Assessment Of Bone Quality Research Articles

The assessment of bone quality in lifestyle-related diseases

Type 2 diabetes mellitus(DM)and other lifestyle-related diseases are associated with an increased risk of bone quality deterioration-type osteoporosis. The deterioration of bone quality in type 2 DM involves factors such as qualitative changes of collagens, reduction in bone turnover, narrow cortical bone diameter, increased cortical bone porosity, and destruction of trabecular bone microarchitecture. In mild to moderate chronic kidney disease and chronic obstructive pulmonary disease, the factors involved are thought to be hyperhomocysteinemia and deterioration of trabecular bone microarchitecture as well as cortical bone structure. Investigations of the usefulness of bone quality assessment using approaches such as the following are under way : biocheminal markers such as pentosidine and homocysteine, bone structure assessment methods such as hip structure analysis, trabecular bone score, and high-resolution peripheral quantitative computed tomography.

Radiological assessment of bone quality

Structural property of bone includes micro- or nano-structural property of the trabecular and cortical bone, and macroscopic geometry. Radiological technique is useful to analyze the bone structural property;micro-CT or synchrotron-CT is available to analyze micro- or nano-structural property of bone samples ex vivo, and multi-detector row CT(MDCT)or high-resolution peripheral QCT(HR-pQCT)is available to analyze human bone in vivo. For the analysis of hip geometry, CT-based hip structure analysis(HSA)is available aw sell se radiography and DXA-based HSA. These structural parameters are related to biomechanical property, and these assessment tools provide information of pathological changes or the effects of anti-osteoporotic agents on bone.

Bone quality assessment through the crystalline structure of hydroxyapatite

Bone quality assessment through the crystalline structure of hydroxyapatite

Bone quality in patients with chronic osteomyelitis of the foot according to computed tomography data

Objective: to study radiographic morphological changes in the bones of the foot in its chronic osteomyelitis and to develop indicators for assessing bone quality. Material and methods. The results of foot bone multislice computed tomography (MSCT) using 64 detector rows were analyzed in 29 patients with chronic osteomyelitis of the talus, calcaneus, and midfoot bones. Results. Radiographic changes in the talus and calcaneus in chronic osteomyelitis were characterized by pronounced polymorphism and accompanied by the lower density of the talus and calcaneus and by the lack of their organotypic structure. In a number of cases, the organotypic structure was entirely absent in the calcaneus along with marked anatomical changes (a defect). In these cases, the talus also undergoes considerable changes; however, its density does not decrease to more than 200 HU. Based on an analysis of the findings on the specific features of the architectonics of the talus and calcaneus and their density, the criteria for assessing bone quality, which allow estimation of the magnitude of radiographic morphological changes in the foot bones, were proposed to choose a method for treatment and rehabilitation. Conclusion. The use of the proposed criteria for assessing bone quality indicated moderate, significant, and serious quality defects in 4, 5, and 20 patients, respectively. The findings should be kept in mind when choosing a method for treatment and rehabilitation measures.

Validation of cone-beam computed tomography as a predictor of osteoporosis using the Klemetti classification.

This study aimed at evaluating the validity of cone-beam computed tomography (CBCT) for assessing mandibular bone quality using the Klemetti classification. The morphology of the endosteal mandibular cortex of 30 (60 hemi-mandibles) postmenopausal women between the ages of 45 and 80 years was evaluated based on the Klemetti classification in panoramic radiographs used as reference images. Afterwards, panoramic reconstruction and cross-sectional slices of CBCT examinations of these patients were analyzed and categorized according to the same classification. All the images were assessed by two oral radiologists. The McNemar-Bowker test compared the agreement between the CBCT images and the reference images. No differences were found between the diagnostic results based on panoramic radiography and panoramic reconstruction. However, the mean scores for the cross-sectional evaluation were higher, and the results, statistically different from the others. Based on the disagreement found between the panoramic radiographs and the CBCT cross-sectional slices, the Klemetti classification is not an adequate means of assessing bone quality with CBCT. On the other hand, the higher values found for the cross-sectional slices could be associated with better visibility on the CBCT images.

Novel Raman Spectroscopic Biomarkers Indicate That Postyield Damage Denatures Bone's Collagen.

