Clinical Tools to Evaluate Bone Strength

Manske, Sarah L.; Macdonald, Heather M.; Nishiyama, Kyle K.; Boyd, Steven K.; McKay, Heather

doi:10.1007/s12018-009-9066-2

Cited by 19 publications

(14 citation statements)

References 109 publications

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“…However, the many limitations of DXA are well known (26) and include its 2D assessment of aBMD, which is influenced by the bone enlargement that can occur in acromegaly. Moreover, DXA does not distinguish between the cortical and trabecular compartments, which The adjusted r 2 value indicates how much of the variance in the dependent variable may be predicted from the independent one.…”

Section: Discussionmentioning

confidence: 99%

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Madeira

Neto

Paranhos-Neto

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

104

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Acromegaly appears to have a deleterious effect on trabecular bone microarchitecture, and in this specific population, the gonadal status might be more important than T2DM or acromegaly activity in determining bone health. High-resolution peripheral quantitative computed tomography seems promising for evaluating acromegalic bone properties and for addressing the limitations posed by dual-energy x-ray absorptiometry.

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Section: Discussionmentioning

confidence: 99%

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Madeira

Neto

Paranhos-Neto

et al. 2013

The Journal of Clinical Endocrinology &Amp; Metabolism

104

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“…We define bone structure as being composed of bone geometry and macroarchitecture (eg, cortical thickness, trabecular and cortical bone area, periosteal and endosteal circumference). We use bone microarchitecture to represent measures of trabecular thickness, trabecular separation, and cortical porosity …”

Section: Methodsmentioning

confidence: 99%

Influence of Physical Activity on Bone Strength in Children and Adolescents: A Systematic Review and Narrative Synthesis

Tan

Macdonald

Kim

et al. 2014

Journal of Bone and Mineral Research

195

151

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A preponderance of evidence from systematic reviews supports the effectiveness of weight-bearing exercises on bone mass accrual, especially during the growing years. However, only one systematic review (limited to randomized controlled trials) examined the role of physical activity (PA) on bone strength. Thus, our systematic review extended the scope of the previous review by including all PA intervention and observational studies, including organized sports participation studies, with child or adolescent bone strength as the main outcome. We also sought to discern the skeletal elements (eg, mass, structure, density) that accompanied significant bone strength changes. Our electronic-database, forward, and reference searches yielded 14 intervention and 23 observational studies that met our inclusion criteria. We used the Effective Public Health Practice Project (EPHPP) tool to assess the quality of studies. Due to heterogeneity across studies, we adopted a narrative synthesis for our analysis and found that bone strength adaptations to PA were related to maturity level, sex, and study quality. Three (of five) weight-bearing PA intervention studies with a strong rating reported significantly greater gains in bone strength for the intervention group (3% to 4%) compared with only three significant (of nine) moderate intervention studies. Changes in bone structure (eg, bone cross-sectional area, cortical thickness, alone or in combination) rather than bone mass most often accompanied significant bone strength outcomes. Prepuberty and peripuberty may be the most opportune time for boys and girls to enhance bone strength through PA, although this finding is tempered by the few available studies in more mature groups. Despite the central role that muscle plays in bones' response to loading, few studies discerned the specific contribution of muscle function (or surrogates) to bone strength. Although not the focus of the current review, this seems an important consideration for future studies.

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“…To differentiate cortical from trabecular bone, the system software uses a threshold that is 1 [27]. We define these variables as measures of bone quality [35]. Reproducibility in our laboratory was 0.2% to 3.8% for all HR-pQCTacquired bone measures at the tibia and radius [University of British Columbia Bone Health Research Group, unpublished data].…”

Section: Methodsmentioning

confidence: 99%

“…Previous DXA studies of the fat-bone relationship [1,11,13,15,16,22,26,37,42,48] were also limited by the inability of planar DXA technology to capture aspects of bone quality such as bone geometry and microstructure and the independent contribution of cortical and trabecular parameters to bone strength [35]. With peripheral quantitative CT (pQCT), one is able to assess associations between excess body fat and bone cross-sectional structure, volumetric BMD, and estimates of bone strength at the radius and tibia in children and adolescents [14,17,18,39,43,50,51].…”

Section: Introductionmentioning

confidence: 99%

How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?

Hoy¹,

Macdonald²,

McKay³

2013

Clinical Orthopaedics &Amp; Related Research

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Background Overweight youth have greater bone mass than their healthy-weight peers but sustain more fractures. However, it is unclear whether and how excess body fat influences bone quality in youth. Questions/purposes We determined whether overweight status correlated with three-dimensional aspects of bone quality influencing bone strength in adolescent and young adult females and males. Methods We categorized males (n = 103; mean age, 17 years) and females (n = 85; mean age, 18 years) into healthy-weight and overweight groups. We measured lean mass (LM) and fat mass (FM) with dual-energy x-ray absorptiometry (DXA). We used high-resolution peripheral quantitative CT to assess the distal radius (7% site) and distal tibia (8% site). Bone quality measures included total bone mineral density (Tt.BMD), total area (Tt.Ar), trabecular bone volume fraction (BV/TV), trabecular number (Tb.N), separation (Tb.Sp), and thickness (Tb.Th). We used multiple regression to compare bone quality between healthy-weight and overweight adolescents adjusting for age, ethnicity, limb length, LM, and FM. Results Overweight males had higher (10%-21%) Tt.BMD, BV/TV, and Tb.N and lower Tb.Sp at the tibia and lower Tt.Ar at the radius than healthy-weight males. No differences were observed between overweight and healthy-weight females. LM attenuated the differences in bone quality between groups in males while FM negatively predicted Tt.BMD, BV/TV, Tb.N, and Tb.Th. Conclusions Our data suggest overweight males have enhanced bone quality compared with healthy-weight males; however, when group differences are interpreted in the context of the mechanostat theory, it appears bone quality of overweight adolescents adapts to LM and not to greater FM.

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Clinical Tools to Evaluate Bone Strength

Cited by 19 publications

References 109 publications

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Acromegaly Has a Negative Influence on Trabecular Bone, But Not on Cortical Bone, as Assessed by High-Resolution Peripheral Quantitative Computed Tomography

Influence of Physical Activity on Bone Strength in Children and Adolescents: A Systematic Review and Narrative Synthesis

How Does Bone Quality Differ Between Healthy-weight and Overweight Adolescents and Young Adults?

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