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Zhang ZZ, Hu TT, Wang Y, Zhu XN, Liu Y, Gao L, Zhang ZK, Gao EP, Zhang W, Zheng YL. Preliminary study on the effect of lumbar axial rotation on bone mineral density measured by DXA and QCT. Sci Rep 2024; 14:20417. [PMID: 39223229 PMCID: PMC11368918 DOI: 10.1038/s41598-024-71229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
Currently, the relationship between axial rotation of the vertebrae and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) remains controversial. The aim of this study is to quantitatively assess the effect of vertebral rotation on volumetric bone mineral density (v-BMD) and areal bone mineral density (a-BMD), further to propose the corrected strategies. To achieve this, a phantom, which was rotated from 0° to 25° in 5° increments, was utilized. Bone mineral content (BMC), a-BMD, v-BMD, and projected area (p-AREA) were measured. The Kruskal-Wallis non-parametric test or one-way ANOVA was used to examine the differences in variables between the different groups. The Pearson and Spearman correlation was used to test the relationships between quantitative parameters and rotated angles. Linear regression analysis was used to evaluate the relationship between angles and quantitative parameters. The findings indicate that, as the angle increased, a-BMD and v-BMD decreased (P < 0.001) , and the p-AREA increased (P < 0.001), but the BMC stays constant. The rotated angle was negative correlated (r = - 0.925, P < 0.001) with a-BMD and v-BMD (r = - 0.880, P < 0.001), positive (r = 0.930, P = < 0.001) correlated with p-AREA. The linear regression analysis showed that a-BMD = 0.808-0.01 × Angle and v-BMD = 151.808-1.588 × Angle. This study showed that, axial rotation might lead to a lower measured for a-BMD and v-BMD, it should be modified. This gives clinicians some insights into how to deal with osteoporosis in scoliosis patients. It's essential for clinicians to incorporate these findings into their diagnostic processes to prevent potential misdiagnosis and over-treatment of osteoporosis.
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Affiliation(s)
- Zu-Zhuo Zhang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Ting-Ting Hu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Yan Wang
- Department of Endocrinology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Xiao-Na Zhu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Ying Liu
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Lei Gao
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Ze-Kun Zhang
- Department of Radiology, Hebei Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, 050011, Hebei, China
| | - En-Peng Gao
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China
| | - Wei Zhang
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China.
| | - Yong-Li Zheng
- Department of Radiology, Hebei Medical University Third Hospital, No. 139 Ziqiang Road, Qiaoxi District, Shijiazhuang, 050051, Hebei, China.
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Chen M, Gerges M, Raynor WY, Park PSU, Nguyen E, Chan DH, Gholamrezanezhad A. State of the Art Imaging of Osteoporosis. Semin Nucl Med 2024; 54:415-426. [PMID: 38087745 DOI: 10.1053/j.semnuclmed.2023.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 05/18/2024]
Abstract
Osteoporosis is a common disease, particularly prevalent in geriatric populations, which causes significant worldwide morbidity due to increased bone fragility and fracture risk. Currently, the gold-standard modality for diagnosis and evaluation of osteoporosis progression and treatment relies on dual-energy x-ray absorptiometry (DXA), which measures bone mineral density (BMD) and calculates a score based upon standard deviation of measured BMD from the mean. However, other imaging modalities can also be used to evaluate osteoporosis. Here, we review historical as well as current research into development of new imaging modalities that can provide more nuanced or opportunistic analyses of bone quality, turnover, and density that can be helpful in triaging severity and determining treatment success in osteoporosis. We discuss the use of opportunistic computed tomography (CT) scans, as well as the use of quantitative CT to help determine fracture risk and perform more detailed bone quality analysis than would be allowed by DXA . Within magnetic resonance imaging (MRI), new developments include the use of advanced MRI techniques such as quantitative susceptibility mapping (QSM), magnetic resonance spectroscopy, and chemical shift encoding-based water-fat MRI (CSE-MRI) to enable clinicians improved assessment of nonmineralized bone compartments as well as a way to longitudinally assess bone quality without the repeated exposure to ionizing radiation. Within ultrasound, development of quantitative ultrasound shows promise particularly in future low-cost, broadly available screening tools. We focus primarily on historical and recent developments within radiotracer use as applicable to osteoporosis, particularly in the use of hybrid methods such as NaF-PET/CT, wherein patients with osteoporosis show reduced uptake of radiotracers such as NaF. Use of radiotracers may provide clinicians with even earlier detection windows for osteoporosis than would traditional biomarkers. Given the metabolic nature of this disease, current investigation into the role molecular imaging can play in the prediction of this disease as well as in replacing invasive diagnostic procedures shows particular promise.
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Affiliation(s)
- Michelle Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Maria Gerges
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Peter Sang Uk Park
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Edward Nguyen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - David H Chan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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Han K, You ST, Lee HJ, Kim IS, Hong JT, Sung JH. Hounsfield unit measurement method and related factors that most appropriately reflect bone mineral density on cervical spine computed tomography. Skeletal Radiol 2022; 51:1987-1993. [PMID: 35419706 DOI: 10.1007/s00256-022-04050-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/31/2022] [Accepted: 03/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Our study's purpose was to determine the most reliable Hounsfield unit (HU) measurement method to reflect bone mineral density (BMD) on cervical spine computed tomography (CT) and to identify any factors that influence these results. MATERIALS AND METHODS We retrospectively analyzed 439 consecutive patients with mild head and neck injuries. Mean HU values of the C2-C7 vertebra were determined on each sagittal, coronal, and axial CT image. Correlation patterns were analyzed between the HU value and corresponding dual-energy X-ray absorptiometry (DXA) in the lumbar vertebra (T-score) and femoral neck (T-score). A sub-group analysis was performed according to patient age, sex, and degree of spinal degeneration. RESULTS The correlation coefficients for HU and DXA ranged from 0.52 to 0.65 in all cervical segments. A simple linear regression analysis revealed the following formula: T-score = 0.01 × (HU) - 4.55. The mean HU values for osteopenia and osteoporosis were 284.0 ± 63.3 and 231.5 ± 52.8, respectively. The ROC curve indicated that the HU method has a sensitivity of 89.2% and specificity of 88.7% to diagnose osteoporosis. The HU measurement showed a high correlation value (range: r = 0.64-0.70) with spine DXA score regardless of the degree of degeneration or patient age or sex. CONCLUSION HU values using the upper two cervical vertebrae (C2 and C3) reflected a more reliable BMD level than other segments. Additionally, the HU of cervical CT provided reliable information regardless of measurement plane, age or sex, and degree of degeneration.
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Affiliation(s)
- Kyungmin Han
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Soon Tae You
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Ho Jin Lee
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea.
| | - Il Sup Kim
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
| | - Jae Taek Hong
- Department of Neurosurgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, 93-6 Ji-Dong, Paldal-gu, Suwon, 442-723, Korea
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Guo S, Zhao G, Chen XM, Xue Y, OuYang XL, Liu JY, Huang YP, Liu YJ, Yao Q, Han L, Zhang CH, Li B, Wang Q, Zhao B. Effect of transcutaneous electrical acupoint stimulation on bone metabolism in patients with immobilisation after foot and ankle fracture surgery: a randomised controlled trial study protocol. BMJ Open 2022; 12:e056691. [PMID: 36691208 PMCID: PMC9462119 DOI: 10.1136/bmjopen-2021-056691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/08/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Fracture is a disease with a high incidence worldwide. Foot and ankle fractures are common among fractures of the lower extremities. Foot and ankle fractures usually require surgical fixation and a period of fixed treatment, which can lead to decreased bone density. Although transcutaneous electrical acupoint stimulation (TEAS) is widely used for movement system diseases, there is minimal evidence to show the effectiveness of TEAS on patients after surgical fixation of ankle and foot fractures. This trial aims to evaluate whether TEAS can reduce bone loss in patients with immobilisation after ankle and foot fractures. METHODS AND ANALYSIS A randomised controlled trial will be conducted in which 60 patients will be randomly divided into two groups: (a) the control group will be treated according to the routine procedures of basic orthopaedics treatment; (b) in the treatment group, bilateral SP36, BL23 and ST36 will be performed on the basis of the control group, and the test will be performed for 30 min every other day for a total of 8 weeks. Bone turnover markers will be used as primary outcome. Secondary outcomes are composed of blood phosphorus, blood calcium and bone mineral density. Treatment safety will be monitored and recorded. ETHICS AND DISSEMINATION This trial is approved by the Ethics Committee of Beijing University of Chinese Medicine (2020BZYLL0611) and the Ethics Committee of Beijing Luhe Hospital (2020-LHKY-055-02), and inpatients who meet the following diagnostic and inclusion criteria are eligible to participate in this study. TRIAL REGISTRATION NUMBER ChiCTR 2000039944.
