increase.
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Affiliation(s)
- Hai-Bo Sun
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China; Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Xiao-Shan Jing
- Beijing Chuiyangliu Hospital, Chaoyang district, Beijing, China
| | - Yu-Zeng Liu
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China
| | - Ming Qi
- Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Xin-Kuan Wang
- Beijing Tongzhou Hospital of Integrated Chinese and Western Medicine, Tongzhou district, Beijing, China
| | - Yong Hai
- Beijing Chao-Yang Hospital, Capital Medical University (BCYH-CMU), Chaoyang District, Beijing, China.
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Krahenbühl T, Guimarães RDF, Barros Filho ADA, Gonçalves EM. BONE GEOMETRY AND PHYSICAL ACTIVITY IN CHILDREN AND ADOLESCENTS: SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2018; 36:230-237. [PMID: 29412432 PMCID: PMC6038793 DOI: 10.1590/1984-0462/;2018;36;2;00005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 04/14/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To perform a systematic review on the practice of physical activity and/or sports in health and its influence on bone geometry of healthy children and adolescents. DATA SOURCE The method used as reference was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Databases searched for articles published from 2006 to 2016, with "Bone geometry" AND (Sport* OR Exercise* OR "Physical Activity") as descriptors, were PubMed, BIREME/LILACS and SciELO. DATA SYNTHESES After the selection, 21 articles were included. Most studies stated that practice of physical activity and/or sports was beneficial for bone geometry and bone mineral density. Only two studies presented values of bone parameters for control individuals better than those of swimmers. Physical activities and sports studied were: gymnastics (n=7), rhythmic gymnastics (n=2), tennis (n=1), soccer (n=3), capoeira (n=1), swimming (n=4), cycling (n=0), jumping activities (n=2), studies relating physical activity with isokinetic peak torque (n=1), physical activity measured by questionnaire (n=4), and additional physical education classes (n=2). CONCLUSIONS Among the sports and physical activities found, gymnastics, soccer, and more intense physical activity assessed by questionnaires were mentioned along with better results in bone geometry compared to the absence of physical activity, whereas swimming and jumping exercises did not influence it. Therefore, sports activities with weight bearing and those practiced more frequently and intensively are beneficial for bone geometry.
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12
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Czyz M, Kapinas A, Holton J, Pyzik R, Boszczyk BM, Quraishi NA. The computed tomography-based fractal analysis of trabecular bone structure may help in detecting decreased quality of bone before urgent spinal procedures. Spine J 2017; 17:1156-1162. [PMID: 28416437 DOI: 10.1016/j.spinee.2017.04.014] [Citation(s) in RCA: 7] [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: 11/14/2016] [Revised: 03/19/2017] [Accepted: 04/10/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT To date, no reliable method is available to determine the parameters of bone density based on the routine spinal computed tomography (CT) in the emergency setup. We propose the use of fractal analysis to detect patients with poor quality of bone before urgent or semi-urgent spinal procedures. PURPOSE This study aimed to validate the hypothesis that the CT-based fractal analysis of the trabecular bone structure may help in detecting patients with poor quality of bone before urgent spinal procedures. STUDY DESIGN This is a retrospective analysis of prospectively collected data. METHODS Patients in whom the dual-energy x-ray absorptiometry (DEXA) scan and lumbar spine CT were performed at an interval of no more than 3 months were randomly selected from a prospectively collected database. Diagnostic axial CT scans of L2, L3, and L4 vertebrae were processed to determine the fractal dimension (FD) of the trabecular structure of each spinal level. Box-count method and ImageJ 1.49 software were used. The FD was compared with the results of the DEXA scan: bone mineral density (BMD) and T-score by mean of correlation coefficients. Receiver operating characteristic curve analysis was later performed to determine the cutoff value of FD. RESULTS A total of 102 vertebral levels obtained from 35 patients (mean age 60±18 years; 29 female) were analyzed. The FD was significantly higher in the group of patients with decreased bone density (DBD) (T-score<-1.0) (1.67 vs. 1.43; p<.0001) and negatively correlated with BMD (R Spearman, -0.53; p<.0001) and T-score (-0.49; p<.0001). Receiver operating characteristic curve analysis revealed that a cutoff value of FD>1.53 indicates DBD (p<.0001; area under the ROC curve [AUC], 0.84; 95% confidence interval [CI], 0.76-0.91). CONCLUSIONS This study shows that fractal analysis of the lumbar spine CT images may be used to determine bone density before spinal instrumentation (eg, metastatic or traumatic cord compression). Further prospective studies comparing results of the fractal analysis of CT scans with quantitative CT (qCT) are warranted.
