Bone Quality—Beyond Bone Mineral Density

Link, Thomas M.; Heilmeier, Ursula

doi:10.1055/s-0036-1592365

Cited by 18 publications

(6 citation statements)

References 97 publications

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“…In these and other studies, texture heterogeneity was described to be associated with therapy response and clinical outcome [ 35 ]. Besides MRI, the use of texture analysis was investigated on using mammography and in CT in the past to analyze its capability to contribute to computer-aided cancer diagnosis or bone quality measurements [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…These texture parameters have been used for trabecular bone microstructure analysis in computed tomography (CT) scans and can similarly be applied on MR-based PDFF maps [ 21 ]. Additionally, certain texture features were shown to be of diagnostic help in identifying soft tissue malignancies from mammograms or fracture risk in CT [ 23 , 24 ]. With that said, the methodic deduction of the concept of using texture parameters to attain a diagnostic gain and subsequent transfer to MRI as radiation-free modality is a logical step and of high clinical significance with implementation in risk stratification for potential fractures or tumor relapse.…”

Section: Introductionmentioning

confidence: 99%

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Texture analysis of vertebral bone marrow using chemical shift encoding–based water-fat MRI: a feasibility study

et al. 2019

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Summary This feasibility study investigated the spatial heterogeneity of the lumbar vertebral bone marrow using chemical shift encoding–based water-fat MRI. Acquired texture features like contrast and dissimilarity allowed for differentiation of pre- and postmenopausal women and may serve as imaging biomarkers in the future. Introduction While the vertebral bone marrow fat using chemical shift encoding water-fat magnetic resonance imaging (MRI) has been extensively studied, its spatial heterogeneity has not been analyzed yet. Therefore, this feasibility study investigated the spatial heterogeneity of the lumbar vertebral bone marrow by using texture analysis in proton density fat fraction (PDFF) maps. Methods Forty-one healthy pre- and postmenopausal women were recruited for this study (premenopausal ( n = 15) 30 ± 7 years, postmenopausal ( n = 26) 65 ± 7 years). An eight-echo 3D spoiled gradient echo sequence was used for chemical shift encoding–based water-fat separation at the lumbar spine. Vertebral bodies L1 to L5 were manually segmented. Mean PDFF values and texture features were extracted at each vertebral level, namely variance, skewness, and kurtosis, using statistical moments and second-order features (energy, contrast, correlation, homogeneity, dissimilarity, entropy, variance, and sum average). Parameters were compared between pre- and postmenopausal women and vertebral levels. Results PDFF was significantly higher in post- than in premenopausal women (49.37 ± 8.14% versus 27.76 ± 7.30%, p < 0.05). Furthermore, PDFF increased from L1 to L5 (L1 37.93 ± 12.85%, L2 38.81 ± 12.77%, L3 40.23 ± 12.72%, L4 42.80 ± 13.27%, L5 45.21 ± 14.55%, p < 0.05). Bone marrow heterogeneity based on texture analysis was significantly ( p < 0.05) increased in postmenopausal women. Contrast and dissimilarity performed best in differentiating pre- and postmenopausal women (AUC = 0.97 and 0.96, respectively), not significantly different compared with PDFF (AUC = 0.97). Conclusion Conclusively, an increased bone marrow heterogeneity could be observed in postmenopausal women. In the future, texture parameters might provide additional information to detect and monitor vertebral bone marrow alterations due to aging or hormonal changes beyond conventional anatomic imaging.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Texture analysis of vertebral bone marrow using chemical shift encoding–based water-fat MRI: a feasibility study

et al. 2019

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“…Considering these clinically relevant results, it should be kept in mind that the participants were menopausal women who were not receiving pharmacological treatments and who were at risk of osteoporosis-some of the women already had osteopenia. The bone compartment is quantified through the BMD, which informs the amount of bone that exists after the growth period is complete [9]. However, a disadvantage of the method used to assess the bone mass is that it is not significantly sensitive to predict fractures [39].…”

Section: Discussionmentioning

confidence: 99%

“…Next, the risk of fracture can be calculated using the Fracture Risk Assessment Tool (FRAX ® ), a validated tool created by the WHO that estimates the 10-year risk of developing an osteoporotic fracture [8]. Finally, to quantify the bone mineral density (BMD), defined as the amount of bone that exists once the growth period is complete [9], there are several techniques, but, with no doubt, the most commonly used is dual-energy X-ray absorptiometry (iDXA). This is a non-invasive technique which is fast to perform with low amounts of radiation and with very a high accuracy and reliability.…”