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Affiliation(s)
- Shiqi Guo
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Guozhen Zhao
- Capital Medical University, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Xue-Ming Chen
- Capital Medical University, Beijing Luhe Hospital, Beijing, China
| | - Ying Xue
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xia-Li OuYang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jin-Yi Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yue-Ping Huang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ya-Jie Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Qin Yao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Li Han
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Chun-Hui Zhang
- Capital Medical University, Beijing Luhe Hospital, Beijing, China
| | - Bo Li
- Capital Medical University, Beijing Hospital of Traditional Chinese Medicine, Beijing, China
| | - Qi Wang
- Capital Medical University, Beijing Luhe Hospital, Beijing, China
| | - Baixiao Zhao
- Affiliated Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Similarities and Differences in Bone Mineral Density between Multiple Sites in the Same Individual: An Elderly Cadaveric Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6094663. [PMID: 35711524 PMCID: PMC9197619 DOI: 10.1155/2022/6094663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Bone mineral density (BMD) is known to vary based on various factors, and the degree of variation is site-specific. However, few studies have investigated the relationship between bone density at trabecular bone-rich and cortical bone-rich sites in the same individual. In this study, we attempted to measure BMD at multiple sites using whole-body computed tomography images taken immediately after death and to clarify the similarities and differences between skeletal sites. Additionally, we aimed to examine the factors that influence changes in BMD, such as the loading environment, bone microstructure, and the ossification process of each skeletal region. A 3D model containing BMD data of the skull, clavicle, lumbar vertebrae, and femur (neck and diaphysis) was created using computed tomography images taken immediately after the death of 60 individuals (28 men and 32 women, average age: 84.0 years) who consented to participate in the study before death. Arbitrary measurement sites were defined, and bone density was measured at each site. We found that the BMDs of all regions were negatively correlated with age, but this correlation was weaker in the skull than in other regions. The negative correlation was especially pronounced in areas with more trabecular bones in men and in areas with more cortical bones in women. Furthermore, these findings suggest that factors, such as the loading environment, bone microstructure, and the ossification process of the skeletal sites, affect the BMD. Furthermore, our results suggest that it is important to assess the BMD of cortical bone in older women.
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Marques ML, Pereira da Silva N, van der Heijde D, Reijnierse M, Baraliakos X, Braun J, van Gaalen FA, Ramiro S. Low-dose CT hounsfield units: a reliable methodology for assessing vertebral bone density in radiographic axial spondyloarthritis. RMD Open 2022; 8:rmdopen-2021-002149. [PMID: 35732346 PMCID: PMC9226987 DOI: 10.1136/rmdopen-2021-002149] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Studying vertebral bone loss in radiographic axial spondyloarthritis (r-axSpA) has been challenging due to ectopic bone formation. We cross-sectionally analysed low-dose CT (ldCT) trabecular bone density Hounsfield units (HU) measurements and calculated inter-reader reliability at the vertebral level in patients with r-axSpA. Methods LdCT scans of 50 patients with r-axSpA from the sensitive imaging in ankylosing spondylitis study, a multicentre 2-year prospective cohort were included. Trabecular bone HU taken from a region of interest at the centre of each vertebra (C3-L5) were independently assessed by two trained readers. HU mean (SD), and range were provided at the vertebral level, for each reader and centre separately. Inter-reader reliability and agreement were assessed using intraclass correlation coefficients (ICC; single measurements, absolute agreement, two-way mixed effects models); smallest detectable difference and Bland-Altman plots. Results Overall, 1100 vertebrae were assessed by each reader. HU values decreased from cranial to caudal vertebrae. For readers 1 and 2 respectively, the highest mean (SD) HU value was obtained at C3 (354(106) and 355(108)), and the lowest at L3 (153(65) and 150 (65)). Inter-reader reliability was excellent (ICC(2,1):0.89 to 1.00). SDD varied from 4 to 8. For most vertebrae, reader 1 scored somewhat higher than reader 2 (mean difference of scores ranging from −0.6 to 2.9 HU). Bland-Altman plots showed homoscedasticity. Conclusion LdCT measurement of HU is a feasible method to assess vertebral bone density in r-axSpA with excellent inter-reader reliability from C3 to L5. These results warrant further validation and longitudinal assessment of reliability.
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Affiliation(s)
- Mary Lucy Marques
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Nuno Pereira da Silva
- Department of Radiology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Juergen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr University Bochum, Bochum, Germany
| | - Floris A van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
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Buenger F, Sakr Y, Eckardt N, Senft C, Schwarz F. Correlation of quantitative computed tomography derived bone density values with Hounsfield units of a contrast medium computed tomography in 98 thoraco-lumbar vertebral bodies. Arch Orthop Trauma Surg 2022; 142:3335-3340. [PMID: 34562119 PMCID: PMC9522714 DOI: 10.1007/s00402-021-04184-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Vertebral fractures in patients with bone density reduction are often a major challenge for the surgeon, as reduced bone density can lead to screw loosening. Several options are available to determine bone density preoperatively. In our study, we investigated the correlation of Hounsfield units (HU) of a contrast medium computed tomography (CT) to the bone density values of a quantitative computed tomography (QCT) and computed a formula to estimate bone density values using HU. MATERIALS AND METHODS In our retrospective data analysis, we examine 98 vertebral bodies from 35 patients who received a contrast medium CT of the spine and a QCT, performed no longer than 1 month apart. The determined HU from the contrast medium CT were compared with the bone density values of the QCT and examined for correlations. Linear logistic regression was used to estimate bone density values base on HU. RESULTS A strong correlation was found between the HU measured in the CT and the bone density values (r = 0.894, p < 0.001), irrespective of patients' gender. We also found no correlation differences when the HU were measured at different levels. Bland-Altman plot demonstrated good agreement between the two measurements. The following formula was developed to estimate bone density values using HU: QCT-value = 0.71 × HU + 13.82. CONCLUSIONS Bone density values correlate well to HU measured in contrast medium CT. Using simple formula, the bone density of a contrast medium CT of vertebral bodies can be estimated based on HU without additional examinations and unnecessary costs.
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Affiliation(s)
- Fabian Buenger
- grid.9613.d0000 0001 1939 2794Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Yasser Sakr
- grid.9613.d0000 0001 1939 2794Department for Anaesthesiology and Intensive Care, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Niklas Eckardt
- grid.9613.d0000 0001 1939 2794Department for Radiology, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Christian Senft
- grid.9613.d0000 0001 1939 2794Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Falko Schwarz
- grid.9613.d0000 0001 1939 2794Department of Neurosurgery, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
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Buenger F, Eckardt N, Sakr Y, Senft C, Schwarz F. Correlation of Bone Density Values of Quantitative Computed Tomography and Hounsfield Units Measured in Native Computed Tomography in 902 Vertebral Bodies. World Neurosurg 2021; 151:e599-e606. [PMID: 33933695 DOI: 10.1016/j.wneu.2021.04.093] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Due to the increasing age of patients, the evaluation of bone density is crucial, especially in preparation for spinal surgery. The aim of this study was to determine bone density using a computed tomography (CT) and to correlate Hounsfield units (HU) with bone density values of a quantitative computed tomography (QCT). METHODS The study is a monocentric, retrospective data analysis. We examined 902 vertebral bodies from a total of 369 patients who received a CT of the thoracolumbar spine in the period from 2015 to 2019 and compared the HU with values of a QCT. A general equation for calculation the QCT values was established. RESULTS We found a significant correlation between the Hounsfield units and the corresponding QCT-values (r = 0.944, P < 0.001). We also demonstrated that the calculated QCT values are independent of patient sex (P < 0.942). Furthermore, we could not demonstrate differences in the correlation of the 3 measured levels (axial, sagittal, and coronary) to the QCT values. The QCT-values can be calculated on the basis of a native CT of the lumbar spine using the equation: QCT = 17.8 + 0.7 × HU. CONCLUSIONS The equation allows calculating bone density values without the need for an additional QCT and without further radiation exposure or costs. With this measuring method it is possible to obtain additional information from a computed tomography.
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Affiliation(s)
- Fabian Buenger
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Niklas Eckardt
- Department of Radiology, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Yasser Sakr
- Department of Anaesthesiology and Intensive Care, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Christian Senft
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University, Jena, Germany
| | - Falko Schwarz
- Department of Neurosurgery, Jena University Hospital - Friedrich Schiller University, Jena, Germany.
