High-Resolution Peripheral Quantitative Computed Tomography for the Assessment of Bone Strength and Structure: A Review by the Canadian Bone Strength Working Group

Cheung, Angela M.; Adachi, Jonathan D.; Hanley, David A.; Kendler, David L.; Davison, K. Shawn; Josse, Robert G.; Brown, Jacques P.; Ste‐Marie, Louis‐Georges; Kremer, Richard; Erlandson, Marta C; Dian, Larry; Burghardt, Andrew J.; Boyd, Steven K.

doi:10.1007/s11914-013-0140-9

Cited by 201 publications

(120 citation statements)

References 76 publications

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“…pQCT can also provide measures of bone geometry, cortical thickness and porosity which are predictive of bone strength [35]. The ability of pQCT in distinguishing trabecular bone from cortical bone deficits is important in GC-induced osteoporosis given that GC effects provide information on bone geometry.…”

Section: Assessment Of Bone Healthmentioning

confidence: 99%

Skeletal Fragility in Children with Chronic Disease

2016

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Skeletal fragility associated with underlying childhood chronic disease is a systemic disorder of poor bone growth and reduction in bone turnover which can lead to abnormal bone mass, geometry and microarchitecture. Due to the growth potential unique to children, remarkable bone recovery following a transient threat to the bone can occur if there is concurrent growth. Addressing bone health in these children should focus on improvement in growth, puberty and removing the primary insult. In conditions where there is a little scope for bone recovery and limited residual growth, bone-targeted therapy may need to be considered, even though there is currently limited evidence. The importance of early detection of signs of bone fragility, by active screening for vertebral fracture using newer imaging techniques such as dual-energy X-ray absorptiometry lateral vertebral morphometry, may now be possible. There is currently, a paucity of evidence to support prophylactic use of anti-resorptive therapy. Where poor growth and low bone turnover are seen, the use of growth-promoting therapies and anabolic bone-protective agents may be more physiological and should be evaluated in well-designed trials. Collaborative studies on long-term fracture outcome and well-designed trials of bone-protective therapies are needed and to be encouraged.

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Section: Assessment Of Bone Healthmentioning

confidence: 99%

Skeletal Fragility in Children with Chronic Disease

2016

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“…3 Due to its ability to evaluate bone in 3D at a high resolution (82 μm) and with minimal irradiation (5 μSv to image a 0.9 cm region of interest), HR-pQCT is being intensely investigated in the evaluation of bone architecture in the small joints of the hands in rheumatoid arthritis, 4-6 psori atic arthritis, 7 and hand osteoarthritis. 8 To what degree can this method now be rated as "progress in imaging" in rheumatology?…”

Section: Correspondencementioning

confidence: 99%

High-resolution peripheral quantitative CT in rheumatology

et al. 2015

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CORRESPONDENCEWe read with interest the Perspectives article by Filippucci et al. (Progress in imaging in rheumatology. Nat. Rev. Rheumatol. 10, 628-634;. 1 This article is a very informative concise paper on MRI and musculoskeletal ultrasono graphy. However, we were surprised that no mention was made of high-resolution peripheral quantitative CT (HR-pQCT), previously highlighted in a Review in this journal, 2 and we would like to call attention to its emerging potential in the field of advanced diagnostic imaging.HR-pQCT was initially developed to study bone diseases such as osteoporosis, and has contributed to a better understanding of the separate behavior of trabecular and cortical bone structures and the different cortical envelopes during ageing, in metabolic bone diseases and during fracture healing; 2 moreover, it allows for calculation of bone strength in vivo using finite-element analysis. 3 Due to its ability to evaluate bone in 3D at a high resolution (82 μm) and with minimal irradiation (5 μSv to image a 0.9 cm region of interest), HR-pQCT is being intensely investigated in the evaluation of bone architecture in the small joints of the hands in rheumatoid arthritis, 4-6 psori atic arthritis, 7 and hand osteoarthritis. 8 To what degree can this method now be rated as "progress in imaging" in rheumatology?Firstly, an increased number of, and earlier stages of, erosions are visible with HR-pQCT than on plain radiography, as evidenced by the work of Stach et al. 4 Secondly, quantification of erosions in terms of size (width, depth and volume) together with changes in trabecular bone is possible, and has been studied in crosssectional and longitudinal studies 5,9-11 and in comparison with MRI. 6 Thirdly, a 3D assessment of joint space is described using quantitative analysis algorithms. 12,13 Fourthly, 3D measurement of bone microarchitecture in rheumatoid arthritis patients showed altered results with disease High-resolution peripheral quantitative CT in rheumatologyCheryl Barnabe, Stephanie Finzel, Kathryn S. Stok and Piet Geusens activity. 14 None of these 3D parameters can currently be evaluated by other imaging techniques at such high resolution.In conclusion, HR-pQCT is, besides MRI and musculoskeletal ultrasonography, also promising "progress in imaging" for clinical research in rheumatic disease of the hand joints. SPECTRA (Study Group for X-treme CT in Rheumatoid Arthritis) 15 is an inter national collaboration between rheumatologists, radiologists, biomedical engineers, physicists and clinical researchers in bone metabolism and osteoimmunology that has provided fertile ground for crossdisciplinary research, united by the desire to certify the validity of the research findings from the application of this technology to the assessment of inflammatory arthritis.

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“…High-resolution peripheral computed tomography (HRpQCT) of the peripheral limbs was performed using XtremeCT ® (Scanco Medical, Br€ uttisellen, Switzerland) (Cheung et al 2013). Baseline measurements were taken 4 months before the start of teriparatide.…”

Section: Case Reportmentioning

confidence: 99%