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van den Bergh JP, Szulc P, Cheung AM, Bouxsein M, Engelke K, Chapurlat R. The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions. Osteoporos Int 2021; 32:1465-1485. [PMID: 34023944 PMCID: PMC8376700 DOI: 10.1007/s00198-021-05999-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/06/2021] [Indexed: 12/13/2022]
Abstract
High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity; (2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.
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Affiliation(s)
- J P van den Bergh
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands.
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
- Faculty of Medicine, Hasselt University, Hasselt, Belgium.
| | - P Szulc
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
| | - A M Cheung
- Department of Medicine and Joint Department of Medical Imaging, University Health Network; and Department of Medicine and Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - M Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 cedex 03, Lyon, France
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Brunet SC, Tse JJ, Kuczynski MT, Engelke K, Boyd SK, Barnabe C, Manske SL. Heterogenous bone response to biologic DMARD therapies in rheumatoid arthritis patients and their relationship to functional indices. Scand J Rheumatol 2021; 50:417-426. [PMID: 33775211 DOI: 10.1080/03009742.2020.1869303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Previous studies of high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of hand joints in patients with rheumatoid arthritis (RA) have suggested that erosion healing may occur. Our objective was to examine changes in erosion volume, joint space width (JSW), bone mineral density (BMD), and bone remodelling, and their association with clinical outcomes and measures of patient hand function.Method: We examined 48 patients who achieved a good response to a newly initiated biologic therapy. HR-pQCT images of the dominant hands' second and third metacarpophalangeal joints were obtained 3 and 12 months after therapy initiation. Bone erosion volume, JSW, BMD, and bone remodelling were quantified from HR-pQCT images, with improvement, no change (unchanged), or progression in these measures determined by least significant change. Disease activity and hand function measures were collected.Results: There were no significant group changes in HR-pQCT outcomes over the 9 month period. Twenty-two patients had total erosion volumes that remained unchanged, nine showed improvement, and two progressed. The majority of JSW and BMD measures remained unchanged. There was a significant association between the baseline Health Assessment Questionnaire score and the change in minimum JSW, but no other significant associations between HR-pQCT outcomes and function were observed.Conclusions: The vast majority of patients maintained unchanged JSW and BMD over the course of follow-up. Significant improvements in total erosion volume occurred in 27% of patients, suggesting that biologic therapies may lead to erosion healing in some patients, although this did not have an impact on self-reported and demonstrated hand function.
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Affiliation(s)
- S C Brunet
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - J J Tse
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M T Kuczynski
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - K Engelke
- Department of Medicine, FAU University Erlangen-Nürnberg and University Clinic Erlangen, Erlangen, Germany
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C Barnabe
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Whittier DE, Boyd SK, Burghardt AJ, Paccou J, Ghasem-Zadeh A, Chapurlat R, Engelke K, Bouxsein ML. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:1607-1627. [PMID: 32458029 PMCID: PMC7429313 DOI: 10.1007/s00198-020-05438-5] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems. METHODS A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document. RESULTS An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems. CONCLUSION This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.
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Affiliation(s)
- D E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - J Paccou
- Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
| | - A Ghasem-Zadeh
- Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Lyon, France
- Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France
| | - K Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Bioclinica, Inc., Hamburg, Germany
| | - M L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Howe JG, Hill RS, Stroncek JD, Shaul JL, Favell D, Cheng RR, Engelke K, Genant HK, Lee DC, Keaveny TM, Bouxsein ML, Huber B. Treatment of bone loss in proximal femurs of postmenopausal osteoporotic women with AGN1 local osteo-enhancement procedure (LOEP) increases hip bone mineral density and hip strength: a long-term prospective cohort study. Osteoporos Int 2020; 31:921-929. [PMID: 31802158 PMCID: PMC7170985 DOI: 10.1007/s00198-019-05230-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED This first-in-human study of AGN1 LOEP demonstrated that this minimally-invasive treatment durably increased aBMD in femurs of osteoporotic postmenopausal women. AGN1 resorption was coupled with new bone formation by 12 weeks and that new bone was maintained for at least 5-7 years resulting in substantially increased FEA-estimated femoral strength. INTRODUCTION This first-in-human study evaluated feasibility, safety, and in vivo response to treating proximal femurs of postmenopausal osteoporotic women with a minimally-invasive local osteo-enhancement procedure (LOEP) to inject a resorbable triphasic osteoconductive implant material (AGN1). METHODS This prospective cohort study enrolled 12 postmenopausal osteoporotic (femoral neck T-score ≤ - 2.5) women aged 56 to 89 years. AGN1 LOEP was performed on left femurs; right femurs were untreated controls. Subjects were followed-up for 5-7 years. Outcomes included adverse events, proximal femur areal bone mineral density (aBMD), AGN1 resorption, and replacement with bone by X-ray and CT, and finite element analysis (FEA) estimated hip strength. RESULTS Baseline treated and control femoral neck aBMD was equivalent. Treated femoral neck aBMD increased by 68 ± 22%, 59 ± 24%, and 58 ± 27% over control at 12 and 24 weeks and 5-7 years, respectively (p < 0.001, all time points). Using conservative assumptions, FEA-estimated femoral strength increased by 41%, 37%, and 22% at 12 and 24 weeks and 5-7 years, respectively (p < 0.01, all time points). Qualitative analysis of X-ray and CT scans demonstrated that AGN1 resorption and replacement with bone was nearly complete by 24 weeks. By 5-7 years, AGN1 appeared to be fully resorbed and replaced with bone integrated with surrounding trabecular and cortical bone. No procedure- or device-related serious adverse events (SAEs) occurred. CONCLUSIONS Treating femurs of postmenopausal osteoporotic women with AGN1 LOEP results in a rapid, durable increase in aBMD and femoral strength. These results support the use and further clinical study of this approach in osteoporotic patients at high risk of hip fracture.
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Affiliation(s)
- J G Howe
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - R S Hill
- AgNovos Healthcare LLC, Rockville, MD, USA.
| | | | - J L Shaul
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - D Favell
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - R R Cheng
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - K Engelke
- Bioclinica-Synarc, Inc., Hamburg, Germany
- FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - H K Genant
- University of California San Francisco, San Francisco, CA, USA
- Bioclinica-Synarc, Inc., Newark, CA, USA
| | - D C Lee
- O.N. Diagnostics, Berkeley, CA, USA
| | - T M Keaveny
- University of California Berkeley, Berkley, CA, USA
| | - M L Bouxsein
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - B Huber
- Mansfield Orthopedics, Morrisville, VT, USA
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Grimm A, Meyer H, Nickel MD, Nittka M, Raithel E, Chaudry O, Friedberger A, Uder M, Kemmler W, Engelke K, Quick HH. A Comparison between 6-point Dixon MRI and MR Spectroscopy to Quantify Muscle Fat in the Thigh of Subjects with Sarcopenia. J Frailty Aging 2019; 8:21-26. [PMID: 30734827 DOI: 10.14283/jfa.2018.16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Changes in muscle fat composition as for example observed in sarcopenia, affect physical performance and muscular function, like strength and power. OBJECTIVES The purpose of this study was to compare 6-point Dixon magnetic resonance imaging and multi-echo magnetic resonance spectroscopy sequences to quantify muscle fat. Setting, participants and measurements: Two groups were recruited (G1: 23 healthy young men (28 ± 4 years), G2: 56 men with sarcopenia (80 ± 5 years)). Proton density fat fraction was measured with a 6-point product and a 6-point prototype Dixon sequence in the left thigh muscle and with a high-speed multi-echo T2*-corrected H1 magnetic resonance spectroscopy sequence within the semitendinosus muscle of the left thigh. To evaluate the comparability among the different methods, Bland-Altman and linear regression analyses of the proton density fat fraction results were performed. RESULTS Mean differences ± 1.96 * standard deviation between spectroscopy and 6pt Dixon sequences were 1.9 ± 3.3% and 1.5 ± 3.6% for the product and prototype sequences, respectively. High correlations were measured between the proton density fat fraction results of the 6-point Dixon sequences and spectroscopy (R = 0.95 for the product sequence and R = 0.97 for the prototype sequence). CONCLUSIONS Dixon imaging and spectroscopy sequences show comparable accuracy for fat measurements in the thigh. Spectroscopy is a local measurement, whereas Dixon sequences provide maps of the fat distribution. The high correlations of the 6-point Dixon sequences with spectroscopy support their clinical use. They provide higher spatial resolution than spectroscopy, but are not suitable for a more complicated spectral analysis to separate extra- and intramyocellular lipids.