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Guebeli A, Platz EA, Paller CJ, McGlynn KA, Rohrmann S. Relationship of sex steroid hormones with bone mineral density of the lumbar spine in adult men. Bone Joint Res 2020; 9:139-145. [PMID: 32435466 PMCID: PMC7229310 DOI: 10.1302/2046-3758.93.bjr-2019-0141.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims To examine the relationship of sex steroid hormones with osteopenia in a nationally representative sample of men in the USA. Methods Data on bone mineral density (BMD), serum sex hormones, dairy consumption, smoking status, and body composition were available for 806 adult male participants of the cross-sectional National Health and Nutrition Examination Survey (NHANES, 1999-2004). We estimated associations between quartiles of total and estimated free oestradiol (E2) and testosterone (T) and osteopenia (defined as 1 to 2.5 SD below the mean BMD for healthy 20- to 29-year-old men) by applying sampling weights and using multivariate-adjusted logistic regression. We then estimated the association between serum hormone concentrations and osteopenia by percentage of body fat, frequency of dairy intake, cigarette smoking status, age, and race/ethnicity. Results Men in the lowest quartile of total E2 concentrations (< 21.52 pg/ml) had greater odds of osteopenia compared with men in the highest quartile (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.11 to 4.73; p-trend = 0.030). Total and free T were not associated with osteopenia. Low total E2 concentrations were associated with greater odds of osteopenia among non-daily dairy consumers (p-trend = 0.046), current or former smokers (p-trend = 0.032), and younger men (p-trend = 0.031). No differences were observed by race/ethnicity and obesity. Conclusion In this nationally representative study of the USA, men with lower total E2 were more likely to have osteopenia, which was particularly evident among younger men, men with less-than-daily dairy consumption, and current or former smokers. Cite this article:Bone Joint Res. 2020;9(3):139–145.
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Affiliation(s)
- Alissa Guebeli
- Department of Orthopaedic Surgery, Cantonal Hospital of Baselland, Liestal, Switzerland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Evaluation of vertebral bone mineral density in scoliosis by using quantitative computed tomography. Pol J Radiol 2019; 84:e131-e135. [PMID: 31019606 PMCID: PMC6479145 DOI: 10.5114/pjr.2019.84060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/14/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose Scoliosis is described as a lateral curvature of the spine. We aimed to evaluate bone mineral density (BMD) in patients with scoliosis by using quantitative computed tomography (QCT) and compare the BMD of idiopathic and congenital scoliosis patients. Material and methods Forty-three patients aged 1 to 40 years with idiopathic, congenital, or neuromuscular scoliosis and 41 matched controls of the same sex and approximate age were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5, and mean BMD was calculated for each case. Results Twenty-two of the patients with scoliosis were idiopathic, 15 were congenital, four were neuromuscular, and two were neurofibromatosis. The mean BMD values of patients with scoliosis were significantly lower compared with the control group (106.8 ± 33.4 mg/cm3 vs. 124.9 ± 29.1 mg/cm3, p = 0.009). No significant difference in BMD values was found between idiopathic and congenital scoliosis patients (p > 0.05). Conclusions This study illustrated that the vertebral body BMD values of the patients with scoliosis were significantly lower than those seen in the control group.
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Abdullayev N, Neuhaus VF, Bratke G, Voss S, Große Hokamp N, Hellmich M, Krug B, Maintz D, Borggrefe J. Effects of Contrast Enhancement on In-Body Calibrated Phantomless Bone Mineral Density Measurements in Computed Tomography. J Clin Densitom 2018; 21:360-366. [PMID: 29169662 DOI: 10.1016/j.jocd.2017.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/06/2017] [Accepted: 10/09/2017] [Indexed: 01/22/2023]
Abstract
We aimed to test the potential of phantomless volumetric bone mineral density (PLvBMD) measurements for the determination of volumetric bone mineral density (vBMD) in routine contrast-enhanced computed tomography (CECT). We evaluated 56 tri-phasic abdominal computed tomography scans, including an unenhanced scan as well as defined CECT scans in the arterial and portalvenous phase. PLvBMD analysis was performed by 4 radiologists using an FDA-approved tool for phantomless evaluation of bone density (IntelliSpace, Philips, The Netherlands). Mean vBMD of the first 3 lumbar vertebrae in each contrast phase was determined and interobserver variance of vBMD independent of contrast phase was analyzed using intraclass correlation, Bland-Altman plots, and Student's t test. CECT scans were associated with a significantly higher PLvBMD compared with unenhanced scans (unenhanced computed tomography: 97.8 mg/cc; arterial CECT: 106.3 mg/cc, portalvenous CECT: 106.3 mg/cc). Overall, there was no significant difference of PLvBMD between data acquisition in arterial and portalvenous phases (increase of 8.6% each, standard deviation ratio 37.7%-38.3%). In Bland-Altman analysis, there was no evidence of a relevant reader-related bias or an increase in standard deviation of PLvBMD measurements in contrast-enhanced scans compared with unenhanced scans. The following conversion formulas for unenhanced PLvBMD were determined: unenhancedPLvBMD=0.89×arterialPLvBMD+3,74mg/cc(r2 = 0.94) and unenhancedPLvBMD=0.88×venousPLvBMD+4,56mg/cc(r2 = 0.93). Compared with the results of phantom-based quantitative computed tomography measurements reported in the literature, the PLvBMD changes associated with contrast enhancement were relatively moderate with an increase of 8.6% in average. The time-point of the contrast-enhanced PLvBMD measurements after injection of contrast media did not appear to affect the results. With the adjustment formulas provided in this study, the method can improve osteoporosis screening through detection of reduced bone mass of the vertebrae in routinely conducted CECT.
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Affiliation(s)
- Nuran Abdullayev
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | | | - Grischa Bratke
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | - Sebastian Voss
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | - Nils Große Hokamp
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | - Martin Hellmich
- Institut für Medizinische Statistik, Informatik und Epidemiologie, Universitätsklinikum Köln, Köln, Germany
| | - Barbara Krug
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | - David Maintz
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany
| | - Jan Borggrefe
- Institut für Diagnostische und Interventionelle Radiologie, Uniklinik Köln, Köln, Germany.
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Mazonakis M, Damilakis J. Computed tomography: What and how does it measure? Eur J Radiol 2016; 85:1499-504. [DOI: 10.1016/j.ejrad.2016.03.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/16/2016] [Accepted: 03/01/2016] [Indexed: 12/25/2022]
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Kim YS, Lee S, Sung YK, Lee BG. Assessment of osteoporosis using pelvic diagnostic computed tomography. J Bone Miner Metab 2016; 34:457-63. [PMID: 26056023 DOI: 10.1007/s00774-015-0684-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/09/2015] [Indexed: 01/22/2023]
Abstract
The purpose of the present study is to determine if a correlation exists between bone mineral density (BMD) obtained from dual energy X-ray absorptiometry (DXA) and Hounsfield unit (HU) from pelvic diagnostic computed tomography (dCT), and to evaluate whether HU could be used to identify osteoporosis. Seventy-nine patients were included in this study. HU values were measured in three different sections: the head-neck junction of the femur, the middle portion of the femoral neck, and the intertrochanter of the femur (IT). In each sectional image, HU values were measured at two regions of interest: cortical and cancellous bone (HU_t) and cancellous bone. The correlation between BMD and HU_t of IT was significant (r = 0.839, p < 0.01). In IT, the area under the curve value of HU_t was 0.875 (0.796-0.955). We found that a HU_t of IT <170 can be regarded as indicating osteoporosis: its positive predictive value is 96.9 %. A HU_t of IT >210 can be regarded as indicating an absence of osteoporosis: its negative predictive value is 84.6 %. In conclusion, we found that a significant correlation between HU of pelvic dCT and BMD of DXA, and HU potentially provided an alternative method for determining regional BMD. Therefore, pelvic dCT could possibly be a supplementary method for initial diagnosis of osteoporosis and for initiation of treatment.
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Affiliation(s)
- Yee-Suk Kim
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea, 133-791.
| | - Seunghun Lee
- Department of Radiology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yoon-Kyoung Sung
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Bong-Gun Lee
- Department of Orthopedic Surgery, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul, South Korea, 133-791
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Pirayesh Islamian J, Garoosi I, Abdollahi Fard K, Abdollahi MR. How much intravenous contrast media affect bone mineral density (BMD) assessed by routine computed tomography (CT). THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pisani P, Renna MD, Conversano F, Casciaro E, Di Paola M, Quarta E, Muratore M, Casciaro S. Major osteoporotic fragility fractures: Risk factor updates and societal impact. World J Orthop 2016; 7:171-81. [PMID: 27004165 PMCID: PMC4794536 DOI: 10.5312/wjo.v7.i3.171] [Citation(s) in RCA: 316] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 11/14/2015] [Accepted: 12/07/2015] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders (for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence.
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Abstract
Bone is a dynamic organ of the endoskeleton, playing an important role in structural integrity, mineral reservoirs, blood production, coagulation, and immunity. Metabolic bone disease encompasses a broad spectrum of inherited and acquired disorders that disrupt the normal homeostasis of bone formation and resorption. For patients affected by these processes, radiologic imaging plays a central role in diagnosis, monitoring treatment, and risk stratification. Radiologists should be familiar with the diseases, intimately aware of the imaging findings, and possessive of multimodality expertise to wisely guide the best practice of medicine. The purpose of this paper is to review the imaging features and characteristics of the most common types of metabolic bone disease with highlights of clinically relevant information so that readers can better generate appropriate differential diagnoses and recommendations. For this review, a thorough literature search for the most up-to-date information was performed on several key types of metabolic bone disease: osteoporosis, osteomalacia, rickets, scurvy, renal osteodystrophy, hyperparathyroidism, Paget’s disease, osteogenesis imperfecta, acromegaly, and osteopetrosis. Although they all affect the bone, these diseases have both shared characteristic features that can be discerned through imaging.
