Assessment of bone mass in the radius by computed tomography

Ps, Jensen; Orphanoudakis, SC; Rauschkolb, EN; Baron, Roland; Lang, Robert; B.-Rasmussen, Helle

doi:10.2214/ajr.134.2.285

Cited by 22 publications

(12 citation statements)

References 9 publications

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“…An even more distal site, closer to the radiocarpal joint, is accessible to computed tomography (CT), using one of several instruments designed specifically for this purpose (44)(45)(46). The results of such studies of the far distal radius, together with histologic measurements in patients with inflammatory arthritis (47), and the frequency with which bone scans are positive at the distal ends of long bones (48) all suggest that trabecular bone closely adjacent to synovial joints has a higher rate of turnover despite the absence of hematopoietic marrow, presumably reflecting a higher local blood flow.…”

Section: Resultsmentioning

confidence: 99%

Irreversible bone loss in osteomalacia. Comparison of radial photon absorptiometry with iliac bone histomorphometry during treatment.

Parfitt¹,

Rao²,

Stanciu³

et al. 1985

J. Clin. Invest.

124

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We examined the relationships between the changes in bone mineral deficit in the radius, determined by single-energy photon absorptiometry at standard proximal and distal sites, and in the ilium, determined by bone histomorphometry, during the treatment of osteomalacia of diverse etiology in 28 patients. In the ilium, relative osteoid volume decreased by 75-80% in both cortical bone (from 6.0% to 1.5%) and trabecular bone (from 30.1% to 6.6%) during a mean treatment duration of 2 yr. There was also a significant fall in iliac cortical porosity from 10.3% to 7.8%. As a result, mineralized bone volume increased by 7.5% in cortical and by 40.1% in trabecular bone; the cortical and trabecular increments were correlated (r = 0.69, P < 0.001). The properly weighted increase for the entire tissue sample was 18.6%. By contrast, there was no change in bone mineral at either radial site, although there was a 2% increase at both sites when allowance was made for age-related bone loss during treatment. The proximal and distal age-adjusted increments were correlated (r = 0.76, P < 0.001), but there was no correlation between the changes in any photon absorptiometric and any histomorphometric index. In that iliac cortical bone turnover in normal subjects was 7.2%/yr, we estimated the rate of bone turnover to be <2%/yr at both proximal and distal radial sites, including any trabecular bone present at the distal site. Compared to appropriate control subjects, the bone mineral deficits fell during treatment from 19.2% to 17.1% at the proximal radius (>95% cortical bone) and from 20.5% to 18.5% at the distal radius (>75% cortical bone). In the ilium the deficits, assuming attainment of normal values for osteoid volume and cortical porosity, fell from 41.7% to 36.1% in cortical and from 31.5% to 6.3% in trabecular bone, the properly weighted combined deficit falling from 38.6% to 27.7%. The irreversible iliac cortical deficit was entirely due to cortical thinning because of increased net endosteal resorption; the resultant expansion of the marrow cavity offset the modest loss of fractional trabecular mineralized bone. We conclude: (a) in osteomalacia there is a large irreversible and a small reversible bone mineral deficit at both proximal and distal radial sites, in similar proportion to the iliac cortex but of smaller This work was presented in part at the Third International Workshop

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Section: Resultsmentioning

confidence: 99%

Irreversible bone loss in osteomalacia. Comparison of radial photon absorptiometry with iliac bone histomorphometry during treatment.

Parfitt¹,

Rao²,

Stanciu³

et al. 1985

J. Clin. Invest.

124

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“…It allows a simple, rapid and digital measure ment of bone mass. A high accuracy and reproducibility has been observed [10,21], particulary when compared with radiodensitometry [12] and photon absorptiometry [11,12], On the other hand, the trabecular bone, more sensitive to metabolic changes than the compact bone, can be distinguished from the surrounding soft tissue. The positive inverse correlation between age and TBM found by us in the control group ( fig.…”