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Affiliation(s)
- A Grimm
- Alexandra Grimm, Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Henkestr. 91, 91052 Erlangen, Germany, E-mail address: , Fax number: +49 9131 8522824, Telephone number: +49 9131 8525535
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Zarka M, Hay E, Ostertag A, Marty C, Chappard C, Oudet F, Engelke K, Laredo JD, Cohen-Solal M. Microcracks in subchondral bone plate is linked to less cartilage damage. Bone 2019; 123:1-7. [PMID: 30862540 DOI: 10.1016/j.bone.2019.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Osteoarthritis (OA) is a disease of the whole joint characterized by cartilage loss and subchondral bone remodeling. The role of microcracks in cartilage integrity and subchondral bone homeostasis is not fully understood. The main goal of this work was to evaluate microcrack density in both calcified cartilage and subchondral bone plate in relation to cartilage damage in humans and to better define the association of microcracks and osteocyte density in subchondral bone. METHODS We investigated 18 bone cores from cadaveric human knees that were stained with En-Bloc Basic Fuchsin. We quantified microcrack density, osteocyte density, cartilage surfaces and cartilage damage. The presence of microcracks was confirmed for each bone core by scanning electron microscopy. Finally, trabecular subchondral bone parameters were measured by micro-CT. RESULTS Microcracks were detected in both calcified cartilage and subchondral bone plate. The density of microcracks in both calcified cartilage (CC) and subchondral bone plate (SBP) was negatively correlated with cartilage damage (r = -0.45, p < 0.05). The presence of microcracks in SBP was associated with a lower histological OA score. Osteocytes formed a dendrite network that abruptly stopped at the border of calcified cartilage. Osteocyte density in subchondral bone plate was increased in the presence of microcracks in calcified cartilage. CONCLUSIONS Subchondral bone plate microcracks might be required for maintaining cartilage homeostasis. Microcracks in calcified cartilage may trigger osteocyte density in subchondral bone plate with subsequent regulation of subchondral bone remodeling to prevent cartilage damage.
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Affiliation(s)
- M Zarka
- Inserm UMR1132 and Paris Diderot University, Paris, France.
| | - E Hay
- Inserm UMR1132 and Paris Diderot University, Paris, France.
| | - A Ostertag
- Inserm UMR1132 and Paris Diderot University, Paris, France.
| | - C Marty
- Inserm UMR1132 and Paris Diderot University, Paris, France.
| | - C Chappard
- B2OA, UMR CNRS7052, Paris Diderot University, Paris, France.
| | - F Oudet
- Direction à la recherche, Sorbonne Universités, Université de technologie de Compiègne, Compiègne, France.
| | - K Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Dept of Medicine, University Hospital Erlangen, Germany.
| | - J D Laredo
- B2OA, UMR CNRS7052, Paris Diderot University, Paris, France; Department of Bone and Joint Imaging, Hôpital Lariboisière, Paris, France.
| | - M Cohen-Solal
- Inserm UMR1132 and Paris Diderot University, Paris, France.
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Thomasius F, Baum E, Bernecker P, Böcker W, Brabant T, Clarenz P, Demary W, Dimai HP, Engelbrecht M, Engelke K, Fratermann U, Grieser T, Gulich M, Hadji P, Henning J, Jehle PM, Kern PM, Ketteler M, Klatt G, Kraenzlin M, Maus U, Meier C, Moser U, Müller D, Peichl P, Pfeifer M, Rintelen B, Rueger JM, Schober HC, Schöffel D, Schwarz H, Siggelkow H, Suhm N, Wiese KG, Wörtler K, Kurth AA. DVO Leitlinie 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1673537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDiese DVO Leitlinien, die in erster Linie für Allgemeinmediziner und Spezialisten für Knochenerkrankungen bestimmt sind, sollten von allen im klinischen und ambulanten Bereich tätigen medizinischen Fachkräften angewendet werden. Ziel der Leitlinie ist die Verbesserung der Diagnose, Prävention und Behandlung von Osteoporose und der Folgen der Erkrankung auf der Grundlage evidenzbasierter Medizin.Klare Empfehlungen, welche Patienten zu diagnostizieren und behandeln sind (basierend auf Risikofaktoren [einschließlich sekundärer Osteoporose]) sowie Primär-, Sekundär- oder Tertiärprävention werden dargestellt, mit dem Schwerpunkt auf der postmenopausalen Osteoporose und der Osteoporose bei Männern.Die Identifizierung von Patienten mit einem hohen Risiko für Frakturen wird hervorgehoben, und spezifische Schwellenwerte für die Intervention sind definiert (20 % Hüftfrakturrisiko innerhalb von 10 Jahren diagnostischer Schwellenwert, 30 % Hüftfrakturrisiko innerhalb von 10 Jahren therapeutische Schwelle). Die Diagnose von Osteoporose basiert auf der Anamnese des Patienten, der körperlichen Untersuchung, dem Funktionstest (z. B. Timed Up and Go Test), konventionellen Röntgenaufnahmen der Brust- und Lendenwirbelsäule und der Bestimmung der Knochenmineraldichte (BMD) durch das DXA Verfahren.Die Anamnese ist entscheidend für die Abschätzung des Frakturrisikos auf der Grundlage von 40 wissenschaftlich überprüften Risikofaktoren, die das Frakturrisiko mindestens verdoppeln (z. B. Begleiterkrankungen, Hüftfrakturen in der Familie, prävalente Frakturen an jedem Ort, Lebensstil, Anwendung von Medikamenten, körperliche Aktivität und Stürze). Röntgenaufnahmen der Brust- und Lendenwirbelsäule sind wichtig, um prävalente Wirbelkörperfrakturen zu erkennen. Beim Fehlen eines großen Traumas kann jede Fraktur bei Erwachsenen über dem Alter von 50 Jahren eine Diagnose von Osteoporose nahelegen, mit dem höchsten Risiko für eine nachfolgende Fraktur innerhalb einer kurzen Zeit nach der ersten Fraktur. BMD-Messungen mit DXA sind wichtig, um das individuelle Frakturrisiko besser abschätzen zu können. Eine grundlegende Laboruntersuchung ist obligatorisch, um verschiedene Formen der sekundären Osteoporose ausschließen zu können.Der DVO-Patientenfindungs-Algorithmus basiert auf dem Geschlecht, Alter, Knochenmineraldichte und vorbestehenden Frakturen als wichtigste Informationen. Die Indikation für eine aktive anti-osteoporotische Therapie kann durch multiple Risikofaktoren modifiziert und verfeinert werden. Dieser Algorithmus wurde seit dem Richtlinien-Update 2006 verwendet und wurde entsprechend der internationalen Literatur zu Risikofaktoren für Osteoporose und osteoporotische Frakturen aktualisiert und angepasst.Die Behandlung der Osteoporose enthält viele Therapiepfeiler. Zusammen mit Empfehlungen für Bewegung, Physiotherapie und Sturzprävention sowie Ernährung (z. B. Calcium, Vit. D), werden pharmakologische Behandlungen basierend auf evidenzbasierter Medizin empfohlen. Die aktiven Anti-Osteoporose-Medikamente müssen für die Indikation postmenopausale Osteoporose und männliche Osteoporose in Deutschland, Österreich und der Schweiz zugelassen sein. Das Management und die Vorbeugung von häufigen oder seltenen Nebenwirkungen aufgrund von Anti-Osteoporose-Behandlungen, die in der klinischen Praxis angewendet werden, werden ebenfalls detailliert behandelt.
