Correlation between Parameters of Calcaneal Quantitative Ultrasound and Hip Structural Analysis in Osteoporotic Fracture Patients

Background

Calcaneal quantitative ultrasound (QUS), which is used in the evaluation of osteoporosis, is believed to be intimately associated with the characteristics of the proximal femur. However, the specific associations of calcaneal QUS with characteristics of the hip sub-regions remain unclear.

Design

A cross-sectional assessment of 53 osteoporotic patients was performed for the skeletal status of the heel and hip.

Methods

We prospectively enrolled 53 female osteoporotic patients with femoral fractures. Calcaneal QUS, dual energy X-ray absorptiometry (DXA), and hip structural analysis (HSA) were performed for each patient. Femoral heads were obtained during the surgery, and principal compressive trabeculae (PCT) were extracted by a three-dimensional printing technique-assisted method. Pearson’s correlation between QUS measurement with DXA, HSA-derived parameters and Young’s modulus were calculated in order to evaluate the specific association of QUS with the parameters for the hip sub-regions, including the femoral neck, trochanteric and Ward’s areas, and the femoral shaft, respectively.

Results

Significant correlations were found between estimated BMD (Est.BMD) and BMD of different sub-regions of proximal femur. However, the correlation coefficient of trochanteric area (r = 0.356, p = 0.009) was higher than that of the neck area (r = 0.297, p = 0.031) and total proximal femur (r = 0.291, p = 0.034). Furthermore, the quantitative ultrasound index (QUI) was significantly correlated with the HSA-derived parameters of the trochanteric area (r value: 0.315–0.356, all p<0.05) as well as with the Young’s modulus of PCT from the femoral head (r = 0.589, p<0.001).

Conclusion

The calcaneal bone had an intimate association with the trochanteric cancellous bone. To a certain extent, the parameters of the calcaneal QUS can reflect the characteristics of the trochanteric area of the proximal hip, although not specifically reflective of those of the femoral neck or shaft.     

Fracture risk in the femoral hip region: A finite element analysis supported experimental approach

The decrease of bone mineral density (BMD) is a multifactorial bone pathology, commonly referred to as osteoporosis. The subsequent decline of the bone's micro-structural characteristics renders the human skeletal system, and especially the hip, susceptible to fragility fractures. This study represents a systematic attempt to correlate BMD spectrums to the mechanical strength characteristics of the femoral neck and determine a fracture risk indicator based on non-invasive imaging techniques. The BMD of 30 patients' femurs was measured in vivo by Dual-energy X-ray absorptiometry (DXA). As these patients were subjected to total hip replacement, the mechanical strength properties of their femurs' were determined ex-vivo using uniaxial compression experiments. FEA simulations facilitated the correlation of the DXA measurements to the apparent fracture risk, indicating critical strain values during complex loading scenarios.     

Cortical Hand Bone Porosity and Its Association with Distal Radius Fracture in Middle Aged and Elderly Women

Objective

Reduced bone mineral density (BMD), assessed by Dual Energy X-ray absorptiometry (DXA), is a well-known risk factor for fragility fracture. A large proportion of patients with fracture have only slightly reduced BMD. Assessment of other bone structure features than BMD may improve identification of individuals at increased fracture risk. Digital X-ray radiogrammetry (DXR), which is a feasible tool for measurement of metacarpal cortical bone density, also gives an estimate of cortical bone porosity. Our primary aim was to explore the association between cortical porosity in the hand assessed by DXR and distal radius fracture.

Methods

This case-control study included 123 women >50 years with distal radius fracture, and 170 controls. DXR was used to measure metacarpal BMD (DXR-BMD), cortical porosity (DXR-porosity), thickness (DXR-CT) and bone width (DXR-W) of the hand. Femoral neck BMD was measured by DXA.

