Bone Microstructure In Patients Research Articles

Association of trabecular bone score corrected for tissue thickness with glucose metabolism in acromegaly.

Acromegaly is associated with increased vertebral fracture (VF) risk regardless of bone mineral density (BMD). However, the vertebral trabecular compartment is still low; a possible contributor to this may be impaired glucose metabolism (GM) which frequently complicates acromegaly. Additionally, soft tissue thickness may confound bone imaging in acromegaly patients. This study aims to assess the association of GM with BMD, trabecular bone score adjusted for BMI (TBSBMI), and trabecular bone score adjusted for tissue thickness (TBSTT) among acromegaly subjects. A cross-sectional study was performed among 70 consecutive acromegaly patients (24 male/46 female, aged 55.1 years) divided in two subgroups: abnormal GM (n = 35) and normal GM (n = 35). Using DXA, BMD, TBSBMI, TBSTT, and VF screening were performed. In all subjects, TBSTT was higher (mean 9.5%) than TBSBMI. Abnormal GM subjects had lower TBSBMI (1.166 ± 0.15) than normal GM subjects (1.232 ± 0.12; p < 0.05). No between-group difference in TBSTT or BMD was observed. In a multiple regression model, the best predictor of TBSTT was HbA1c (p = 0.002). None of the DXA measures or GM parameters was a significant predictor of VF (n = 7). The abnormal GM acromegaly subjects had lower TBSBMI than those with normal GM. TBSTT was higher than TBSBMI, and no between-group difference based on GM status was observed. TBSTT was significantly associated with GM parameters, notably HbA1c. The relationship of TBSTT with GM parameters may imply an effect of GM on trabecular bone microstructure in patients with acromegaly; a further study is indicated.

Investigating the subchondral trabecular bone microstructure in patients with osteonecrosis of the femoral head using multi-detector row computed tomography.

To analyse the microstructural changes of subchondral trabecular bone in patients with osteonecrosis of the femoral head (ONFH) using multi-detector row computed tomography (MDCT). We retrospectively investigated 76 hips in 50 patients diagnosed with ONFH between 2017 and 2021. Groups 1, 2, 3, and 4 comprised hips without ONFH, ONFH without femoral head collapse (FHC), ONFH with mild collapse (<2 mm), and ONFH with severe collapse (>2 mm), respectively. All patients underwent MDCT, and the subchondral trabecular bone microstructure was assessed. Regions of interests were set at the lateral boundary of the femoral head necrotic lesion and centre of the acetabular weight-bearing portion. In both the femoral head and the acetabular regions, there were significant differences in Groups 2 and 3 compared to Group 1, with increased volumetric bone mineral density and apparent bone volume fraction, and more plate-like with increased connectivity, indicating that osteosclerotic changes were occurring. In both the femoral head and the acetabular regions, osteosclerotic changes of subchondral trabecular bone microstructure were present before FHC.

Bone microstructure of adult patients with non-surgical hypoparathyroidism assessed by high-resolution peripheral quantitative computed tomography.

Hypoparathyroidism (hypoPT) is a rare disease characterized by the lack of parathyroid hormone. There is limited evidence regarding changes in bone microstructure in patients with non-surgical hypoPT. We investigated bone microstructure of patients with non-surgical hypoPT using a non-invasive technique. Patients with hypoPT were assessed using high-resolution peripheral quantitative computed tomography (HR-pQCT) and compared to age- and sex-matched healthy controls randomly selected from a pre-existing HR-pQCT database in a cross-sectional study. Preliminary comparison between patients with different etiologies of hypoPT was performed. Associations between bone microstructure and clinical parameters were investigated using correlation and regression analyses. A total of 94 patients with non-surgical hypoPT were recruited. Patients displayed an increase in trabecular volumetric BMD of the tibia (170.57 ± 34.32 vs. 156.48 ± 40.55mg HA/cm3, p = 0.011) and increase in trabecular number of both the radius (1.48 ± 0.29 vs. 1.36 ± 0.22mm-1, p = 0.003) and tibia (1.42 ± 0.23 vs. 1.24 ± 0.22mm-1, p < 0.001) compared to healthy controls. Trabecular number was higher for non-surgical hypoPT compared to post-surgical hypoPT (1.37 ± 0.25 and 1.17 ± 0.13mm-1, p = 0.022). Trends towards increase in cortical volumetric BMD were only present for post-menopausal female and male patients above the age of 50. For female patients, cortical volumetric BMD and area increased with age and decreased after menopause. For males, age had little influence on bone microstructure, but cortical porosity increased with longer treatment durations. Results from this pilot study suggested that both cortical and trabecular bone were altered in this group of patients with hypoPT. Etiology for hypoPT might influence bone microstructure, mainly on trabeculae. Age, menstrual status, and treatment duration were likely to influence bone microstructure in hypoPT.

