Top

Published in:

01-07-2008 | Musculoskeletal

Vertebral morphometry: current methods and recent advances

Authors: G. Guglielmi, D. Diacinti, C. van Kuijk, F. Aparisi, C. Krestan, J. E. Adams, T. M. Link

Published in: European Radiology | Issue 7/2008

Abstract

Vertebral fractures are the hallmark of osteoporosis and are associated with increased morbility and mortality. Because a majority of vertebral fractures often occur in absence of specific trauma and are asymptomatic, their identification is radiographic. The two most widely used methods to determine the severity of vertebral fractures are the visual semiquantitative (SQ) assessment and the morphometric quantitative approach, involving the measurements of vertebral body heights. The measurements may be made on conventional spinal radiographs (MRX: morphometric X-ray radiography) or on images obtained from dual X-ray absorptiometry (DXA) scans (MXA: morphometric X-ray absorptiometry).The availability of a rapid, low-dose method for assessment of vertebral fractures, using advanced fan-beam DXA devices, provides a practical method for integrated assessment of BMD and vertebral fracture status. The visual or morphometric assessment of lateral DXA spine images may have a potential role for use as a prescreening tool, excluding normal subjects prior to performing conventional radiographs.

Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMed

Pongchaiyakul C, Nguyen ND, Jones G et al (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 20:1349–1355CrossRefPubMed

Lindsay R, Pack S, Li Z (2005) Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporosis Int 16:306–312CrossRef

Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767CrossRefPubMed

Finnern HW, Sykes DP (2003) The hospital cost of vertebral fractures in the EU: estimates using national datasets. Osteoporos Int 14:429–436CrossRefPubMed

Link TM, Guglielmi G, van Kuijk C, Adams JE (2003) The hospital cost of vertebral fractures in the EU: estimates using national datasets. Eur Radiol 15:1521–1532CrossRef

Jackson SA, Tenenhouse A, Robertson L, the CaMos Study Group (2000) Vertebral fracture definition from population-based data: preliminary results from the Canadian Multicenter Osteoporosis Study (CaMos). Osteoporos Int 11:680–687CrossRefPubMed

Melton LJ III (1997) Epidemiology of spinal osteoporosis. Spine 22(Suppl 1):2S–11SCrossRefPubMed

Roy DK, O’Neill TW, Finn JD, Lunt M, Silman AJ et al (2003) Determinants of incident vertebral fracture in men and women: results from the European prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26CrossRefPubMed

10.

Center JR, Nguyen TV, Schneider D et al (1999) Mortality after all major types of osteoporotic fractures in men and women: an observational study. Lancet 353:878–882CrossRefPubMed

11.

Kado DM, Browner WS, Palermo L et al (1999) Vertebral fractures and mortality in older women: study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220CrossRefPubMed

12.

Burger H, Van Daele PLA, Gashuis K et al (1997) Vertebral deformities and functional impairment in men and women. J Bone Miner Res 12:152–157CrossRefPubMed

13.

Fink HA, Ensrud KE, Nelson DB et al (2003) Disability after clinical fracture in postmenopausal women with low bone density: The Fracture Intervention Trial (FIT). Osteoporos Int 14:69–76CrossRefPubMed

14.

Hasserius R, Karlsson MK, Jonsson B et al (2005) Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly-a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int 76:235–242CrossRefPubMed

15.

Nevitt MC, Ettinger B, Black DM et al (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800PubMed

16.

Schlaich C, Minne HW, Bruckner T et al (1998) Reduced pulmonary function in patient with spinal osteoporotic fractures. Osteoporos Int 8:261–267CrossRefPubMed

17.

Delmas PD, Genant HK, Crans GG et al (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from MORE trial. Bone 33:522–532CrossRefPubMed

18.

Chesnut CH III, Skag A, Christiansen C et al (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249CrossRef

19.

Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomised clinical trial- Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 282:637–645CrossRefPubMed

20.

Liberman UA, Weiss SR, Broll J et al (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. N Engl J Med 333:1437–1443CrossRefPubMed

21.