Results

The fracture group had a statistically significant lower DXR-BMD (0.492 vs. 0.524 g/cm² p<0.001), higher cortical DXR-porosity (0.01256 vs. 0.01093, p<0.001), less DXR-CT (0.148 vs. 0.161cm, p<0.001) and lower femoral neck DXA-BMD (0.789 vs. 0.844 g/cm², p = 0.001) than the controls. In logistic regression analysis adjusted for age, a significant association with distal radius fracture (OR, 95% CI) was found for body mass index (0.930, 0.880–0.983), DXA-BMD (0.996, 0.995–0.999), DXR-BMD (0.990, 0.985–0.998), DXR-porosity (1.468, 1.278–1.687) and DXR-CT (0.997, 0.996–0.999). In an adjusted model, DXR-porosity remained the only variable associated with distal radius fracture (1.415, 1.194–1.677).

Conclusion

DXR derived porosity is associated with fracture at distal radius and might be a sensitive marker for skeletal fragility.     

The Lichfield bone study: the skeletal response to exercise in healthy young men

The skeletal response to short-term exercise training remains poorly described. We thus studied the lower limb skeletal response of 723 Caucasian male army recruits to a 12-wk training regime. Femoral bone volume was assessed using magnetic resonance imaging, bone ultrastructure by quantitative ultrasound (QUS), and bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) of the hip. Left hip BMD increased with training (mean ± SD: 0.85 ± 3.24, 2.93 ± 4.85, and 1.89 ± 2.85% for femoral neck, Ward's area, and total hip, respectively; all P < 0.001). Left calcaneal broadband ultrasound attenuation rose 3.57 ± 0.5% (P < 0.001), and left and right femoral cortical volume by 1.09 ± 4.05 and 0.71 ± 4.05%, respectively (P = 0.0001 and 0.003), largely through the rise in periosteal volume (0.78 ± 3.14 and 0.59 ± 2.58% for right and left, respectively, P < 0.001) with endosteal volumes unchanged. Before training, DXA and QUS measures were independent of limb dominance. However, the dominant femur had higher periosteal (25,991.49 vs. 2,5572 mm(3), P < 0.001), endosteal (6,063.33 vs. 5,983.12 mm(3), P = 0.001), and cortical volumes (19,928 vs. 19,589.56 mm(3), P = 0.001). Changes in DXA, QUS, and magnetic resonance imaging measures were independent of limb dominance. We show, for the first time, that short-term exercise training in young men is associated not only with a rise in human femoral BMD, but also in femoral bone volume, the latter largely through a periosteal response.     

Frax Prediction without BMD for Assessment of Osteoporotic Fracture Risk

ObjectiveTo compare Fracture Risk Assessment Tool (FRAX) calculations with and without bone mineral density (BMD) in predicting the 10-year probability of hip and major osteoporotic fractures (MOF).MethodsA cross-sectional review of patients requiring screening for osteoporosis as part of their routine medical care was conducted. Postmenopausal women and men over 50 years of age who were never diagnosed with osteoporosis or treated with U.S. Food and Drug Administration-approved agents for osteoporosis were included. Height, weight, FRAX questionnaire, femoral neck BMD, and T-score data were obtained. FRAX scores with BMD (FRAX/BMD) and without BMD (FRAX) were calculated. Subjects were separated on the basis of identical and different treatment recommendations. Fracture risk factors were compared between groups using simple Student’s t test analysis of numerical variables and Fisher’s exact test analysis of binary variables.ResultsOf 151 total subjects, 127 (84%) had identical fracture risk predictions with or without BMD included in the FRAX calculation. Thirty subjects met treatment criteria and 97 did not, but the FRAX prediction was the same with risk factors alone or with risk factors plus BMD. Age was the only risk factor that was significantly different between those with identical and different predictions (median age, 64.42 and 76.25 years, respectively; P&#x003C;.001).ConclusionIn most cases, FRAX alone provides the same prediction as FRAX with BMD. Younger age is more indicative of an identical prediction. (Endocr Pract. 2013;19:780-784)     

Estimation of in vivo bone mineral density (BMD) and shape characterization for diagnosing osteoporosis by ultrasonic inspection.

