Reliability of analysis of the bone mineral density of the second and fifth metatarsals using dual-energy x-ray absorptiometry (DXA)

Reliability of Quadriceps and Hamstring Soft Tissue Measures Using Dual-Energy X-Ray Absorptiometry (DXA) Scans

Purpose: The purpose of this study was to determine the intra- and interrater reliability of quadriceps and hamstring soft tissue measures using DXA scans. Methods: A total of 44 subjects (23 males) participated in this study. The first total body DXA scan was performed in the standard anterior/posterior scanning position, followed by two additional total body scans while the subjects were lying on their left and right sides with the leg of interest extended and the contralateral leg bent. Unique regions of interest were created for analyses of mineral-free lean masses (MFL) using custom analysis software with manual tracing (by two investigators) of the quadriceps (QUADS) and hamstrings (HAMS) of the right and left thighs. Between-within repeated measure analysis of variance (ANOVA) was used to determine if there were significant differences among the MFL measures, while intraclass correlation coefficients (ICC) and coefficients of variation (CV) were used to assess the intra- and interrater reliability. Results: Between-group analyses revealed that Investigator 2 had small yet significantly higher mean differences for right QUADS (2346.6 ± 602.4 g vs. 2327.4 ± 587.9 g), left QUADS (2337.3 ± 581.9 g vs. 2312.8 ± 581.2 g), right HAMS (2655.9 ± 626.3 g vs. 2543.0 ± 593.5 g), and left HAMS (2686.1 ± 628.1 g vs. 2562.8 ± 596.5 g) when compared to Investigator 1. Intraclass correlation coefficients between (≥0.984) and within (≥0.992) raters were high for all MFL measures, with low variation across all MFL measures (≤1.62%). Conclusions: Despite having significant group mean differences, our results revealed strong and significant reliability, and we recommend that a single investigator analyze the scans twice and that the mean of the two measures be used for final reporting within a given study.

Micro-CT analysis of the Lisfranc complex reveals higher bone mineral density in dorsal compared to plantar regions

Injuries to the Lisfranc complex may require surgical fixation, the stability of which may be correlated with bone mineral density (BMD). However, there is limited research on regional BMD variations in the Lisfranc complex. This study used quantitative micro-CT to characterize regional BMD in the four bones (medial cuneiform, intermediate cuneiform, first metatarsal, and second metatarsal) of this complex. Twenty-four cadaveric specimens were imaged with a calibration phantom using micro-CT. Each bone was segmented and divided into eight regions based on an anatomical coordinate system. BMD for each octant was calculated using scan-specific calibration equations and average image intensity. Differences between regions were analyzed using ANOVA with post hoc analysis and differences between groups of four octants in each plane were analyzed with t-tests with significance level α = 0.05. The highest density region in the medial cuneiform was the distal-dorsal-lateral and dorsal regions showed significantly higher BMD than plantar regions. The intermediate cuneiform had the highest density in the distal-dorsal-medial region and the dorsal and medial regions had higher BMD than the plantar and lateral regions, respectively. The densest region of the first metatarsal was the distal-dorsal-lateral and distal regions had significantly higher BMD than proximal regions. In the second metatarsal, the distal-dorsal-medial region had the highest density, and the distal, dorsal, and medial regions had significantly higher BMD than the proximal, plantar, and lateral regions, respectively. The predominant finding was a pattern of increased density in the dorsal bone regions, which may be relevant in the surgical management of Lisfranc injuries.

An investigation into the association of bone characteristics and body composition with stress fracture in athletes

BACKGROUND

The aim of the study was to establish the bone and body composition characteristics of high-level athletes with and without a history of stress fracture injury.

METHODS

Overall, 279 high-level athletes (212 men, 67 women) (age 28.0±9.2 years; body mass 75.0±17.4 kg; height 1.78±0.10 m) and 112 non-athletic controls (60 women, 52 men) 36.2±15.0 years; 70.9±12.9 kg; 1.71±0.10 m) were assessed by DXA to establish their bone mineral density and content, body fat and lean mass. Athletes completed a questionnaire detailing their stress fracture history.

RESULTS

There were no differences in whole-body bone mineral density (men 1.41±0.12 g/cm², women 1.19±0.09 g/cm²), bone mineral content (men 3709±626 g, women 2263±290 g), body fat (men 16.3±5.0%,women 23.0±4.6%) and lean mass (men 65.4±9.9 kg, women 38.7±3.6 kg) between athletes with a history of stress fracture (34 men, 16 women) and those without (176 men, 40 women).

CONCLUSIONS

DXA derived bone and body composition characteristics were not independent risk factors for stress fracture injury in high-level athletes. This study in a large cohort of high-level athletes provides normative bone and body composition values that can be used as a benchmark for researchers and applied practitioners.

A Narrative Review of Metatarsal Bone Stress Injury in Athletic Populations: Etiology, Biomechanics, and Management

Metatarsal bone stress injuries (BSIs) are common in athletic populations. BSIs are overuse injuries that result from an accumulation of microdamage that exceeds bone remodeling. Risk for metatarsal BSI is multifactorial and includes factors related to anatomy, biology, and biomechanics. In this article, anatomic factors including foot type, metatarsal length, bone density, bone geometry, and intrinsic muscle strength, which each influence how the foot responds to load, are discussed. Biologic factors such as low energy availability and impaired bone metabolism influence the quality of the bone. Finally, the influence of biomechanical loads to bone such as peak forces, load rates, and loading cycles are reviewed. General management of metatarsal BSI is discussed, including acute care, rehabilitation, treatment of refractory metatarsal BSI, and evaluation of healing/return to sport. Finally, we identify future research priorities and emerging treatments for metatarsal BSI.