Mc Closkey E, Selby P, de Takats D et al (2001) Effects of clodronate on vertebral fracture risk in osteoporosis: a 1-year interim analysis. Bone 28(3):310–315 2001CrossRef

22.

Neer RM, Arnaud CD, Zanchetta JR et al (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441CrossRefPubMed

23.

Reid DM, Hughes RA, Laan RFJM et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. European Corticosteroid-Induced Osteoporosis Treatment Study. J Bone Miner Res 15:1006–1013

24.

Fink AH, Milavetz DL, Palermo L et al (2005) What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 20:1216–1222CrossRefPubMed

25.

Hedlund LR, Gallagher JC (1988) Vertebral morphometry in diagnosis of spinal fractures. Bone Miner 5:59–67CrossRefPubMed

26.

Eastell R, Cedel SL, Wahner H et al (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215PubMed

27.

Mc Closkey EV, Spector TD, Eyres KS et al (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3:138–147CrossRef

28.

Minne HW, Leidig C, Wuster CHR et al (1988) A newly developed spine deformity index (SDI) to quantitative vertebral crush fractures in patients with osteoporosis. Bone Miner 3:335–349PubMed

29.

Kleerekoper M, Nelson DA (1992) Vertebral fracture or vertebral deformity? Calcif Tissue Int 50:5–6CrossRefPubMed

30.

Genant HK, Siris E, Crans GG et al (2005) Reduction in vertebral fracture risk in teriaparatide-treated postmenopausal women as assessed by spinal deformity index. Bone 37:170–174CrossRefPubMed

31.

Crans GG, Genant HK, Krege JH (2005) Measurement of vertebral heights. Bone 37:175–179CrossRefPubMed

32.

Genant HK, Jergas M, Palermo L et al (1996) Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis. J Bone Miner Res 11:984–996PubMed

33.

Barnett E, Nordin BEC (1960) Radiographic diagnosis of osteoporosis: new approach. Clin Radiol 11:166–174CrossRefPubMed

34.

Jergas M, San Valentin R (1995) Techniques for the assessment of vertebral dimensions in quantitative morphometry. In: Genant HK, Jergas M, van Juijk C (eds) Vertebral Fracture In Osteoporosis. University of California Osteoporosis Research Group, San Francisco, pp 163–188

35.

Hurxthal LM (1968) Measurement of vertebral heights. AJR 103:635–644

36.

Diacinti D, Acca M, Tomei E (1995) Metodica di’radiologia digitale per la valutazione dell’osteoporosi vertebrale. Radiol Med 91:1–5

37.

Nelson D, Peterson E, Tilley B et al (1990) Measurement of vertebral area on spine X-rays in osteoporosis: reliability of digitizing techniques. J Bone Miner Res; 5:707–716PubMed

38.

Kalidis L, Felsenberg D, Kalender WA et al (1992) Morphometric analysis of digitized radiographs: descrption of automatic evaluation. In: Ring EFJ (ed) Current research in osteoporosis and bone mineral measurement II. British Institute of Radiology, London, pp 14–16

39.

Nicholson PHF, Haddaway MJ, Davie MWJ et al (1993) A computerized technique for vertebral morphometry. Physiol Meas 14:195–204CrossRefPubMed

40.

O’Neill TW, Felsenberg D, Varlow J et al (1996) The prevalence of vertebral deformity in European men and women: The European Vertebral Osteoporosis Study. J Bone Miner Res 11:1010–1018PubMed

41.

Smyth PP, Taylor CJ, Adams JE (1999) Vertebral shape: automatic measurement with active shape models. Radiology 211:571–578PubMed

42.

Roberts M, Cootes TF, Adams JE (2006) Vertebral morphometry: semiautomatic determination of detailed shape from dual-energy X-ray absorptiometry images using active appearance models. Invest Radiol 41(12):849–859CrossRefPubMed

43.

Zamora G, Sari-Sarraf H, Long LR (2003) Hierarchical segmentation of vertebrae from X-ray images. In Proc. of SPIE Medical Imaging 5032:631–642

44.