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Screening for osteoporosis after trauma: a new approach using quantitative computed tomography of the skull. J Trauma Acute Care Surg 2015; 77:635-9. [PMID: 25250607 DOI: 10.1097/ta.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The diagnosis of osteoporosis is important in the care of elderly patients at risk of trauma. While pelvis computed tomography (CT) is accurate in the measurement of bone mineral density, axial skull CT has not previously been evaluated for this purpose. This study investigated whether data from axial skull CT scans can screen for osteoporosis. METHODS Bone density measurements were derived from digital analysis of routine scans of the head and pelvis using quantitative CT. The study took place from October 2010 to November 2011 at a medium-sized community hospital. The first study phase included patients older than 18 years who had both a head and a pelvis CT scan within 30 days. The known diagnostic value for osteoporosis on pelvis CT scans was used to derive a diagnostic value for head CT. The second study phase included adult trauma patients who underwent noncontrast head CT during an initial trauma evaluation. A subgroup analysis was performed during Phase II on patients older than 65 years to identify the incidence of fracture as it is affected by age and bone mineral density. RESULTS Our data demonstrated that head CT was able to identify osteoporosis with a sensitivity of 0.70, a specificity of 0.81, and an accuracy of 0.76 compared with pelvic CT. Of 261 trauma patients, 54% had bone disease based on axial skull CT criteria. Patients older than 65 years with a positive screen result for osteoporosis on head CT were twice as likely to have a fracture. CONCLUSION Analysis of data from head CT scans has the potential to provide a useful screen for osteoporosis. Adding this analysis to CT scans performed for elderly trauma patients could result in improved diagnosis and treatment of osteoporosis. LEVEL OF EVIDENCE Diagnostic study, level II.
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Abstract
Conventional radiography can detect most fractures, evaluate their healing, and visualize characteristic skeletal abnormalities for some metabolic bone diseases. Dual-energy X-ray absorptiometry (DXA) is used to measure areal bone mineral density (BMD) in order to diagnose osteoporosis, estimate fracture risk, and monitor changes in BMD over time. Vertebral fracture assessment by DXA can diagnose vertebral fractures with less ionizing radiation, greater patient convenience, and lower cost than conventional radiography. Quantitative computed tomography (QCT) measures volumetric BMD separately in cortical and trabecular bone compartments. High resolution peripheral QCT and high resolution magnetic resonance imaging are noninvasive research tools that assess the microarchitecture of bone. The use of these technologies and others has been associated with special challenges in men compared with women, provided insights into differences in the pathogenesis of osteoporosis in men and women, and enhanced understanding of the mechanisms of action of osteoporosis treatments.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA.
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Guglielmi G, Muscarella S, Bazzocchi A. Integrated imaging approach to osteoporosis: state-of-the-art review and update. Radiographics 2012; 31:1343-64. [PMID: 21918048 DOI: 10.1148/rg.315105712] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Osteoporosis is the most common of all metabolic bone disorders. It is characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. Because of the increasing aging of the world population, the number of persons affected by osteoporosis is also increasing. Complications related to osteoporosis can create social and economic burdens. For these reasons, the early diagnosis of osteoporosis is crucial. Conventional radiography allows qualitative and semiquantitative evaluation of osteoporosis, whereas other imaging techniques allow quantification of bone loss (eg, dual-energy x-ray absorptiometry and quantitative computed tomography [CT]), assessment for the presence of fractures (morphometry), and the study of bone properties (ultrasonography). In recent years, new imaging modalities such as micro-CT and high-resolution magnetic resonance imaging have been developed in an attempt to help diagnose osteoporosis in its early stages, thereby reducing social and economic costs and preventing patient suffering. The correct diagnosis of osteoporosis results in better management in terms of prevention and adequate pharmacologic or surgical treatment.
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Papadakis AE, Karantanas AH, Papadokostakis G, Damilakis J. Assessment of the morpho-densitometric parameters of the lumbar pedicles in osteoporotic and control women undergoing routine abdominal MDCT examinations. J Bone Miner Metab 2011; 29:352-8. [PMID: 20976512 DOI: 10.1007/s00774-010-0227-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
Abstract
In transpedicular surgical operations, the pedicle should be safely penetrated. In this study, we hypothesize that morpho-densitometric data describing the physical status of the pedicle isthmus in osteoporotic versus control postmenopausal women may be generated using high-resolution three-dimensional images obtained from routine abdominal multidetector computed tomography (MDCT) scans. Thus, 32 osteoporotic and 38 postmenopausal control women had a routine abdominal scan using a 16-row CT scanner. Images of the pedicle isthmus of the L2-L4 vertebrae were generated at the plane that was vertical to the pedicle axis. Several indices were calculated based on the measurements of outer and inner dimension of the pedicle isthmus, pedicle isthmus area, and pedicle isthmus endosteal area. The mean Hounsfield unit number within the isthmus endosteal area (HU(IEA)) and the trabecular portion of the vertebral body (HU(VERT)) were measured. All subjects had a dual X-ray absorptiometry scan (DXA) in the lumbar spine. Most of the indices calculated showed statistically significant differences between osteoporotic and control women. HU(IEA) was significantly correlated to T-score (r = 0.580, P < 0.0001). HU(IEA) showed the best discriminatory ability between the two groups (area under ROC curve, 0.840). Routine abdominal MDCT can be used to assess the morpho-densitometric characteristics of the lumbar pedicle isthmus and differentiate osteoporotic from control postmenopausal women.
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Affiliation(s)
- Antonios E Papadakis
- Department of Medical Physics, Faculty of Medicine, University Hospital of Heraklion, P.O. Box 2208, 71003 Iraklion, Crete, Greece.
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21
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Edelmann-Schäfer B, Berthold LD, Stracke H, Lührmann PM, Neuhäuser-Berthold M. Identifying elderly women with osteoporosis by spinal dual X-ray absorptiometry, calcaneal quantitative ultrasound and spinal quantitative computed tomography: a comparative study. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:29-36. [PMID: 21084160 DOI: 10.1016/j.ultrasmedbio.2010.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 08/05/2010] [Accepted: 10/03/2010] [Indexed: 05/30/2023]
Abstract
The ability of spinal dual x-ray absorptiometry (DXA), calcaneal quantitative ultrasound (QUS) and spinal quantitative computed tomography (QCT) to identify women with osteoporosis within the GISELA study was evaluated in 43 women, aged 62-87 years. Osteoporosis was defined as a T-score below or equal to -2.5 using DXA (femoral neck). To determine the performance of each method, the sensitivity, specificity and area under the curve (by means of a receiver operating characteristic [ROC] analysis) were calculated. The median T-scores from the measurements differed significantly (p < 0.0001). DXA (spine) identified 75% of women with osteoporosis; QUS and QCT identified 100%. The specificity was 89% for DXA (spine), 66% for QUS and 29% for QCT. ROC analysis showed that all three methods are qualified to identify women with osteoporosis; however, the different sensitivities and specificities of the methods, as well as the thresholds used for diagnosing osteoporosis have to be considered.
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Abstract
Measurement of bone mineral density (BMD) is used to diagnose osteoporosis, assess fracture risk, and monitor response to therapy. Of the different methods for measuring BMD, dual-energy X-ray absorptiometry (DXA) is the only technology for classifying BMD according to criteria established by the World Health Organization (WHO) and the only technology that is validated for BMD input with the WHO fracture risk assessment algorithm, FRAX. Vertebral fracture assessment (VFA) by DXA provides an image of the thoracic and lumbar spine for the purpose of detecting vertebral fracture deformities. Identification of a previously unrecognized vertebral fracture may change diagnostic classification, assessment of fracture risk, and treatment decisions. In comparison with standard radiographs of the spine, the correlation for detecting moderate and severe vertebral fractures is good, with a smaller dose of ionizing irradiation, greater patient convenience, and lower cost. Optimal performance of DXA and VFA requires training and adherence to quality standards.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak Street NE, Albuquerque, NM 87106, USA.
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23
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Abstract
Dual-energy x-ray absorptiometry (DXA) scans to measure bone mineral density at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have several advantages that include a consensus that bone mineral density results should be interpreted using the World Health Organization T score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning. Particular attention is directed at the new World Health Organization Fracture Risk Assessment Tool (FRAX) algorithm, which uses clinical risk factors in addition to a hip DXA scan to predict a patient's 10-year probability of suffering an osteoporotic fracture. We also discuss the recently published clinical guidelines that incorporate the FRAX fracture risk assessment in decisions about patient treatment.
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Affiliation(s)
- Glen M Blake
- King's College London, Guy's Campus, London, United Kingdom.
