Precision of Second-Generation High-Resolution Peripheral Quantitative Computed Tomography: Intra- and Intertester Reproducibilities and Factors Involved in the Reproducibility of Cortical Porosity

117

High‐resolution peripheral quantitative computed tomography (HR‐pQCT) is a noninvasive imaging modality for assessing volumetric bone mineral density (vBMD) and microarchitecture of cancellous and cortical bone. The objective was to (1) assess fracture‐associated differences in HR‐pQCT bone parameters; and (2) to determine if HR‐pQCT is sufficiently precise to reliably detect these differences in individuals. We systematically identified 40 studies that used HR‐pQCT (39/40 used XtremeCT scanners) to assess 1291 to 3253 and 3389 to 10,687 individuals with and without fractures, respectively, ranging in age from 10.9 to 84.7 years with no comorbid conditions. Parameters describing radial and tibial bone density, microarchitecture, and strength were extracted and percentage differences between fracture and control subjects were estimated using a random effects meta‐analysis. An additional meta‐analysis of short‐term in vivo reproducibility of bone parameters assessed by XtremeCT was conducted to determine whether fracture‐associated differences exceeded the least significant change (LSC) required to discern measured differences from precision error. Radial and tibial HR‐pQCT parameters, including failure load, were significantly altered in fracture subjects, with differences ranging from −2.6% (95% confidence interval [CI] −3.4 to −1.9) in radial cortical vBMD to −12.6% (95% CI −15.0 to −10.3) in radial trabecular vBMD. Fracture‐associated differences reported by prospective studies were consistent with those from retrospective studies, indicating that HR‐pQCT can predict incident fracture. Assessment of study quality, heterogeneity, and publication biases verified the validity of these findings. Finally, we demonstrated that fracture‐associated deficits in total and trabecular vBMD and certain tibial cortical parameters can be reliably discerned from HR‐pQCT‐related precision error and can be used to detect fracture‐associated differences in individual patients. Although differences in other HR‐pQCT measures, including failure load, were significantly associated with fracture, improved reproducibility is needed to ensure reliable individual cross‐sectional screening and longitudinal monitoring. In conclusion, our study supports the use of HR‐pQCT in clinical fracture prediction. © 2019 American Society for Bone and Mineral Research.

“…A–D ; Supplemental Table S6). Consistent with ranges reported in HR‐pQCT fracture studies (Supplemental Fig. S13 B ), density‐related measurements ( CV % RMS = 0.8 − 2.0%; Fig.…”

Section: Resultssupporting

confidence: 87%

Section: Hr-pqct Reproducibilitymentioning

confidence: 82%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Hr-pqct Reproducibilitymentioning

confidence: 99%

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HR-pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Meta-Analysis

Mikolajewicz

Bishop

Burghardt

et al. 2019

117

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

Whittier

Burt

Hanley

et al. 2020

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.

Bone microarchitecture in patients with autoimmune hepatitis

Schmidt

Stürznickel

Strahl

et al. 2020

In patients with autoimmune hepatitis (AIH), osteoporosis represents a common extrahepatic complication, which we recently demonstrated by an assessment of areal bone mineral density (aBMD) via dual-energy X-ray absorptiometry (DXA). However, it is well established that bone quality and fracture risk does not solely depend on aBMD, but also on bone microarchitecture. It is currently not known whether AIH patients exhibit a site-or compartment-specific deterioration in the skeletal microarchitecture. In order to assess potential geometric, volumetric, and microarchitectural changes, high-resolution peripheral quantitative computed tomography (HR-pQCT) measurements were performed at the distal radius and distal tibia in female patients with AIH (n=51) and compared to agematched female healthy controls (n=32) as well as AIH/primary biliary cholangitis (PBC) overlap syndrome (n=25) and PBC alone (PBC, n=36). DXA at the lumbar spine and hip, clinical characteristics, transient elastography (FibroScan) and laboratory analyses were also included in this analysis. AIH patients showed a predominant reduction of cortical thickness (Ct.Th) in the distal radius and tibia compared to heathy controls (p<0.0001 and p=0.003, respectively). In contrast, trabecular parameters such as bone volume per tissue volume (BV/TV) did not differ significantly at the distal radius (p=0.453) or tibia (p=0.508). Linear regression models revealed significant negative associations of Ct.Th with age (95% CI:-14 to-5 µm / year, p<0.0001) but not liver stiffness, cumulative prednisolone dose (even after an adjustment for age) or disease duration. The duration of high dose prednisolone (≥7.5mg) was negatively associated with trabecular thickness (Tb.Th) at the distal radius but none of the other microarchitectural parameters. No differences in bone microarchitecture parameters between AIH, AIH/PBC and PBC could be detected. In conclusion, AIH patients showed a severe age-dependent deterioration of the cortical bone microarchitecture, which is most likely the major contribution to the observed increased fracture risk in these patients.