Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naïve postmenopausal women

Lian, K.; Lang, Thomas; Keyak, Joyce H.; Modin, Gunnard; Rehman, Q.; Do, Loi; Lane, Nancy E.

doi:10.1007/s00198-004-1736-9

Cited by 58 publications

(35 citation statements)

References 42 publications

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“…In particular, studies at the scale of 5-8 mm could be particularly useful for testing the idea that changes in bone microarchitecture and/or tissue material properties are responsible for any clinically relevant changes in bone biomechanical performance relative to density. For example, if it turns out that a particular treatment does not change bone quality at the scale of 5-8 mm, then attention can be focused on analysis of bone quality at higher physical scales, which should be feasible using current radiological techniques combined with finite element analysis [44,[60][61][62][63][64][65] or with whole bone mechanical testing. In this way a more complete picture of how characteristics of bone might explain discrepancies between aBMD and fracture incidence can be achieved.…”

Section: What Do We Know About Trabecular Bone Quality?mentioning

confidence: 99%

A biomechanical perspective on bone quality

Hernandez¹,

Keaveny²

2006

Bone

273

183

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Observations that dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density cannot completely explain fracture incidence after anti-resorptive treatment have led to renewed interest in bone quality. Bone quality is a vague term, but generally refers to the effects of skeletal factors that contribute to bone strength but are not accounted for by measures of bone mass. Since a clinical fracture is ultimately a mechanical event, it follows then that any clinically relevant modification of bone quality must change bone biomechanical performance relative to bone mass. In this perspective, we discuss a framework for assessing the clinically relevant effects of bone quality based on two general concepts: 1) the biomechanical effects of bone quality can be quantified from analysis of the relationship between bone mechanical performance and bone density; and 2) because of its hierarchical nature, biomechanical testing of bone at different physical scales (<1mm, 1mm, 1 cm, etc.) can be used to isolate the scale at which the most clinically relevant changes in bone quality occur. As an example, we review data regarding the relationship between the strength and density in excised specimens of trabecular bone and highlight the fact that it is not yet clear how this relationship changes during aging, osteoporosis development, and anti-resorptive treatment. Further study of new and existing data using this framework should provide insight into the role of bone quality in osteoporotic fracture risk.

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Section: What Do We Know About Trabecular Bone Quality?mentioning

confidence: 99%

A biomechanical perspective on bone quality

Hernandez¹,

Keaveny²

2006

Bone

273

183

View full text Add to dashboard Cite

show abstract

“…(8) FE modeling has been used in many osteoporosis biomechanics studies over the past 15 years (4)(5)(6)(9)(10)(11)(12) and most recently has been applied clinically to the assessment of glucocorticoid treatment at the hip. (13) In addition to providing noninvasive measures of strength and density, controlled parameter studies of the FE models of a patient's vertebra can be performed to assess the independent effects on vertebral strength of such parameters as bone geometry, average density, density distribution, and the relative contribution of the trabecular bone.…”

Section: Introductionmentioning

confidence: 99%

Effects of Teriparatide and Alendronate on Vertebral Strength as Assessed by Finite Element Modeling of QCT Scans in Women With Osteoporosis

Keaveny

Donley

Hoffmann

et al. 2007

Journal of Bone and Mineral Research

233

137

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FE modeling was used to estimate the biomechanical effects of teriparatide and alendronate on lumbar vertebrae. Both treatments enhanced predicted vertebral strength by increasing average density. This effect was more pronounced for teriparatide, which further increased predicted vertebral strength by altering the distribution of density within the vertebra, preferentially increasing the strength of the trabecular compartment.Introduction: Teriparatide 20 g/day (TPTD) and alendronate 10 mg/day (ALN) increase areal, measured by DXA, and volumetric, measured by QCT, lumbar spine BMD through opposite effects on bone remodeling. Using finite element (FE) modeling of QCT scans, we sought to compare the vertebral strength characteristics in TPTD-and ALN-treated patients. Materials and Methods: A subset of patients (N ‫ס‬ 28 TPTD; N ‫ס‬ 25 ALN) from the Forteo Alendronate Comparator Trial who had QCT scans of the spine at baseline and postbaseline were analyzed. The QCT scans were analyzed for compressive strength of the L 3 vertebra using FE modeling. In addition, using controlled parameter studies of the FE models, the effects of changes in density, density distribution, and geometry on strength were calculated, a strength:density ratio was determined, and a response to bending was also quantified. Results: Both treatments had positive effects on predicted vertebral strength characteristics. At least 75% of the patients in each treatment group had increased strength of the vertebra at 6 months compared with baseline. Patients in both treatment groups had increased average volumetric density and increased strength in the trabecular bone, but the median percentage increases for these parameters were 5-to 12-fold greater for TPTD. Larger increases in the strength:density ratio were also observed for TPTD, and these were primarily attributed to preferential increases in trabecular strength. Conclusions: These results provide new insight into the effects of these treatments on estimated biomechanical properties of the vertebra. Both treatments positively affected predicted vertebral strength through their effects on average BMD, but the magnitudes of the effects were quite different. Teriparatide also affected vertebral strength by altering the distribution of density within the vertebra, so that overall, teriparatide had a 5-fold greater percentage increase in the strength:density ratio.

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“…In general, with the calibration phantom employment, the precision error of QCT can be limited effectively. The QCT volumetric density assessment in the hip has also shown a very low (b2%) precision error [84,85]. All studies indicated that there was a significant association between the hip CTXA and DXA (rN0.95) with a high precision (CV b 2%) [13,20].…”

Section: Precision Of the Qct In Central Peripheral And Ctdx Assessmentmentioning

confidence: 99%

“…Those simulated strength models based on CT or MRI images included various bones (spine, hip, radius and tibia) validated by vitro studies [84,[142][143][144]. The two-or three-dimensional model map of finite element contained the pixel or voxel data of BMD or microarchitecture, and combined geometric behaviors that related to the orientation of loading force.…”

Section: Assessment Of Bone Mechanical Propertymentioning

confidence: 99%

Application of quantitative computed tomography for assessment of trabecular bone mineral density, microarchitecture and mechanical property

et al. 2016

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a b s t r a c t a r t i c l e i n f oOsteoporosis is a common metabolic bone disease, causing increased skeletal fragility characterized by a low bone mass and trabecular microarchitectural deterioration. Assessment of the bone mineral density (BMD) is the primary determinant of skeletal fragility. Computed tomography (CT)-based trabecular microarchitectural and mechanical assessments are important methods to evaluate the skeletal strength. In this review, we focus the feasibility of QCT BMD measurement using a calibration phantom or phantomless. The application of QCT could extend the bone mineral density assessment to all patients who underwent a heart, lung, whole-body, and as well as all routine clinical implications of CT scan.

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Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naïve postmenopausal women

Cited by 58 publications

References 42 publications

A biomechanical perspective on bone quality

A biomechanical perspective on bone quality

Effects of Teriparatide and Alendronate on Vertebral Strength as Assessed by Finite Element Modeling of QCT Scans in Women With Osteoporosis

Application of quantitative computed tomography for assessment of trabecular bone mineral density, microarchitecture and mechanical property

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