A new method for estimating in vivo bone mineral density (BMD) and characterizing the shape of cancellous bone has been proposed using the results of ultrasonic inspection for the diagnosis of osteoporosis. The method is based on two-dimensional bone area fraction S (percent bone area between bone and bone marrow) calculated from the difference in the speed of ultrasonic wave propagation through cancellous bone. It was shown that the two-dimensional area fraction of a heel bone gives a good relationship to the BMD by DXA (dual energy x-ray absorptiometry) testing of human heel bone (calcaneus) and spine (vertebrae lumbar), as expressed by the relation, BMD (g/cm2) = 0.0167S for heel bone (r = 0.83), and BMD (g/cm2) = 0.0254S + 0.123 for the spine (r = 0.77). Shape characterization is based on the image simulation procedure employing eight random variables from a computer and the statistical results of fractal analysis for numerous cancellous bone patterns. We also demonstrate the validity of the shape characterization using autopsy specimens as a diagnostic tool for osteoporosis.     

Dual-Energy X-Ray Absorptiometry And Calculated Frax Risk Scores May Underestimate Osteoporotic Fracture Risk In Vitamin D-Deficient Veterans With Hiv Infection

Objective: We evaluated the utility of the Fracture Risk Assessment Tool (FRAX) in assessing fracture risk in patients with human immunodeficiency virus (HIV) and vitamin D deficiency.Methods: This was a retrospective study of HIV-infected patients with co-existing vitamin D deficiency at the Atlanta Veterans Affairs Medical Center. Bone mineral density (BMD) was assessed by dual-energy X-ray absorptiometry (DEXA), and the 10-year fracture risk was calculated by the FRAX algorithm. Two independent radiologists reviewed lateral chest radiographs for the presence of subclinical vertebral fractures.Results: We identified 232 patients with HIV and vitamin D deficiency. Overall, 15.5% of patients met diagnostic criteria for osteoporosis on DEXA, and 58% had low BMD (T-score between -1 and -2.5). The median risk of any major osteoporotic and hip fracture by FRAX score was 1.45 and 0.10%, respectively. Subclinical vertebral fractures were detected in 46.6% of patients. Compared to those without fractures, those with fractures had similar prevalence of osteoporosis (15.3% versus 15.7%; P>.999), low BMD (53.2% versus 59.3%; P = .419), and similar FRAX hip scores (0.10% versus 0.10%; P = .412). While the FRAX major score was lower in the nonfracture group versus fracture group (1.30% versus 1.60%; P = .025), this was not clinically significant.Conclusion: We found a high prevalence of subclinical vertebral fractures among vitamin D–deficient HIV patients; however, DEXA and FRAX failed to predict those with fractures. Our results suggest that traditional screening tools for fragility fractures may not be applicable to this high-risk patient population.Abbreviations:25(OH)D = 25-hydroxyvitamin DBMD = bone mineral densityBMI = body mass indexDEXA = dual-energy X-ray absorptiometryFRAX = Fracture Risk Assessment ToolHIV = human immunodeficiency virusIQR = interquartile rangePTH = parathyroid hormoneVA = Veterans AffairsWHO = World Health Organization     

Combined effects of collagen type I alpha1 (COL1A1) Sp1 polymorphism and osteoporosis risk factors on bone mineral density in Turkish postmenopausal women

Identification of risk factors for osteoporosis has been essential for understanding the development of osteoporosis. The collagen type I alpha1 (COL1A1) gene is suggested to be implicated in reduced bone mineral density (BMD) in osteoporosis. In the present study, the investigation of the effects of Sp1 polymorphic variants of COL1A1 gene on BMD values, and the determination of the association between COL1A1 Sp1 gene variants and osteoporosis risk factors in the context of gene–environment interaction in Turkish postmenopausal women were aimed. For the detection of COL1A1 Sp1 polymorphism, PCR-RFLP techniques have been used. BMD for lumbar spine (L1–L4) and hip (femoral neck and total hip) was measured by DXA. This study was carried out using a sample of 254 postmenopausal women. We observed a trend decrease in BMD values in the subjects with “ss” genotype having lower BMD of lumbar spine, femoral neck and total hip than those with “SS” and “Ss” genotype, however the differences did not reach statistical significance (P > 0.05). We also found that the frequencies of the BMD under mean values at the femoral neck (57.5%) and total hip (76.2%) increased considerably in the subjects carrying “Ss/ss” genotypes in combination of having family history of osteoporosis (61.5% for femoral neck) and smoking history (90.0% for total hip). This population-based study indicates that COL1A1 Sp1 polymorphism may contribute to the development of osteoporosis in combination of osteoporosis risk factors in Turkish postmenopausal women.     

