Hip Structure Analysis Variables Research Articles

Sarcopenia negatively affects hip structure analysis variables in a group of Lebanese postmenopausal women

BackgroundThe current study’s purpose is to compare hip structural analysis variables in a group of postmenopausal women with sarcopenia and another group of postmenopausal women with normal skeletal muscle mass index. To do so, the current study included 8 postmenopausal women (whose ages ranged between 65 and 84 years) with sarcopenia and 60 age-matched controls (with normal skeletal muscle mass index (SMI)). Body composition and bone parameters were evaluated by dual-energy X-ray absorptiometry (DXA).ResultsWeight, lean mass, body mass index, femoral neck cross-sectional area (FN CSA), FN section modulus (Z), FN cross sectional moment of inertia (CSMI), intertrochanteric (IT) CSA, IT Z, IT CSMI, IT cortical thickness (CT), femoral shaft (FS) CSA, FS Z and FS CSMI were significantly greater (p < 0.05) in women with normal SMI compared to women with sarcopenia. In the whole population, SMI was positively associated with IT CSA, IT Z, IT CSMI, IT CT, FS CSA, FS Z, FS CSMI, FS CT but negatively correlated to IT buckling ratio (BR) and FS BR.ConclusionThe current study suggests that sarcopenia has a negative effect on hip bone strength indices in postmenopausal women.

Effects of Hip Structure Analysis Variables on Hip Fracture: A Propensity Score Matching Study.

The purpose of this retrospective study was to compare the hip structural analysis (HSA) levels of patients with those of a hip fracture group. All patients with an initial hip fracture who were older than or equal to 65 years old and admitted to our hospital between March 2018 and January 2019 were eligible for this study. During the study period, 134 hip fracture patients aged 65 years and older were admitted to the study institution, and a total of 51 hip fracture patients were ultimately assigned to the patient group. Age, sex, body mass index (BMI), skeletal muscle index (SMI), and vitamin D were matched in the two groups (hip fracture (HF) group vs. non-hip fracture group) using propensity score matching (PSM) without any statistical differences. Following propensity score matching, 51 patients in the HF group and 51 patients in the non-HF group were included in the study, respectively. Hip axis length (p = 0.031), neck-shaft angle (p = 0.043), width of intertrochanter (p = 0.005), and femur shaft (p = 0.01) were found to be significantly higher in the HF group (107.31 (mean) ± 9.55 (standard deviation, SD), 131.11 ± 5.29, 5.57 ± 0.58, and 3.05 ± 0.23, respectively) than in the non-HF group (102.07 ± 14.15, 128.85 ± 5.81, 5.29 ± 0.38, and 2.92 ± 0.23, respectively). However, cross-sectional area (CSA) of femur neck (p = 0.005) and femur shaft (p = 0.01) as well as cortical thickness (CT) of femur neck (p = 0.031) and femur shaft (p = 0.031) were found to be significantly lower in the HF group (1.93 ± 0.44, 3.18 ± 0.83, 0.11 ± 0.02, and 0.38 ± 0.09, respectively) than in the non-HF group (2.12 ± 0.46, 3.57 ± 0.78, 0.13 ± 0.03, and 0.47 ± 0.11, respectively). The HSA showed excellent sensitivity (82.4% to 90.2%). HSA is an important factor in predicting the occurrence of hip fracture. Therefore, not only should bone mineral density (BMD) be considered clinically, but it is also important to look closely at HSA for risk of hip fracture.