Howe B, Gururajan A, Sari-Sarraf H, Long LR (2004) Hierarchical segmentation of cervical and lumbar vertebrae using a customized generalized Hough transform and extensions to active appearance models. In: Proc IEEE 6^th SSIAI; 182–186

45.

de Bruijne M and Nielsen M (2004) Image segmentation by shape particle filtering. In: Proc. 17th International Conference on Pattern Recognition 2004;722–725

46.

Guglielmi G, Palmieri F, Placentino MG et al (2008) Assessment of osteoporotic vertebral fractures using specialized workflow software for six point morphometry. Eur J Radiol Jan 31 [Epub ahead of print] DOI 10.1016/j.ejrad.2007.12.001

47.

Guglielmi G, Stoppino LP, Placentino MG et al (2007) Reproducibility of a Semi-Automatic Method for 6-Point Vertebral Morphometry in a Multi-Centre Trial. Eur J Radiol Dec 8 [Epub ahead of print] DOI 10.1016/j.ejrad.2007.09.040

48.

Banks LM, van Juijk C, Genant HK (1995) Radiographic technique for assessing osteoporotic vertebral fracture. In: Genant, Jergas M, van Juijk C (eds) Vertebral Fracture In Osteoporosis. University of California Osteoporosis Research Group, San Francisco, pp 131–147

49.

Gallagher JC, Hedlund LR, Stoner S et al (1988) Vertebral morphometry: normative data. Bone Miner 4:189–196PubMed

50.

Adams JE (1997) Single and dual energy X-ray absorptiometry. In: Guglielmi G, Passariello R,Genant HK (eds) Bone Densitometry: an update. Eur Radiol 7(Suppl 2):S20–S31

51.

Steiger P, Cummings SR, Genant HK, Weiss H, the Study of Osteoporotic Fractures Research Group (1994) Morphometric X-ray absorptiometry of the spine: correlation in vivo with morphometric radiography. Osteoporos Int 4:238–244CrossRefPubMed

52.

Blake JM, Jagathesan T, Herd RJM, Fogelman I (1994) Dual X-ray absorptiometry of the lumbar spine: the precision of paired anteroposterior/lateral studies. Br J Radiol 67:624–630PubMed

53.

Gardner JC, von Ingersleben G, Heyano SL et al (2001) An interactive tutorial-based training technique for vertebral morphometry. Osteoporosis Int 12:63–70CrossRef

54.

Blake GM, Rea JA, Fogelman I (1997) Vertebral morphometry studies using dual-energy X-ray absorptiometry. Semin Nucl Med 27:276–290CrossRefPubMed

55.

Harvey SB, Hutchinson KM, Rennie EC et al (1998) Comparison of the precision of two vertebral morphometry programs for the Lunar Expert-XL imaging densitometer. Br J Radiol 71:388–398PubMed

56.

Crabtree N, Wright J, Walgrove A et al (2000) Vertebral morphometry: repeat scan precision using the Lunar Expert-XL and the Hologic 4500A. A study for the ‘WISDOM’ RCT of hormone replacement therapy. Osteoporos Int 11:537–543

57.

Ferrar L, Jiang G, Eastell R et al (2003) Visual identification of vertebral fractures in osteoporosis using morphometric X-ray absorptiometry. J Bone Miner Res 18:933–938CrossRefPubMed

58.

Kalender WA, Eidloth H (1991) Determination of geometric parameters and osteoporosis indices for lumbar vertebrae from lateral QCT localizer radiographs. Osteoporos Int 1:197–200

59.

Lewis MK, Blake GM (1995) Patient dose in morphometric X-ray absorptiometry (letter). Osteoporos Int 5:281–282CrossRefPubMed

60.

Njeh CF, Fuerst T, Hans D et al (1999) Radiation exposure in bone mineral density assessment. Appl Radiat Isot 50:215–236CrossRefPubMed

61.

Rea JA, Li J, Blake GM et al (2000) Visual assessment of vertebral deformity by X-ray absorptiometry: a highly predictive method to exclude vertebral deformity. Osteoporos Int 11:660–668CrossRefPubMed

62.