Age related changes in the bone microstructure in patients with femoral neck fractures

BackgroundThe risk of femoral neck fracture progressively increases with age. However, the reasons behind this consistent increase in the fracture risk can't be completely justified by the decrease in the bone mineral density. The objective of this study was to analyze the correlation between various bone structural features and age. Study Design & MethodsA total of 29 consecutive patients who suffered an intracapsular hip fracture and underwent joint replacement surgery between May 2012 and March 2013 were included in this study. A 2 cm × 1 cm Ø cylindrical trabecular bone sample was collected from the femoral heads and preserved in formaldehyde. Bone mineral density (BMD), microarchitecture, organic content and crystallography were analyzed using a Dual-energy X-ray absorptiometry scan, micro-CT scan, and high resolution magic-angle-spinning-nuclear magnetic resonance (MAS-NMR), respectively. Statistical correlations were made using Spearman´s or Pearson´s correlation tests depending on the distribution of the continuous variables. ResultsThe mean patient age was 79.83 ± 9.31 years. A moderate negative correlation was observed between age and the hydrogen content in bone (1H), which is an indirect estimate to quantify the organic matrix (r = −0.512, p = 0.005). No correlations were observed between BMD, trabecular number, trabecular thickness, phosphorous content, apatite crystal size, and age (r = 0.06, p = 0.755; r = −0.008, p = 0.967; r = −0.046, p = 0.812; r = −0.152, p = 0.430, respectively). A weak positive correlation was observed between Charlson´s comorbidity index (CCI) and c-axis of the hydroxiapatite (HA) crystals (r = −0.400, p = 0.035). ConclusionThe femoral head relative protein content progressively decreases with age. BMD was not correlated with other structural bone parameters and age. Patients with higher comorbidity scores had larger HA crystals. The present results suggest that the progressive increase in the hip fracture risk in elderly patients could be partially explained by the lower bone protein content in this age group.

Deteriorating subchondral bone microstructure accelerates osteoarthritis progression in developmental dysplasia of the hip than in primary osteoarthritis

Purpose: Developmental dysplasia of the hip (DDH) is recognized as a frequent cause of secondary osteoarthritis (OA). Compared with primary hip OA, DDH often causes changes in the anatomical hip structure and leads to more severe symptoms and imaging manifestations. However, the subchondral bone microstructure and biomechanical property of patients with DDH has not been previously evaluated. Thus, we aimed to analyze the subchondral bone and its association with articular cartilage damage in DDH and primary hip OA through a novel technique for microstructural observation, the individual trabecula segmentation (ITS) analysis. We hypothesized that the changes of subchondral bone in DDH could partly account for the acceleration of OA progression. Methods: Thirty-three femoral head specimens obtained from patients underwent total hip arthroplasty (DDH, n=17; primary OA, n=16) were scanned using Micro-CT, and the selected volume of interest (VOI) was processed by ITS to obtain the microstructural types of subchondral bone. The biomechanical property of VOI was analyzed by micro-finite element analysis (μFEA) and cartilage damage was evaluated by the histology. Moreover, the linear regression analysis was utilized to indicate the association between microstructures, biomechanical property and articular cartilage. Results: Compared with the OA group, the DDH group showed lower total bone volume fractions (BV/TV) and plate bone volume fractions (pBV/TV) by the ITS-based analysis (p<0.05). The plate-to-rod ratio was significantly higher in the OA group than in the DDH group (p<0.05). Remarkably, there were varying degrees of discrepancy between the two groups in pTb.N/rTb.N (plate/rod trabecular number), pTb.Th/rTb.Th (plate/rod trabecular thickness), pTb.S/rTb.L (plate surface area and rod length) and P-P Junc.D/R-R Junc.D/P-R Junc.D (junction density with different trabecular modes). Moreover, the μFEA, histology and linear regression analysis revealed that the subchondral bone in patients with DDH had inferior biomechanical property, and the cartilage damage was severer than patients with OA due to the different subchondral bone microstructures. Conclusions: In this study, our findings detected a less connected, more widely separated trabecular network and deteriorating subchondral bone microstructure in patients with DDH than those with primary OA. The mass and type changes of subchondral bone may contribute to worsening biomechanical property and cartilage damage, thus leading to the acceleration of OA progression in patients with DDH.