Sarcopenia and Hip-Structure Analysis Variables in Korean Elderly Population

The purpose of this study is comparing the hip-structure analysis (HSA) variables with the skeletal muscle index (SMI) in elderly patients with sarcopenia using nationwide representative data on the Republic of Korea (ROK). The survey data were collected from household interviews and direct standardized physical examinations conducted in specially equipped mobile examination centers. The data were collected in 2008 from 9744 participants. Patients under 65 years of age who were without data on the skeletal-muscle-mass and HSA variables were excluded. After these exclusions, a total of 744 participants (293 men and 451 women) were ultimately analyzed. The HSA measurements of the hip-bone geometry were analyzed using dual-energy X-ray absorptiometry. The appendicular SMI is defined as the sum of the arm and leg SMIs. Sarcopenia is defined according to the criteria for the Asia Working Group for Sarcopenia as SMIs of less than 5.4 kg/m2 and 7.0 kg/m2 for women and men, respectively. In the entire population, SMI was found to be positively correlated to HSA variables. After adjusting for age, body mass index, and energy intake in both the women and men groups, a statistically significant difference became evident in all variables between the SMI and the HSA. The present study suggests that skeletal-muscle loss negatively affects hip-bone-strength indices in elderly sarcopenia patients. Implementing strategies to increase SMI in the elderly population may be useful for reducing the vulnerability to hip fracture.

Osteoporotic Hip Fracture Prediction: Is T-Score-Based Criterion Enough? A Hip Structural Analysis-Based Model.

At present, the current gold-standard for osteoporosis diagnosis is based on bone mineral density (BMD) measurement, which, however, has been demonstrated to poorly estimate fracture risk. Further parameters in the hands of the clinicians are represented by the hip structural analysis (HSA) variables, which include geometric information of the proximal femur cross section. The purpose of this study was to investigate the suitability of HSA parameters as additional hip fracture risk predictors. With this aim, twenty-eight three-dimensional patient-specific models of the proximal femur were built from computed tomography (CT) images and a sideways fall condition was reproduced by finite element (FE) analyses. A tensile or compressive predominance based on minimum and maximum principal strains was determined at each volume element and a risk factor (RF) was calculated. The power of HSA variables combinations to predict the maximum superficial RF values was assessed by multivariate linear regression analysis. The optimal regression model, identified through the Akaike information criterion (AIC), only comprises two variables: the buckling ratio (BR) and the neck-shaft angle (NSA). In order to validate the study, the model was tested on two additional patients who suffered a hip fracture after a fall. The results classified the patients in the high risk level, confirming the prediction power of the adopted model.

Skeletal Characteristics of Competitive Female Rowers

Weight-supported activities, such as rowing, are not commonly prescribed for fracture prevention. However, rowing requires large magnitudes of internal loading, thus it has potential to induce positive skeletal adaptations, especially in the hip and radius, two common fracture sites. PURPOSE: To examine skeletal health and body composition in college aged competitive female rowers. METHODS: In this cross-sectional study, 24 rowers and 24 age and body mass (±2yrs and 5lbs) matched physically active controls were compared. DXA was used to measure body composition and areal BMD (aBMD) of the total body, lumbar spine, hips and forearms, and hip structural analysis variables. pQCT was used to assess bone characteristics and bone strength of the tibiae (4%, 38%, 66%) and radii (4%, 66%) sites. RESULTS: Age- and height-adjusted aBMDs were not significantly different between groups (p>0.05), but rowers had greater hip cross-sectional moment of inertia (p≤0.05). Rowers had greater tibiae 4% total area, trabecular area, and periosteal circumference (PeriC) (p≤0.05). Also, total bone content and area, cortical area, PeriC, iPolar and SSI were greater at the tibiae 38% and 66% sites for rowers (p≤0.05). Controls had significantly greater 38% tibiae cortical density than rowers (p≤0.05). Rowers had significantly greater forearm muscle cross sectional area (p≤0.01) at the 66% radial site, and greater PeriC at the 4% radial site (p≤0.05). CONCLUSIONS: Rowers had greater tibiae bone area and strength compared to controls, but there were no group differences in aBMD or most radial bone variables. Our findings suggest that competitive rowing has osteogenic potential and may be particularly beneficial for improving bone quality at the tibiae even when compared to physically active controls.Table 1: Group comparisons of mean bilateral skeletal characteristics (means±SE)

Geometric indices of hip bone strength in overweight and control elderly men.