Edmondston SJ, Price RI, Valente B et al (1999) Measurement of vertebral body height: ex vivo comparison between morphometric X-ray absorptiometry, morphometric radiography and direct measurements. Osteoporosis Int 10:7–13CrossRef

63.

Rea JA, Chen MB, Li J et al (2000) Morphometry X-ray absorptiometry and morphometric radiography of the spine: a comparison of prevalent vertebral deformity identification. J Bone Miner Res 15:564–574CrossRefPubMed

64.

Steiger P, Wahner H (1994) Instruments using fan-beam geometry. In: Wahner, Fogelman I (eds) The Evaluation of Osteoporosis. Dual Energy X-Ray Absorptiometry in Clinical Practice. Martin Dunitz, Ltd., London, pp 281–288

65.

Djoumessi RMZ, Maalouf G, Wehbe J et al (2004) The varying distribution of intra-and intervertebral height ratios determines the prevalence of vertebral fractures. Bone 35:348–356CrossRefPubMed

66.

O’Neill TW, Varlow J, Felsenberg D et al (1994) Variation in vertebral heights ratios in population studies. J Bone Miner Res 9:1895–1907PubMed

67.

Smith-Bindman R, Cummings SR, Steiger P et al (1991) A comparison of morphometric definitions of vertebral fracture. J Bone Miner Res 6:25–34PubMed

68.

Cline MG, Meredith KE, Boyer JT et al (1989) Decline in height with age in adults in a general population sample: estimating maximum height and distinguishing birth cohort effect from actual loss of stature with aging. Hum Biol 61:415–425PubMed

69.

Diacinti D, Acca M, D’Erasmo E et al (1995) Aging changes in vertebral morphometry. Calcif Tissue Int 57:426–429CrossRefPubMed

70.

Nicholson PHF, Haddaway MJ, Davie MWJ et al (1993) Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years. Osteoporos Int 3:300–307CrossRefPubMed

71.

Evans SF, Nicholson PHF, Haddaway MJ et al (1993) Vertebral morphometry in women aged 50–81 years. Bone Miner 21:29–40PubMedCrossRef

72.

Melton LJ III, Kan SH, Frye MA et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1010PubMed

73.

Black DM, Cummings SR, Stone K et al (1991) A new approach to defining normal vertebral dimensions. J Bone Miner Res 6:883–892PubMed

74.

Hermann AP, Brixen K, Andersen J et al (1993) Reference values for vertebral heights in Scandinavian females and males. Acta Radiologica 34:48–52PubMedCrossRef

75.

Diacinti D, Francucci C, Fiore C et al (2005) Italian preliminary reference data of normal vertebral dimensions for morphometric X-ray absorptiometry (MXA): Normal morphometric Dexa (NORMODEXA) Study. Bone 36(Suppl.2):S351

76.

Ziegler R, Scheidt-Nave C, Leidig-Bruckner G (1996) What is a vertebral fracture? Bone 18:169–177CrossRef

77.

Grados F, Roux C, de Vernejoul MC et al (2001) Comparison of four morphometric definitions and a semiquantitative consensus reading for assessing prevalent vertebral fractures. Osteoporos Int 12:716–722CrossRefPubMed

78.

Nevitt MC, Ross PD, Palermo L et al (1999) Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. Bone 25:613–619CrossRefPubMed

79.

Lunt M, Ismail AA, Felsenberg D et al (2002) Defining incident vertebral deformities in population studies: a comparison of morphometric criteria. Osteoporos Int 13:809–815CrossRefPubMed

80.

Hochberg MC, Ross PD, Black D et al (1999) Larger increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Fracture Inteventional Trial Research Group. Arthritis Rheum 42:1246–1254

81.

Melton LJ III, Egan KS, O’Fallon WM et al (1998) Influence of fracture criteria on the outcome of a randomized trial of therapy. Osteoporos Int 8:184–191CrossRefPubMed

82.

Sauer P, Leidig G, Minne HW et al (1991) Spine Deformity Index (SDI) versus other objective procedures of vertebral fracture identification in patients with osteoporosis: a comparative study. J Bone Miner Res 6:227–238PubMed

83.