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Affiliation(s)
- Marcin Czyz
- Spinal Service, The Royal Orhopaedic Hospital NHS Trust, Birmingham, UK; The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - Arion Kapinas
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - James Holton
- Spinal Service, The Royal Orhopaedic Hospital NHS Trust, Birmingham, UK
| | - Renata Pyzik
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bronek M Boszczyk
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nasir A Quraishi
- The Centre for Spinal Studies and Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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14
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Trabecular Bone Score Reflects Trabecular Microarchitecture Deterioration and Fragility Fracture in Female Adult Patients Receiving Glucocorticoid Therapy: A Pre-Post Controlled Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4210217. [PMID: 28127556 PMCID: PMC5239831 DOI: 10.1155/2017/4210217] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/27/2016] [Accepted: 12/15/2016] [Indexed: 01/28/2023]
Abstract
A recently developed diagnostic tool, trabecular bone score (TBS), can provide quality of trabecular microarchitecture based on images obtained from dual-energy X-ray absorptiometry (DXA). Since patients receiving glucocorticoid are at a higher risk of developing secondary osteoporosis, assessment of bone microarchitecture may be used to evaluate risk of fragility fractures of osteoporosis. In this pre-post study of female patients, TBS and fracture risk assessment tool (FRAX) adjusted with TBS (T-FRAX) were evaluated along with bone mineral density (BMD) and FRAX. Medical records of patients with (n = 30) and without (n = 16) glucocorticoid treatment were retrospectively reviewed. All patients had undergone DXA twice within a 12- to 24-month interval. Analysis of covariance was conducted to compare the outcomes between the two groups of patients, adjusting for age and baseline values. Results showed that a significant lower adjusted mean of TBS (p = 0.035) and a significant higher adjusted mean of T-FRAX for major osteoporotic fracture (p = 0.006) were observed in the glucocorticoid group. Conversely, no significant differences were observed in the adjusted means for BMD and FRAX. These findings suggested that TBS and T-FRAX could be used as an adjunct in the evaluation of risk of fragility fractures in patients receiving glucocorticoid therapy.
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15
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Zhong BY, He SC, Zhu HD, Wu CG, Fang W, Chen L, Guo JH, Deng G, Zhu GY, Teng GJ. Risk Prediction of New Adjacent Vertebral Fractures After PVP for Patients with Vertebral Compression Fractures: Development of a Prediction Model. Cardiovasc Intervent Radiol 2016; 40:277-284. [PMID: 27812782 DOI: 10.1007/s00270-016-1492-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE We aim to determine the predictors of new adjacent vertebral fractures (AVCFs) after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compression fractures (OVCFs) and to construct a risk prediction score to estimate a 2-year new AVCF risk-by-risk factor condition. MATERIALS AND METHODS Patients with OVCFs who underwent their first PVP between December 2006 and December 2013 at Hospital A (training cohort) and Hospital B (validation cohort) were included in this study. In training cohort, we assessed the independent risk predictors and developed the probability of new adjacent OVCFs (PNAV) score system using the Cox proportional hazard regression analysis. The accuracy of this system was then validated in both training and validation cohorts by concordance (c) statistic. RESULTS 421 patients (training cohort: n = 256; validation cohort: n = 165) were included in this study. In training cohort, new AVCFs after the first PVP treatment occurred in 33 (12.9%) patients. The independent risk factors were intradiscal cement leakage and preexisting old vertebral compression fracture(s). The estimated 2-year absolute risk of new AVCFs ranged from less than 4% in patients with neither independent risk factors to more than 45% in individuals with both factors. CONCLUSIONS The PNAV score is an objective and easy approach to predict the risk of new AVCFs.