DEXA对骨髓炎骨缺损治疗中骨痂密度的评价

目的：探讨DEXA对骨髓炎骨缺损治疗中骨痂密度的评价及意义。方法：严格按照纳入排除标准,选取21例骨髓炎清创后伴大段皮质骨缺损一期植骨的病人。术后4,6,8,10个月后对骨折端骨痂行双能X线骨密度仪检测,并进行X摄片以及Enneking评分,从而明确植骨区愈合骨痂的密度变化趋势,骨愈合情况以及症状改善情况。结果：（1）X线摄片结果显示：4个月后：骨缺损区依然清晰可见,内有少量稀疏骨痂通过,少量外骨痂形成。6个月后：植骨区内骨痂含量明显增多,且外骨痂膨大。8个月：缺损区模糊,有较致密骨痂生成,且外骨痂逐渐减少。10个月：植骨区骨痂更加致密,且部份髓腔再通。（2）Enneking评分：患者术后第10个月功能恢复情况评估正常功能20例,20分以下的患者1例。（3）BMD测定：骨折端的骨密度及骨密度比率随时间延长而增加,植骨10个月后患侧的骨密度已可基本上达到正常对照侧的骨密度水平。结论：双能X线骨密度测量从一定程度上反映出骨痂的力学强度特性。在感染性骨缺损治疗中可以作为检测植骨区的恢复情况的参考。     

How drugs decrease fracture risk: lessons from trials

In women with osteoporosis, each 1% improvement in spine BMD (by DXA) is expected to reduce vertebral fracture risk by about 4%. However, randomized trials of antiresorptive agents show that 1 to 6% improvements in spine BMD reduce vertebral fracture risk by 35 to 50%. Less 20% of the decreased spine fracture risk produced by alendronate or raloxifene be explained by improvement in spine BMD. The discrepancy is even greater during the first year or two of treatment when 1 to 4% improvements in BMD are associated with 65-68% decreases in spine fracture risk. Bisphosphonates continue to increase BMD but the reduction in fracture risk wanes to 20 to 45%. DXA underestimates the change in bone density of spinal trabecular bone and this might explain part of the discrepancy between expected and observed reductions in spine fracture risk. Even more accurate measurement of BMD would not explain the rapid onset and later waning of effect despite gradually increasing BMD. The biomechanical effects inhibiting bone resorption could explain the early onset but not the waning effectiveness. The waning effectiveness of antiresorptives raises concerns that prolonged inhibition of remodeling may weaken bone by allowing microdamage to accumulate. The effect of drugs on nonspine fracture risk is more complex and cannot be predicted from changes in DXA BMD. For example, Beck showed that long-term users of estrogen increase section modulus vs. nonusers with a net increase in section modulus and predicted femoral neck strength despite losing about 0.4% per year in femoral neck BMD. PTH reduces spine fracture risk and this effect is more completely explained by improvement in spine BMD. This suggests that sustaining the increased BMD produced by PTH may maintain long-term reductions in fracture risk.     