Raman spectroscopy has become a powerful tool in the assessment of bone quality. However, the use of Raman spectroscopy to assess collagen quality in bone is less established than mineral quality. Because postyield mechanical properties of bone are mostly determined by collagen rather than the mineral phase, it is essential to identify new spectroscopic biomarkers that help infer the status of collagen quality. Amide I and amide III bands are uniquely useful for collagen conformational analysis. Thus, the first aim of this work was to identify the regions of amide bands that are sensitive to thermally induced denaturation. Collagen sheets and bone were thermally denatured to identify spectral measures that change significantly following denaturation. The second aim was to assess whether mechanical damage denatures the collagen phase of bone, as reflected by the molecular spectroscopic biomarkers identified in the first aim. The third aim was to assess the correlation between these new spectroscopic biomarkers and postyield mechanical properties of cortical bone. Our results revealed five peaks whose intensities were sensitive to thermal and mechanical denaturation: ∼1245, ∼1270, and ∼1320 cm(-1) in the amide III band, and ∼1640 and ∼1670 cm(-1) in the amide I band. Four peak intensity ratios derived from these peaks were found to be sensitive to denaturation: 1670/1640, 1320/1454, 1245/1270, and 1245/1454. Among these four spectral biomarkers, only 1670/1640 displayed significant correlation with all postyield mechanical properties. The overall results showed that these peak intensity ratios can be used as novel spectroscopic biomarkers to assess collagen quality and integrity. The changes in these ratios with denaturation may reflect alterations in the collagen secondary structure, specifically a transition from ordered to less-ordered structure. The overall results clearly demonstrate that this new spectral information, specifically the ratio of 1670/1640, can be used to understand the involvement of collagen quality in the fragility of bone. © 2015 American Society for Bone and Mineral Research.

Evaluation of a Bacillus direct-fed microbial candidate on digesta viscosity, bacterial translocation, microbiota composition and bone mineralisation in broiler chickens fed on a rye-based diet

1. The effects of the dietary inclusion of a Bacillus-based direct-fed microbial (DFM) candidate on digesta viscosity, bacterial translocation, microbiota composition and bone mineralisation were evaluated in broilers consuming rye-based diets.2. In the present study, control mash rye-based diets (CON) or Bacillus-DFM supplemented diets (TRT) were administered ad libitum to male broilers in three independent experiments.3. In Experiments 1 and 2 (n = 25/group), liver samples were taken to evaluate bacterial translocation, digesta samples were used for viscosity measurements and the intestinal microbial flora was evaluated from different intestinal sections to enumerate total recovered gram-negative bacteria (TGB), lactic acid bacteria (LAB) and anaerobic bacteria (TAB). Additionally, both tibias were removed for assessment of bone quality.4. In Experiment 3, each experimental group had 8 replicates of 20 chickens (n = 160/group). Weekly, body weight (BW), feed intake (FI) and feed conversion ratio (FCR) were evaluated. At d 28-of-age, samples were taken to determine bacterial translocation, digesta viscosity and bone quality characteristics.5. In all experiments, consumption of Bacillus-DFM reduced bacterial translocation to the liver and digesta viscosity. Additionally, DFM supplementation improved BW, bone quality measurements and FCR. Moreover, chickens fed on the Bacillus-DFM diet in Experiments 1 and 2 showed a significant reduction in the number of gram-negative and anaerobic bacteria in the duodenal content compared to control.6. In summary, chickens fed on a rye-based diet without DFM inclusion showed an increase in bacterial translocation and digesta viscosity, accompanied by reduced performance and bone quality variables relative to the Bacillus-DFM candidate group. Hence, incorporation into the feed of a selected DFM ameliorated the adverse anti-nutritional effects related to utilisation of rye-based diets in broilers chickens.

Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck.

In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n = 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 [IQR 61-74] years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. © 2015 American Society for Bone and Mineral Research.

Bone Marrow Stress Decreases Osteogenic Progenitors.

Age-related bone loss may be a result of declining levels of stem cells in the bone marrow. Using the Col2.3Δtk (DTK) transgenic mouse, osteoblast depletion was used as a source of marrow stress in order to investigate the effects of aging on osteogenic progenitors which reside in the marrow space. Five-month-old DTK mice were treated with one or two cycles of ganciclovir to conditionally ablate differentiated osteoblasts, whereas controls were saline-treated. Treatment cycles were two weeks in length followed by four weeks of recovery. All animals were sacrificed at 8 months of age; bone marrow stromal cells (BMSCs) were harvested for cell culture and whole bones were excised for bone quality assessment. Colony-forming unit (CFU) assays were conducted to investigate the osteogenic potential of BMSC in vitro, and RNA was extracted to assess the expression of osteoblastic genes. Bone quality assessments included bone histomorphometry, TRAP staining, microcomputed tomography, and biomechanical testing. Osteoblast depletion decreased CFU-F (fibroblast), CFU-ALP (alkaline phosphatase), and CFU-VK (von Kossa) counts and BMSC osteogenic capacity in cell culture. Ex vivo, there were no differences in bone mineral density of vertebrae or femurs between treatment groups. Histology showed a decrease in bone volume and bone connectivity with repeated osteoblast depletion; however, this was accompanied by an increase in bone formation rate. There were no notable differences in osteoclast parameters or observed bone marrow adiposity. We have developed a model that uses bone marrow stress to mimic age-related decrease in osteogenic progenitors. Our data suggest that the number of healthy BMSCs and their osteogenic potential decline with repeated osteoblast depletion. However, activity of the remaining osteoblasts increases to compensate for this loss in progenitor osteogenic potential.