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Krause M, Museyko O, Wulff B, Campbell G, Damm T, Daug schies M, Huber G, Lu Y, Peña J, Waldhausen S, Bastgen J, Rohde K, Breer S, Steinebach I, Thomsen F, Amling M, Barkmann R, Engelke K, Morlock M, Pfeilschifter J, Püschel K, Glüer CC. New horizons for the in vivo assessment of major aspects of bone quality. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1630120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe Biomechanically founded individualised osteoporosis Assessment and treatment (BioAsset) consortium pursues experimental and clinical studies in the context of skeletal effects of bisphosphonate treatment. Here, first results using newly developed diagnostic methods in a set of vertebral bone specimen obtained from donors with documented bisphosphonate history ranging from 0 to more than 5 years of treatment are presented. A new thoracolumbar quantitative computed tomography (QCT) protocol covering T6 to L4 plus high-resolution QCT (HRQCT) assessment of T12 were compared with high-resolution peripheral QCT (HRpQCT) and micro-CT scans of excised specimens serving as gold standard techniques. Finite element (FE) modelling was performed. Material, ultrastructural, and micromechanical properties were tested on a set of single trabeculae obtained from the donor specimens. A newly developed quantitative ultrasound (QUS) device for measuring the anisotropy of cortical material properties at the tibia was designed and built. The thoracolumbar QCT protocol permitted in situ imaging with good image quality and automated segmentation of vertebral bodies in the whole range from T6 to L4. The duration of bisphosphonate treatment was significantly associated with increased levels of mineralization and this effect could be measured with HRQCT performed on excised specimens. Microstructural parameters contributed to vertebral bone strength modelled by FE analysis independently of bone mineral density. The new QUS tibia scanner permitted measuring the acoustical anisotropy of reference materials. Taken together, these results document that new methods developed in BioAsset permit a more comprehensive assessment of bone fragility. The set of donor specimens with a documented history of bisphosphonate treatment allows for the assessment of the effects of long-term treatment from the organ down to the tissue and material level. These results will ultimately be linked to the parallel clinical study to provide guidance for determining the optimum duration of bisphosphonate treatment to reduce the incidence of osteoporotic fractures.
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Kemmler W, Teschler M, Weissenfels A, Bebenek M, von Stengel S, Kohl M, Freiberger E, Goisser S, Jakob F, Sieber C, Engelke K. Whole-body electromyostimulation to fight sarcopenic obesity in community-dwelling older women at risk. Resultsof the randomized controlled FORMOsA-sarcopenic obesity study. Osteoporos Int 2016; 27:3261-3270. [PMID: 27289534 DOI: 10.1007/s00198-016-3662-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/06/2016] [Indexed: 12/30/2022]
Abstract
UNLABELLED The effect of whole body-electromyostimulation in community-dwelling women ≥70 with sarcopenic obesity was heterogeneous, with high effects on muscle mass, moderate effects on functional parameters, and minor effects on fat mass. Further, we failed to determine a supportive effect of additional protein-enriched dietary supplementation in this albeit predominately well-nourished group. INTRODUCTION The aim of the study was to determine the effect of whole-body electromyostimulation (WB-EMS) on sarcopenic obesity (SO) in community-dwelling women more than 70 years with sarcopenic obesity. METHODS Seventy-five community-dwelling women ≥70 years with SO were randomly allocated to either a WB-EMS-application with (WB-EMS &P; 24.9 ± 1.9 kg/m2) or without (WB-EMS; 25.2 ± 1.8 kg/m2) dietary supplementation (150 kcal/day, 56 % protein) or a non-training control group (CG; 24.7 ± 1.4 kg/m2). WB-EMS consisted of one weekly session of 20 min (85 Hz, 350 μs, 4 s of strain-4 s of rest) performed with moderate to high intensity. Primary study endpoint was the Sarcopenia Z-Score constituted by skeletal muscle mass index (SMI, as assessed by dual energy X-ray absorptiometry), grip strength, and gait speed, and secondary study endpoint was body fat (%). RESULTS Sarcopenia Z-score comparably increases in the WB-EMS and the WB-EMS&P-group (p ≤ .046). Both groups differ significantly (p ≤ .001) from the CG which deteriorated significantly (p = .006). Although body fat changes were most pronounced in the WB-EMS (-0.9 ± 2.1; p = .125) and WB-EMS&P (-1.4 ± 2.5; p = .028), reductions did not statistically differ (p = .746) from the CG (-0.8 ± 2.7; p = .179). Looking behind the covariates, the most prominent changes were determined for SMI, with a significant increase in both EMS-groups (2.0-2.5 %; p ≤ .003) and a decrease in the CG (-1.2 ± 3.1 %; p = .050) with significant between-group differences (p = .001). CONCLUSION WB-EMS is a safe and attractive method for increasing muscle mass and functional capacity in this cohort of women 70+ with SO; however, the effect on body fat is minor. Protein-enriched supplements did not increase effects of WB-EMS alone.
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Affiliation(s)
- W Kemmler
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany.
| | - M Teschler
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - A Weissenfels
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - M Bebenek
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - S von Stengel
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
| | - M Kohl
- Faculty of Medical and Life Sciences, University of Furtwangen, Furtwangen, Germany
| | - E Freiberger
- Institute for Biomedicine of Aging, FAU Erlangen Nürnberg, Nürnberg, Germany
| | - S Goisser
- Institute for Biomedicine of Aging, FAU Erlangen Nürnberg, Nürnberg, Germany
| | - F Jakob
- Musculoskeletal Research Center, University of Würzburg, Würzburg, Germany
| | - C Sieber
- Institute for Biomedicine of Aging, FAU Erlangen Nürnberg, Nürnberg, Germany
| | - K Engelke
- Institute of Medical Physics, FAU Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany
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Langdahl B, Libanati C, Crittenden D, Bolognese M, Brown J, Daizadeh N, Dokoupilova E, Engelke K, Finkelstein J, Genant H, Goemaere S, Hyldstrup L, Jodar-Gimeno E, Keaveny T, Kendler D, Lakatos P, Maddox J, Malouf J, Massari F, Molina J, Ulla M, Grauer A. OP0100 Superior Gains in Bone Mineral Density and Estimated Strength at The Hip for Romosozumab Compared with Teriparatide in Women with Postmenopausal Osteoporosis Transitioning from Bisphosphonate Therapy: Results of The Phase 3 Open-Label Structure Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simon D, Kleyer A, Stemmler F, Simon C, Hueber A, Kampylafka E, Englbrecht M, Figueiredo C, Engelke K, Berlin A, Haschka J, Rech J, Schett G. SAT0543 Accurate Determination of Periarticular Bone Composition in Healthy Individuals and Comparison To Acpa-Positive Rheumatoid Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Figueiredo C, Simon D, Stemmler F, Weissenfels A, Weishaeupl D, Museyko O, Friedberger A, Rech J, Hueber A, Haschka J, Schett G, Engelke K, Kleyer A. AB0938 A Comparison of Two Methods To Segment Bone Erosions in The Metacarpophalangeal Joints of Rheumatoid Arthritis Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Friedberger A, Museyko O, Figueiredo C, Bäuerle T, Chaudry O, Grimm A, Schett G, Engelke K. SAT0539 A New Method for The Quantitative Analysis of Hand Muscle Volume for Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Museyko O, Bousson V, Adams J, Laredo JD, Engelke K. QCT of the proximal femur--which parameters should be measured to discriminate hip fracture? Osteoporos Int 2016; 27:1137-1147. [PMID: 26415934 DOI: 10.1007/s00198-015-3324-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 09/11/2015] [Indexed: 02/04/2023]
Abstract
SUMMARY For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with "cortical" thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination. INTRODUCTION For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures. METHODS The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.2 ± 9.3 years) were compared with 46 female patients (age 80.9 ± 11.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups. RESULTS For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC) = 0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only "cortical" cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry parameter, "cortical" thickness of the neck discriminated hip fracture with an AUC value of 0.83 which was significantly better than 0.77 for total femur BMD alone. A comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination. CONCLUSIONS If QCT of the hip is performed, the analysis should include neck and trochanter. In particular, for fractures of any type, a comprehensive slice-based analysis of the neck along its axis did not significantly improve hip fracture discrimination nor did the inclusion of strength-related parameters other than "cortical" area or thickness. One BMD and one geometry parameter, in this study, the combination of trabecular BMD of the trochanter and of "cortical" thickness of the neck resulted in significant hip fracture discrimination.