Section: Introductionmentioning

confidence: 99%

A Dairy Product to Reconstitute Enriched with Bioactive Nutrients Stops Bone Loss in High-Risk Menopausal Women without Pharmacological Treatment

et al. 2020

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Osteoporosis is a multifactorial disease characterized by the loss of bone mass and deterioration of the internal structure of the bone, increasing the risk of fractures, and is becoming an economic and social problem. The main treatment is pharmacological, however, the population demands other therapies, such as foods with nutrients beneficial to bone health. Seventy-eight healthy menopausal women at risk of osteoporosis or untreated osteopenia were recruited for a randomized, parallel, double-blind clinical trial with two intervention groups: one group consumed a serving a day of the experimental enriched product (experimental group (EG)) and the other group (control group (CG)) consumed the same product without enrichment. The main objective was to compare the effect of consuming a dairy preparation to reconstitute, similar to yogurt when prepared, enriched in calcium, vitamin D, vitamin K, vitamin C, zinc, magnesium, L-leucine and probiotic (Lactobacillus plantarum 3547) on bone metabolism markers for 24 weeks. The EG showed a significantly increased bone mass compared to the CG (0.01 ± 0.03 vs. −0.01 ± 0.03 kg; p < 0.05). In addition, the EG maintained their bone mineral density (BMD) compared to the CG, whose BMD significantly decreased at the end of the study. For biochemical markers, the EG significantly increased the serum levels of the N-terminal propeptide of type I collagen (P1NP) bone formation marker (13.19 ± 25.17 vs. −4.21 ± 15.62 ng/mL; p < 0.05), and decreased the carbo-terminal telopeptide of type I collagen (CTx) bone resorption marker compared to the CG (−0.05 ± 0.19 vs. 0.04 ± 0.14 ng/mL; p < 0.05). On the other hand, the EG exhibited a significantly decreased systolic and diastolic blood pressure compared to the start of the study. Finally, the EG significantly increased their dietary calcium and vitamin D intake compared to the CG. In conclusion, the regular consumption of a dairy product to reconstitute enriched with bioactive nutrients improves bone health markers in menopausal women at risk of osteoporosis without pharmacological treatment.

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“…This information is obtained from second-order features which can be extracted from the gray-level co-occurrence matrix (GLCM) as described by Haralick et al (25). Texture features have previously been applied in different biomedical imaging modalities, e.g., for computed tomography (CT)-based analysis of bone microstructure, CTbased fracture risk assessment, and diagnostic support in mammography (26)(27)(28), in multi-modal oncologic imaging analysis (29)(30)(31) as well as for MRI-based computer-aided diagnosis and classification of vertebral compression fractures (32,33). In a recent preliminary study, CSE-MRI-based texture analysis demonstrated an increased vertebral bone marrow heterogeneity after menopause and the second-order features contrast and dissimilarity were shown to differentiate postfrom premenopausal equally well as PDFF (24).…”

Section: Introductionmentioning

confidence: 99%

Vertebral Bone Marrow Heterogeneity Using Texture Analysis of Chemical Shift Encoding-Based MRI: Variations in Age, Sex, and Anatomical Location

et al. 2020

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Objective: Vertebral bone marrow composition has been extensively studied in the past and shown potential as imaging biomarker for osteoporosis, hematopoietic, and metabolic disorders. However, beyond quantitative assessment of bone marrow fat, little is known about its heterogeneity. Therefore, we investigated bone marrow heterogeneity of the lumbar spine using texture analysis of chemical-shift-encoding (CSE-MRI) based proton density fat fraction (PDFF) maps and its association with age, sex, and anatomical location. Methods: One hundred and fifty-six healthy subjects were scanned (age range: 20–29 years, 12/30 males/females; 30–39, 15/9; 40–49, 5/13; 50–59, 9/27; ≥60: 9/27). A sagittal 8-echo 3D spoiled-gradient-echo sequence at 3T was used for CSE-MRI-based water-fat separation at the lumbar spine. Manual segmentation of vertebral bodies L1-4 was performed. Mean PDFF and texture features (global: variance, skewness, kurtosis; second-order: energy, entropy, contrast, homogeneity, correlation, sum-average, variance, dissimilarity) were extracted at each vertebral level and compared between age groups, sex, and anatomical location. Results: Mean PDFF significantly increased from L1 to L4 (35.89 ± 11.66 to 39.52 ± 11.18%, p = 0.017) and with age (females: 27.19 ± 6.01 to 49.34 ± 7.75%, p < 0.001; males: 31.97 ± 7.96 to 41.83 ± 7.03 %, p = 0.025), but showed no difference between females and males after adjustment for age and BMI (37.13 ± 11.63 vs. 37.17 ± 8.67%; p = 0.199). Bone marrow heterogeneity assessed by texture analysis, in contrast to PDFF, was significantly higher in females compared to males after adjustment for age and BMI (namely contrast and dissimilarity; p < 0.031), demonstrated age-dependent differences, in particular in females ( p < 0.05), but showed no statistically significant dependence on vertebral location. Conclusion: Vertebral bone marrow heterogeneity, assessed by texture analysis of PDFF maps, is primarily dependent on sex and age but not on anatomical location. Future studies are needed to investigate bone marrow heterogeneity with regard to aging and disease.

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Bone Quality—Beyond Bone Mineral Density

Cited by 18 publications

References 97 publications

Texture analysis of vertebral bone marrow using chemical shift encoding–based water-fat MRI: a feasibility study

Texture analysis of vertebral bone marrow using chemical shift encoding–based water-fat MRI: a feasibility study

A Dairy Product to Reconstitute Enriched with Bioactive Nutrients Stops Bone Loss in High-Risk Menopausal Women without Pharmacological Treatment

Vertebral Bone Marrow Heterogeneity Using Texture Analysis of Chemical Shift Encoding-Based MRI: Variations in Age, Sex, and Anatomical Location

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