影响中国女性峰值骨密度的潜在基因间相互作用

峰值骨密度是由遗传和环境因素及其相互作用共同决定的复杂性状。维生素D受体基因、雌激素α受体基因、白介素6基因、副甲状腺素基因、Ⅰ型胶原α2基因、骨钙素基因、α2巯基糖蛋白基因是与骨代谢相关的7个重要的候选基因。本研究旨在检测这7个候选基因之间的相互作用对中国女性峰值骨密度的影响。样本为中国上海的361个无关、健康的绝经前女性,均为汉族人,年龄为20—44岁。采用Hologic QDR2000＋双能X射线扫描仪对腰椎与髋部的骨密度进行了检测。采用聚合酶链式反应-限制性片段长度多态分析方法对每个个体的以下8个多态性标记位点进行基因分型：维生素D受体基因的Apa Ⅰ位点,雌激素α受体基因的PvuⅡ和XbaⅠ位点,白介素6基因的BsrB Ⅰ位点,副甲状腺素基因的BstB Ⅰ位点,Ⅰ型胶原α2基因的Msp Ⅰ位点,骨钙素基因的Hind Ⅲ位点,娃巯基糖蛋白基因的SacⅠ位点。采用二元方差分析对基因相互作用与骨密度的关系进行研究。结果表明,白介素基因和雌激素α受体基因（PvuⅡ）的相互作用对髋部（P=0．019）、转子间区（P=0．016）和股骨颈（P=0．019）的骨密度有显著作用。在这3个部位,GGPp基因型携带者比GGpp基因型携带者的骨密度值分别高出18．0％、19．5％和14．8％。另外观察到醒巯基糖蛋白基因与自介素6基因的相互作用对股骨颈骨密度有显著影响（P=0．046）。GGSS基因型携带者的股骨颈骨密度值比GGSs基因型携带者高出18．8％。该项群体水平的统计分析表明：对于中国女性峰值骨密度的遗传决定,白介素基因和雌激素α受体基因、α2巯基糖蛋白基因的相互作用显著。     

Pregnancy-associated changes in bone density and bone turnover in the physiological state: prospective data on sixteen women.

Areal bone mineral density (BMD, g/cm 2) was measured for the total body, lumbar spine and hip with dual-energy x-ray absorptiometry (DXA) before pregnancy and after delivery in sixteen women aged 21 - 35 years. Additional measurements included quantitative ultrasound indices (broadband ultrasound attenuation, BUA, at the calcaneus at baseline and at 16, 26, and 36 weeks of pregnancy, and postpartum) as well as biochemical markers of bone formation and resorption (measured before pregnancy and during pregnancy at 16, 22, 26, 30, 34, and 36 weeks of pregnancy and postpartum). The results of measurements were as follows: 1. Postpartum BMD showed a significant reduction in the total body (- 13.4 %), in the spine (- 9.2 %) and in the hip (-7.8 % at the femoral neck and - 9.2 % at the Ward's triangle) compared to pre-pregnancy values. 2. Biochemical markers of bone resorption increased by 26 weeks. 3. Bone ultrasound measurements that provide information on bone density before delivery did not change throughout pregnancy. A significant reduction of BUA (- 14.5 % compared to baseline) was observed postpartum only. These data would suggest that pregnancy-induced bone loss develops rapidly after the 36 week of pregnancy, possibly via enhanced bone resorption.     

Bone related health status in adolescent cyclists

Purpose

To describe bone status and analyse bone mass in adolescent cyclists.

Methods

Male road cyclists (n = 22) who had been training for a minimum of 2 years and a maximum of 7 years with a volume of 10 h/w, were compared to age-matched controls (n = 22) involved in recreational sports activities. Subjects were divided in 2 groups based on age: adolescents under 17 yrs (cyclists, n = 11; controls, n = 13) and over 17 yrs (cyclists, n = 11; controls, n = 9). Peak oxygen uptake (VO₂max) was measured on a cycloergometer. Whole body, lumbar spine, and hip bone mineral content (BMC), density (BMD) and bone area were assessed using dual x-ray absorptiometry (DXA). Volumetric BMD (vBMD) and bone mineral apparent density (BMAD) were also estimated.