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Affiliation(s)
- O Museyko
- Institute of Medical Physics (IMP), University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany.
| | - V Bousson
- Service de Radiologie OstéoArticulaire, Hôpital Lariboisière, Paris, France
| | - J Adams
- Clinical Radiology, The Royal Infirmary, University of Manchester, Manchester, UK
| | - J -D Laredo
- Service de Radiologie OstéoArticulaire, Hôpital Lariboisière, Paris, France
| | - K Engelke
- Institute of Medical Physics (IMP), University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany
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Delecourt C, Relier M, Touraine S, Bouhadoun H, Engelke K, Laredo JD, Chappard C. Cartilage morphology assessed by high resolution micro-computed tomography in non OA knees. Osteoarthritis Cartilage 2016; 24:567-71. [PMID: 26505662 DOI: 10.1016/j.joca.2015.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE At the microscopic level, there is no established 3D method to measure cartilage volume and thickness. An easy, precise and accurate volume and thickness measurements of human cartilage has been developed from micro-computed tomography (micro-CT) images. DESIGN In the medial tibial plateau of twenty nine left cadaveric knees classified as normal, vertical cores (7 mm in diameter) were extracted in three locations: lateral (LAT), medial posterior (MP) and medial anterior (MA). The cores were imaged in mineral oil with micro-CT (voxel size 10.2 μm) and were measured cartilage volume (Cart.Vol, mm(3)) and cartilage thickness (Cart.Th, mm) using a thickness plugin. Short term reproducibility and standard deviation (ST_RMSCV%, ST_RMSSD, mm) were determined. To assess accuracy, holes with diameters of 2 mm, 3 mm, and 4 mm were artificially generated and nominal and measured hole sizes were compared. RESULTS Precision of Cart.Vol_ST_RMSCV% was 1.35%. The mean biases between nominal hole volume and measurements were -0.49 ± 1.5 mm(3) (2 mm), -0.41 ± 4.2 mm(3) (3 mm) and +0.34 ± 4.4 mm(3) (4 mm). ST_RMSSD was 100 times lower than the biological variation and the highest bias to measure volume was 24 times lower. Cart.Th results statistically differed among core extraction locations: 1.75 ± 0.28 mm (LAT), 1.84 ± 0.40 mm (MP) and 2.32 ± 0.41 mm (MA). CONCLUSION With a standard laboratory micro-CT system, it was possible to measure cartilage volume and thickness with good precision and accuracy relative to the biological variation of the specimen cohort. Cartilage measurements from micro-CT probably will improve the knowledge of the relationship between cartilage and subchondral bone and may allow to better understand the OA process.
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Affiliation(s)
- C Delecourt
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France
| | - M Relier
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France
| | - S Touraine
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France; Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, Paris, France
| | - H Bouhadoun
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France
| | - K Engelke
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - J D Laredo
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France; Service de Radiologie Ostéo-Articulaire, Hôpital Lariboisière, Paris, France
| | - C Chappard
- B2OA, UMR CNRS 7052, University Diderot-PRES Sorbonne-Paris Cité, Paris, France.
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Kemmler W, von Stengel S, Engelke K, Sieber C, Freiberger E. Prevalence of sarcopenic obesity in Germany using established definitions: Baseline data of the FORMOsA study. Osteoporos Int 2016; 27:275-81. [PMID: 26318759 DOI: 10.1007/s00198-015-3303-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/21/2015] [Indexed: 11/27/2022]
Abstract
UNLABELLED The prevalence of sarcopenic obesity in community-dwelling women 70 years and older according to established sarcopenia and obesity definitions averaged between 0 and 2.3 % and can thus be considered as relatively low. However, the converse argument that sarcopenic obesity was incompatible with an independent life cannot be confirmed. INTRODUCTION The primary aim of the study was to determine the prevalence of sarcopenic obesity (SO) in community-dwelling (CD) older females in Germany. The secondary aim was to assess whether these females really live independently and autonomously. METHODS A total of 1325 CD females 70 years and older living in the area of Erlangen-Nürnberg, Germany were assessed. Sarcopenia as defined by (a) the European Working Group on Sarcopenia in older people (EWGSOP) and (b) the International working group on Sarcopenia (IWGS) combined with obesity defined as (a) BMI ≥ 30 kg/m(2) (NIH) or (b) body-fat ≥ 35 % (WHO) was determined. In participants with SO, Barthel Index, care level and social network were retrospectively evaluated via personal interview. RESULTS Based on anthropometric data, family, education and social status, lifestyle, number and distribution of diseases and medication, the present cohort is representative for the corresponding German population. Sarcopenia prevalence was 4.5 % according to EWGSOP and 3.3 % according to the IWGS criteria. Obesity prevalence in our cohort averaged 19.8 % (BMI, NIH) and 63.8 % (body fat, WHO). The overlap between both factors (i.e. SO) ranged from 0 % (EWGSOP + NIH criteria) to 2.3 % (EWGSOP + WHO criteria). Factors that may represent limited autonomy or independence were very rarely identified in this SO cohort. CONCLUSION The prevalence of sarcopenic obesity in the CD (female) German population 70 years + is relatively low. With respect to our second research aim, the hypothesis that SO was incompatible with independent life was rejected. However, the latter finding should be addressed with more dedicated study designs.
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Affiliation(s)
- W Kemmler
- Institute of Medical Physics, University of Erlangen-Nürnberg, 91052, Erlangen, Germany.
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Henkestrasse 91, 91052, Erlangen, Germany.