Mazzuoli GF, Diacinti D, Acca M et al (1998) Relationship between spine bone mineral density and vertebral body heights. Calcif Tissue Int 62:486–490CrossRefPubMed

84.

Zebaze R, Maalouf G, Maalouf N, Seeman E (2004) Loss of regularity in the curvature of the thoracolumbar spine: a measure of structural failure. J Bone Miner Res 19:1099–1104CrossRefPubMed

85.

Black DM, Palermo L, Nevitt MC et al (1995) Comparison of methods for defining prevalent vertebral deformities: the study of osteoporotic fractures. J Bone Miner Res 10:890–902PubMedCrossRef

86.

Wu C, van Kuijk C, Jiang Y et al (2000) Comparison of digitized images with original radiography for semiquantitative assessment of osteoporotic fractures. Osteoporos Int 11:25–30CrossRefPubMed

87.

Ferrar L, Jiang G, Armbrecht G et al (2007) Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). Bone 41(1):5–12CrossRefPubMed

88.

Genant HK, Jergas M (2003) Assessment of prevalent and incident vertebral fractures in osteoporosis research. Osteoporos Int 14(Suppl 3):S43–S55PubMed

89.

Lenchik LL, Rogers LF, Delmas PD et al (2004) Diagnosis of osteoporotic vertebral fractures: importance of recognition and description by radiologists. AJR 183:949–958PubMed

90.

Jiang G, Ferrar L, Barrington NA, Eastell R (2007) Standardised quantitative morphometry: a modified approach for quantitative identification of prevalent vertebral deformities. Osteoporos Int 18(10):1411–1419CrossRefPubMed

91.

Jiang G, Eastell R, Barrington NA, Ferrar L (2004) Comparison of methods for the visual identification of prevalent vertebral fracture in osteoporosis. Osteoporos Int 15:887–896CrossRefPubMed

92.

Ferrar L, Jiang G, Cawthon PM et al (2007) Identification of vertebral fracture and non–osteoporotic short vertebral height in men: the MrOS study. J Bone Miner Res 22:1434–1441CrossRefPubMed

93.

Giannini S, Nobile M, Dalle Carbonare L et al (2001) Vertebral morphometry by X-ray absorptiometry before and after liver transplant: a cross-sectional study. Eur J Gastroenterol Hepatol 13:1201–1207CrossRefPubMed

94.

Mazzaferro S, Diacinti D, Proietti E et al (2006) Morphometric X-ray absorptiometry in the assessment of vertebral fractures in renal transplant patients. Nephrol Dial Transplant 21:466–471CrossRefPubMed

95.

National Osteoporosis Foundation (1998) Osteoporosis: review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis. Osteoporos Int 8(Suppl 4):S1–S85

96.

Kanis JA, Black D, Cooper C et al (2002) A new approach to the development of assessment guidelines for osteoporosis. Osteoporos Int 13:527–536CrossRefPubMed

97.

International Osteoporosis Foundation and European Society of Musculoskeletal Radiology (2003) Vertebral Fracture Initiative Resource Document. Available from URL: http://www.iofbonehealth.org/vfi/assets/resources/Resource-Document.pdf [accessed October 29, 2007]

Title: Vertebral morphometry: current methods and recent advances
Authors: G. Guglielmi
D. Diacinti
C. van Kuijk
F. Aparisi
C. Krestan
J. E. Adams
T. M. Link
Publication date: 01-07-2008
Publisher: Springer-Verlag
Published in: European Radiology / Issue 7/2008
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-008-0899-8

At a glance: The STEP trials

Springer Medicine

Vertebral morphometry: current methods and recent advances

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2008

Percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of 80 patients treated with two consecutive sessions

Detection and localization of acute upper and lower gastrointestinal (GI) bleeding with arterial phase multi-detector row helical CT

Radiology report turnaround: expectations and solutions

Percutaneous chemical nerve block with ultrasound-guided intraneural injection

Detection of mechanical ventricular asynchrony by high temporal resolution cine MRI

Stereological estimation of left-ventricular volumetric and functional parameters from multidetector-row computed tomography data