Results

The BMC of cyclists was lower for the whole body, pelvis, femoral neck and legs; BMD for the pelvis, hip, legs and whole body and legs bone area was lower but higher in the hip area (all, P≤0.05) after adjusting by lean mass and height. The BMC of young cyclists was 10% lower in the leg and 8% higher in the hip area than young controls (P≤0.05). The BMC of cyclists over 17 yrs was 26.5%, 15.8% and 14.4% lower BMC at the pelvis, femoral neck and legs respectively while the BMD was 8.9% to 24.5% lower for the whole body, pelvis, total hip, trochanter, intertrochanter, femoral neck and legs and 17.1% lower the vBMD at the femoral neck (all P≤0.05). Grouped by age interaction was found in both pelvis and hip BMC and BMD and in femoral neck vBMD (all P≤0.05).

Conclusion

Cycling performed throughout adolescence may negatively affect bone health, then compromising the acquisition of peak bone mass.     

老年男性血清脂联素与骨密度的关系

目的：研究老年男性血清脂联素与骨密度和骨转化指标之间的关系。方法：对165例男性老年患者采用双能量X线吸收测量仪测定骨密度、肌肉及脂肪量,同时测定患者血清脂联素、骨碱性磷酸酶、甲状旁腺素、25羟维生素D和I型胶原β羧基端肽水平。结果：165例年龄超过58岁男性患者（平均年龄69.4±6.4岁,体重指数24.9±3.1 kg/m2）,脂联素与股骨颈骨密度相关系数为-0.31（P〈0.05）、与全髋骨密度相关系数为-0.23（P〈0.05）,年龄、BMI和脂肪量校正后,脂联素仅与股骨颈骨密度有显著相关（r=-0.25,P〈0.05）;脂联素与骨碱性磷酸酶正相关（r=0.28,P〈0.01）,混杂因素校正后,相关仍具有显著性（r=0.19,P〈0.05）;脂联素与I型胶原β羧基端肽呈正相关（r=0.15,P〈0.05）。结论：老年男性血清脂联素与股骨颈骨密度和骨ALP密切相关。     

In-Vivo Assessment of Femoral Bone Strength Using Finite Element Analysis (FEA) Based on Routine MDCT Imaging: A Preliminary Study on Patients with Vertebral Fractures

PurposeTo experimentally validate a non-linear finite element analysis (FEA) modeling approach assessing in-vitro fracture risk at the proximal femur and to transfer the method to standard in-vivo multi-detector computed tomography (MDCT) data of the hip aiming to predict additional hip fracture risk in subjects with and without osteoporosis associated vertebral fractures using bone mineral density (BMD) measurements as gold standard.MethodsOne fresh-frozen human femur specimen was mechanically tested and fractured simulating stance and clinically relevant fall loading configurations to the hip. After experimental in-vitro validation, the FEA simulation protocol was transferred to standard contrast-enhanced in-vivo MDCT images to calculate individual hip fracture risk each for 4 subjects with and without a history of osteoporotic vertebral fractures matched by age and gender. In addition, FEA based risk factor calculations were compared to manual femoral BMD measurements of all subjects.ResultsIn-vitro simulations showed good correlation with the experimentally measured strains both in stance (R² = 0.963) and fall configuration (R² = 0.976). The simulated maximum stress overestimated the experimental failure load (4743 N) by 14.7% (5440 N) while the simulated maximum strain overestimated by 4.7% (4968 N). The simulated failed elements coincided precisely with the experimentally determined fracture locations. BMD measurements in subjects with a history of osteoporotic vertebral fractures did not differ significantly from subjects without fragility fractures (femoral head: p = 0.989; femoral neck: p = 0.366), but showed higher FEA based risk factors for additional incident hip fractures (p = 0.028).ConclusionFEA simulations were successfully validated by elastic and destructive in-vitro experiments. In the subsequent in-vivo analyses, MDCT based FEA based risk factor differences for additional hip fractures were not mirrored by according BMD measurements. Our data suggests, that MDCT derived FEA models may assess bone strength more accurately than BMD measurements alone, providing a valuable in-vivo fracture risk assessment tool.     

