Abstract
Idiopathic osteoporosis (IOP) in premenopausal women is a poorly understood entity in which otherwise healthy women have low-trauma fracture or very low bone mineral density (BMD). In this study, we applied individual trabeculae segmentation (ITS)–based morphological analysis to high-resolution peripheral quantitative computed tomography (HR-pQCT) images of the distal radius and distal tibia to gain greater insight into skeletal microarchitecture in premenopausal women with IOP. HR-pQCT scans were performed for 26 normal control individuals and 31 women with IOP. A cubic subvolume was extracted from the trabecular bone compartment and subjected to ITS-based analysis. Three Young's moduli and three shear moduli were calculated by micro–finite element (µFE) analysis. ITS-based morphological analysis of HR-pQCT images detected significantly decreased trabecular plate and rod bone volume fraction and number, decreased axial bone volume fraction in the longitudinal axis, increased rod length, and decreased rod-to-rod, plate-to-rod, and plate-to-plate junction densities at the distal radius and distal tibia in women with IOP. However, trabecular plate and rod thickness did not differ. A more rod-like trabecular microstructure was found in the distal radius, but not in the distal tibia. Most ITS measurements contributed significantly to the elastic moduli of trabecular bone independent of bone volume fraction (BV/TV). At a fixed BV/TV, plate-like trabeculae contributed positively to the mechanical properties of trabecular bone. The results suggest that ITS-based morphological analysis of HR-pQCT images is a sensitive and promising clinical tool for the investigation of trabecular bone microstructure in human studies of osteoporosis. © 2010 American Society for Bone and Mineral Research.
Highlights
Osteoporosis, characterized by low bone mass and microarchitectural deterioration, is diagnosed most commonly in postmenopausal women and elderly men.[1]
In our previous work we studied the relative importance of trabecular types in the architecture and mechanical properties of trabecular bone and developed imageprocessing techniques for volumetrically segmenting the 3D trabecular bone microstructure as a collection of trabecular plates and rods.[27,28] We developed individual trabeculae segmentation (ITS)–based morphological analysis to assess trabecular microstructure based on measurements of each
Most idiopathic osteoporosis (IOP) subjects were included on the basis of low-trauma fractures regardless of areal bone mineral density (aBMD), aBMD was lower at all sites in IOP subjects than in the control individuals ( p < .05)
Summary
Osteoporosis, characterized by low bone mass and microarchitectural deterioration, is diagnosed most commonly in postmenopausal women and elderly men.[1] young or middle-aged men and premenopausal women can suffer from osteoporosis. An in vivo clinical imaging modality, high-resolution peripheral quantitative computed tomography (HR-pQCT), has been developed to assess bone microstructure (XtremeCT, Scanco Medical AG, Bassersdorf, Switzerland). Several clinical studies have demonstrated the ability of HR-pQCT to detect age- or disease-related changes in bone microarchitecture and to provide additional fracture risk determinants.[19,20,21,22,23,24] In addition, we recently applied HR-pQCT technology to a group of premenopausal women with IOP and detected abnormal trabecular microstructure and reduced mechanical competence.[25]
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