The aim of this study was to compare geometric indices of hip bone strength in overweight and control elderly men. This study included 16 overweight (Body mass index (BMI) > 25 kg/m2) elderly men (aged 65-84 years) and 38 age-matched controls (BMI < 25 kg/m2). Body composition and bone mineral density (BMD) were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate hip bone geometry, DXA scans were analyzed at the femoral neck, the intertrochanteric region, and the femoral shaft by the Hip Structure Analysis (HSA) program. Cross sectional area (CSA), an index of axial compression strength, section modulus (Z), an index of bending strength, cross sectional moment of inertia (CSMI), an index of structural rigidity, cortical thickness (CT) and buckling ratio (BR) were measured from bone mass profiles. Lean mass, body weight, fat mass and BMI were higher in overweight men compared to controls (p < 0.001). CSA and Z were higher in overweight subjects compared to controls (p < 0.05) at the three regions (femoral neck, intertrochanteric and femoral shaft). After adjustment for age, CSA and Z of the intertrochanteric region and the femoral shaft remained significantly higher in overweight men compared to controls (p < 0.05). After adjustment for either body weight, BMI or lean mass, there were no differences between the two groups (overweight and controls) regarding the HSA variables (CSA, CSMI, Z, CT and BR) of the three regions. This study suggests that overweight elderly men have greater indices of bone axial and bending strength in comparison to controls at the intertrochanteric and the femoral shaft.

Prediction of incident hip fracture with the estimated femoral strength by finite element analysis of DXA Scans in the study of osteoporotic fractures.

A bone fractures only when loaded beyond its strength. The purpose of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of dual-energy X-ray absorptiometry (DXA) scans, with incident hip fracture in comparison to hip bone mineral density (BMD), Fracture Risk Assessment Tool (FRAX), and hip structure analysis (HSA) variables. This prospective case-cohort study included a random sample of 1941 women and 668 incident hip fracture cases (295 in the random sample) during a mean ± SD follow-up of 12.8 ± 5.7 years from the Study of Osteoporotic Fractures (n = 7860 community-dwelling women ≥67 years of age). We analyzed the baseline DXA scans (Hologic 1000) of the hip using a validated plane-stress, linear-elastic finite element (FE) model of the proximal femur and estimated the femoral strength during a simulated sideways fall. Cox regression accounting for the case-cohort design assessed the association of estimated femoral strength with hip fracture. The age-body mass index (BMI)-adjusted hazard ratio (HR) per SD decrease for estimated strength (2.21; 95% CI, 1.95-2.50) was greater than that for total hip (TH) BMD (1.86; 95% CI, 1.67-2.08; p < 0.05), FN BMD (2.04; 95% CI, 1.79-2.32; p > 0.05), FRAX scores (range, 1.32-1.68; p < 0.0005), and many HSA variables (range, 1.13-2.43; p < 0.005), and the association was still significant (p < 0.05) after further adjustment for hip BMD or FRAX scores. The association of estimated strength with incident hip fracture was strong (Harrell's C index 0.770), significantly better than TH BMD (0.759; p < 0.05) and FRAX scores (0.711-0.743; p < 0.0001), but not FN BMD (0.762; p > 0.05). Similar findings were obtained for intracapsular and extracapsular fractures. In conclusion, the estimated femoral strength from FE analysis of DXA scans is an independent predictor and performs at least as well as FN BMD in predicting incident hip fracture in postmenopausal women.

Relations between Birth Weight and Hip Bone Strength Indices in a Group of Adolescent Girls

The aim of this study was to explore the relations between birth weight and hip bone strength indices in a group of adolescent girls. This study included 26 adolescent girls (153 +/- 2.9 years old). Weight and height were measured and body mass index (BMI) was calculated. Birth weights were obtained from obstetric records. Body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate bone geometry, DXA scans were analyzed at the femoral neck (FN), the intertrochanteric (IT) region and the femoral shaft (FS) by the Hip Structure Analysis (HSA) program. Cross sectional area (CSA), an index of axial compression strength, cross sectional moment of inertia (CSMI), an index of structural rigidity and section modulus (Z), an index of bending strength, were measured from bone mass profiles. Birth weight was positively correlated to CSA, CSMI and Z of the three sites (FN, IT and FS). However, the positive associations between birth weight and HSA variables disappeared after controlling for body weight. In this population, the positive associations between birth weight and hip bone strength indices disappear after controlling for body weight.