Study on Bone Density at Various Skeletal Sites for the Diagnosis of Primary Osteoporosis

The objective of this study was to evaluate the diagnostic value of bone density changes in lumbar vertebrae and femoral necks in patients with primary osteoporosis (OP) at various ages. Dual-energy X-ray absorptiometry (DXA) scans were performed on patients who had their primary visits between March 2008 and February 2009. The bone mineral density (BMD) of the lumbar vertebrae 1-4 (L1-L4) in anteroposterior projection and the proximal femoral neck in lateral projection were measured. If the BMD values (T score) of any site is -2.5 or less (T ≤?-2.5), the patients were diagnosed as primary OP, and the T scores were statistically analyzed. The 81 patients who had lumbar vertebrae with a T ≤?-2.5 led to a positive rate of 80.1?% in the diagnosis of primary OP; the 47 patients who had femoral neck with a T ≤?-2.5 gave a positive rate of 47.0?%. The patients with type I or type II primary OP were divided into two age groups of ≤70 and ≥71?years old. The comparison of lumbar spine T score values did not show significant statistical difference (P?>?0.05) between the age groups, while the result of the femoral necks revealed significant difference between the two groups (P?相似文献   

Bone Mineral Density,Bone Turnover Markers and Fractures in Patients with Systemic Sclerosis: A Case Control Study

Objective

The aim of our study was to elucidate the pathophysiology of systemic sclerosis-related osteoporosis and the prevalence of vertebral fragility fracture in postmenopausal women with systemic sclerosis (SSc).

Methodology

Fifty-four postmenopausal women with scleroderma and 54 postmenopausal controls matched for age, BMI, and smoking habits were studied. BMD was measured by dual energy-x-ray absorptiometry at spine and femur, and by ultrasonography at calcaneus The markers of bone turnover included serum osteocalcin and urinary deoxypyridinoline. All subjects had a spine X-ray to ascertain the presence of vertebral fractures.

Results

bone mineral density at lumbar spine (BMD 0.78±0.08 vs 0.88±0.07; p<0,001), femoral neck (BMD: 0.56±0.04 vs 0.72±0.07; p<0,001) and total femur (BMD: 0.57±0.04 vs 0.71±0.06; p<0,001) and ultrasound parameter at calcaneus (SI: 80.10±5.10 vs 94.80±6.10 p<0,001) were significantly lower in scleroderma compared with controls; bone turnover markers and parathyroid hormone level were significantly higher in scleroderma compared with controls, while serum of 25(OH)D3 was significantly lower. In scleroderma group the serum levels of 25(OH)D3 significantly correlated with PTH levels, BMD, stiffness index and bone turnover markers. One or more moderate or severe vertebral fractures were found in 13 patients with scleroderma, wherease in control group only one patient had a mild vertebral fracture.

Conclusion

Our data shows, for the first time, that vertebral fractures are frequent in subjects with scleroderma, and suggest that lower levels of 25(OH)D3 may play a role in the risk of osteoporosis and vertebral fractures.     

Prediction of femoral strength using 3D finite element models reconstructed from DXA images: validation against experiments

Computed tomography (CT)-based finite element (FE) models may improve the current osteoporosis diagnostics and prediction of fracture risk by providing an estimate for femoral strength. However, the need for a CT scan, as opposed to the conventional use of dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnostics, is considered a major obstacle. The 3D shape and bone mineral density (BMD) distribution of a femur can be reconstructed using a statistical shape and appearance model (SSAM) and the DXA image of the femur. Then, the reconstructed shape and BMD could be used to build FE models to predict bone strength. Since high accuracy is needed in all steps of the analysis, this study aimed at evaluating the ability of a 3D FE model built from one 2D DXA image to predict the strains and fracture load of human femora. Three cadaver femora were retrieved, for which experimental measurements from ex vivo mechanical tests were available. FE models were built using the SSAM-based reconstructions: using only the SSAM-reconstructed shape, only the SSAM-reconstructed BMD distribution, and the full SSAM-based reconstruction (including both shape and BMD distribution). When compared with experimental data, the SSAM-based models predicted accurately principal strains (coefficient of determination >0.83, normalized root-mean-square error <16%) and femoral strength (standard error of the estimate 1215 N). These results were only slightly inferior to those obtained with CT-based FE models, but with the considerable advantage of the models being built from DXA images. In summary, the results support the feasibility of SSAM-based models as a practical tool to introduce FE-based bone strength estimation in the current fracture risk diagnostics.     