Bone microstructure is significantly altered in CRPS-affected distal tibiae as detected by HR-pQCT: a retrospective cross-sectional study.

In the course of complex regional pain syndrome (CRPS), local osteopenia in the subchondral/subcortical areas of the affected limb represents a central manifestation. Mechanistic aspects of CRPS-associated pathologies remain unclear, and knowledge about bone morphology in CRPS-affected areas is rare. The aim of this study was to assess trabecular and cortical bone microstructure in patients with CRPS of the distal tibiae. We retrospectively analysed 14 women diagnosed with unilateral CRPS type I of the lower limb whose affected and unaffected distal tibiae were examined by high-resolution peripheral quantitative computed tomography (HR-pQCT). Laboratory tests included serum levels of calcium, phosphate, 25-hydroxyvitamin D, bone alkaline phosphatase, parathyroid hormone, osteocalcin and urinary levels of deoxypyridinoline (DPD). Bone mineral density was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and both proximal femurs. Average urinary DPD levels, a biochemical marker of bone resorption, were elevated in the examined patient cohort (7.1 ± 1.9nmol/mmol, reference 3.0-7.0nmol/mmol). According to HR-pQCT, CRPS-affected distal tibiae showed significantly lower values of cortical BMD and cortical thickness compared to the unaffected contralateral side. Also, bone volume relative to total volume was significantly lower. Trabecular number and trabecular thickness tended to be lower in the affected tibiae. CRPS is associated with significant alterations in bone microstructure of the affected tibiae. Increased bone resorption seems to play a crucial role within a multifactorial process of CRPS-mediated bone atrophy. HR-pQCT could possibly serve as a diagnostic tool in specific CRPS therapy.

Disease Duration and Stage Influence Bone Microstructure in Patients With Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is known to be a major risk factor for osteoporosis reflected by a reduction of bone mineral density (BMD). However, both the extent of the macro- and microstructural alterations of bone as well as the causative factors are unknown. We have retrospectively analyzed a total of 96 patients with PBC and 53 healthy controls matched for age, sex, and body mass index. In addition to dual-energy X-ray absorptiometry (DXA) measurements at the lumbar spine and hip, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to assess the geometric, volumetric, and microstructural changes of bone at the distal radius and tibia. Furthermore, serum analyses and measures of disease duration and stage including transient elastography were performed. Total, cortical, and trabecular volumetric BMD as well as geometric parameters were significantly reduced in PBC patients. Microstructural analysis revealed a significantly lower cortical thickness (p < 0.001) and bone volume per tissue volume (p < 0.001) in the radius and tibia but unchanged trabecular number in patients with PBC (radius: p = 0.42; tibia: p = 0.12). Multivariate regression models pointed out that disease duration and stage are the primary factors that are independently associated with bone loss in PBC. A subgroup analysis of patients with additional autoimmune hepatitis (AIH) revealed no significant changes in bone structure compared with PBC only. Taken together, PBC patients demonstrate severe alterations in bone microstructure that are positively associated with disease duration and stage. By applying HR-pQCT in the distal radius and tibia, a combined bone loss syndrome expressed by a predominant decrease in BMD and cortical thickness could be detected. © 2018 American Society for Bone and Mineral Research.

