Abstract
Crohn’s disease (CD) is associated with bone loss and increased fracture risk. TX-Analyzer™ is a new fractal-based technique to evaluate bone microarchitecture based on conventional radiographs. The aim of the present study was to evaluate the TX-Analyzer™ of the thoracic and lumbar spine in CD patients and healthy controls (CO) and to correlate the parameters to standard imaging techniques. 39 CD patients and 39 age- and sex-matched CO were analyzed. Demographic parameters were comparable between CD and CO. Bone structure value (BSV), bone variance value (BVV) and bone entropy value (BEV) were measured at the vertebral bodies of T7 to L4 out of lateral radiographs. Bone mineral density (BMD) and trabecular bone score (TBS) by dual energy X-ray absorptiometry (DXA) were compared to TX parameters. BSV and BVV of the thoracic spine of CD were higher compared to controls, with no difference in BEV. Patients were further divided into subgroups according to the presence of a history of glucocorticoid treatment, disease duration > 15 years and bowel resection. BEV was significantly lower in CD patients with these prevalent risk factors, with no differences in BMD at all sites. Additionally, TBS was reduced in patients with a history of glucocorticoid treatment. Despite a not severely pronounced bone loss in this population, impaired bone quality in CD patients with well-known risk factors for systemic bone loss was assessed by TX-Analyzer™.
Highlights
Bone loss and increased fracture risk are well-known extraintestinal complications of Crohn’s disease (CD) [1,2]
There were no significant differences between CD patients and controls in age, sex or body mass index (BMI)
The software TX-AnalyzerTM is a non-invasive tool for indirect assessment of bone microstructure based on existing conventional radiographs
Summary
Bone loss and increased fracture risk are well-known extraintestinal complications of Crohn’s disease (CD) [1,2]. As has been recently shown by our study group, CD patients have an increased risk for hip fractures and an associated higher mortality risk after fracture compared to the general population [3]. Overall data on osteoporosis and fracture risk are conflicting in literature and largely depend on the patient population, severity of disease, disease duration and different imaging techniques in assessing bone mineral density (BMD) [4]. Patients with CD have many risk factors contributing to bone loss and need special attention to identify patients at risk and prevent fractures. The gold-standard for examination of BMD is dual X-ray absorptiometry (DXA), a two-dimensional imaging method. Anterior–posterior DXA scanning may not accurately reflect true changes in BMD, e.g., due to calcification of the aorta or osteophytes within the region of interest (ROI) [5,6,7]
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