Section: Discussionmentioning

confidence: 99%

A New Method for the Assessment of Bone Mass in Renal Osteodystrophy

Torres¹,

Benavent²

1982

Nephron

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We have designed a method for the assessment of trabecular bone mass (TBM) in a central portion of L₄ by means of CT scanning. A total of 29 normal individuals of different ages from both sexes, and 19 hemodialysis patients were studied. 3 selected patients were also studied 1 year later. A good in vivo reproducibility was demonstrated in a dog after repositioning. A positive inverse correlation was observed in the control group between age and TBM supporting the reliability of this method. As reported by others in the postmortem bone mineral analysis of L₄, a majority of patients (78.9%) showed a normal or high TBM. From a total of 5 patients with increased TBM only 2 showed radiological osteosclerosis, and 4 of them presented advanced subperiostal resorption suggesting a pathogenetic role of excessive circulating PTH in the genesis of osteosclerosis. A total of 4 had decreased TBM and only 2 of them showed radiological demineralization. 2 patients with decreased TBM, 1 of them under anticonvulsant therapy, experienced a considerable increase in the TBM after 1 year of 25OHD₃ therapy. We conclude that this method can be an important help in the early detection and management of renal osteodystrophy.

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“…CT values for spongy bone in normal subjects are similar to those for soft tissue, and negative CT values do occur in bone disease [6,7,[10][11][12], indicating influences not only of low bone mass but of yellow marrow and/or bone composition. Conventional CT scans, whether using monoenergetic or polychromatic beams, have been shown to involve substantial errors due to marrow fat [13,22].…”

Section: Discussionmentioning

confidence: 99%

“…Variable bone and marrow composition undoubtedly contribute to the poor accuracy (30% or more) of CT on vertebral specimens measured in vitro in several studies [12,23,24]. Jensen et al [6] found an error of at least 5% in predicting TBV of iliac crest biopsies (from CT of the distal radius): this amounted to an error of 25% relative to a normal TBV of 20% and an error of 50% at low TBV. Such errors greatly exceed the 0.5% accuracy that Brooks [25] estimates might be obtained in vivo, and are consistent with a wide range of marrow composition.…”

Section: Discussionmentioning

confidence: 99%

“…The CT values could be more useful clinically than the mineral content obtained by 24~Am or ~2~I absorptiometry. CT offers an even greater potential advantage if it could be used to measure the trabecular bone of either the appendicular [6][7][8][9] or axial skeleton [10][11][12]. However, there is some doubt if conventional "single-energy" CT methods, using either monoenergetic radionuclide or polychromatic X-ray beams, can be used on trabecular bone because (a) the variable adipose content of the marrow leads to errors [13], and (b) bone substance itself has a variable composition.…”

Section: Abstract: Bone --Computed Tomography --mentioning

confidence: 99%

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Errors in measuring trabecular bone by computed tomography due to marrow and bone composition

Mazess

1983

Calcif Tissue Int

104

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The linear attenuation coefficient (mu in cm-1) of trabecular bone was modeled for different conditions of bone and marrow composition in order to assess their influence on computed tomography (CT) quantitation. A large relative change (10% of TBV at 15% TBV) of bone concentration resulted in small changes of mu: 2.3% at 60 keV, 3.4% at 44 keV, 5.2% at 29 keV. Relative changes of trabecular bone volume (TBV) on the order of 3% could be detected in vivo by CT were it not for errors of relocation and for compositional influences on accuracy. The mu (and density) depended critically not only on amounts of bone substance and marrow but on their compositions. Normal variation in the composition of bone substance produced an uncertainty in mu equivalent to 0.5 to 1% TBV. Increases of yellow marrow produced a decrease of mu which could be mistaken for a decrease of bone concentration. The biological variation (90% confidence limit) of marrow composition gives an uncertainty at 15% TBV of about 2.4% TBV at 60 keV, 1.7% at 44 keV, and 1.3% at 29 keV. These correspond to relative uncertainties of 16, 11, and 9% respectively. These factors help explain the large accuracy errors (30%) observed in all studies of trabecular bone where single-energy CT was used. Marrow composition also can affect precision of bone measurement. Systematic shifts of red and yellow marrow could mask biological changes such as those occurring with aging or treatment.

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Assessment of bone mass in the radius by computed tomography

Cited by 22 publications

References 9 publications

Irreversible bone loss in osteomalacia. Comparison of radial photon absorptiometry with iliac bone histomorphometry during treatment.

Irreversible bone loss in osteomalacia. Comparison of radial photon absorptiometry with iliac bone histomorphometry during treatment.

A New Method for the Assessment of Bone Mass in Renal Osteodystrophy

Errors in measuring trabecular bone by computed tomography due to marrow and bone composition

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