| | - S von Stengel
- Institute of Medical Physics, University of Erlangen-Nürnberg, 91052, Erlangen, Germany
| | - K Engelke
- Institute of Medical Physics, University of Erlangen-Nürnberg, 91052, Erlangen, Germany
| | - C Sieber
- Institute of Biomedicine of Aging, University of Erlangen-Nürnberg, 90408, Nürnberg, Germany
| | - E Freiberger
- Institute of Biomedicine of Aging, University of Erlangen-Nürnberg, 90408, Nürnberg, Germany
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Engelke K, Töpfer D, Finzel S, Museyko O, Schett G. FRI0596 Impact of Spatial Resolution on Size Quantification of Erosions in the Metacarpals: A Cadaver Study Comparing Clinical Whole Body Scanners with High Resolution Xtremect. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Genant H, Bolognese M, Mautalen C, Brown J, Recknor C, Goemaere S, Engelke K, Yang YC, Austin M, Grauer A, Libanati C. OP0291 Romosozumab Administration is Associated with Significant Improvements in Lumbar Spine and Hip Volumetric Bone Mineral Density and Content Compared with Teriparatide. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Barnabe C, Marotte H, Scharmga A, Kraus S, Burghardt A, Hauge EM, Boutroy S, Toepfer D, Engelke K, Kocijan R, de Jong J, Li X, Stok K, Finzel S. SAT0178 Rheumatoid Arthritis Erosion Detection and Measurement in Longitudinal Datasets Using High-Resolution Peripheral Quantitative Computed Tomography (HR-PQCT): Reliability Exercise-2 (RELEX-2). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Relier M, Touraine S, Bouhadoun H, Engelke K, Laredo JD, Chappard C. SAT0551 Location Dependence of the Microstructure of Cartilage and of Subchondral Cortical and Trabecular Bone Microstructure in Knees with NO or Mild OA Assessed by High Resolution Micro-Computed Tomography. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Krause M, Museyko O, Breer S, Wulff B, Duckstein C, Vettorazzi E, Glueer C, Püschel K, Engelke K, Amling M. Accuracy of trabecular structure by HR-pQCT compared to gold standard μCT in the radius and tibia of patients with osteoporosis and long-term bisphosphonate therapy. Osteoporos Int 2014; 25:1595-606. [PMID: 24566588 DOI: 10.1007/s00198-014-2650-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 02/05/2014] [Indexed: 12/27/2022]
Abstract
UNLABELLED Despite an increasing use of high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone morphology in vivo, there are reservations about its applicability in patients with osteoporosis and antiresorptive therapy. This study shows that HR-pQCT provides acceptable in vivo accuracy for bone volume fraction (BV/TV) in patients with osteoporosis and bisphosphonate (BP) treatment. INTRODUCTION The primary aim was to analyze agreement of trabecular structure between HR-pQCT and gold standard microtomography (μCT) in patients with osteoporosis and long-term BP therapy. METHODS In the BioAsset study, we analyzed cadaver radii and tibiae of 34 postmenopausal females (81.1 ± 7.1 years) with osteoporosis (no BP n = 22, 1-5 years BP n = 5, >5 years BP n = 7). Two HR-pQCT protocols (patient-mode and μCT-mode) were compared with gold standard μCT after image registration. Undecalcified histological sections were obtained to quantify nonmineralized bone matrix. Bland-Altman plots illustrated methodological agreement. Multiple regression analysis was used to test for variables associated with method agreement. RESULTS In the radius and tibia, patient-mode HR-pQCT derived indices including bone volume fraction, trabecular number, and trabecular separation correlated well with gold standard μCT (R(2) = 0.78 - 0.88) except for trabecular thickness (R(2) = 0.11). Bland-Altman plots illustrated adequate agreement for bone volume fraction. Lower agreement of trabecular number and trabecular separation improved with decreasing structural impairment at the tibia only. Trabecular thickness was not appropriately assessed with HR-pQCT at both skeletal sites. Higher agreement for bone volume fraction was associated with increasing tissue mineral density in the tibia. CONCLUSIONS HR-pQCT provides acceptable in vivo accuracy for BV/TV in patients with osteoporosis and BP treatment. Higher TMD was associated with higher BV/TV accuracy in vivo. Overall, methodological agreement got less accurate with increasing structural impairment in the tibia.
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Affiliation(s)
- M Krause
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Museyko O, Heinemann A, Krause M, Wulff B, Amling M, Püschel K, Glüer CC, Kalender W, Engelke K. A low-radiation exposure protocol for 3D QCT of the spine. Osteoporos Int 2014; 25:983-92. [PMID: 24142100 DOI: 10.1007/s00198-013-2544-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
SUMMARY Cadaver and phantom measurements and simulations confirmed that radiation exposure in 3D QCT of the spine can be reduced if 80 kV instead of 120 kV protocols are used; 120 mAs and slice thicknesses of 1-1.3 mm should be usable but obese patient will require higher milliampere-second settings. PURPOSE To develop a low-radiation exposure CT acquisition protocol for 3D QCT of the thoracolumbar spine. METHODS Twenty-six cadavers were scanned with a standard protocol of 120 kV, 100 mAs and with a low-dose protocol using 90 kV, 150 mAs. The scan range included the vertebrae T6 to L4. Each vertebra was segmented and the integral volume and BMD of the total vertebral body were determined. Effective dose values were estimated. The impact of milliampere-second reduction on image quality was simulated by adding noise. RESULTS One hundred ninety-six vertebrae were analyzed. Integral volume as well as integral BMD correlated significantly (p < 0.001) between standard and low-dose protocols (volume, r (2) = 0.991, residual root mean square (RMS) error, 0.77 cm(3); BMD, r (2) = 0.985, RMS error, 4.21 mg/cm(3)). The slope significantly differed from 1 for integral BMD but not for volume hinting at residual field inhomogeneity differences between the two voltage settings that could be corrected by cross-calibration. Compared to the standard protocol, effective dose was reduced by over 50 % in the low-dose protocol. Adding noise in the 90 kV images to simulate a reduction from 150 to 100 mAs did not affect the results for integral volume or BMD. CONCLUSIONS For 3D QCT of the spine, depending on scanner type, 80 or 90 kV instead of 120 kV protocols may be considered as an important option to reduce radiation exposure; 120 mAs and slice thicknesses of 1-1.5 mm are usable if segmentation is robust to noise. In obese patients, higher milliampere-second settings will be required.
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Affiliation(s)
- O Museyko
- Institute of Medical Physics (IMP), University of Erlangen-Nuremberg, Henkestr. 91, 91052, Erlangen, Germany,
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Toepfer D, Finzel S, Museyko O, Schett G, Engelke K. AB0720 Monitoring of changes of size, shape and bone mineral density of bone erosions in high resolution ct datasets of patients with rheumatoid arthritis under treatment. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-eular.3042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Based on spiral 3D tomography a large variety of applications have been developed during the last decade to asses bone mineral density, bone macro and micro structure, and bone strength. Quantitative computed tomography (QCT) using clinical whole body scanners provides separate assessment of trabecular, cortical, and subcortical bone mineral density (BMD) and content (BMC) principally in the spine and hip, although the distal forearm can also be assessed. Further bone macrostructure, for example bone geometry or cortical thickness can be quantified. Special high resolution peripheral CT (hr-pQCT) devices have been introduced to measure bone microstructure for example the trabecular architecture or cortical porosity at the distal forearm or tibia. 3D CT is also the basis for finite element analysis (FEA) to determine bone strength. QCT, hr-pQCT, and FEM are increasingly used in research as well as in clinical trials to complement areal BMD measurements obtained by the standard densitometric technique of dual x-ray absorptiometry (DXA). This review explains technical developments and demonstrates how QCT based techniques advanced our understanding of bone biology.
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Affiliation(s)
- K Engelke
- Institute of Medical Physics, University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany,
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Topfer D, Finzel S, Museyko O, Schett G, Engelke K. Segmentation and quantification of bone erosions in high-resolution peripheral quantitative computed tomography datasets of the metacarpophalangeal joints of patients with rheumatoid arthritis. Rheumatology (Oxford) 2013; 53:65-71. [DOI: 10.1093/rheumatology/ket259] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lowitz T, Museyko O, Bousson V, Laouisset L, Kalender WA, Laredo JD, Engelke K. Bone marrow lesions identified by MRI in knee osteoarthritis are associated with locally increased bone mineral density measured by QCT. Osteoarthritis Cartilage 2013; 21:957-64. [PMID: 23602981 DOI: 10.1016/j.joca.2013.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Bone marrow lesions (BMLs) in the knee are associated with pain and compartment-specific joint space narrowing. However, the correlation of BMLs with bone mineral density (BMD) has rarely been investigated. The aim of the present study was to examine whether BMD in BMLs is altered compared to the surrounding bone. DESIGN Thirty-four BMLs detected in osteoarthritis (OA) knees (KL grade 2 and 3) of 26 patients were investigated. A 3D-segmentation was used to determine BML volumes of interest (VOI) and their surrounding bone in MR images. These VOIs were registered to corresponding single-energy QCT images and a BMD analysis was performed. The same VOIs were transferred to control datasets (19 OA patients without BMLs) by an elastic registration, where the BMD analysis was repeated. To account for the dependence of bone marrow composition on BMD measures derived using single-energy QCT, simulations were performed to evaluate how changing fat-water compositions likely occurring with BML development may influence BMD measures and observed BMD differences between patients with and without BMLs. The association between loading in the knee and the occurrence of BMLs was investigated by medial to lateral (M:L) BMD ratios. RESULTS BMD was significantly increased at BML locations, even with a fat-to-water conversion rate of 39%. The M:L BMD ratio was significantly increased in bones with medial BMLs. CONCLUSIONS BMD was examined exactly at BML locations and surrounding bone using highly accurate segmentation and registration methods. BMD was significantly increased at BML locations (P < 0.05).
