Top

Osteoporosis International

Published in:

01-07-2012 | Original Article

Comparative high-resolution pQCT analysis of femoral neck indicates different bone mass distribution in osteoporosis and osteoarthritis

Authors: A. Rubinacci, D. Tresoldi, E. Scalco, I. Villa, F. Adorni, G. L. Moro, G. F. Fraschini, G. Rizzo

Published in: Osteoporosis International | Issue 7/2012

Abstract

Summary

Osteoarthritis is linked to a reduced risk of femoral fracture despite osteoporosis. Different bone distribution in the femoral neck in osteoarthritis and fracture was revealed using a peripheral quantitative computed tomography (pQCT) comparative analysis. Our findings sustain the presence of an adaptive mechanism of bone structure providing fracture protection in osteoarthritis.

Introduction

Although osteoarthritis is associated with reduced femoral fracture risk, it does not protect from bone loss. We investigated whether adaptive mechanisms are present at the arthritic joint, leading to reduced fracture risk, despite the presence of low bone mass density.

Methods

We performed pQCT comparative analyses of human femoral neck specimens derived from 32 postmenopausal women who received hip prostheses for osteoarthritis (n = 19) or femoral fracture (n = 13) by applying an in-house automated software to extract bone structure descriptors, characterize trabecular and cortical bone distribution, and evaluate their mutual relationships.

Results

The cortical bone volume and trabecular thickness were significantly (p < 0.05) higher in the osteoarthritis group than in the fracture group. Trabecular bone volume was also significantly (p < 0.05) higher in the osteoarthritis group than the fracture group at the inferior and anterior quadrants. Significance was maintained after adjusting for age, cortical bone volume, and cortical porosity thickness. Multiple linear regression analysis showed that thickness, volume, and apparent density of the trabecular region significantly (p < 0.05) correlated with the same cortical descriptors in osteoarthritis, but no significant relationship was found in the fracture group. Age differentially affected the mutual relationships in the two groups, showing a significant correlation with trabecular thickness in both groups and with apparent trabecular density only in femoral fracture group.

Conclusions

Starting from these differences in the structural descriptors, our study sustains the presence of a compensatory mechanism in osteoarthritis to preserve the mechanical competence of bone structure, despite the loss of trabecular bone, underlying lower fracture risk.

Foss MV, Byers PD (1972) Bone density, osteoarthrosis of the hip, and fracture of the upper end of the femur. Br Med J 31:259

Dequeker J, Aerssens J, Luyten FP (2003) Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res 15:426–439PubMed

Cauley JA, Fullman RL, Stone KL, Zmuda JM, Bauer DC, Barrett-Connor E, Ensrud K, Lau EMC, Orwoll ES (2005) Factors associated with the lumbar spine and proximal femur bone mineral density in older men. Osteoporosis Int 16:1525–1537CrossRef

Vestergaard P, Rejnmark L, Mosekilde L (2009) Osteoarthritis and risk of fractures. Calcif Tissue Int 84:249–256PubMedCrossRef

Arden NK, Nevitt MC, Lane NE, Gore LR, Hochberg MC, Scott JC, Pressman AR, Cummings SR (1999) Osteoarthritis and risk of falls, rates of bone loss, and osteoporotic fractures. Arthritis Rheum 42:1378–1385PubMedCrossRef

Antoniades L, MacGregor AJ, Matson M, Spector TD (2000) A cotwin control study of the relationship between hip osteoarthritis and bone mineral density. Arthritis Rheum 43:1450–1455PubMedCrossRef

Fazzalari NL, Parkinson IH (1998) Femoral trabecular bone of osteoarthritic and normal subjects in an age and sex matched group. Osteoarthritis Cartilage 6:377–382PubMedCrossRef

Papaloucas CD, Ward RJ, Tonkin CJ, Buckland-Wright C (2005) Cancellous bone changes in hip osteoarthritis: a short-term longitudinal study using fractal signature analysis. Osteoarthritis Cartilage 13:998–1003PubMedCrossRef

Zhang ZM, Li ZC, Jiang LS, Jiang SD, Dai LY (2010) Micro-CT and mechanical evaluation of subchondral trabecular bone structure between postmenopausal women with osteoarthritis and osteoporosis. Osteoporosis Int 8:1383–1390CrossRef

10.

McDonald Blumer MH (2005) Bone mineral content versus bone density in a population with osteoarthritis: a new twist to the controversy? J Rheumatol 32:1868–1869PubMed

11.

