Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography

Whittier, Danielle E.; Boyd, Steven K.; Burghardt, Andrew J.; Paccou, Julien; Ghasem‐Zadeh, Ali; Chapurlat, Roland; Engelke, Klaus; Bouxsein, Mary L.

doi:10.1007/s00198-020-05438-5

Cited by 237 publications

(221 citation statements)

References 108 publications

Supporting

Mentioning

216

Contrasting

Unclassified

Order By: Relevance

“…1), likely aligned with accelerated bone loss perimenopause. Although Ct.Po remains imprecise relative to other HR‐pQCT parameters, ( 16,30 ) these population‐based trends are indicative that this property plays an important role in bone loss due to aging and the perimenopause transition. In comparison, the male centile curves show a consistent decline in Tt.BMD throughout adulthood, and on average males have higher Tt.BMD, Tb.Th, and failure load at both sites than females.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies using the second‐generation HR‐pQCT have used an offset from the reference line that is 0.5 mm more distal than the offset used in this study; (13 ) furthermore, as the application of the technology evolves, an offset relative to limb length has been proposed for standardization. ( 16,31 ) The effect of these subtle variations in scan region location on estimation of percentiles is likely small for most properties but not known. In addition, the cross‐sectional design of this study presents limitations because of secular changes that may impact bone mineral density and microarchitecture, but this approach is necessary because of the wide age range of our participants and inherent in all normative cohorts covering the adult life span.…”

Section: Discussionmentioning

confidence: 99%

“…Participants' non‐dominant distal radius and left tibia were scanned using second‐generation HR‐pQCT (XtremeCT II, Scanco Medical AG, Brütisellen, Switzerland) following the standard in vivo protocol. ( 6,16 ) In the case of prior fractures, surgery, or implants, the non‐fractured side was scanned. The reference line was placed at the endplate of the distal radius and tibia, and scan acquisition began at a fixed‐offset proximal from the reference line of 9.5 and 22.5 mm, for the radius and tibia, respectively.…”

Section: Methodsmentioning

confidence: 99%

“…Image analysis followed the manufacturer's standard patient evaluation protocol. ( 6,16 ) The periosteal and endocortical contours were automatically generated using a dual‐threshold technical, as described in detail elsewhere. ( 18 ) Contours were inspected and manually corrected, following previously reported guidelines.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT

Whittier

Burt

Hanley

et al. 2020

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

There are currently no population-based reference data sets available for volumetric bone mineral density and microarchitecture parameters measured using the second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT), yet the technology is rapidly becoming a standard for studies of bone microarchitecture. Although cross-calibrated data sets from the first-generation HR-pQCT have been reported, they are not suitable for second-generation bone microarchitecture properties because of fundamental differences between scanner generations. This study provides site-and sex-specific centile curves across the adult life span for second-generation HR-pQCT properties. A total of 1236 adult participants (768 female and 468 male) from the Calgary area between the ages of 18 and 90 years were scanned at the distal tibia and radius using the second-generation HR-pQCT. Bone densities, microarchitectural properties, and failure load estimated using finite element analysis were determined using standard in vivo protocol. Site-and sex-specific centile curves were generated using the generalized additive models for location, scale, and shape (GAMLSS) method. These data provide reference curves appropriate for predominantly white male and female adults, which can be used as a tool to assess patient-or cohort-specific bone health.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT

Whittier

Burt

Hanley

et al. 2020

Journal of Bone and Mineral Research

View full text Add to dashboard Cite

show abstract

“…The manufacturer segmentation procedures for HR-pQCT are widely used in HR-pQCT studies ( Whittier et al, 2020 ). The approach for 82 μm HR-pQCT begins with a semi-automated hand-drawn contour of the periosteal surface, generated using the scanner manufacturer's software.…”

Section: Segmentationmentioning

confidence: 99%

Validation of HR-pQCT against micro-CT for morphometric and biomechanical analyses: A review

2020

View full text Add to dashboard Cite

High-resolution peripheral quantitative computed-tomography (HR-pQCT) has the potential to become a powerful clinical assessment and diagnostic tool. Given the recent improvements in image resolution, from 82 to 61 μm, this technology may be used to accurately quantify in vivo bone microarchitecture, a key biomarker of degenerative bone diseases. However, computational methods to assess bone microarchitecture were developed for micro computed tomography (micro-CT), a higher-resolution technology only available for ex vivo studies, and validation of these computational analysis techniques against the gold-standard micro-CT has been inconsistent and incomplete. Herein, we review methods for segmentation of bone compartments and microstructure, quantification of bone morphology, and estimation of mechanical strength using finite-element analysis, highlighting the need throughout for improved standardization across the field. Studies have relied on homogenous datasets for validation, which does not allow for robust comparisons between methods. Consequently, the adaptation and validation of novel segmentation approaches has been slow to non-existent, with most studies still using the manufacturer's segmentation for morphometric analysis despite the existence of better performing alternative approaches. The promising accuracy of HR-pQCT for capturing morphometric indices is overshadowed by considerable variability in outcomes between studies. For finite element analysis (FEA) methods, the use of disparate material models and FEA tools has led to a fragmented ability to assess mechanical bone strength with HR-pQCT. Further, the scarcity of studies comparing 62 μm HR-pQCT to the gold standard micro-CT leaves the validation of this imaging modality incomplete. This review revealed that without standardization, the capabilities of HR-pQCT cannot be adequately assessed. The need for a public, extendable, heterogeneous dataset of HR-pQCT and corresponding gold-standard micro-CT images, which would allow HR-pQCT users to benchmark existing and novel methods and select optimal methods depending on the scientific question and data at hand, is now evident. With more recent advancements in HR-pQCT, the community must learn from its past and provide properly validated technologies to ensure that HR-pQCT can truly provide value in patient diagnosis and care.

show abstract

What is normal bone health? A bioarchaeological perspective on meaningful measures and interpretations of bone strength, loss, and aging

Agarwal

2021

American J Hum Biol

View full text Add to dashboard Cite

Bioarchaeological (the study of archeological human remains together with contextual and documentary evidence) offers a unique vantage point to examine variation in skeletal morphology related to influences such as activity, disease, and nutrition. The human skeleton is composed of a dynamic tissue that is forged by biocultural factors over the entire life course, providing a record of individual, and community history. Various aspects of adult bone health, particularly bone maintenance and loss and the associated skeletal disease osteoporosis, have been examined in numerous past populations. The anthropological study of bone loss has traditionally focused on the signature of postmenopausal aging, costs of reproduction, and fragility in females. The a priori expectation of normative sex‐related bone loss/fragility in bioanthropological studies illustrates the wider gender‐ideological bias that continues in research design and data analysis in the field. Contextualized data on bone maintenance and aging in the archeological record show that patterns of bone loss do not constitute predictable consequences of aging or biological sex. Instead, the critical examination of bioarchaeological data highlights the complex and changing processes that craft the human body over the life course, and calls for us to question the ideal or “normal” range of bone quantity and quality in the human skeleton, and to critically reflect on what measures are actually biologically and/or socially meaningful.

show abstract

Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography

Cited by 237 publications

References 108 publications

Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT

Sex- and Site-Specific Reference Data for Bone Microarchitecture in Adults Measured Using Second-Generation HR-pQCT

Validation of HR-pQCT against micro-CT for morphometric and biomechanical analyses: A review

What is normal bone health? A bioarchaeological perspective on meaningful measures and interpretations of bone strength, loss, and aging

Contact Info

Product

Resources

About