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Mueller DK, Kutscherenko A, Bartel H, Vlassenbroek A, Ourednicek P, Erckenbrecht J. Phantom-less QCT BMD system as screening tool for osteoporosis without additional radiation. Eur J Radiol 2010; 79:375-81. [PMID: 20223609 DOI: 10.1016/j.ejrad.2010.02.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Phantom-less bone mineral density (PLBMD) systems are easily integrated into the CT workflow for non-dedicated Quantitative CT (QCT) BMD measurements in thoracic and abdominal scans. This in vivo retrospective study aims to determine accuracy and precision of the PLBMD option located on the Extended Brilliance Workspace (Philips Medical Systems, Cleveland, OH, US) from both cross-sectional and longitudinal image data. MATERIALS AND METHODS The cross-sectional comparison with phantom-based QCT BMD was performed for 82 patients (61 female, 21 male) with a mean age of (63.0±11.8 SD) years on 197 vertebrae. This was followed by an interobserver variability analysis on 71 vertebrae. The longitudinal PLBMD study was carried out on 45 vertebrae from 10 patients (5 female, 5 male) with a mean age of (64.4±11.5 SD) years. They were re-scanned with standardized scan and contrast-injection protocols within a mean and median of (33±41 SD) and 8 days, respectively. All CT scans were acquired on an Mx8000 Quad (Philips) at Florence-Nightingale Hospital, Kaiserswerth, Germany, in a spiral acquisition mode. RESULTS A negligible BMD bias of -0.9mg/cm(3) for the PLBMD option was observed with respect to phantom-based QCT BMD. Applying CT number matching of muscle and fat ROIs, the analysis of cross-sectional interobserver and of longitudinal variability yielded precision values of 3.1mg/cm(3) (CV%=4.0) and 4.2mg/cm(3) (CV%=5.3), respectively. CONCLUSION Although the precision is inferior to phantom-based BMD systems, PLBMD is a robust clinical utility for the detection of lowered BMD in a large patient population. This can be achieved without additional radiation exposure from non-contrasted CT scans, to perform an ancillary diagnosis of osteopenia or osteoporosis.
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Johnston JD, Masri BA, Wilson DR. Computed tomography topographic mapping of subchondral density (CT-TOMASD) in osteoarthritic and normal knees: methodological development and preliminary findings. Osteoarthritis Cartilage 2009; 17:1319-26. [PMID: 19427927 DOI: 10.1016/j.joca.2009.04.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 04/01/2009] [Accepted: 04/12/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a precise imaging tool which measures three-dimensional (3D) subchondral bone mineral density (BMD), and investigate its ability to distinguish subchondral bone properties in osteoarthritic and normal cadaveric tibiae. METHODS We developed a novel imaging tool [Computed tomography topographic mapping of subchondral density (CT-TOMASD)], which employs a surface projection image processing technique to map 3D subchondral BMD measured in relation to depth from the joint surface. Sixteen intact cadaver knees from 10 donors (8M:2F; age: 77.8+/-7.4) were scanned using quantitative computed tomography (QCT). Projections of average BMD to normalized depths of 2.5mm and 5.0mm were acquired, with regional analyses including: (1) medial and lateral BMD, (2) anterior/central/posterior compartmental BMD, (3) max BMD contained within a 10mm diameter 'core', and (4) medial:lateral BMD ratio. Precision was assessed using coefficients of variation (CV%). Osteoarthritis (OA) severity was assessed by examination of computed tomography (CT) and fluoroscopic radiographic images, and categorized using modified Kellgren-Lawrence (mKL) scoring. RESULTS Precision errors for CT-TOMASD BMD measures were focused around 1.5%, reaching a maximum CV% of 3.5%. OA was identified in eight compartments of six knees. Substantial qualitative and quantitative differences were observed between the OA and normal knees, with the medial:lateral BMD ratio and peak core regional analyses demonstrating differences greater than 4.7 standard deviations (SDs) when compared with normals. Preliminary results revealed effect sizes ranging from 1.6 to 4.3 between OA and normal knees. CONCLUSIONS CT-TOMASD offers precise 3D measures of subchondral BMD. Preliminary results demonstrate large qualitative and quantitative differences and large effect sizes between OA and normal knees. This method has the potential to identify and quantify changes in subchondral BMD associated with OA disease progression.
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Affiliation(s)
- J D Johnston
- Department of Mechanical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, SK S7N 1G9, Canada.
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26
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van Rijn R, Van Kuijk C. Of small bones and big mistakes; bone densitometry in children revisited. Eur J Radiol 2009; 71:432-9. [DOI: 10.1016/j.ejrad.2008.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 08/29/2008] [Indexed: 12/18/2022]
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Adams JE. Quantitative computed tomography. Eur J Radiol 2009; 71:415-24. [PMID: 19682815 DOI: 10.1016/j.ejrad.2009.04.074] [Citation(s) in RCA: 259] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
Abstract
Quantitative computed tomography (QCT) was introduced in the mid 1970s. The technique is most commonly applied to 2D slices in the lumbar spine to measure trabecular bone mineral density (BMD; mg/cm(3)). Although not as widely utilized as dual-energy X-ray absortiometry (DXA) QCT has some advantages when studying the skeleton (separate measures of cortical and trabecular BMD; measurement of volumetric, as opposed to 'areal' DXA-BMDa, so not size dependent; geometric and structural parameters obtained which contribute to bone strength). A limitation is that the World Health Organisation (WHO) definition of osteoporosis in terms of bone densitometry (T score -2.5 or below using DXA) is not applicable. QCT can be performed on conventional body CT scanners, or at peripheral sites (radius, tibia) using smaller, less expensive dedicated peripheral CT scanners (pQCT). Although the ionising radiation dose of spinal QCT is higher than for DXA, the dose compares favorably with those of other radiographic procedures (spinal radiographs) performed in patients suspected of having osteoporosis. The radiation dose from peripheral QCT scanners is negligible. Technical developments in CT (spiral multi-detector CT; improved spatial resolution) allow rapid acquisition of 3D volume images which enable QCT to be applied to the clinically important site of the proximal femur, more sophisticated analysis of cortical and trabecular bone, the imaging of trabecular structure and the application of finite element analysis (FEA). Such research studies contribute importantly to the understanding of bone growth and development, the effect of disease and treatment on the skeleton and the biomechanics of bone strength and fracture.
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Affiliation(s)
- Judith E Adams
- Department of Radiology, The Royal Infirmary and University, Manchester, UK.
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Blake GM, Fogelman I. The clinical role of dual energy X-ray absorptiometry. Eur J Radiol 2009; 71:406-14. [PMID: 19647962 DOI: 10.1016/j.ejrad.2008.04.062] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2008] [Accepted: 04/30/2008] [Indexed: 11/18/2022]
Abstract
Dual energy X-ray absorptiometry (DXA) measurements of hip and spine bone mineral density (BMD) have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of anti-fracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organisation (WHO) T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting anti-fracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.
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Affiliation(s)
- Glen M Blake
- King's College London School of Medicine, London, UK.
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Sehmisch S, Dullin C, Zaroban A, Tezval M, Rack T, Schmelz U, Seidlova-Wuttke D, Dunkelberg H, Wuttke W, Marten K, Stuermer KM, Stuermer EK. The use of flat panel volumetric computed tomography (fpVCT) in osteoporosis research. Acad Radiol 2009; 16:394-400. [PMID: 19268850 DOI: 10.1016/j.acra.2008.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 09/23/2008] [Accepted: 09/24/2008] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES Improvements in imaging technology have led to the increased use of computed tomography (CT). For example, micro-CT and quantitative CT (QCT) are now often used in osteoporosis research, in which micro-CT is able to analyze small bones or bone samples with high spatial resolution. In contrast, QCT is able to investigate large samples with low spatial resolution. The aim of this study was to test the usefulness of flat-panel volumetric CT (fpVCT) in a rat model of osteopenia. MATERIAL AND METHODS Twenty-two 3-month-old rats underwent ovariectomy and were either left untreated or supplemented with estradiol for 15 weeks. After sacrificing, the rats' second lumbar vertebral body bone mineral density (BMD) was analyzed using fpVCT and ashing. The results were compared to those of a microstructural analysis of the first lumbar vertebrae and a biomechanical evaluation of the fourth lumbar vertebrae. RESULTS BMD measurements using both fpVCT (0.39 vs 0.35 mg/cm(3)) and ashing (0.52 vs 0.48 mg/cm(3)) demonstrated a significant improvement after estradiol supplementation. The correlation coefficient of the two methods was 0.858. After estradiol supplementation, the bone microstructural and bone biomechanical parameters were improved, compared to no treatment. The correlations of both the microstructural and the biomechanical evaluations were closer for BMD measured using fpVCT (r = 0.482-0.769) than on the basis of ashing (r = 0.345-0.573). FpVCT was not able to display the trabecular microstructure of the rat lumbar vertebrae. CONCLUSION The use of fpVCT demonstrated a close relationship between morphologic and biomechanical evaluations in a rat model of osteopenia. Because of its different proportions, fpVCT might be able to bridge the gap between micro-CT and QCT in analyzing larger animals.
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Affiliation(s)
- Stephan Sehmisch
- University of Goettingen, Robert-Koch-Strasse 40, 37075 Goettingen, Germany.