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Affiliation(s)
- Bin-Yan Zhong
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Shi-Cheng He
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Hai-Dong Zhu
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Chun-Gen Wu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yi Shan Road, Shanghai, 200233, China
| | - Wen Fang
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Li Chen
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Jin-He Guo
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Gang Deng
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Guang-Yu Zhu
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China
| | - Gao-Jun Teng
- Department of Radiology, Medical School, Zhongda Hospital, Southeast University, 87 DingjiaqiaoRoad, Nanjing, 210009, China.
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Choi YJ. Dual-Energy X-Ray Absorptiometry: Beyond Bone Mineral Density Determination. Endocrinol Metab (Seoul) 2016; 31:25-30. [PMID: 26996419 PMCID: PMC4803557 DOI: 10.3803/enm.2016.31.1.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 01/06/2023] Open
Abstract
Significant improvements in dual-energy X-ray absorptiometry (DXA) concerning quality, image resolution and image acquisition time have allowed the development of various functions. DXA can evaluate bone quality by indirect analysis of micro- and macro-architecture of the bone, which and improve the prediction of fracture risk. DXA can also detect existing fractures, such as vertebral fractures or atypical femur fractures, without additional radiologic imaging and radiation exposure. Moreover, it can assess the metabolic status by the measurement of body composition parameters like muscle mass and visceral fat. Although more studies are required to validate and clinically use these parameters, it is clear that DXA is not just for bone mineral densitometry.
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Affiliation(s)
- Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
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17
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Dhainaut A, Hoff M, Syversen U, Haugeberg G. Technologies for assessment of bone reflecting bone strength and bone mineral density in elderly women: an update. ACTA ACUST UNITED AC 2016; 12:209-16. [PMID: 26900798 DOI: 10.2217/whe.15.94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Reduced bone mineral density is a strong risk factor for fracture. The WHO's definition of osteoporosis is based on bone mineral density measurements assessed by dual x-ray absorptiometry. Several on other techniques than dual x-ray absorptiometry have been developed for quantitative assessment of bone, for example, quantitative ultrasound and digital x-ray radiogrammetry. Some of these techniques may also capture other bone properties than bone mass that contribute to bone strength, for example, bone porosity and microarchitecture. In this article we give an update on technologies which are available for evaluation primarily of bone mass and bone density, but also describe methods which currently are validated or are under development for quantitative assessment of other bone properties.
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Affiliation(s)
- Alvilde Dhainaut
- Department of Neuroscience (INM) Norwegian University of Science & Technology (NTNU), Trondheim, Norway.,Department of Public Health & General Practice (ISM), Norwegian University of Science & Technology, Trondheim Norway
| | - Mari Hoff
- Department of Public Health & General Practice (ISM), Norwegian University of Science & Technology, Trondheim Norway.,Department of Rheumatology, St Olav's Hospital, Trondheim, Norway
| | - Unni Syversen
- Department of Cancer Research & Molecular Medicine (IKM), NTNU, Trondheim, Norway.,Department of Endocrinology, St. Olav's Hospital, Norway
| | - Glenn Haugeberg
- Department of Neuroscience (INM) Norwegian University of Science & Technology (NTNU), Trondheim, Norway.,Department of Rheumatology, Hospital of Southern Norway, Kristiansand S, Norway
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18
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Ayoub ML, Maalouf G, Bachour F, Barakat A, Cortet B, Legroux-Gérot I, Zunquin G, Theunynck D, Nehme A, El Hage R. DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women. Orthop Traumatol Surg Res 2014; 100:855-8. [PMID: 25459457 DOI: 10.1016/j.otsr.2014.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. MATERIALS AND METHODS One thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. RESULTS Femoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385-0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. CONCLUSION This study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. LEVEL OF EVIDENCE Epidemiological study, level IV.
