Highly Precise Peripheral Quantitative Computed Tomography for the Evaluation of Bone Density, Loss of Bone Density and Structures

Ma, Dambacher; Neff, M.; Kissling, R; Qin, Ling

doi:10.2165/00002512-199812001-00003

Cited by 44 publications

(31 citation statements)

References 9 publications

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Section: Discussionsupporting

confidence: 85%

“…This provides some support for the hypothesis proposed by other authors [26,3] that persons with osteoporosis can be classed into "fast" and "slow" bone losers. Dambacher et al [26] proposed this distinction for postmenopausal women with osteoporosis, and identified trabecular BMD as an appropriate parameter to distinguish between the two subgroups. deBruin et al [3] suggested an equivalent pattern in patients with disuse osteoporosis as a result of SCI, based on their results from a longitudinal pQCT study in ten SCI patients involving an initial scan in the acute phase and a repeat scan at around 3 years post-injury.…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

Coupaud¹,

McLean

Lloyd

et al. 2012

Disability and Rehabilitation

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3 Robertson Centre for Biostatistics, University of Glasgow, Glasgow G12 8QQ. AbstractPurpose: People with spinal cord injury (SCI) experience bone loss and have an elevated rate of fracture in the paralysed limbs. The literature suggests an exponential time course of bone loss after SCI, but true rates may vary between patients. We propose systematic evaluation of bone status in the early stages of SCI to identify fast bone losers. Method: A case series of six patients with complete SCI were scanned using peripheral Quantitative Computed Tomography within five weeks and at four, eight and twelve months post-injury. Bone mineral density (BMD) and content (BMC) were measured at fracture-prone sites in the tibia and femur. Patientspecific-predictions (PSP) of expected rates of bone loss were produced by individualising published model equations according to each patient's measured values at baseline. Wilcoxon Signed-Rank tests were used to identify changes between time-points; chi-squared tests for differences between measured and PSP values.Results: In the lower limbs, mean values decreased significantly between baseline and eight months postinjury, by 19-31% for trabecular BMD, 21-32% for total BMD, and 9-29% for BMC. Most subjects showed no significant differences between PSP and measured values, but individuals with significantly faster rates of bone loss than predicted should be investigated further.Conclusions: There was considerable intersubject variability in rates of bone loss after SCI. Patients showing fastest bone loss could benefit from continued follow-up and possibly treatment.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 85%

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

Coupaud¹,

McLean

Lloyd

et al. 2012

Disability and Rehabilitation

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show abstract

“…In a mixed population of normal individuals and patients with osteopenia or osteoporosis, it has been possible to differentiate between fast and slow bone loser within a few months. 26 From the results of this study, it can be hypothesized that there are 'fast loser' and 'slow loser' individuals in a newly injured SCI population as well. Further research should substantiate this assumption and should determine the factors responsible for these differences in bone parameter development.…”

Section: Discussionmentioning

confidence: 85%

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

Bruin

Vanwanseele

et al. 2004

Spinal Cord

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Design: A prospective inception cohort study with an observational analytic design in a spinal cord injury (SCI) centre hospital. Objective: To assess changes in trabecular and compact bone of the tibia and radius prospectively in subjects with SCI. Subjects: In total, 10 individuals with an acute SCI. Methods: Trabecular and compact bone density of the tibia and radius by peripheral quantitative computerised tomography. Results: Analysis of the individual gradients of the curve coefficient showed changes in trabecular bone between À0.19 and À2.46 and in cortical bone between þ 0.07 and À0.93 in the tibia within 34 months after the SCI. Both trabecular and cortical bone showed a group mean loss of 99 mg/cm 3 . No changes were observed in the radius. Conclusion: There is a major decrease in tibia mineral density over 3 years; however, no change is observed for the radius mineral content. Large interindividual differences existed in the patterns of loss in the tibia bone substance after SCI. These patterns indicate that there is no steady state of bone mineral density following 3 years of spinal cord injury.

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“…18 This study showed that pQCT can identify those patients with the most severe disuse-related bone loss, similar to the pQCT-based stratification into slow-or fast-progressing bone loss suggested previously for women with postmenopausal osteoporosis. 19 Trabecular BMD measured using pQCT has been shown to be the parameter that best discriminates between individuals who do or do not sustain fractures after SCI.…”

mentioning

confidence: 99%

Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: A finite element study

Gislason

Coupaud

Sasagawa

et al. 2014

Proc Inst Mech Eng H

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The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography. Images were used to develop full three-dimensional models of the tibiae in Mimics (Materialise) and exported into Abaqus (Simulia) for calculation of stress distribution and fracture risk in response to specified loading conditions -compression, bending and torsion. The percentage of elements that exceeded a calculated value of the ultimate stress provided an estimate of the risk of fracture for each subject, which differed between spinal cord injury subjects and their controls. The differences in bone mineral density distribution along the tibia in different subjects resulted in different regions of the bone being at high risk of fracture under set loading conditions, illustrating the benefit of creating individual material distribution models. A predictive tool can be developed based on these models, to enable clinicians to estimate the amount of loading that can be safely allowed onto the skeletal frame of individual patients who suffer from extensive musculoskeletal degeneration (including spinal cord injury, multiple sclerosis and the ageing population). The ultimate aim is to reduce fracture occurrence in these vulnerable groups.

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Highly Precise Peripheral Quantitative Computed Tomography for the Evaluation of Bone Density, Loss of Bone Density and Structures

Cited by 44 publications

References 9 publications

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: A finite element study

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