Glowacki J, Hurwitz S, Thornhill TS, Kelly M, LeBoff MS (2003) Osteoporosis and vitamin-D deficiency among postmenopausal women with osteoarthritis undergoing total hip arthroplasty. J Bone Joint Surg Am 85:2371PubMed

12.

Mäkinen TJ, Alm JJ, Laine H, Svedström E, Aro HT (2007) The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone 40:1041–1047PubMedCrossRef

13.

Ding C, Cicuttini F, Boon C, Boon P, Srikanth V, Cooley H, Jones G (2010) Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: a prospective study. J Bone Miner Res 25:858–865PubMed

14.

Buckland-Wright JC, Lynch JA, Macfarlane DG (1996) Fractal signature analysis measures cancellous bone organisation in macroradiographs of patients with knee osteoarthritis. Ann Rheum Dis 55:749PubMedCrossRef

15.

Rizzo G, Scalco E, Tresoldi D, Villa I, Moro GL, Lafortuna CL, Rubinacci A (2011) An automatic segmentation method for regional analysis of femoral neck images acquired by pQCT. Ann Biomed Eng 39(1):172–184PubMedCrossRef

16.

MacNeil JA, Boyd SK (2007) Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality. Med Eng Phys 29:1096–1105PubMedCrossRef

17.

MacNeil JA, Boyd SK (2008) Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone 42:1203–1213PubMedCrossRef

18.

Ciarallo A, Barralet J, Tanzer M, Kremer R (2006) An approach to compare the quality of cancellous bone from the femoral necks of healthy and osteoporotic patients through compression testing and microcomputed tomography imaging. McGill J Med 9:102–107PubMed

19.

Amin S (2002) Osteoarthritis and bone mineral density: what is the relation and why does it matter? J Rheumatol 29:1348PubMed

20.

Crabtree N, Loveridge N, Parker M, Rushton N, Power J, Bell KL, Beck TJ, Reeve J (2001) Intracapsular hip fracture and the region-specific loss of cortical bone: analysis by peripheral quantitative computed tomography. J Bone Miner Res 16:1318–1328PubMedCrossRef

21.

Laib A, Ruegsegger P (1999) Comparison of structure extraction methods for in vivo trabecular bone measurements. Comput Med Imaging Graph 23:69–74PubMedCrossRef

22.

Hildebrand T, Ruegsegger P (1997) A new method for the model-independent assessment of thickness in three-dimensinal images. J Microsc 185:67–75CrossRef

23.

Ashman RB, Rho JY (1988) Elastic modulus of trabecular bone material. J Biomech 21:177–181PubMedCrossRef

24.

Li B, Aspden RM (1997) Material properties of bone from the femoral neck and calcar femorale of patients with osteoporosis or osteoarthritis. Osteoporosis Int 7:450–456CrossRef

25.

Ciarelli TE, Fyhrie DP, Schaffler MB, Goldstein SA (2000) Variations in three-dimensional cancellous bone architecture of the proximal femur in female hip fractures and in controls. J Bone Miner Res 15:32–40PubMedCrossRef

26.

Lotz JC, Cheal EJ, Hayes WC (1995) Stress distributions within the proximal femur during gait and falls: implications for osteoporotic fracture. Osteoporosis Int 5:252–261CrossRef

27.

Verhulp E, van Rietbergen B, Huiskes R (2008) Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side. Bone 42:30–35PubMedCrossRef

28.

Mayhew PM, Thomas CD, Clement JG, Loveridge N, Beck TJ, Bonfield W, Burgoyne CJ, Reeve J (2005) Relation between age, femoral neck cortical stability, and hip fracture risk. Lancet 366:129–135PubMedCrossRef

29.

Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J (1999) Regional differences in cortical porosity in the fractured femoral neck. Bone 24:57–64PubMedCrossRef

30.

Sun SS, Ma HL, Liu CL, Huang CH, Cheng CK, Wei HW (2008) Difference in femoral head and neck material properties between osteoarthritis and osteoporosis. Clin Biomech (Bristol, Avon) 23:S39CrossRef

31.

Jordan GR, Loveridge N, Bell KL, Power J, Dickson GR, Vedi S, Rushton N, Clarke MT, Reeve J (2003) Increased femoral neck cancellous bone and connectivity in coxarthrosis (hip osteoarthritis). Bone 32:86–95PubMedCrossRef

32.

Blain H, Chavassieux P, Portero-Muzy N, Bonnel F, Canovas F, Chammas M, Maury P, Delmas PD (2008) Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. Bone 43:862–868PubMedCrossRef

33.

Hernandez CJ, Keaveny TM (2006) A biomechanical perspective on bone quality. Bone 39:1173–1181PubMedCrossRef

34.

