Top

Published in:

01-09-2013 | Hot Topic

Advanced CT based In Vivo Methods for the Assessment of Bone Density, Structure, and Strength

Authors: K. Engelke, C. Libanati, T. Fuerst, P. Zysset, H. K. Genant

Published in: Current Osteoporosis Reports | Issue 3/2013

Abstract

Based on spiral 3D tomography a large variety of applications have been developed during the last decade to asses bone mineral density, bone macro and micro structure, and bone strength. Quantitative computed tomography (QCT) using clinical whole body scanners provides separate assessment of trabecular, cortical, and subcortical bone mineral density (BMD) and content (BMC) principally in the spine and hip, although the distal forearm can also be assessed. Further bone macrostructure, for example bone geometry or cortical thickness can be quantified. Special high resolution peripheral CT (hr-pQCT) devices have been introduced to measure bone microstructure for example the trabecular architecture or cortical porosity at the distal forearm or tibia. 3D CT is also the basis for finite element analysis (FEA) to determine bone strength. QCT, hr-pQCT, and FEM are increasingly used in research as well as in clinical trials to complement areal BMD measurements obtained by the standard densitometric technique of dual x-ray absorptiometry (DXA). This review explains technical developments and demonstrates how QCT based techniques advanced our understanding of bone biology.

Cann CE, Genant HK. Precise measurement of vertebral mineral content using computed tomography. J Comput Assist Tomogr. 1980;4(4):493–500.PubMed

Rüegsegger P, Elsasser U, Anliker M, Gnehm H, Kind H, Prader A. Quantification of bone mineralization using computed tomography. Radiology. 1976;121:93–7.PubMed

Genant HK, Boyd D. Quantitative bone mineral analysis using dual energy computed tomography. Invest Radiol. 1977;12(6):545–51.PubMed

Cann CE. Quantitative CT, for determination of bone mineral density: a review. Radiology. 1988;166:509–22.PubMed

Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of Osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom. 2008;11(1):123–62.PubMed

Faulkner KG, Cann CE, Hasegawa BH. Effect of bone distribution on vertebral strength: assessment with patient-specific nonlinear finite element analysis. Radiology. 1991;179(3):669–74.PubMed

Morgan E, Bouxsein M. Use of finite element analysis to assess bone strength. Bonekey Osteovision. 2005;2(12):8–19.

Faulkner KG, von Stetten E, Miller P. Discordance in patient classification using T-scores. J Clin Densitom. 1999;2(3):343–50.PubMed

Bergot C, Laval-Jeantet AM, Hutchinson K, Dautraix I, Caulin F, Genant HK. A comparison of spinal quantitative computed tomography with dual energy X-ray absorptiometry in European women with vertebral and nonvertebral fractures. Calcif Tissue Int. 2001;68(2):74–82.PubMed

10.

Khoo BC, Brown K, Cann C, Zhu K, Henzell S, Low V, et al. Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores. Osteoporos Int. 2009;20(9):1539–45.PubMed

11.

• Bousson VD, Adams J, Engelke K, Aout M, Cohen-Solal M, Bergot C, et al. In vivo discrimination of hip fracture with quantitative computed tomography: results from the prospective European Femur Fracture Study (EFFECT). JBMR. 2011;26(4):881–93. Cross sectional studies comparing QCT and DXA with discriminate fresh femur fractures from controls.

12.

Cheng X, Li J, Lu Y, Keyak J, Lang T. Proximal femoral density and geometry measurements by quantitative computed tomography: association with hip fracture. Bone. 2007;40(1):169–74.PubMed

13.

• Johannesdottir F, Poole KE, Reeve J, Siggeirsdottir K, Aspelund T, Mogensen B, et al. Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study. Bone. 2011;48(6):1268–76. Prospective study with incident hip fractures that specifically investigated hip fracture prediction of various parameters in the neck determined in different neck quadrants. Estimated cortical thickness in the superior-anterior quadrant C best discriminated hip fracture cases from controls.PubMed

14.

Black DM, Bouxsein ML, Marshall LM, Cummings SR, Lang TF, Cauley JA, et al. Proximal femoral structure and the prediction of hip fracture in men: a large prospective study using QCT. J Bone Miner Res. 2008;23(8):1326–33.PubMed

15.

Yang L, Burton AC, Bradburn M, Nielson CM, Orwoll ES, Eastell R. Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: the MrOS study. J Bone Miner Res. 2012;27(11):2314–24.PubMed

16.

•• Wang XA, Sanyal PM, Cawthon L, Palermo M, Jekir J, Christensen KE, et al. Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans. J Bone Miner Res. 2012;27(4):808–16. FEA and QCT show better vertebral fracture predition in men than DXA. Retrospective analysis of the MrOS study.PubMed

17.

Duboeuf F, Jergas M, Schott AM, Wu CY, Gluer CC, Genant HK. A comparison of bone densitometry measurements of the central skeleton in post-menopausal women with and without vertebral fracture. Br J Radiol. 1995;68(811):747–53.PubMed

18.