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Bredella MA, Misra M, Miller KK, Madisch I, Sarwar A, Cheung A, Klibanski A, Gupta R. Distal radius in adolescent girls with anorexia nervosa: trabecular structure analysis with high-resolution flat-panel volume CT. Radiology 2008; 249:938-46. [PMID: 19011190 DOI: 10.1148/radiol.2492080173] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine trabecular microarchitecture with high-resolution flat-panel volume computed tomography (CT) and bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) in adolescent girls with anorexia nervosa (AN) and to compare these results with those in normal-weight control subjects. MATERIALS AND METHODS The study was approved by the institutional review board and complied with HIPAA guidelines. Informed consent was obtained. Twenty adolescent girls, 10 with mild AN (mean age, 15.9 years; range, 13-18 years) and 10 age- and sex-matched normal-weight control subjects (mean age, 15.9 years; range, 12-18 years) underwent flat-panel volume CT of distal radius to determine apparent trabecular bone volume fraction (BV/TV), apparent trabecular number (TbN), apparent trabecular thickness (TbTh), and apparent trabecular separation (TbSp). All subjects underwent DXA of spine, hip, and whole body to determine BMD and body composition. The means and standard deviations (SDs) of structure parameters were calculated for AN and control groups. Groups were compared (Student t test). Linear regression analysis was performed. RESULTS AN subjects compared with control subjects, respectively, showed significantly lower mean values for BV/TV (0.37% +/- 0.05 [SD] vs 0.46% +/- 0.03, P = .0002) and TbTh (0.31 mm +/- 0.03 vs 0.39 mm +/- 0.03, P < .0001) and higher mean values for TbSp (0.54 mm +/- 0.13 vs 0.44 mm +/- 0.04, P = .02). TbN was lower in AN subjects than in control subjects, but the difference was not significant (1.17 mm(-3) +/- 0.15 vs 1.22 mm(-3) +/- 0.07, P = .43). There was no significant difference in BMD between AN and control subjects. BMD parameters showed positive correlation with BV/TV and TbTh in the control group (r = 0.55-0.84, P = .05-.01) but not in AN patients. CONCLUSION Flat-panel volume CT is effective in evaluation of trabecular structure in adolescent girls with AN and demonstrates that bone structure is abnormal in these patients compared with that in normal-weight control subjects despite normal BMD. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/249/3/938/DC1.
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Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114, USA.
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West ATH, Marshall TJ, Bearcroft PW. CT of the musculoskeletal system: what is left is the days of MRI? Eur Radiol 2008; 19:152-64. [PMID: 18690452 DOI: 10.1007/s00330-008-1129-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2008] [Revised: 04/30/2008] [Accepted: 05/03/2008] [Indexed: 12/28/2022]
Abstract
Magnetic resonance imaging (MRI) plays a central role in the modern imaging of musculoskeletal disorders, due to its ability to produce multiplanar images and characterise soft tissues accurately. However, computed tomography (CT) still has an important role to play, not merely as an alternative to MRI, but as being the preferred imaging investigation in some situations. This article briefly reviews the history of CT technology, the technical factors involved and a number of current applications, as well as looking at future areas where CT may be employed. The advent of ever-increasing numbers of rows of detectors has opened up more possible uses for CT technology. However, diagnostic images may be obtained from CT systems with four rows of detectors or more, and their ability to produce near isotropic voxels and therefore multiplanar reformats.
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Affiliation(s)
- A T H West
- Department of Radiology, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom.
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Papadakis AE, Karantanas AH, Papadokostakis G, Petinellis E, Damilakis J. Can abdominal multi-detector CT diagnose spinal osteoporosis? Eur Radiol 2008; 19:172-6. [PMID: 18641992 DOI: 10.1007/s00330-008-1099-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 05/09/2008] [Accepted: 05/17/2008] [Indexed: 11/28/2022]
Abstract
The aim of this study was to (1) generate quantitative CT (QCT) densitometric data based on routine abdominal multi-detector (MDCT) examinations and (2) investigate whether these data can be used to differentiate osteoporotic from healthy females. Twenty-five female patients (group A) with a history of radiotherapy were examined both with routine abdominal MDCT and standard QCT to generate a MDCT-to-QCT conversion equation. Twenty-one osteoporotic (group B) and 23 healthy female patients (group C) were also recruited in the study. Patients of groups B and C underwent routine abdominal MDCT examination for various clinical indications. Mean bone mineral density (BMD) in patients of group A was 103.4 mg/ml +/- 32.8 with routine abdominal MDCT and 91.0 mg/ml +/- 28.5 with QCT. Quantitative CT BMD(QCT) values for patients in groups B and C were calculated utilizing the BMD(MDCT) values derived from routine abdominal MDCT data sets and the MDCT to QCT conversion equation: BMD(QCT)=0:78 x BMD(MDCT) + 10:13. The calculated QCT densitometric data adequately differentiated osteoporotic from healthy females (area under ROC curve 0.828, p = 0.05). In conclusion, this study showed that in a group of female patients, QCT data derived from routine abdominal MDCT examinations discriminated osteoporotic from healthy subjects.
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Affiliation(s)
- Antonios E Papadakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece.
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33
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Blake GM, Fogelman I. The role of DXA bone density scans in the diagnosis and treatment of osteoporosis. Postgrad Med J 2007; 83:509-17. [PMID: 17675543 PMCID: PMC2600106 DOI: 10.1136/pgmj.2007.057505] [Citation(s) in RCA: 298] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Dual energy x ray absorptiometry (DXA) scans to measure bone mineral density (BMD) at the spine and hip have an important role in the evaluation of individuals at risk of osteoporosis, and in helping clinicians advise patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques, hip and spine DXA examinations have a number of advantages that include a consensus that BMD results can be interpreted using the World Health Organization T-score definition of osteoporosis, a proven ability to predict fracture risk, proven effectiveness at targeting antifracture therapies, and the ability to monitor response to treatment. This review discusses the evidence for these and other clinical aspects of DXA scanning, including its role in the new WHO algorithm for treating patients on the basis of their individual fracture risk.
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Affiliation(s)
- Glen M Blake
- King's College London School of Medicine, London, UK.
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34
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Bauer JS, Henning TD, Müeller D, Lu Y, Majumdar S, Link TM. Volumetric quantitative CT of the spine and hip derived from contrast-enhanced MDCT: conversion factors. AJR Am J Roentgenol 2007; 188:1294-301. [PMID: 17449773 DOI: 10.2214/ajr.06.1006] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to perform volumetric quantitative CT (QCT) of the spine and hip using nondedicated contrast-enhanced standard MDCT data sets and to derive a conversion factor for bone mineral density (BMD) assessment based on dedicated volumetric QCT data sets. SUBJECTS AND METHODS Forty postmenopausal women with a mean +/- SD age of 71 +/- 9 years underwent routine contrast-enhanced abdominal and pelvic MDCT. Before this imaging examination, standard volumetric QCT of the spine (L1-L3, n = 40) and hip (n = 21) was performed. Relations between QCT and contrast-enhanced MDCT findings were assessed with linear regression analysis. RESULTS Mean lumbar BMD was 84.1 +/- 35.8 mg/mL, and mean femoral BMD was 0.62 +/- 0.12 g/cm2, as determined with QCT. Contrast-enhancement values with MDCT were on average 30.3% higher than those of QCT in the spine and 2.3% higher in the proximal femur (p < 0.05). Based on linear regression, a correlation coefficient of r = 0.98 was calculated for lumbar BMD with the equation BMD(QCT) = 0.96xBMD(MDCT) - 20.9 mg/mL. A coefficient of r = 0.99 was calculated for the proximal femur with the equation BMD(QCT) = 0.99xBMD(MDCT) - 12 mg/cm2 (p < 0.01). In 17 of 40 patients, 33 vertebral fractures were found. The dedicated QCT and enhanced MDCT data sets did not show a significant difference (p > 0.05) between patients with fractures and those without fractures. CONCLUSION With the conversion factors, reliable volumetric BMD measurements can be calculated for the hip and the spine from routine abdominal and pelvic MDCT data sets.
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Affiliation(s)
- Jan S Bauer
- Department of Radiology, Technische Univerität München, Klinikum rechts der Isar, Institut für Roentgendiagnostik, Ismaninger Str. 22, München, Germany 81675.
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36
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Blake GM, Fogelman I. Role of dual-energy X-ray absorptiometry in the diagnosis and treatment of osteoporosis. J Clin Densitom 2007; 10:102-10. [PMID: 17289532 DOI: 10.1016/j.jocd.2006.11.001] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2006] [Revised: 10/31/2006] [Accepted: 11/01/2006] [Indexed: 11/22/2022]
Abstract
Dual energy X-ray absorptiometry (DXA) measurements of spine and hip bone mineral density (BMD) (referred to here as central DXA) have an important role as a clinical tool for the evaluation of individuals at risk of osteoporosis, and in helping clinicians give advice to patients about the appropriate use of antifracture treatment. Compared with alternative bone densitometry techniques such quantitative computed tomography (QCT), peripheral DXA (pDXA) and quantitative ultrasound (QUS), central DXA has a number of significant advantages that include a consensus that BMD results can be interpreted using the World Health Organization (WHO) T-score definition of osteoporosis, a proven ability to predict fracture risk, and proven effectiveness at targeting antifracture treatments. This review article discusses the evidence for these and other advantages of central DXA, including its role in the new WHO algorithm for treating patients on the basis of individual fracture risk.