Stochastic multiscale modelling of cortical bone elasticity based on high-resolution imaging.

Accurate and reliable assessment of bone quality requires predictive methods which could probe bone microstructure and provide information on bone mechanical properties. Multiscale modelling and simulation represent a fast and powerful way to predict bone mechanical properties based on experimental information on bone microstructure as obtained through X-ray-based methods. However, technical limitations of experimental devices used to inspect bone microstructure may produce blurry data, especially in in vivo conditions. Uncertainties affecting the experimental data (input) may question the reliability of the results predicted by the model (output). Since input data are uncertain, deterministic approaches are limited and new modelling paradigms are required. In this paper, a novel stochastic multiscale model is developed to estimate the elastic properties of bone while taking into account uncertainties on bone composition. Effective elastic properties of cortical bone tissue were computed using a multiscale model based on continuum micromechanics. Volume fractions of bone components (collagen, mineral, and water) were considered as random variables whose probabilistic description was built using the maximum entropy principle. The relevance of this approach was proved by analysing a human bone sample taken from the inferior femoral neck. The sample was imaged using synchrotron radiation micro-computed tomography. 3-D distributions of Haversian porosity and tissue mineral density extracted from these images supplied the experimental information needed to build the stochastic models of the volume fractions. Thus, the stochastic multiscale model provided reliable statistical information (such as mean values and confidence intervals) on bone elastic properties at the tissue scale. Moreover, the existence of a simpler "nominal model", accounting for the main features of the stochastic model, was investigated. It was shown that such a model does exist, and its relevance was discussed.

A Preliminary Study of DXA and QCT Derived Femur Cross-Section Stiffness

Dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) are the two clinic imaging modalities available for examining bone quality. However, there is a dilemma in their selection. DXA uses a lower and safer X-ray dosage, but the produced image is two-dimensional, the information of bone spatial geometry and heterogeneous material distribution required for evaluating bone quality is missing; On the other hand, although QCT is able to capture all the required information, it has to use amuch higher X-ray dosage that may be a potentialhealth concern. Femur cross-section stiffness is an important parameter forassessing bone quality. Although itcan be determined from both DXA and QCT image, it is best computed from QCT for the reason mentioned in the above. In this study, we attempted to establish the ‘equivalence’ between DXA and QCT derived femur cross-section stiffness. If it is successful, DXA can be used in replacement of QCT in assessing bone quality. The study results showed that there indeed exist strong correlations between DXA and QCT derived femur stiffness, but they are not equivalent to each other.

Comparing two scanning protocols for high-resolution peripheral quantitative computed tomography for bone quality assessment in young subjects

Comparing two scanning protocols for high-resolution peripheral quantitative computed tomography for bone quality assessment in young subjects

206 Bone quality at the time of lung transplant in cystic fibrosis patients

Background and Hypothesis As CF patients get older, morbidities such as CF-related bone disease (CFBD), superimpose on the pre-existing complications. CFBD predisposes to fractures, especially of the ribs and vertebrae. Knowing that bone mineral density (BMD) is a poor predictor of fractures in CF, we postulate that alterations in bone quality will likely contribute to their propensity to fracture. Methods In order to assess bone quality in CF patients, a 2 cm segment of rib was recovered during lung transplant (LTx). Controls consisted in similarly aged lung donors (D). Dual-energy X-ray absorptiometry (DXA), micro-CT, bone histomorphometry and microcrack detection were used to assess BMD, microarchitecture, bone remodeling and quality of bone respectively. Results Over 17 CF and 21 donor's specimens were analyzed. Patients were stratified according to bisphosphonate (BP) or steroid (GC) treatment at the time of LTx. Ex vivo rib BMD, trabecular BMD and bone volume determined by micro-CT as well as trabecular thickness were significantly reduced in CF, with patients on GC having the lowest values. Despite similar surface occupied by osteoblasts, osteoid parameters (volume, surface and thickness) were lower in CF, regardless of the use of GC or BP. Number of osteoclasts and eroded surfaces were comparable among the groups. Microcracks were 3 to 4 times higher in CF than in D. Of note, the highest microcrack density was found in patients on BP. Conclusion Our data suggest alterations in the bone quality of CF ribs as evidenced by a decrease in osteoblast function and bone formation resulting in the uncoupling of bone remodeling, and the accumulation of microdamages.