Hochberg MC, Lethbridge-Cejku M, Tobin JD (2004) Bone mineral density and osteoarthritis: data from the Baltimore Longitudinal Study of Aging1. Osteoarthritis Cartilage 12:45–48CrossRef

35.

Abdin-Mohamed M, Jameson K, Dennison EM, Cooper C, Arden NK, Hertfordshire Cohort Study Group (2009) Volumetric bone mineral density of the tibia is not increased in subjects with radiographic knee osteoarthritis. Osteoarthritis Cartilage 17:174–177PubMedCrossRef

36.

Lingard EA, Mitchell SY, Francis RM, Rawlings D, Peaston R, Birrell FN, McCaskie AW (2010) The prevalence of osteoporosis in patients with severe hip and knee osteoarthritis awaiting joint arthroplasty. Age Ageing 39:234–239PubMedCrossRef

37.

Sandini L, Arokoski J, Jurvelin JS, Kröger H (2005) Increased bone mineral content but not bone mineral density in the hip in surgically treated knee and hip osteoarthritis. J Rheumatol 32:1951PubMed

38.

Bennell KL, Creaby MW, Wrigley TV, Hunter DJ (2008) Tibial subchondral trabecular volumetric bone density in medial knee joint osteoarthritis using peripheral quantitative computed tomography technology. Arthritis Rheum 58:2776–2785PubMedCrossRef

39.

Schneider DL, Barrett-Connor E, Morton DJ, Weisman M (2002) Bone mineral density and clinical hand osteoarthritis in elderly men and women: the Rancho Bernardo study. J Rheumatol 29:1467PubMed

40.

Zebaze RM, Jones A, Knackstedt M, Maalouf G, Seeman E (2007) Construction of the femoral neck during growth determines its strength in old age. J Bone Miner Res 22:1055–1061PubMedCrossRef

41.

Javaid MK, Lane NE, Mackey DC, Lui LY, Arden NK, Beck TJ, Hochberg MC, Nevitt MC (2009) Changes in proximal femoral mineral geometry precede the onset of radiographic hip osteoarthritis. Arthritis Rheum 60:2028–2036PubMedCrossRef

42.

Stromsoe K, Hoiseth A, Alho A, Kok WL (1995) Bending strength of the femur in relation to non-invasive bone mineral assessment. J Biomech 28:857–861PubMedCrossRef

43.

Breijawi N, Eckardt A, Pitton MB, Hoelzl AJ, Giesa M, von Stechow D, Haid F, Drees P (2008) Bone mineral density and vitamin D status in female and male patients with osteoarthritis of the knee or hip. Eur Surg Res 42:1–10PubMedCrossRef

44.

Lotinun S, Evans GL, Bronk JT, Bolander ME, Wronski TJ, Ritman EL, Turner RT (2004) Continuous parathyroid hormone induces cortical porosity in the rat: effects on bone turnover and mechanical properties. J Bone Miner Res 19:1165–1171PubMedCrossRef

45.

Bousson V, Meunier A, Bergot C, Vicaut E, Rocha MA, Morais MH, Laval-Jeantet AM, Laredo JD (2001) Distribution of intracortical porosity in human midfemoral cortex by age and gender. J Bone Miner Res 16:1308–1317PubMedCrossRef

46.

Manolagas SC, Parfitt AM (2010) What old means to bone. Trends Endocrinol Metab 21:369–374PubMedCrossRef

Title: Comparative high-resolution pQCT analysis of femoral neck indicates different bone mass distribution in osteoporosis and osteoarthritis
Authors: A. Rubinacci
D. Tresoldi
E. Scalco
I. Villa
F. Adorni
G. L. Moro
G. F. Fraschini
G. Rizzo
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 7/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1795-7

At a glance: The STEP trials

Springer Medicine

Comparative high-resolution pQCT analysis of femoral neck indicates different bone mass distribution in osteoporosis and osteoarthritis

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2012

Comment on: cost-effectiveness of denosumab for the treatment of postmenopausal osteoporosis

Fat mass is negatively associated with bone mineral content in Koreans

Polymorphisms in the human ALOX12 and ALOX15 genes are associated with peak bone mineral density in Chinese nuclear families

Frailty and sarcopenia: definitions and outcome parameters

Quality of life and health status with zoledronic acid and generic alendronate—a secondary analysis of the Rapid Onset and Sustained Efficacy (ROSE) study in postmenopausal women with low bone mass

Serum adiponectin and bone mineral density in male hemodialysis patients