Advanced imaging assessment of bone fragility in glucocorticoid-induced osteoporosis

Kalpakcioglu, Banu; Engelke, Klaus; Genant, Harry K.

doi:10.1016/j.bone.2011.02.005

Cited by 49 publications

(32 citation statements)

References 76 publications

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“…Microstructural changes such as trabecular thinning, lower BV/TV, and reduced connectivity have been reported for GIO based on histological data34–36 or micro-CT analysis 36. However, to date, it has not been possible to measure these aspects noninvasively in humans 9. The publication by Ito and colleagues6 confirmed the potential of QCT approaches for assessing vertebral microstructure in vivo.…”

Section: Discussionmentioning

confidence: 95%

“…Along with such therapies, more sensitive diagnostic and evaluation methods beyond DXA, such as quantitative computed tomography (QCT) or assessment of cancellous microstructure with either high-resolution QCT (HRQCT)6–8 or magnetic resonance imaging (MRI) techniques should be applied 9. Moreover, vertebral bone strength as the most important determinant of fracture risk can be assessed in vivo by a simulated mechanical test based on the BMD distribution using finite element (FE) analysis 10.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial

Glüer

Marín²,

Ringe

et al. 2013

Journal of Bone and Mineral Research

154

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Data on treatment of glucocorticoid-induced osteoporosis (GIO) in men are scarce. We performed a randomized, open-label trial in men who have taken glucocorticoids (GC) for ≥3 months, and had an areal bone mineral density (aBMD) T-score ≤ –1.5 standard deviations. Subjects received 20 μg/d teriparatide (n = 45) or 35 mg/week risedronate (n = 47) for 18 months. Primary objective was to compare lumbar spine (L1–L3) BMD measured by quantitative computed tomography (QCT). Secondary outcomes included BMD and microstructure measured by high-resolution QCT (HRQCT) at the 12th thoracic vertebra, biomechanical effects for axial compression, anterior bending, and axial torsion evaluated by finite element (FE) analysis from HRQCT data, aBMD by dual X-ray absorptiometry, biochemical markers, and safety. Computed tomography scans were performed at 0, 6, and 18 months. A mixed model repeated measures analysis was performed to compare changes from baseline between groups. Mean age was 56.3 years. Median GC dose and duration were 8.8 mg/d and 6.4 years, respectively; 39.1% of subjects had a prevalent fracture, and 32.6% received prior bisphosphonate treatment. At 18 months, trabecular BMD had significantly increased for both treatments, with significantly greater increases with teriparatide (16.3% versus 3.8%; p = 0.004). HRQCT trabecular and cortical variables significantly increased for both treatments with significantly larger improvements for teriparatide for integral and trabecular BMD and bone surface to volume ratio (BS/BV) as a microstructural measure. Vertebral strength increases at 18 months were significant in both groups (teriparatide: 26.0% to 34.0%; risedronate: 4.2% to 6.7%), with significantly higher increases in the teriparatide group for all loading modes (0.005 < p < 0.015). Adverse events were similar between groups. None of the patients on teriparatide but five (10.6%) on risedronate developed new clinical fractures (p = 0.056). In conclusion, in this 18-month trial in men with GIO, teriparatide showed larger improvements in spinal BMD, microstructure, and FE-derived strength than risedronate.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial

Glüer

Marín²,

Ringe

et al. 2013

Journal of Bone and Mineral Research

154

View full text Add to dashboard Cite

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“…Despite the widespread usage of BMD, recent studies have indicated that measurement of BMD alone is insufficient for evaluation of bone strength [26–29]. Recent studies have explored the use of high resolution CT imaging to model bone mechanical characteristics in order to predict fracture risk through finite element analysis (FEA) [26, 30–32]. Until recently, mechanical properties of bone were tested ex vivo , requiring the use of a large number of animals to provide sufficient data points.…”

Section: Discussionmentioning

confidence: 99%

Parametric response mapping of CT images provides early detection of local bone loss in a rat model of osteoporosis