Bone Mass and the CAG and GGN Androgen Receptor Polymorphisms in Young Men

Background

To determine whether androgen receptor (AR) CAG (polyglutamine) and GGN (polyglycine) polymorphisms influence bone mineral density (BMD), osteocalcin and free serum testosterone concentration in young men.

Methodology/Principal Findings

Whole body, lumbar spine and femoral bone mineral content (BMC) and BMD, Dual X-ray Absorptiometry (DXA), AR repeat polymorphisms (PCR), osteocalcin and free testosterone (ELISA) were determined in 282 healthy men (28.6±7.6 years). Individuals were grouped as CAG short (CAG_S) if harboring repeat lengths of ≤21 or CAG long (CAG_L) if CAG >21, and GGN was considered short (GGN_S) or long (GGN_L) if GGN ≤23 or >23. There was an inverse association between logarithm of CAG and GGN length and Ward''s Triangle BMC (r = −0.15 and −0.15, P<0.05, age and height adjusted). No associations between CAG or GGN repeat length and regional BMC or BMD were observed after adjusting for age. Whole body and regional BMC and BMD values were similar in men harboring CAG_S, CAG_L, GGN_S or GGN_L AR repeat polymorphisms. Men harboring the combination CAG_L+GGN_L had 6.3 and 4.4% higher lumbar spine BMC and BMD than men with the haplotype CAG_S+GGN_S (both P<0.05). Femoral neck BMD was 4.8% higher in the CAG_S+GGN_S compared with the CAG_L+GGN_S men (P<0.05). CAG_S, CAG_L, GGN_S, GGN_L men had similar osteocalcin concentration as well as the four CAG-GGN haplotypes studied.

Conclusion

AR polymorphisms have an influence on BMC and BMD in healthy adult humans, which cannot be explained through effects in osteoblastic activity.     

Bone Analysis Using Trabecular Bone Score and Dual-Energy X-Ray Absorptiometry-Based 3-Dimensional Modeling in Postmenopausal Women With Primary Hyperparathyroidism

ObjectivePredominance of bone loss in cortical sites with relative preservation of trabecular bone, even in postmenopausal women, has been described in primary hyperparathyroidism (PHPT). The aim of this study was to evaluate bone microarchitectural differences using dual-energy x-ray absorptiometry (DXA), trabecular bone score (TBS), and DXA-based 3-dimensional (3D) modeling (3D-DXA) between postmenopausal women diagnosed with PHPT (PM-PHPT) and healthy postmenopausal controls.MethodsThis retrospective study included 44 women with PM-PHPT (9 of whom had fractures) and 48 healthy women matched by age, body mass index, and years since menopause treated at Hospital Universitario Fundación Jiménez Díaz between 2008 and 2017. The bone mineral density (BMD) of the lumbar spine (LS), femoral neck, total hip (TH), and 1/3 radius was assessed using DXA, and trabecular volumetric BMD (vBMD), cortical vBMD, integral vBMD, cortical thickness, and cortical surface BMD at TH were assessed using a 3D-DXA software and TBS at LS.ResultsThe mean adjusted BMD values at LS, the femoral neck, and TH; TBS at LS; and TH 3D-DXA parameters (trabecular vBMD, integral vBMD, cortical thickness, and cortical surface BMD) were significantly reduced in women with PM-PHPT compared with those in the controls. However, differences in mean cortical vBMD were not statistically significant (P = .078). There were no significant differences in mean BMD, TBS, or the 3D-DXA parameters between patients with fractures and those without fractures. The 25-hydroxyvitamin D level appeared to be associated with TBS but not with DXA and 3D-DXA measurements.ConclusionPM-PHPT has significant involvement of the trabecular and cortical compartments of the bone, as determined by DXA, TBS, and 3D-DXA.