Geometric Indices of Hip Bone Strength in Obese, Overweight, and Normal-Weight Adolescent Girls

The aim of this study was to compare hip bone strength indices in obese, overweight, and normal-weight adolescent girls using hip structure analysis (HSA). This study included 64 postmenarcheal adolescent girls (14 obese, 21 overweight, and 29 normal weight). The 3 groups (obese, overweight, and normal weight) were matched for maturity (years since menarche). Body composition and bone mineral density (BMD) of whole body, lumbar spine, and proximal femur were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate hip bone strength, DXA scans were analyzed at the femoral neck (FN) at its narrow neck (NN) region, the intertrochanteric (IT), and the femoral shaft (FS) by the HSA program. Cross-sectional area and section modulus were measured from hip BMD profiles. Total hip BMD and FN BMD were significantly higher in obese and overweight girls in comparison with normal-weight girls (p < 0.05). However, after adjusting for weight, using a one-way analysis of covariance, there were no significant differences among the 3 groups regarding HSA variables. This study suggests that in obese and overweight adolescent girls, axial strength and bending strength indices of the NN, IT, and FS are adapted to the increased body weight.

DXA Femoral Neck Strength Analysis in Chinese Overweight and Normal Weight Adolescents

The aim of this study was to compare femoral neck (FN) strength in Chinese overweight adolescents with gender-matched normal weight controls and investigate the relationship of total body soft tissue composition (lean and fat masses) to indices of FN strength. Dual-energy X-ray absorptiometry (DXA) measurements of the proximal femur and total body were made in 65 Chinese overweight adolescents and 89 gender-matched normal weight controls using Lunar Prodigy DXA bone densitometer (GE Healthcare, Madison, WI). FN bone mineral density (BMD), total body lean mass, fat mass, and bone mineral content (BMC) were measured. Using FN BMD values derived from DXA measurements, hip structural analysis (HSA) was performed using Lunar enCORE (GE Healthcare), version 10.5 software. Structural parameters derived by HSA were bone cross-sectional area (CSA), cross-sectional moment of inertia (CSMI), and the section modulus (Z). Data were analyzed by Student’s t-test, Pearson correlation coefficients (r), and one-way analysis of covariance (ANCOVA). Overweight boys and girls had higher body weight, lean mass, fat mass, and body mass index (p<0.001) than normal controls. CSA, CSMI, and Z were higher in overweight groups compared with controls (p<0.05). Lean mass correlated well with all HSA parameters (range of r: 0.501–0.714) for both genders. ANCOVA test showed no significant differences between overweight and normal weight groups regarding HSA variables in both genders after adjustment for lean mass. However, the differences remain significant after adjustment for fat mass in boys but not in girls. This study supports the conclusion that overweight individuals have greater hip neck strength in comparison with normal weight controls in Chinese adolescents. Lean mass is a major determinant for FN strength.

Hip bone strength indices in overweight and control adolescent boys

The influence of being overweight on bone strength in adolescents remains controversial. The aim of this study was to compare hip bone strength indices in overweight and control adolescent boys using hip structure analysis (HSA). This study included 25 overweight adolescent boys [body mass index (BMI) >25 kg/m(2)] and 31 maturation-matched controls (BMI <25 kg/m(2)). Body composition and bone mineral density were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate hip bone strength, DXA scans were analyzed at femoral neck, intertrochanteric, and femoral shaft by the HSA program. Cross-sectional area (CSA), an index of axial compression strength, section modulus (Z), an index of bending strength, cross-sectional moment of inertia (CSMI), cortical thickness (CT), and buckling ratio (BR) were measured from bone mass profiles. Body weight, lean mass, fat mass, and BMI were higher in overweight boys compared to controls (P < 0.001). CSA, CSMI, and Z of the three sites (femoral neck, intertrochanteric, and femoral shaft) were higher in overweight boys compared to controls (P < 0.01). BR was not significantly different between the two groups at the three sites. After adjustment for either body weight, BMI, or fat mass, using a one-way analysis of covariance, there were no differences between the two groups regarding the HSA variables (CSA, Z, CSMI, CT, and BR). After adjusting for lean mass, overweight boys displayed higher values of femoral shaft CSA, CSMI, and Z in comparison to controls (P < 0.05). In conclusion, this study suggests that overweight adolescent boys have greater indices of bone axial and bending strength in comparison to controls at the femoral neck, the intertrochanteric, and the femoral shaft.