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Affiliation(s)
- M-L Ayoub
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - G Maalouf
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - F Bachour
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - A Barakat
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - B Cortet
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - I Legroux-Gérot
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - G Zunquin
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - D Theunynck
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - A Nehme
- Department of Orthopedic Surgery and Traumatology, Saint-Georges University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, 1100 2807 Beirut, Lebanon
| | - R El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
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Tatoń G, Rokita E, Korkosz M, Wróbel A. The ratio of anterior and posterior vertebral heights reinforces the utility of DXA in assessment of vertebrae strength. Calcif Tissue Int 2014; 95:112-21. [PMID: 24854155 PMCID: PMC4104001 DOI: 10.1007/s00223-014-9868-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
The objective of the study was to introduce a new parameter describing bone strength with greater precision than the widely used antero-posterior DXA (dual-energy X-ray absorptiometry), which measures areal bone mineral density (aBMD). The adjusted areal bone mineral density (AaBMD) defined as the ratio between aBMD and h a/h p (h a and h p: anterior and posterior vertebral body heights measured on the lateral view, respectively) is proposed: AaBMD = aBMD/(h a/h p). The utility of AaBMD in prediction of bone strength was assessed by in vitro measurements of cadaver L3 vertebrae. The AaBMD of 31 vertebrae was correlated with the ultimate stress (P max) and load (F max) values obtained in mechanical tests. The correlations were compared to those obtained for aBMD and for volumetric bone mineral density (vBMD) measured by computed tomography. The correlation of AaBMD to F max adjusted for donor's age was significantly higher than for aBMD and vBMD (r = 0.740, 0.658, and 0.609, respectively, p < 0.05). The differences between partial correlation coefficients for P max to AaBMD, aBMD and vBMD relationships were smaller (r = 0.764, 0.720, and 0.732, respectively, p < 0.05), but also showed the superiority of AaBMD. Combining antero-posterior DXA aBMD and the lateral h a/h p ratio, measured, for example, by the Vertebral Fracture Assessment software of the new generation of DXA devices, seems to accurately predict the mechanical vertebral parameters related to bone strength. It is assumed that the proposed AaBMD parameter may be more predictive for fracture risk assessment, which requires further studies.
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Affiliation(s)
- Grzegorz Tatoń
- Department of Biophysics, Jagiellonian University Medical College, Łazarza 16, 31530 Kraków, Poland
| | - Eugeniusz Rokita
- Department of Biophysics, Jagiellonian University Medical College, Łazarza 16, 31530 Kraków, Poland
| | - Mariusz Korkosz
- Division of Rheumatology, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Śniadeckich 10, 31-531 Kraków, Poland
| | - Andrzej Wróbel
- Institute of Physics, Jagiellonian University, Reymonta 4, 30-059 Kraków, Poland
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Bone mineral density evaluation in osteoporosis: why yes and why not? Aging Clin Exp Res 2013; 25 Suppl 1:S47-9. [PMID: 24046042 DOI: 10.1007/s40520-013-0074-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 06/17/2013] [Indexed: 10/26/2022]
Abstract
Osteoporosis is a diffuse skeletal disease in which a decrease in bone strength leads to an increased risk of fractures. A wide variety of types of bone densitometry measurements are available, including quantitative computed tomography measurements of the spine, quantitative ultrasound devices for measurements of the heel and other peripheral sites and dual-energy X-ray absorptiometry (DXA) for measurement of bone mineral density (BMD) at the lumbar spine, proximal femur, forearm and total body scans. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. However, in recent years, the authors have raised some important questions about the objective limits of this method that have led to doubts about its effectiveness in terms of clinical outcome.
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