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Affiliation(s)
- T Lowitz
- Institute of Medical Physics, University of Erlangen-Nuernberg, Erlangen, Germany.
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Hecht CF, Englbrecht M, Schmidt S, Rech J, Engelke K, Araujo E, Schett G, Finzel S. FRI0481 Anti- citrullinated protein antibodies but not rheumatoid factor are associated with larger bone erosions in ra patients- a cross-sectional hr-pqct study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lowitz T, Museyko O, Laouisset L, Laredo JD, Bousson V, Kalender W, Engelke K. OP0233 QCT indicates locally increased bone mineral density (BMD) in regions of bone marrow lesions (BML) segmented on MR images. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Toepfer D, Finzel S, Museyko O, Schett G, Engelke K. THU0419 A novel technique to quantify bone erosions in patients with rheumatoid diseases using high-resolution PQCT images. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
In osteoarthritis, magnetic resonance imaging is the method of choice to image articular cartilage and "bone marrow lesions." However, the calcified cartilage, the subchondral bone plate, and trabecular subchondral bone that are mineralized tissues strongly attenuate X-rays and are therefore potentially accessible for analyses using computed tomography (CT). CT images nicely show osseous cardinal signs of advanced osteoarthritis such as osteophytes, subchondral cysts, and subchondral bone sclerosis. But more importantly, CT can help us to better understand the pathophysiology of knee osteoarthritis from the measurement of the density and structure of subchondral mineralized tissues in vivo. For that purpose, we recently developed dedicated image analysis software called Medical Image Analysis Framework (MIAF)-Knee. In this manuscript, our aims are to present current knowledge on CT imaging of the subchondral bone in knee osteoarthritis and to provide a brief introduction to basic technical aspects of MIAF-Knee as well as preliminary results we obtained in patients with knee osteoarthritis as compared to control subjects.
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Affiliation(s)
- V Bousson
- AP-HP, Radiologie Ostéo-Articulaire, Hôpital Lariboisière, Université Paris VII Denis Diderot, 2 rue Ambroise Paré, 75010, Paris, France.
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Kemmler W, Engelke K, von Stengel S. Ganzkörper-Elektromyostimulation zur Prävention der Sarkopenie bei einem älteren Risikokollektiv. Die Test-III Studie. Dtsch Z Sportmed 2012. [DOI: 10.5960/dzsm.2012.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zerfass P, Lowitz T, Museyko O, Bousson V, Laouisset L, Kalender WA, Laredo JD, Engelke K. An Integrated Segmentation and Analysis Approach for QCT of the Knee to Determine Subchondral Bone Mineral Density and Texture. IEEE Trans Biomed Eng 2012; 59:2449-58. [DOI: 10.1109/tbme.2012.2202660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Engelke K, Stampa B, Timm W, Dardzinski B, de Papp AE, Genant HK, Fuerst T. Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia. Osteoporos Int 2012; 23:2151-8. [PMID: 22143491 DOI: 10.1007/s00198-011-1829-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Abstract
UNLABELLED In vivo hr-pQCT precision was determined in 42 postmenopausal women using double baseline measurements from a multicenter trial of odanacatib. Errors, e.g., at the radius below 1.3% for BMD and below 6.3% for trabecular structure, were comparable to single-center results. Motion artifacts remain a challenge, particularly at the forearm. INTRODUCTION The short-term in vivo precision of BMD, trabecular bone structure, cortical thickness and porosity of the forearm and tibia was measured by hr-pQCT. Also the effect of image quality on precision was evaluated. METHODS In 42 postmenopausal women (age 64.4 ± 6.8 years) out of 214 subjects enrolled in a multi center advanced imaging phase III study of odanacatib (DXA spine or hip T-scores between -1.5 and -3.5), double baseline hr-pQCT (XtremeCT) measurements with repositioning were performed. The standard ultradistal location and a second, more proximally located VOI were measured at the radius and tibia to better assess cortical thickness and porosity. Image analysis and quality grading (grades: perfect, slight artifacts, pronounced artifacts, unacceptable) were performed centrally. RESULTS At the radius RMS%CV values varied from 0.7% to 1.3% for BMD and BV/TV and from 5.6% to 6.3% for Tb.Sp, Tb.Th, Tb.N, and cortical porosity. Numerically at the tibia, precision errors were approx. 0.5% lower for BMD and 1% to 2% lower for structural parameters although most differences were insignificant. In the radius but not in the tibia, precision errors for cortical thickness were smaller at the distal compared to the ultradistal location (1% versus 2%). CONCLUSIONS BMD precision errors were lower than those for trabecular architecture and cortical porosity. Motion artifacts remain a challenge, particularly at the forearm. Quality grading remains subjective, and more objective evaluation methods are needed. Precision in the context of a multicenter clinical trial, with centralized training and scan analysis, was comparable to single-center results previously reported.
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Affiliation(s)
- K Engelke
- Synarc Inc., Lübecker Strasse 128, Hamburg, Germany.
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Allena R, Duchemin L, Bousson V, Mitton D, Laredo J, Engelke K, Skalli W. EVALUATION OF A SUBJECT SPECIFIC FINITE ELEMENT MODEL IN A SIDE LOAD CONFIGURATION. J Biomech 2012. [DOI: 10.1016/s0021-9290(12)70527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kemmler W, von Stengel S, Bebenek M, Engelke K, Hentschke C, Kalender WA. Exercise and fractures in postmenopausal women: 12-year results of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS). Osteoporos Int 2012; 23:1267-76. [PMID: 21625881 DOI: 10.1007/s00198-011-1663-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 04/19/2011] [Indexed: 11/24/2022]
Abstract
UNLABELLED This trial is the first exercise study that focuses on fracture incidence as a primary study endpoint. Although we marginally failed to determine significant effects on "overall" fracture risk (p = .074) or rate ratio (p = .095), our findings further increased the evidence that exercise relevantly prevents fractures in the elderly. INTRODUCTION The purpose of this study is to determine the effect of strictly supervised long-term exercise training on "overall" fracture incidence and bone mineral density (BMD) in postmenopausal osteopenic women. METHODS Eighty-five early postmenopausal (1-8 years), osteopenic women living in the area of Erlangen-Nuremberg, Germany without any medication or diseases affecting bone metabolism were assessed after 12 years of supervised exercise (EG) or unvarying lifestyle (control, CG). Exercisers were encouraged to perform two group sessions/week and two home training sessions/week. Calcium and vitamin D supplementation was provided for both groups. "Overall" fractures were determined by questionnaires and structured interviews. The BMD was assessed at lumbar spine and proximal femur by dual-energy X-ray absorptiometry. RESULTS "Overall" fracture risk ratio in the EG was 0.32 (95% confidence interval (CI), 0.08 to 1.05; p = .074), and the rate ratio for "overall" fractures was 0.38 (95% CI, 0.11 to 1.15; p = .095). BMD changes at lumbar spine (EG, -0.8%; 95% CI, 0.8% to -2.7% vs. CG, -4.0%; 95% CI, -2.4% to -5.7%; p = .011) and femoral neck (EG, -3.7%; 95% CI, -2.4% to -5.0% vs. CG, -6.7%; 95% CI, -5.3% to -8.2%; p = .003) significantly differed between both groups. CONCLUSION Although we marginally failed to determine significant effects on overall fracture risk or rate ratio, our study increased the body of evidence for the fracture prevention efficiency of exercise programs, with special regard on bone strength (as assessed by bone mineral density measurement). Future studies should focus on subjects more prone to fractures to generate enough statistical power to clearly determine this issue.