Femoral neck geometry in overweight and normal weight adolescent girls

Being overweight is associated with increased bone mineral content, bone mineral density (BMD), and bone strength in adults. However, the effect of being overweight on bone strength during adolescence is poorly understood. The aim of this study was to compare femoral neck geometry in overweight and normal weight adolescent girls. This study included 22 overweight (BMI > 25 kg/m(2)) adolescent girls (15.4 +/- 2.4 years old) and 20 maturation-matched (15.2 +/- 1.9 years old) controls (BMI < 25 kg/m(2)). Body composition and BMD were assessed by dual-energy X-ray absorptiometry (DXA). To evaluate bone geometry, DXA scans were analyzed at the femoral neck by the hip structure analysis (HSA) program. Cross-sectional area (CSA), an index of axial compression strength, section modulus (Z), an index of bending strength, cross-sectional moment of inertia (CSMI), cortical thickness (CT), and buckling ratio (BR) were measured from bone mass profiles. Lean mass, body weight, fat mass, and BMI were higher in overweight girls compared to controls (P < 0.001). CSA, Z, and CSMI were higher in overweight girls compared to controls (P < 0.05; P < 0.01 and P < 0.01, respectively). CT and BR were not significantly different between the two groups. After adjustment for body weight, lean mass, or fat mass, using a one-way analysis of covariance (ANCOVA), there were no differences between the two groups (overweight and controls) regarding the HSA variables (CSA, Z, CSMI, CT, and BR). In conclusion, this study suggests that overweight adolescent girls have greater indices of bone axial and bending strength in comparison to controls at the femoral neck.

Prediction of Incident Hip Fracture Risk by Femur Geometry Variables Measured by Hip Structural Analysis in the Study of Osteoporotic Fractures

The role of bone tissue's geometric distribution in hip fracture risk requires full evaluation in large population-based datasets. We tested whether section modulus, a geometric index of bending strength, predicted hip fracture better than BMD. Among 7474 women from the Study of Osteoporotic Fractures (SOF) with hip DXA scans at baseline, there were 635 incident hip fractures recorded over 13 yr. Hip structural analysis software was used to derive variables from the DXA scans at the narrow neck (NN), intertrochanter (IT), and shaft (S) regions. Associations of derived structural variables with hip fracture were assessed using Cox proportional hazard modeling. Hip fracture prediction was assessed using the C-index concordance statistic. Incident hip fracture cases had larger neck-shaft angles, larger subperiosteal and estimated endosteal diameters, greater distances from lateral cortical margin to center of mass (lateral distance), and higher estimated buckling ratios (p < 0.0001 for each). Areal BMD, cross-sectional area, cross-sectional moment of inertia, section modulus, estimated cortical thickness, and centroid position were all lower in hip fracture cases (p < 0.044). In hip fracture prediction using NN region parameters, estimated cortical thickness, areal BMD, and estimated buckling ratio were equivalent (C-index = 0.72; 95% CI, 0.70, 0.74), but section modulus performed less well (C-index = 0.61; 95% CI, 0.58, 0.63; p < 0.0001 for difference). In multivariable models combining hip structural analysis variables and age, effects of bone dimensions (i.e., lateral distance, subperiosteal diameter, and estimated endosteal width) were interchangeable, whereas age and neck-shaft angle were independent predictors. Several parsimonious multivariable models that were prognostically equivalent for the NN region were obtained combining a measure of width, a measure of mass, age, and neck-shaft angle (BMD is a ratio of mass to width in the NN region; C-index = 0.77; 95% CI, 0.75, 0.79). Trochanteric fractures were best predicted by analysis of the IT region. Because section modulus failed to predict hip fracture risk as well as areal BMD, the thinner cortices and wider bones among those who fractured may imply that simple failure in bending is not the usual event in fracture. Fracture might require initiation (e.g., by localized crushing or buckling of the lateral cortex).