Assessment of bone quality, measured by trabecular bone score, in acromegaly

Assessment of bone quality, measured by trabecular bone score, in acromegaly

Axial quantitative ultrasound assessment of pediatric bone quality in eastern Nepal

This study presents quantitative ultrasonography (QUS) bone quality data for an underrepresented, south Asian pediatric population from Nepal. Data were collected as part of a longitudinal study of growth and development. This study offers normative data and documents the effect of stunting, wasting, and underweight on the bone properties measured by QUS. The purpose of this study was to (1) examine the bone quality of a rural, non-Western pediatric population using QUS, (2) explore variation in the trajectory of bone quality development between males and females, and (3) examine the impact of growth disruption(s) on bone quality. A cross-sectional study of 860 children and adolescents aged 5-18 years from the Jirel ethnic group in eastern Nepal was performed. The Sunlight Omnisense 7000P was used to assess bone quality of the distal 1/3 radius and midshaft tibia. WHO reference standards were used to assess growth disruptions of height, weight, and BMI. QUS bone quality data for an underrepresented, non-Western pediatric population are presented for the radius and tibia. A sizable portion of the study participants were classified as stunted, wasted, and/or underweight. Despite this prevalence of growth disruption in the study sample, bone quality data conform to other documented populations with less growth disruption. Thus, this study offers normative data and documents the minimal effect of stunting, wasting, and underweight on the bone properties measured by QUS. Non-Western pediatric populations are significantly underserved with regard to simple, non-invasive screening tools that may help identify developmental disorders and assess bone health. The children and adolescents examined here represent normal growth and development for an underrepresented south Asian population. While this work demonstrates that stunting, wasting, or underweight status at time of QUS assessment is not associated with poor bone quality, we do suggest that further study is needed to examine possible cumulative effects of persistent disruptions that may lead to compromised bone quality in later adolescence.

Multiscale assessment of cortical bone properties with quantitative ultrasound

Clinical bone quality assessment still relies strongly on bone mineral density (BMD). It is now well accepted that BMD predicts only around 60% of the individual fracture risk because it depends on geometrical dimensions of the bone and mechanical properties of its cortical shell. The tibia mid-shaft is a clinically relevant site for ultrasound axial transmission (AT) measurements, which allow simultaneous assessment of cortical thickness (Ct.Th) and tissue elasticity. This ex-vivo study investigated 19 representative human tibiae (native samples, mid-shaft, age range: 69–94 yrs) using AT with the aim to develop novel ultrasound biomarkers of cortical bone loss. Ct.ThAT was in good agreement with corresponding data from micro-computed tomography (R2 = 0.90). Resonant ultrasound spectroscopy was used to measure the transverse isotropic elasticity tensor of extracted bone cubes. Strong linear correlation between axial stiffness (c33) and mass density (R2 = 0.86) was found. Mechanical testing based strength was moderately correlated to c33 (R2 = 0.72) and mass density (R2 = 0.65). These findings indicate the potential of cortical elasticity to be an adequate biomarker of bone quality which combined with information about bone geometry (e.g., Ct.Th) could improve clinical fracture risk assessment.

Augmented glenoid component designs for type B2 erosions: a computational comparison by volume of bone removal and quality of remaining bone

The purpose of this computational modeling study was to compare the volume of glenoid bone removal required to implant 3 augmented component designs for management of B2 erosions. In addition, we assessed bone quality of the supporting bone directly beneath the implants by measuring bone density and porosity. Three augmented component designs—full-wedge, posterior-wedge, and posterior-step—were studied by virtual implantation in a cohort of 16 patients with B2 glenoids. B2 retroversion was corrected to 0° and 10°. The outcome variables were the volume of glenoid bone removal required for implantation and the density and porosity of the bone immediately beneath the implant. Implant design had a significant effect on the volume of bone removal (P < .001). When correcting to 0°, the posterior-wedge implant removed less bone than the posterior-step (P < .001) and the full-wedge (P = .004). At 10° retroversion, the posterior-wedge removed less bone (P = .029) than the posterior-step but was no different than the full-wedge (P = .143). The residual glenoid bone density with the posterior-wedge was significantly greater than with the posterior-step (P = .048), with no other significant differences (P > .05). Residual glenoid bone porosity was not significantly different between implants (P > .262). Augmented components can provide a bone-preserving option for B2 glenoid management. Substantial variations in the volume of bone removal and the quality of the remaining glenoid bone were found between 3 different designs of augmented implants. Simulations with the posterior-wedge implant resulted in substantially less glenoid bone removal, with the remaining supporting bone being of better quality.

