Volumetric quantitative computed tomography of the proximal femur: Precision and relation to bone strength

Lang, T.F.; Keyak, Joyce H.; Heitz, Markus; Augat, Peter; Lü, Ying; Mathur, Ashwini; Genant, Harry K.

doi:10.1016/s8756-3282(97)00072-0

Cited by 253 publications

(181 citation statements)

References 36 publications

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“…First, the best discrimination was obtained by a combination of one density parameter (ie, a bone quantity) and one geometric parameter. This is in perfect agreement with several in vitro (14,15,41,42) and in vivo studies. (41,43) Second, the best discrimination was obtained by combining one parameter representative of the trabecular compartment and one representative of the cortical compartment.…”

Section: Discussionsupporting

confidence: 92%

“…(49) Trochanteric fractures also have been shown to be associated with increased mortality when compared with cervical fractures, and this could not be explained by differences in age or comorbidity. (4) Since there is evidence in both in vitro (14,15,42,47,50) and in vivo (3,30) studies that cervical and trochanteric fractures have different risk factors, we compared densitometric and geometric variables between the two subgroups and analyzed hip fracture discrimination separately for each subgroup. Compared with cervical fracture cases, we found lower DXA aBMD and QCT BMD values in trochanteric fracture cases, but differences were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…(12,13) Dual-energy X-ray absorptiometry (DXA) is the established method to measure aBMD, but it does not provide other important features of a whole bone's mechanical competence, such as the 3D geometry of bone. (12) aBMD predicts 50% to 80% of the breaking strength of bone in in vitro experiments (14)(15)(16) and is the best validated in vivo parameter in predicting femoral fractures. (17)(18)(19) However, in an individual subject, aBMD is still inadequate to predict whether or not the bone will fracture; other factors (eg, whether the patient falls, how she or he falls, and the response to the fall) play an additional role.…”

Section: Introductionmentioning

confidence: 99%

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In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Bousson

Adams

Engelke³

et al. 2010

Journal of Bone and Mineral Research

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In assessing osteoporotic fractures of the proximal femur, the main objective of this in vivo case-control study was to evaluate the performance of quantitative computed tomography (QCT) and a dedicated 3D image analysis tool [Medical Image Analysis Framework-Femur option (MIAF-Femur)] in differentiating hip fracture and non-hip fracture subjects. One-hundred and seven women were recruited in the study, 47 women (mean age 81.6 years) with low-energy hip fractures and 60 female non-hip fracture control subjects (mean age 73.4 years). Bone mineral density (BMD) and geometric variables of cortical and trabecular bone in the femoral head and neck, trochanteric, and intertrochanteric regions and proximal shaft were assessed using QCT and MIAF-Femur. Areal BMD (aBMD) was assessed using dual-energy X-ray absorptiometry (DXA) in 96 (37 hip fracture and 59 non-hip fracture subjects) of the 107 patients. Logistic regressions were computed to extract the best discriminates of hip fracture, and area under the receiver characteristic operating curve (AUC) was calculated. Three logistic models that discriminated the occurrence of hip fracture with QCT variables were obtained (AUC ¼ 0.84). All three models combined one densitometric variable-a trabecular BMD (measured in the femoral head or in the trochanteric region)-and one geometric variable-a cortical thickness value (measured in the femoral neck or proximal shaft). The best discriminant using DXA variables was obtained with total femur aBMD (AUC ¼ 0.80, p ¼ .003). Results highlight a synergistic contribution of trabecular and cortical components in hip fracture risk and the utility of assessing QCT BMD of the femoral head for improved understanding and possible insights into prevention of hip fractures. ß

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Bousson

Adams

Engelke³

et al. 2010

Journal of Bone and Mineral Research

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“…CT images were transferred to a computer workstation and processed to extract measures of bone mineral content (BMC), volumetric bone mineral density (vBMD) and bone volume (VOL) using analysis techniques described previously [23,24]. The processing task included calibration of the CT images from the native scanner Hounsfield Units to equivalent concentration (g/cm 3 ) of calcium hydroxyapatite (HA) and determination of integral (whole bone), cortical and trabecular regions of interest from vQCT scans of the hip as described in detail in a previous publication (Fig.…”

Section: Vqct Bmd Analysismentioning

confidence: 99%

Young-elderly differences in bone density, geometry and strength indices depend on proximal femur sub-region: A cross sectional study in Caucasian-American women