New methods for the evaluation of bone quality. Assessment of bone quality by HR-pQCT.

Bone microstructure is one of the important factors for defining bone quality. High Resolution peripheral Quantitative CT(HR-pQCT)enables us to evaluate bone microstructure in patients with osteoporosis noninvasively. It is applied to fracture risk assessment, analysis for pathogenesis of osteoporosis, and study of effects of osteoporosis drugs.

Evaluation of bone microstructure in CRPS-affected upper limbs by HR-pQCT.

Complex regional pain syndrome (CRPS) is a major complication after trauma, surgery, and/or immobilization of an extremity. The disease often starts with clinical signs of local inflammation and develops into a prolonged phase that is characterized by trophic changes and local osteoporosis and sometimes results in functional impairment of the affected limb. While the pathophysiology of CRPS remains poorly understood, increased local bone resorption plays an undisputed pivotal role. The aim of this retrospective clinical study was to assess the bone microstructure in patients with CRPS. Patients with CRPS type I of the upper limb whose affected and unaffected distal radii were analyzed by high-resolution peripheral quantitative computed tomography (HR-pQCT) were identified retrospectively. The osteology laboratory data and dual-energy X-ray absorptiometry (DXA) images of the left femoral neck and lumbar spine, which were obtained on the same day as HR-pQCT, were extracted from the medical records. Five patients were identified. The CRPS-affected upper limbs had significantly lower trabecular numbers and higher trabecular thicknesses than the unaffected upper limbs. However, the trabecular bone volume to total bone volume and cortical thickness values of the affected and unaffected sides were similar. Trabecular thickness tended to increase with time since disease diagnosis. CRPS associated with significant alterations in the bone microstructure of the affected upper limb that may amplify as the duration of disease increases.

Improvement of cancellous bone microstructure in patients on teriparatide following alendronate pretreatment

An increase in procollagen type I amino-terminal propeptide (PINP) early after teriparatide initiation was shown to correlate with increased lumbar spine areal BMD and is a good predictor of the anabolic response to teriparatide. Few data exist correlating PINP and bone microstructure, and no data exist in patients on teriparatide following prior potent antiresorptive treatment. This exploratory analysis aimed to investigate the effects of teriparatide on cancellous bone microstructure and correlations of bone markers with microstructure in alendronate-pretreated patients. This was a post hoc analysis of changes in bone markers and three-dimensional indices of bone microstructure in paired iliac crest biopsies from a prospective teriparatide treatment study in postmenopausal women with osteoporosis who were either treatment-naïve (TN, n=16) or alendronate-pretreated (ALN, n=29) at teriparatide initiation. Teriparatide (20μg/day) was given for 24months; biopsies were taken at baseline and endpoint, and serum concentrations of PINP and type 1 collagen cross-linked C-telopeptide (βCTX) were measured at intervals up to 24months. In the TN and ALN groups, respectively, mean (SD) increases in three-dimensional bone volume/tissue volume were 105 (356)% (P=0.039) and 55 (139)% (P<0.005) and trabecular thickness 30.4 (30)% (P<0.001) and 30.8 (53)% (P<0.001). No significant changes were observed in trabecular number or separation. In the ALN patients, 3-month change of neither PINP nor βCTX correlated with indices of cancellous bone microstructure. However, 12-month changes in biochemical bone markers correlated significantly with improvements in bone volume/tissue volume, r=0.502 (P<0.01) and r=0.378 (P<0.05), trabecular number, r=0.559 (P<0.01) and r=0.515 (P<0.01), and reduction of trabecular separation, r=−0.432 (P<0.05) and r=−0.530 (P<0.01), for PINP and βCTX, respectively. We conclude that cancellous bone microstructure improved with teriparatide therapy irrespective of prior antiresorptive use.