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Affiliation(s)
- W Kemmler
- Institute of Medical Physics, University of Erlangen, Henkestrasse 91, 91052 Erlangen, Germany.
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Ramamurthi K, Ahmad O, Engelke K, Taylor RH, Zhu K, Gustafsson S, Prince RL, Wilson KE. An in vivo comparison of hip structure analysis (HSA) with measurements obtained by QCT. Osteoporos Int 2012; 23:543-51. [PMID: 21394495 PMCID: PMC3261404 DOI: 10.1007/s00198-011-1578-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/31/2011] [Indexed: 01/10/2023]
Abstract
SUMMARY In a population of elderly women, bone cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), section modulus (Z), femoral neck axis length (FNAL), and width measured with hip structure analysis (HSA) on dual-energy x-ray absorptiometry (DXA) images in the femoral neck and trochanteric regions are highly correlated to quantitative computed tomography (QCT) measurements. INTRODUCTION HSA is a method of obtaining measurements of proximal femur structure using 2D DXA technology. This study was designed to examine the correlations between HSA measurements and 3D QCT. METHODS Forty-one women (mean age, 82.8 ± 2.5 years) were measured using DXA and a 64-slice CT scanner (1 mm slice thickness, 0.29 mm in plane resolution). HSA parameters were calculated at the narrow neck (NN) and trochanteric (IT) regions on the DXA image. These regions were then translated to anatomically equivalent regions on the QCT dataset by co-registering the DXA image and QCT dataset using four DXA images acquired at different angles. RESULTS At the NN and IT regions, high linear correlations were measured between HSA and QCT for CSA r = 0.95 and 0.93, CSMI r = 0.94 and 0.93, and Z r = 0.93 and 0.89, respectively. All correlations were highly significant (p < 0.001), but there were differences in slope and offset between the two techniques, at least in part due to differences in calibration between the two techniques. FNAL and width of the bone at the NN and IT regions, physical measurements independent of the calibration, were highly correlated (r = 0.90-0.95, p < 0.001) and had slopes close to 1.0 (range, 0.978 to 1.003). CONCLUSION CSA, CSMI, Z, FNAL, and width measured by HSA correlate highly to high-resolution QCT.
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Affiliation(s)
| | - O. Ahmad
- Department of Computer Science, Engineering Research Center for Computer-Integrated Surgical Systems and Technology, The Johns Hopkins University, Baltimore, MD USA
| | - K. Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - R. H. Taylor
- Department of Computer Science, Engineering Research Center for Computer-Integrated Surgical Systems and Technology, The Johns Hopkins University, Baltimore, MD USA
| | - K. Zhu
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - S. Gustafsson
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
| | - R. L. Prince
- Department of Endocrinology and Diabetes, The Univerisity of Western Australia School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Perth, Western Australia Australia
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Kemmler W, Bebenek M, von Stengel S, Engelke K, Kalender WA. Effect of block-periodized exercise training on bone and coronary heart disease risk factors in early post-menopausal women: a randomized controlled study. Scand J Med Sci Sports 2011; 23:121-9. [PMID: 21631599 DOI: 10.1111/j.1600-0838.2011.01335.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this 12 month randomized exercise intervention was to determine the effect of a block-periodized multipurpose exercise program on bone mineral density (BMD) and parameters of the metabolic syndrome (MetS) in early post-menopausal women. Eighty-five subjects (52.3 ± 2.4 years) living in the area of Erlangen (Germany) were randomly assigned into an exercise (EG, n=43) or a wellness-control group (CG: n=42). The EG performed a periodized multipurpose exercise program with 4-6-week blocks of high-intensity bone-specific exercise intermitted by 10-12 weeks of exercise dedicated to increase endurance and reduce cardiac and metabolic risk factors. The CG performed a low-volume/low-intensity "wellness" program to increase well-being. After 12 months, significant exercise effects were observed for the lumbar spine (LS) BMD as assessed by quantitative computed tomography [total BMD (EG: -0.3 ± 2.1% vs CG: -2.1 ± 2.2%, P=0.015); trabecular BMD (EG: -0.7 ± 3.4% vs CG: -4.7 ± 4.9%, P=0.001) and dual-energy x-ray absorptiometry (DXA) (EG: -0.1 ± 2.2% vs CG: -2.0 ± 2.0%, P=0.002)]. However, no significant effects were observed for total hip BMD as assessed by DXA (P=0.152). Although all MetS parameters were favorably affected among the EG, only the effect for waist circumference was significant. In summary, short periods of bone-specific intervention embedded in longer periods of exercises dedicated to improve cardiovascular and metabolic risk factors positively affected BMD at the LS.
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Affiliation(s)
- W Kemmler
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany.
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Finzel S, Rech J, Schmidt S, Engelke K, Englbrecht M, Stach C, Schett G. Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis 2011; 70:1587-93. [DOI: 10.1136/ard.2010.148395] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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von Stengel S, Kemmler W, Engelke K, Kalender WA. Effects of whole body vibration on bone mineral density and falls: results of the randomized controlled ELVIS study with postmenopausal women. Osteoporos Int 2011; 22:317-25. [PMID: 20306017 DOI: 10.1007/s00198-010-1215-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 01/29/2010] [Indexed: 12/30/2022]
Abstract
UNLABELLED We determined whether the effect of exercise on bone mineral density (BMD) and falls can be enhanced by whole body vibration (WBV). In summary, the multi-purpose exercise training was effective to increase lumbar BMD but added WBV did not enhance this effect. However, falls were lowest in the exercise program combined with WBV. INTRODUCTION WBV is a new approach to reduce the risk of osteoporotic fractures. In the "Erlangen Longitudinal Vibration Study" (ELVIS), we investigated whether WBV enhances the effect of multifunctional exercise on BMD and falls. METHODS One hundred fifty-one postmenopausal women (68.5 ± 3.1 years) were randomly assigned to a: (1) conventional training group (TG); (2) conventional training group including vibration (TGV); and (3) wellness control group (CG). TG conducted an exercise program consisting of 20 min dancing aerobics, 5 min balance training, 20 min functional gymnastics, and 15 min dynamic leg-strength training on vibration plates (without vibration) twice a week. TGV performed an identical exercise regimen with vibration (25-35 Hz) during the leg-strengthening sequence. CG performed a low-intensity wellness program. BMD was measured at the hip and lumbar spine at baseline and follow-up using the DXA method. Falls were recorded daily via the calendar method. RESULTS After 18 months, an increase in BMD at the lumbar spine was observed in both training groups (TGV: +1.5% vs. TG: +2.1%). The difference between the TG and the CG (1.7%) was significant. At the hip no changes were determined in either group. The fall frequency was significantly lower in TGV (0.7 falls/person) compared with CG (1.5), whereas the difference between TG (0.96) and CG was not significant. CONCLUSIONS A multifunctional training program had a positive impact on lumbar BMD. The application of vibration did not enhance these effects. However, only the training including WBV affected the number of falls significantly.