Hoff

Kozloff

Boes

et al. 2012

Bone

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Loss of bone mass due to disease, such as osteoporosis and metastatic cancer to the bone, is a leading cause of orthopedic complications and hospitalization. Onset of bone loss resulting from disease increases the risk of incurring fractures and subsequent pain, increasing medical expenses while reducing quality of life. Although current standard CT-based protocols provide adequate prognostic information for assessing bone loss, many of the techniques for evaluating CT scans rely on measures based on whole-bone summary statistics. This reduces the sensitivity at identifying local regions of bone resorption, as well as formation. In this study, we evaluate the effectiveness of a voxel-based image post-processing technique, called the Parametric Response Map (PRM), for identifying local changes in bone mass in weight-bearing bones on CT scans using an established animal model of osteoporosis. Serial CT scans were evaluated weekly using PRM subsequent to ovariectomy or sham surgeries over the period of one month. For comparison, bone volume fraction and mineral density measurements were acquired and found to significantly differ between groups starting 3 weeks post-surgery. High resolution ex vivo measurements acquired four weeks post-surgery validated the extent of bone loss in the surgical groups. In contrast to standard methodologies for assessing bone loss, PRM results were capable of identifying local decreases in bone mineral by week 2, which were found to be significant between groups. This study concludes that PRM is able to detect changes in bone mineral with higher sensitivity and spatial differentiation than conventional techniques for evaluating CT scans, which may aid in clinical decision making for patients suffering from bone loss.

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“…The fourth limitation is from the fact that, corticosteroid-induced osteoporosis has pathologic difference compared with other types of osteoporosis. 33 Corticosteroid is known to inhibit differentiation and function of the osteoblast, to induce apoptosis, and to show anti-apoptotic effect to the osteoclast. 34,35 As for this study, we induced severe osteoporosis by ovariectomy and corticosteroid injection, which has different pathophysiology from general osteoporosis, which makes it a limitation to generalize our result.…”

Section: Discussionmentioning

confidence: 99%

Effects of Ovariectomy and Corticosteroid-Induced Osteoporosis on the Osteoinductivity of rhBMP-2 in a Segmental Long-Bone Defect Model

Lee

Baek

Lee

et al. 2015

Tissue Engineering Part A

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This study used the segmental long-bone defect model to assess the effects of osteoporosis on the formation of new bones and the osteoinductivity of recombinant human bone morphogenetic protein-2 (rhBMP-2). Seventy-two female Sprague-Dawley rats were divided into two groups: an osteoporosis group with ovariectomies and dexamathasone intramuscular injections and a sham group. When they reached 22 weeks in age, each group was further divided into two groups and a 5-mm defect was made in both fibular mid-shafts of each rat. One fibula in each rat was picked randomly and was injected with 0.05 mL of hydrogel carrier; the opposite fibula was injected with the same carrier mixed with rhBMP-2 (10 μg). After rearing for a further 5 and 9 weeks, the ratios of the lengths of the newly formed bones in the fibular defects were determined using micro-CT and undecalcified histology. The sham rhBMP-2-injected group-in all of the 5- and 9-week-kept groups-showed a significantly higher bridging bone formation ratio than the other three groups. The osteoporosis rhBMP-2-injected group showed a significantly higher ratio than both the non-rhBMP-2-injected sham hydrogel and the osteoporosis hydrogel groups. The comparison of the micro-CT parameters of the newly formed bones showed that the sham rhBMP-2 group at both 5 and 9 weeks compared with the osteoporosis rhBMP-2 group had significantly higher percentage bone volumes, trabecular thicknesses, and trabecular numbers, in addition to significantly lower specific surfaces, trabecular pattern factors, and structural model indices. The histology results showed that the sham-rhBMP-2 group began forming bridging bones in the defect areas at 5 weeks, and at 9 weeks, trabeculae and marrow spaces were observed. However, the osteoporosis rhBMP-2 group exhibited a relatively minor level of new bone and trabecula formation. Consequently, the rhBMP-2 group showed significantly increased bone formation in the osteoporosis rat fibular defect model compared with the hydrogel group, whereas the new bone quantities, qualities, and remodeling in the osteoporosis rhBMP-2 group were less effective than those in the sham-rhBMP-2 group, signaling that ovariectomy and corticosteroid-induced osteoporosis significantly undermines rhBMP-2 osteoinductivity.

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Advanced imaging assessment of bone fragility in glucocorticoid-induced osteoporosis

Cited by 49 publications

References 76 publications

Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial

Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial

Parametric response mapping of CT images provides early detection of local bone loss in a rat model of osteoporosis

Effects of Ovariectomy and Corticosteroid-Induced Osteoporosis on the Osteoinductivity of rhBMP-2 in a Segmental Long-Bone Defect Model

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