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Affiliation(s)
- Glen M Blake
- King's College London School of Medicine, London, UK.
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37
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Abstract
Strontium ranelate is a new treatment for osteoporosis that is of interest for, among other reasons, its unusual effect on measurements of bone mineral density (BMD). When some of the calcium in bone is replaced by strontium, X-ray absorptiometry measurements of BMD are overestimated because strontium attenuates X-rays more strongly than calcium. In this study, we report the first theoretical estimation of this effect for measurements made using axial (spine and hip) dual-energy X-ray absorptiometry (DXA), peripheral DXA (pDXA), and single-energy quantitative computed tomography (SEQCT). Tables of X-ray attenuation coefficients were used to calculate values of the strontium ratio defined as the ratio of the percentage overestimation of BMD to the molar percentage of strontium (%Sr/[Ca+Sr]) in bone. For DXA measurements, the theoretical value of the strontium ratio increased slightly with increasing effective photon energy of the X-ray beam with figures of 9.0 for Osteometer DTX200 and G4 pDXA devices (Osteometer Meditech Inc., Hawthorne, CA), 10.0 for GE-Lunar DPX and Prodigy DXA systems (GE-Lunar, Madison, WI), 10.4 for Hologic QDR1000 and QDR2000, and 10.8 for Hologic QDR4500 and Discovery (Hologic Inc., Bedford, MA). Results for SEQCT also varied with the effective photon energy with strontium ratios of 6.2 at 60 keV and 4.4 at 80 keV. The results of the theoretical study are in good agreement with the experimental value of 10 reported by Pors Nielsen and colleagues for a variety of different axial DXA systems. A reliable figure for the strontium ratio is important for adjusting BMD measurements in strontium ranelate treated patients for the effect of bone strontium content. This latter correction will be required for the interpretation of future DXA scans in patients who have discontinued strontium ranelate treatment.
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Affiliation(s)
- Glen M Blake
- King's College London School of Medicine, London, UK.
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38
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Damilakis J, Maris TG, Karantanas AH. An update on the assessment of osteoporosis using radiologic techniques. Eur Radiol 2006; 17:1591-602. [PMID: 17131124 DOI: 10.1007/s00330-006-0511-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Revised: 09/26/2006] [Accepted: 10/16/2006] [Indexed: 10/23/2022]
Abstract
In this article, the currently available radiologic techniques for assessing osteoporosis are reviewed. Density measurements of the skeleton using dual X-ray absorptiometry (DXA) are clinically indicated for the assessment of osteoporosis and for the evaluation of therapies. DXA is the most widely used technique for identifying patients with osteoporosis. Quantitative computed tomography (QCT) is the only method, which provides a volumetric density. Unlike DXA, QCT allows for selective trabecular measurement and is less sensitive to degenerative diseases of the spine. The analysis of bone structure in conjunction with bone density is an exciting new field in the assessment of osteoporosis. High-resolution multi-slice CT and micro-CT are useful tools for the assessment of bone microarchitecture. A growing literature indicates that quantitative ultrasound (QUS) techniques are capable of assessing fracture risk. Although the ease of use and the absence of ionizing radiation make QUS attractive, the specific role of QUS techniques in clinical practice needs further determination. Considerable progress has been made in the development of MR techniques for assessing osteoporosis during the last few years. In addition to relaxometry techniques, high-resolution MR imaging, diffusion MR imaging and in-vivo MR spectroscopy may be used to quantify trabecular bone architecture and mineral composition.
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Affiliation(s)
- John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete, Greece.
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39
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Lewiecki EM, Borges JLC. Bone density testing in clinical practice. ACTA ACUST UNITED AC 2006; 50:586-95. [PMID: 17117284 DOI: 10.1590/s0004-27302006000400004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 05/20/2006] [Indexed: 11/22/2022]
Abstract
The diagnosis of osteoporosis and monitoring of treatment is a challenge for physicians due to the large number of available tests and complexities of interpretation. Bone mineral density (BMD) testing is a non-invasive measurement to assess skeletal health. The "gold-standard" technology for diagnosis and monitoring is dual-energy X-ray absorptiometry (DXA) of the spine, hip, or forearm. Fracture risk can be predicted using DXA and other technologies at many skeletal sites. Despite guidelines for selecting patients for BMD testing and identifying those most likely to benefit from treatment, many patients are not being tested or receiving therapy. Even patients with very high risk of fracture, such as those on long-term glucocorticoid therapy or with prevalent fragility fractures, are often not managed appropriately. The optimal testing strategy varies according to local availability and affordability of BMD testing. The role of BMD testing to monitor therapy is still being defined, and interpretation of serial studies requires special attention to instrument calibration, acquisition technique, analysis, and precision assessment. BMD is usually reported as a T-score, the standard deviation variance of the patient's BMD compared to a normal young-adult reference population. BMD in postmenopausal women is classified as normal, osteopenia, or osteoporosis according to criteria established by the World Health Organization. Standardized methodologies are being developed to establish cost-effective intervention thresholds for pharmacological therapy based on T-score combined with clinical risk factors for fracture.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, New Mexico 87106, USA.
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40
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Brutus JP, Rajkumar JS, Rust E, Harley BJ, Palmer AK, Werner FW. Bone density comparison of selected carpal and tarsal bones: validation for their use in compression fracture fixation studies of scaphoid screws. ACTA ACUST UNITED AC 2006; 25:77-80. [PMID: 16841768 DOI: 10.1016/j.main.2006.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. METHODS Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. RESULTS A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. DISCUSSION Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.
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Affiliation(s)
- J P Brutus
- Department of Orthopedic Surgery, State University of New York, Upstate Medical University, Institute for Human Performance, 505 Irving Avenue, Syracuse, NY 13210, USA.
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41
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Parsch D, Ludwig K. [Computed tomography of the musculoskeletal system]. DER ORTHOPADE 2006; 35:644-50. [PMID: 16552516 DOI: 10.1007/s00132-006-0950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Computed tomography (CT) is an important diagnostic modality in the work-up of musculoskeletal diseases. Just as projection radiography and magnetic resonance imaging, it has specific possible uses. As a tool to guide interventional and surgical procedures, it is a significant imaging technique. The technical development of multislice spiral CT in recent years has contributed considerably to increasing the diagnostic quality of CT. In particular, the possibilities for depicting the findings with methods for secondary image reconstruction have been decidedly improved.
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Affiliation(s)
- D Parsch
- Abteilung Orthopädie I, Orthopädische Universitätsklinik, Heidelberg, Germany
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42
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Batchelar DL, Davidson MTM, Dabrowski W, Cunningham IA. Bone-composition imaging using coherent-scatter computed tomography: Assessing bone health beyond bone mineral density. Med Phys 2006; 33:904-15. [PMID: 16696465 DOI: 10.1118/1.2179151] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Quantitative analysis of bone composition is necessary for the accurate diagnosis and monitoring of metabolic bone diseases. Accurate assessment of the bone mineralization state is the first requirement for a comprehensive analysis. In diagnostic imaging, x-ray coherent scatter depends upon the molecular structure of tissues. Coherent-scatter computed tomography (CSCT) exploits this feature to identify tissue types in composite biological specimens. We have used CSCT to map the distributions of tissues relevant to bone disease (fat, soft tissue, collagen, and mineral) within bone-tissue phantoms and an excised cadaveric bone sample. Using a purpose-built scanner, we have measured hydroxyapatite (bone mineral) concentrations based on coherent-scatter patterns from a series of samples with varying hydroxyapatite content. The measured scatter intensity is proportional to mineral density in true g/cm3. Repeated measurements of the hydroxyapatite concentration in each sample were within, at most, 2% of each other, revealing an excellent precision in determining hydroxyapatite concentration. All measurements were also found to be accurate to within 3% of the known values. Phantoms simulating normal, over-, and under-mineralized bone were created by mixing known masses of pure collagen and hydroxyapatite. An analysis of the composite scatter patterns gave the density of each material. For each composite, the densities were within 2% of the known values. Collagen and hydroxyapatite concentrations were also examined in a bone-mimicking phantom, incorporating other bone constituents (fat, soft tissue). Tomographic maps of the coherent-scatter properties of each specimen were reconstructed, from which material-specific images were generated. Each tissue was clearly distinguished and the collagen-mineral ratio determined from this phantom was also within 2% of the known value. Existing bone analysis techniques cannot determine the collagen-mineral ratio in intact specimens. Finally, to demonstrate the in situ potential of this technique, the mineralization state of an excised normal cadaveric radius was examined. The average collagen-mineral ratio of the cortical bone derived from material-specific images of the radius was 0.53+/-0.04, which is in agreement with the expected value of 0.55 for healthy bones.