Grampp S, Genant HK, Mathur A, Lang P, Jergas M, Takada M, et al. Comparisons of noninvasive bone mineral measurements in assessing age-related loss, fracture discrimination, and diagnostic classification. J Bone Miner Res. 1997;12(5):697–711.PubMed

19.

Melton III LJ, Riggs BL, Keaveny TM, Achenbach SJ, Hoffmann PF, Camp JJ, et al. Structural determinants of vertebral fracture risk. J Bone Miner Res. 2007;22(12):1885–92.PubMed

20.

Ross PD, Genant HK, Davis JW, Miller PD, Wasnich RD. Predicting vertebral fracture incidence from prevalent fractures and bone density among non-Black, osteoporotic women. Osteoporosis Int. 1993;3(3):120–6.

21.

Engelke K, Fuerst T, Dasic G, Davies RY, Genant HK. Regional distribution of spine and hip QCT BMD responses after one year of once-monthly ibandronate in postmenopausal osteoporosis. Bone. 2010;46(6):1626–32.PubMed

22.

Black DM, Bilezikian JP, Ensrud KE, Greenspan SL, Palermo L, Hue T, et al. One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis. N Engl J Med. 2005;353(6):555–65.PubMed

23.

Lewiecki EM, Keaveny TM, Kopperdahl DL, Genant HK, Engelke K, Fuerst T, et al. Once-monthly oral ibandronate improves biomechanical determinants of bone strength in women with postmenopausal osteoporosis. J Clin Endocrinol Metab. 2009;94(1):171–80.PubMed

24.

• Fitzpatrick LA, Dabrowski CE, Cicconetti G, Gordon DN, Fuerst T, Engelke K, et al. Ronacaleret, a calcium-sensing receptor antagonist, increases trabecular but not cortical bone in postmenopausal women. J Bone Miner Res. 2012;27(2):255–62. Interesting study comparing effects of 3 different pharmacological treatments (ronacanaleret, alendronate, and teriparatide) on QCT of the spine and hip.PubMed

25.

Imai K, Ohnishi I, Matsumoto T, Yamamoto S, Nakamura K. Assessment of vertebral fracture risk and therapeutic effects of alendronate in postmenopausal women using a quantitative computed tomography-based nonlinear finite element method. Osteoporos Int. 2009;20(5):801–10.PubMed

26.

Keaveny TM, Donley DW, Hoffmann PF, Mitlak BH, Glass EV, San Martin JA. Effects of teriparatide and alendronate on vertebral strength as assessed by finite element modeling of QCT scans in women with osteoporosis. J Bone Miner Res. 2007;22(1):149–57.PubMed

27.

Keaveny TM, Hoffmann PF, Singh M, Palermo L, Bilezikian JP, Greenspan SL, et al. Femoral bone strength and its relation to cortical and trabecular changes after treatment with PTH, alendronate, and their combination as assessed by finite element analysis of quantitative CT scans. J Bone Miner Res. 2008;23(12):1974–82.PubMed

28.

Keaveny TM, McClung MR, Wan X, Koppaherdl DL, Mitlak BH, Krohn K. Femoral strength in osteoporotic women treated with teriparatide or alendronate. Bone. 2012;50(1):165–70.PubMed

29.

Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med. 2007;146(5):326–39.PubMed

30.

Eastell R, Lang T, Boonen S, Cummings S, Delmas PD, Cauley JA, et al. Effect of once-yearly zoledronic acid on the spine and hip as measured by quantitative computed tomography: results of the HORIZON Pivotal Fracture Trial. Osteoporos Int. 2010;21(7):1277–85.PubMed

31.

Borggrefe J, Graeff C, Nickelsen TN, Marin F, Gluer CC. Quantitative computed tomographic assessment of the effects of 24 months of teriparatide treatment on 3D femoral neck bone distribution, geometry, and bone strength: results from the EUROFORS study. J Bone Miner Res. 2010;25(3):472–81.PubMed

32.

Genant HK, Lang T, Fuerst T, Pinette KV, Zhou C, Thiebaud D, et al. Treatment with raloxifene for 2 years increases vertebral bone mineral density as measured by volumetric quantitative computed tomography. Bone. 2004;35(5):1164–8.PubMed

33.

McClung MR, Zanchetta JR, Hoiseth A, Kendler DL, Yuen CK, Brown JP, et al. Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis. J Clin Densitom. 2012;16(2):250–256.

34.

Brixen K, Chapurlat R, Cheung AM, Keaveny TM, Fuerst T, Engelke K, et al. Bone density, turnover, and estimated strength in postmenopausal women treated with odanacatib: a randomized trial. J Clin Endocrinol Metab. 2013;98(2):571–580.

35.

Engelke K, Libanati C, Liu Y, Wang H, Austin M, Fuerst T, et al. Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA). Bone. 2009;45(1):110–8.PubMed

36.