Posterolateral lumbar fusion: Relationship between computed tomography Hounsfield units and symptomatic pseudoarthrosis.

Background:Assessment of bone quality can guide spinal surgery. However, surgeons infrequently evaluate bone quality in a quantitative manner. Recent literature suggests a role for computed tomography (CT) Hounsfield units (HUs) as a marker for bone quality. Limited data exist regarding its utility with respect to posterolateral lumbar fusion (PLF).Methods:From fall 2010 to winter 2012, 10 patients underwent revision surgery for symptomatic pseudoarthrosis (defined as intractable pain associated with either radiographic evidence of nonunion or intraoperative evidence of nonunion) after a prior L4–S1 PLF. These patients were age-matched (±5 years) to 10 patients who underwent L4–S1 PLF with no clinical signs of pseudoarthrosis at 1-year follow-up. Available CT imaging (with or without instrumentation) was evaluated from L1 to L5 for the averaged HU. Data were pooled among L1–L3 values and between L4 and L5 values.Results:Within the pseudoarthrosis group, the pooled L1–L3 HU value was similar to the pooled L4–L5 HU value (168.39 ± 22.84 HU vs. 166.98 ± 23.20 HU respectively, P = 0.89). The same pattern was observed for the control group (190.24 ± 37.13 HU vs. 201.89 ± 36.59 HU respectively, P = 0.44). On the other hand, the pooled L1–L3 and L4–L5 HU values were larger for the control group compared to the pseudoarthrosis group, with the pooled L4–L5 HU demonstrating statistical significance, P = 0.01.Conclusion:Currently, CT imaging is typically not obtained prior to lumbar fusion. Results demonstrated that CT HU values were significantly larger for patients who did not exhibit symptomatic pseudoarthrosis at 1-year follow-up compared to those who required revision surgery. As such, CT HU values may serve as a predictor for bony fusion to guide surgical management of patients under consideration for PLF.

Early diagnosis of osteoporosis in male and female patients between 30 and 75 years using orthopantomography

Background: Osteoporosis is a systemic bone disease that is characterized by a generalized reduction of the bone mass. This bone disease exhibits microarchitectural degradation/disintegration of the bone scaffold that leads to increased bone fragility and more prone to fracture. Dental radiographs are one of the commonly used imaging modalities for teeth and jaw pathology. Aims and Objectives: The aim of this study was to assess the mandibular bone quality in panoramic radiographs for an initial evaluation of osteoporosis in male and female patients between 30 and 75 years using mental index (MI), which measures the cortical bone thickness of mandible. Materials and Methods: Hundred digital panoramic radiographs were screened. MI was used to evaluate the mandibular cortical bone thickness bilaterally. In males and females average MI scores were then assessed by using the t-sample independent test. Results: The study was statistically significant with P < 0.001 which showed differences of mandibular bone quality between the groups based on MI measurements. Conclusion: Using MI for assessment of mandibular bone quality in panoramic radiograph showed a significant difference between males and females. Correlation between MI and age showed elderly females were most affected by osteoporosis. Thus, panoramic radiographs can act as a diagnostic aid for early detection of osteoporosis.

Determination of Micromotion at the Implant Bone Interface - An In-Vitro Methodologic Study

Dental implants lacking primary stability show increased levels of micromotion which may result in fibrous encapsulation instead of osseointegration. A novel experimental technique has been used for directly measuring implant displacement as a consequence of occlusal loading. Implants were inserted in bone surrogate material differing in density thereby measuring insertion torque and implant stability by means of resonance frequency analysis. Implants placed in bone with a density of 10 pcf and loaded with a mean force of 62.7 N showed maximum mean displacement of 71.9 μm. Significant differences in micromotion resulted from placing implants in bone with varying densities. Measurements of implant insertion torque correlated well with measurements of implant displacement. Implant stability measurements of specific implants showed consistency, no correlation between implant stability and maximum implant displacement could be established. It appears that a reliable assessment of bone quality may be best used for predicting micromotion at the implant-abutment interface.