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Affiliation(s)
- Deidre L Batchelar
- Imaging Research Laboratories, Roberts Research Institute, London, Ontario, N6A 5K8, Canada
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43
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Abstract
Bone mineral density (BMD) testing is a noninvasive measurement to diagnose osteoporosis or low bone density, predict fracture risk, and monitor changes in bone density over time. The "gold-standard" technology for diagnosis and monitoring is dual-energy x-ray absorptiometry of the spine, hip, or forearm. Fracture risk can be predicted using a variety of technologies at many skeletal sites. BMD is usually reported as T-score, the standard deviation variance of the patient's BMD compared with a normal young-adult reference population. In untreated postmenopausal women, there is a strong correlation between T-score and fracture risk, with fracture risk increasing approximately two-fold for every standard deviation decrease in bone density. BMD in postmenopausal women is classified as normal, osteopenia, or osteoporosis according to criteria established by the World Health Organization. Standardized methodologies are being developed to establish intervention thresholds for pharmacologic therapy based on T-score combined with clinical risk factors for fracture.
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Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM 87106, USA.
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Hoesel LM, Wehr U, Rambeck WA, Schnettler R, Heiss C. Biochemical bone markers are useful to monitor fracture repair. Clin Orthop Relat Res 2005; 440:226-32. [PMID: 16239812 DOI: 10.1097/01.blo.0000180891.03042.8d] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
UNLABELLED Biochemical bone markers reflect bone metabolism but little is known regarding their usefulness during fracture repair. Reduced bone mineral density may influence fracture healing. We hypothesized that low bone mineral density results in decreased levels of bone markers during the acute phase of fracture healing, especially in women who are postmenopausal. We also addressed the question of different fracture types and locations resulting in different levels of bone markers. Urinary levels of N-terminal cross-linked telopeptide, deoxypyridinoline, and pyridinoline were measured preoperatively and postoperatively in patients with hip fractures, distal forearm fractures, and in 25 control subjects. Bone mineral density was determined using quantitative computed tomography of the spine. Patients with low bone mineral density, especially women who were postmenopausal, had greater concentrations of N-terminal cross-linked telopeptide when compared with patients with normal bone mineral density or men. Patients with pertrochanteric fractures had greater concentrations than patients with femoral neck fractures, as did patients with hip fractures compared with patients with fractures of the distal forearm. These results suggest that levels of bone markers increase during fracture healing despite low bone mineral density and that different fracture types and locations result in different levels of bone markers. LEVEL OF EVIDENCE Prognostic study, Level I (high quality prospective study-all patients were enrolled at the same time with > or = 80% of followup of enrolled patients). See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- L M Hoesel
- Department of Trauma Surgery, Justus-Liebig-University of Giessen, Giessen, Germany.
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45
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Theodorou SJ, Theodorou DJ, Sartoris DJ. Osteoporosis: a global assessment of clinical and imaging features. Orthopedics 2005; 28:1346-53; quiz 1354-5. [PMID: 16295193 DOI: 10.3928/0147-7447-20051101-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Stavroula J Theodorou
- Department of Radiology, School of Medicine, University of California, San Diego Medical Center, San Diego, Calif, USA
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46
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Lian KC, Lang TF, Keyak JH, Modin GW, Rehman Q, Do L, Lane NE. Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naive postmenopausal women. Osteoporos Int 2005; 16:642-50. [PMID: 15455195 DOI: 10.1007/s00198-004-1736-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2003] [Accepted: 07/29/2004] [Indexed: 10/26/2022]
Abstract
UNLABELLED Chronic treatment with glucocorticoids (GCs) leads to significant bone loss and increased risk of fractures. In chronically GC-treated patients, hip fracture risk is nearly 50%. The purpose of this investigation was to determine if there are differences in the quantities of trabecular and cortical bone and bone strength of the hip between GC-treated osteoporotic patients and controls. METHODS Study subjects were GC-treated osteoporotic postmenopausal women, and controls were postmenopausal women, recruited for separate clinical trials. Quantitative computed tomography (QCT) and dual-energy X-ray absorptiometry (DXA) of the hip were obtained from all subjects. QCT outcome variables measured included total, cortical, and trabecular BMD of hip subregions (femoral neck and trochanter) and total hip. In addition, finite element modeling (FEM) was performed on a subset of 19 cases and 38 controls, matched on age (+/- 5 years), weight (+/- 5 kg), and history of hormone replacement (> 1 year use) to assess failure load in stance and fall loading conditions. Generalized linear models were used to adjust the QCT variables for covariates between groups. Multiple regression was performed to identify independent predictors of bone strength from the QCT variables. RESULTS Compared with controls, GC-treated subjects were significantly (p < 0.05) younger, weighed less, and had more years of hormone replacement. QCT of the hip in GC-treated subjects for total femoral integral, cortical, and trabecular BMD averaged 4.9-23.2% (p < 0.002) less than controls, and similar results were seen by hip subregion including the trochanter and femoral neck. DXA of the total hip was 17% lower in GC subjects than controls (p < 0.05). Compared with controls, FEM failure load in GC subjects was 15% (p<0.05) and 16% (p = 0.07) lower for stance and fall loading conditions, respectively. Multiple regression analysis demonstrated that a combination of QCT measures was correlated with bone strength as measured by FEM. CONCLUSIONS Chronic GC treatment in postmenopausal women resulted in significantly decreased BMD of the hip, measured by QCT, with loss of both trabecular and cortical bone. In addition, GC treatment decreased bone strength as determined by FEM. The reduced cortical and trabecular bone mass in the hip may contribute to the disproportionately high hip fracture rates observed in GC-treated subjects.
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Affiliation(s)
- Kuo-Chiang Lian
- Department of Medicine and Radiology, University of California-San Francisco, San Francisco, CA 94143, USA
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47
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Alesci S, De Martino MU, Ilias I, Gold PW, Chrousos GP. Glucocorticoid-induced osteoporosis: from basic mechanisms to clinical aspects. Neuroimmunomodulation 2005; 12:1-19. [PMID: 15756049 DOI: 10.1159/000082360] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Accepted: 03/23/2004] [Indexed: 01/06/2023] Open
Abstract
Glucocorticoid (GC)-induced osteoporosis (GCOP) is the most common cause of osteoporosis in adults aged 20-45 years as well as the most common cause of iatrogenic osteoporosis. GC excess, either endogenous or exogenous, induces bone loss in 30-50% of cases. Indeed, bone loss leading to fractures is perhaps the most incapacitating, sometimes partially irreversible, complication of GC therapy. Nevertheless, GCOP is often underdiagnosed and left untreated. The following article provides an update on the cellular and molecular mechanisms implicated in the pathophysiology of GC-induced bone loss, as well as some guidelines on diagnostic, preventive and therapeutic strategies for this medical condition, in an effort to promote a better knowledge and greater awareness of GCOP by both the patient and the physician.
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Affiliation(s)
- Salvatore Alesci
- Clinical Neuroendocrinology Branch, National Institute of Mental Health, Bethesda, MD 20892-1284, USA.
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Lenchik L, Shi R, Register TC, Beck SR, Langefeld CD, Carr JJ. Measurement of trabecular bone mineral density in the thoracic spine using cardiac gated quantitative computed tomography. J Comput Assist Tomogr 2004; 28:134-9. [PMID: 14716247 DOI: 10.1097/00004728-200401000-00023] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a method and evaluate the performance of thoracic bone mineral density (BMD) measurement using cardiac gated quantitative computed tomography (QCT). METHODS A total of 762 participants (57% female) with a mean age of 61 years had a CT examination of the heart using prospective cardiac gating. A subset of 443 participants had replicate CT examinations of the heart. Another, nonindependent subset of 464 participants had CT examination of the abdomen. A QCT calibration phantom was included in all scans. Trabecular BMD was measured in the thoracic (T6-T11) and lumbar (T11-L4) spine. Tests of calibration and refinement and simple correlations between replicate thoracic BMD measurements and between thoracic and lumbar BMD measurements were calculated. RESULTS There was high correlation between replicated thoracic BMD measurements in men (r = 0.995, P < 0.0001) and in women (r = 0.995, P < 0.0001). There was high correlation between thoracic and lumbar BMD in men (r = 0.90, P < 0.0001) and in women (r = 0.94, P < 0.0001). The mean BMD was higher in the thoracic spine than the lumbar spine in men (137.58 mg/cm3 vs. 126.94 mg/cm3, P < 0.0001) and in women (152.07 mg/cm3 vs. 133.44 mg/cm3, P < 0.0001). In both genders, thoracic and lumbar BMD was inversely associated with age (all P < 0.05). CONCLUSIONS Cardiac gated CT, primarily intended for measurement of coronary vascular calcium, can be used to measure thoracic BMD with high precision. Thoracic BMD measurements using this method are highly correlated with QCT measurements in the lumbar spine.
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Affiliation(s)
- Leon Lenchik
- Department of Radiology, Wake Forest University School of Medicine, University Health Sciences, Winston-Salem, NC 27157, USA.
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