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Affiliation(s)
- S von Stengel
- Institute of Medical Physics, University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany.
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Finzel S, Englbrecht M, Engelke K, Stach C, Schett G. A comparative study of periarticular bone lesions in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis 2010; 70:122-7. [DOI: 10.1136/ard.2010.132423] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Genant HK, Engelke K, Hanley DA, Brown JP, Omizo M, Bone HG, Kivitz AJ, Fuerst T, Wang H, Austin M, Libanati C. Denosumab improves density and strength parameters as measured by QCT of the radius in postmenopausal women with low bone mineral density. Bone 2010; 47:131-9. [PMID: 20399288 DOI: 10.1016/j.bone.2010.04.594] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 03/25/2010] [Accepted: 04/09/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bone strength is determined by both cortical and trabecular bone compartments and can be evaluated radiologically through measurement of bone density and geometry. Quantitative computed tomography (QCT) separately assesses cortical and trabecular bone reliably at various sites, including the distal radius where there is a gradation of cortical and trabecular bone. We evaluated the effect of denosumab, a fully human monoclonal antibody that inhibits RANK ligand, on distal radius QCT in women with low bone mass to assess the impact of this novel therapy separately on trabecular and cortical bone. METHODS Postmenopausal women (n=332) with spine areal bone mineral density (BMD) T-scores between -1.0 and -2.5 received denosumab 60 mg or placebo every 6 months during the 24-month study. QCT measurements along the distal radius were made using a whole-body computed tomography scanner and were used to determine the percentage change from baseline in volumetric BMD; volumetric bone mineral content (BMC); cortical thickness; volume; circumference; and density-weighted polar moment of inertia (PMI), a derived index of bone strength. RESULTS Denosumab treatment significantly increased total BMD and BMC along the radius (proximal, distal, and ultradistal sections). At 24 months, the ultradistal region had the greatest percentage increase in total BMD (4.7% [95% CI, 3.6-5.7]; P<0.001) and total BMC (5.7% [95% CI, 4.8-6.6]; P<0.001) over placebo. When cortical and trabecular bone at the proximal and distal regions were separately assessed, cortical bone had significant (P<0.001) increases in BMD, BMC, and thickness, and trabecular bone had a significant increase in BMD relative to placebo (P<0.05). Bone strength, estimated by density-weighted PMI, significantly increased compared with placebo after 6 months of treatment, with the largest percentage increase occurring at 24 months in the ultradistal region (6.6% [95% CI, 5.6-7.6]; P<0.0001). CONCLUSIONS QCT measurements demonstrated that denosumab significantly increased BMD, BMC, and PMI along the radius over 24 months. Additionally, denosumab prevented the decrease in QCT-measured cortical thickness observed in the placebo group. These data extend the evidence from previous dual-energy X-ray absorptiometry studies for a positive effect of denosumab on both the cortical and trabecular bone compartments and propose a possible mechanism for the reduction in fracture risk achieved with denosumab therapy.
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Affiliation(s)
- H K Genant
- Dept. of Radiology, University of California, San Francisco, CA 94143, USA.
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von Stengel S, Kemmler W, Engelke K, Kalender WA. Effect of whole-body vibration on neuromuscular performance and body composition for females 65 years and older: a randomized-controlled trial. Scand J Med Sci Sports 2010; 22:119-27. [PMID: 20500555 DOI: 10.1111/j.1600-0838.2010.01126.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We examined whether the effect of multipurpose exercise can be enhanced by whole-body vibration (WBV). One hundred and fifty-one post-menopausal women (68.5 ± 3.1 years) were randomly assigned to three groups: (1) a training group (TG); (2) training including vibration (VTG); and (3) a wellness control group (CG). TG and VTG performed the same training program twice weekly (60 min), consisting of aerobic and strength exercises, with the only difference that leg strength exercises (15 min) were performed with (VTG) or without (TG) vibration. CG performed a low-intensity "wellness" program. At baseline and after 18 months, body composition was determined using dual-X-ray-absorptiometry. Maximum isometric strength was determined for the legs and the trunk region. Leg power was measured by countermovement jumps using a force-measuring plate. In the TG lean body mass, total body fat, and abdominal fat were favorably affected, but no additive effects were generated by the vibration stimulus. However, concerning muscle strength and power, there was a tendency in favor of the VTG. Only vibration training resulted in a significant increase of leg and trunk flexion strength compared with CG. In summary, WBV embedded in a multipurpose exercise program showed minor additive effects on body composition and neuromuscular performance.
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Affiliation(s)
- S von Stengel
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nuernberg, Erlangen, Germany.
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Bohm C, Zaiss MM, Axmann R, Hess A, Engelke K, Kollias G, Schett G, David JP. ERK-activated kinase RSK2 protects against inflammatory arthritis-induced bone destruction by opposing the tumour necrosis factor -mediated inhibition of bone formation. Ann Rheum Dis 2010. [DOI: 10.1136/ard.2010.129593v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gruetzmann S, Engelke K, Winter M, Polt A. Effiziente Ressourcennutzung durch ereignisdiskrete Simulation. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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von Stengel S, Kemmler W, Mayer S, Engelke K, Klarner A, Kalender WA. [Effect of whole body vibration exercise on osteoporotic risk factors]. Dtsch Med Wochenschr 2009; 134:1511-6. [PMID: 19603365 DOI: 10.1055/s-0029-1233971] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Whole body vibration (WBV) training is a new approach which is currently discussed in the context of reducing the risk of osteoporotic fractures. The study was undertaken to determine the effect of one-year WBV exercise on bone mineral density (BMD) and the number of falls. METHODS 151 postmenopausal women (68.5 +/- 3.1 years) were randomly assigned to three groups: (1) conventional (multifunctional) training (TG); (2) multifunctional training including WBV (VTG); (3) wellness-control group (CG). The training groups performed multifunctional training twice weekly (60 min; dancing aerobics, balance training, functional strength training). In the last 15 min of each session, leg strength exercises on vibration platforms were performed. The plates were switched on only in the VTG. The CG performed a low intensity gymnastic and relaxation programme (4 x 10 sessions of 60 min). BMD was measured at the hip and lumbar spine at baseline and after 12 months with the DXA method. Falls were recorded daily with the calendar method in a fall log. RESULTS An increase in BMD at the lumbar spine was measured after one year in both training groups (VTG: + 1.17 +/- 2.4 % vs. TG: + 1.73 +/- 2.4 %). The difference between the TG and the CG was significant (p < .05). Regarding the hip region a loss was noted in the CG (- 0.9 +/- 2.5), whereas the BMD stayed stable in the training groups (TG: - 0.3 %; VTG: + 0.1 %). The fall rate was significantly lower in VTG compared to CG (0.43 falls/person/year (VTG) vs. 1.14 (CG). CONCLUSION The multifunctional training resulted in a gain of BMD at the lumbar spine. Vibration training did not enhance the effect on bone but significantly reduced falls.
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Affiliation(s)
- S von Stengel
- Institut für Medizinische Physik, Friedrich-Alexander Universität Erlangen-Nürnberg.
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Kalender W, Engelke K, Fuerst TP, Glüer CC, Laugier P, Shepherd J. 4. Concepts of quality assurance and standardization. J ICRU 2009; 9:33-35. [PMID: 24174557 DOI: 10.1093/jicru/ndp007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kalender W, Engelke K, Fuerst TP, Glüer CC, Laugier P, Shepherd J. 2. Quantities and units in bone densitometry. J ICRU 2009; 9:7-10. [PMID: 24174555 DOI: 10.1093/jicru/ndp005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Kalender W, Engelke K, Fuerst TP, Glüer CC, Laugier P, Shepherd J. 6. Quantitative computed tomography. J ICRU 2009; 9:59-69. [PMID: 24174559 DOI: 10.1093/jicru/ndp009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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