Comparison of DXA Hip Structural Analysis with Volumetric QCT

Hip structural analysis (HSA) estimates geometrical and mechanical properties from hip dual-energy X-ray absorptiometry (DXA) images and is widely used in osteoporosis trials. This study compares HSA to volumetric quantitative computed tomography (QCT) measurements in the same population. A total of 121 women (mean age 58 yr, mean body mass index 27 kg/m 2) participated. Each woman received a volumetric QCT scan and DXA scan of the left hip. QCT scans were analyzed with in-house software that directly computed geometric and mechanical parameters at the neck and trochanteric regions. DXA HSA was performed with an implementation by GE/Lunar. Pair-wise linear regression of HSA variables was conducted by method to site matched QCT variables for bone density, cross-sectional area, and cross-sectional moment of inertia (CSMI) of the femur neck. HSA correlated well with QCT ( r 2 = 0.67 for neck bone mineral density [BMD] and 0.5 for CSMI) and standard DXA at the neck ( r 2 = 0.82 for BMD). HSA and volumetric QCT compared favorably, which supports the validity of a projective technique such as DXA to derive geometrical properties of the proximal hip.

Bone cross-sectional geometry in adolescents and young women with anorexia nervosa: a hip structural analysis study.

Better characterization of bone geometry in adolescents with anorexia nervosa (AN) may improve understanding of skeletal deficits in this population. Our objective was to determine whether hip cross-sectional geometry and bone strength were altered in adolescents with AN. Measurements of the left total proximal femur and body composition were obtained in 85 adolescents with AN and 61 healthy controls by dual X-ray absorptiometry. The Hip Structural Analysis (HSA) program was used to determine aBMD, cross-sectional area (CSA), and section modulus (Z) at the femoral neck and shaft. Strength indices were calculated and corrected for lean mass. Femoral neck and shaft aBMD were lower in AN patients than healthy controls (-36% and -29%, p < 0.001). In both regions, bone CSA and Z were lower in AN sufferers (-11 to -35%, p < 0.001). While lean body mass correlated with HSA variables (r = 0.48 to 0.58, p < 0.001), body fat did not. AN sufferers had lower indices of both whole bone strength (-40%, p < 0.001) and relative bone strength (-36%, p < 0.001) than controls. Anorexia nervosa sufferers had decreased resistance to axial (CSA) and bending loads (Z) compared with healthy controls. Differences in strength properties were significant even when adjusted for lean mass, suggesting that not only decreased mechanical loading, but also known metabolic differences are likely responsible for deficits in bone strength in these patients.

In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials

Hip structural analysis (HSA) is a technique for extracting strength-related structural dimensions of bone cross-sections from two-dimensional hip scan images acquired by dual energy X-ray absorptiometry (DXA) scanners. Heretofore the precision of the method has not been thoroughly tested in the clinical setting. Using paired scans from two large clinical trials involving a range of different DXA machines, this study reports the first precision analysis of HSA variables, in comparison with that of conventional bone mineral density (BMD) on the same scans. A key HSA variable, section modulus ( Z), biomechanically indicative of bone strength during bending, had a short-term precision percentage coefficient of variation (CV%) in the femoral neck of 3.4–10.1%, depending on the manufacturer or model of the DXA equipment. Cross-sectional area (CSA), a determinant of bone strength during axial loading and closely aligned with conventional DXA bone mineral content, had a range of CV% from 2.8% to 7.9%. Poorer precision was associated with inadequate inclusion of the femoral shaft or femoral head in the DXA-scanned hip region. Precision of HSA-derived BMD varied between 2.4% and 6.4%. Precision of DXA manufacturer-derived BMD varied between 1.9% and 3.4%, arising from the larger analysis region of interest (ROI). The precision of HSA variables was not generally dependent on magnitude, subject height, weight, or conventional femoral neck densitometric variables. The generally poorer precision of key HSA variables in comparison with conventional DXA-derived BMD highlights the critical roles played by correct limb repositioning and choice of an adequate and appropriately positioned ROI.