Meta

Lü

Keyak

et al. 2006

Bone

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Fragility fractures at the trochanter (TR) and the femoral neck (FN) have distinct etiologies, but the underlying age-related structural changes at these proximal femoral sub-regions are poorly understood. 28 young (41 ± 3 years) and 124 elderly (74 ± 3 years) healthy Caucasian women underwent volumetric quantitative computed tomography at the hip. Integral (i), cortical (c) and trabecular (t) bone mineral density and content (BMD, BMC) were measured. Geometric parameters included cross sectional area (CSA), and volumes of the integral, cortical and trabecular regions (VOL). Structural measures included indices of compressive (Compstr) and bending (BSI) strength. After adjusting for height and weight, an F-test was used to compare the TR and the FN mean values between young and elderly and to test for interaction to compare logarithmic difference of young and elderly (log(Young)-log(Elderly), Y/E d ) between the FN and the TR in an ANOCOVA model. All BMC, iBMD and tBMD values were significantly lower in elderly than in young women, with the largest Y/E d in the FN tBMC and tBMD (P < 0.0011 and P < 0.0001). cBMD in young and elderly groups was not significantly different at the TR while at the FN it was greater (P = 0.0075) in elderly than young women, showing significant Y/E d (P = 0.0003) dependence on skeletal site. Elderly women had significantly larger iVOL and CSA values (0.0001 < P < 0.0051), except for the FN iVOL. cVOL values were smaller in elderly than young women (P < 0.0001). Y/E d in bone geometry differed by sub-region only for cVOL measures (P = 0.0267). Despite larger CSA and iVOL measures in elderly, the younger women had greater Compstr (P < 0.0001) and BSI (P = 0.0051). Thus, although both the TR and the FN appear to increase in size with age, this enlargement is insufficient to protect against loss of bone strength.

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“…The femoral neck axis is angulated relative to the coronal plane, therefore making it difficult to accurately evaluate cross-sectional geometry from such images. Computed tomography (CT) (13,14) and peripheral quantitative CT (pQCT) (15,16) have been used to measure 3D cortical geometry, but these techniques are confined to the more distal locations of the peripheral skeleton, such as the wrist and ankle. Nevertheless, these studies support the importance of 3D cortical structure analysis.…”

Section: Introductionmentioning

confidence: 99%

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

Gomberg¹,

Saha²,

Wehrli³

2005

Academic Radiology

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Rationale-Quantitative evaluation of cortical bone architecture as a means to assess bone strength is typically accomplished on the basis of images obtained by dual-energy X-ray absorptiometry (DXA) or computed tomography (CT). Magnetic resonance imaging (MRI) has potential advantages for this task in that it allows imaging in arbitrary scan planes at high spatial resolution. However, several hurdles have to be overcome in order to make this approach practical, including resolution of issues related to nonlinear receive coil sensitivity, variations in marrow composition and the presence periosteal isointense tissues which all complicate segmentation. Objectives-To develop MR acquisition and analysis methods optimized for detection of cortical boundaries in complex geometries such as the femoral neck.Materials and Methods-Cortical boundary detection is achieved by radially tracing intensity profiles that intersect the bone's periosteal and endosteal boundary. The profiles are subsequently normalized to the intensity of the marrow signal, processed with morphologic image operators and binarized. The resulting boundaries are then mapped back onto the spatial image and erroneous boundary points removed. From the detected cortical boundaries cortical cross-sectional area and thickness are computed. The method was evaluated on cortical bone specimens and human volunteers on the basis of high-resolution images acquired at 1.5 Tesla field strength. To assess whether the method is sensitive to detect the expected dependencies of cortical parameters in weight-bearing bone on overall habitus, ten women ages 46-73 years (mean 56 years) underwent the cortical imaging protocol in the proximal femur and the results were compared with DXA BMD parameters of the hip and spine.Results-Reproducibility was on the order of 2%. Double oblique images of the femoral neck in the ten women studied showed cortical cross-sectional area to correlate strongly with height (r = 0.88, p = 0.0008) while cortical diameter versus age approached significance (r = 0.61, p = 0.06). Measurements in specimens of some cortical parameters indicated a resolution dependence. It is to be noted, however, that parameter rank remained constant across all specimens studied. Conclusion-The data suggest the new method to be robust and applicable on standard clinical MR scanners at arbitrary anatomic locations to yield clinically meaningful quantitative results.

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Volumetric quantitative computed tomography of the proximal femur: Precision and relation to bone strength

Cited by 253 publications

References 36 publications

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)

Young-elderly differences in bone density, geometry and strength indices depend on proximal femur sub-region: A cross sectional study in Caucasian-American women

Method for Cortical Bone Structural Analysis From Magnetic Resonance Images1

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