Nicks KM, Amin S, Melton LJ III, Atkinson EJ, McCready LK, Riggs BL, et al. Three-dimensional structural analysis of the proximal femur in an age-stratified sample of women. Bone. 2013;55(1):179–188.

37.

Ito M, Nakata T, Nishida A, Uetani M. Age-related changes in bone density, geometry and biomechanical properties of the proximal femur: CT-based 3D hip structure analysis in normal postmenopausal women. Bone. 2011;48(3):627–30.PubMed

38.

Bousson V, Le Bras A, Roqueplan F, Kang Y, Mitton D, Kolta S, et al. Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone. Osteoporos Int. 2006;17(6):855–64.PubMed

39.

Prevrhal S, Fox JC, Shepherd JA, Genant HK. Accuracy of CT-based thickness measurement of thin structures: modeling of limited spatial resolution in all three dimensions. Med Phys. 2003;30(1):1–8.PubMed

40.

Prevrhal S, Engelke K, Kalender WA. Accuracy limits for the determination of cortical width and density: the influence of object size and CT imaging parameters. Phys Med Bio. 1999;44:751–64.

41.

• Treece GM, Poole KE, Gee AH. Imaging the femoral cortex: thickness, density and mass from clinical CT. Med Image Anal. 2012;16(5):952–65. Technical paper describing an advanced method for segmenting the cortex in CT images.PubMed

42.

Treece GM, Gee AH, Mayhew PM, Poole KE. High resolution cortical bone thickness measurement from clinical CT data. Med Image Anal. 2010;14(3):276–90.PubMed

43.

Poole KE, Treece GM, Mayhew PM, Vaculik J, Dungl P, Horak M, et al. Cortical thickness mapping to identify focal osteoporosis in patients with hip fracture. PLoS One. 2012;7(6):e38466.PubMed

44.

Ito M, Ikeda K, Nishiguchi M, Shindo H, Uetani M, Hosoi T, et al. Multi-detector row CT imaging of vertebral microstructure for evaluation of fracture risk. J Bone Miner Res. 2005;20(10):1828–36.PubMed

45.

Graeff C, Timm W, Nickelsen TN, Farrerons J, Marin F, Barker C, et al. Monitoring teriparatide-associated changes in vertebral microstructure by high-resolution CT in vivo: results from the EUROFORS Study. J Bone Miner Res. 2007;22(9):1426–33.PubMed

46.

• Graeff C, Marin F, Petto H, Kayser O, Reisinger A, Pena J, et al. High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis. Bone. 2013;52(2):568–77. Comparison of QCT, high resolution QCT, FEA, and DXA for association with vertebral deformities in same study.PubMed

47.

Gluer CC, Marin F, Ringe JD, Hawkins F, Moricke R, Papaioannu N, et al. Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial. J Bone Miner Res. 2013;28(6):1335–68.

48.

Krebs A, Graeff C, Frieling I, Kurz B, Timm W, Engelke K, et al. High resolution computed tomography of the vertebrae yields accurate information on trabecular distances if processed by 3D fuzzy segmentation approaches. Bone. 2009;44(1):145–52.PubMed

49.

• Burghardt AJ, Pialat JB, Kazakia GJ, Boutroy S, Engelke K, Patsch JM, et al. Multi-center precision of cortical and trabecular bone quality measures assessed by HR-PQCT. J Bone Miner Res. 2012;28(3):524–536. Technical study on spatial resolution and phantom precison of nine different hr-pQCT scanners.

50.

Boutroy S, Bouxsein ML, Munoz F, Delmas PD. In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography. J Clin Endocrinol Metab. 2005;90(12):6508–15.PubMed

51.

Szulc P, Boutroy S, Vilayphiou N, Chaitou A, Delmas PD, Chapurlat R. Cross-sectional analysis of the association between fragility fractures and bone microarchitecture in older men: the STRAMBO study. J Bone Miner Res. 2011;26(6):1358–67.PubMed

52.

Sornay-Rendu E, Cabrera-Bravo JL, Boutroy S, Munoz F, Delmas PD. Severity of vertebral fractures is associated with alterations of cortical architecture in postmenopausal women. J Bone Miner Res. 2009;24(4):737–43.PubMed

53.

Vico L, Zouch M, Amirouche A, Frere D, Laroche N, Koller B, et al. High-resolution pQCT analysis at the distal radius and tibia discriminates patients with recent wrist and femoral neck fractures. J Bone Miner Res. 2008;23(11):1741–50.PubMed

54.

Stein EM, Liu XS, Nickolas TL, Cohen A, Thomas V, McMahon DJ, et al. Abnormal microarchitecture and reduced stiffness at the radius and tibia in postmenopausal women with fractures. J Bone Miner Res. 2010;25(12):2572–81.PubMed

55.

Sornay-Rendu E, Boutroy S, Munoz F, Delmas PD. Alterations of cortical and trabecular architecture are associated with fractures in postmenopausal women, partially independent of decreased BMD measured by DXA: the OFELY study. J Bone Miner Res. 2007;22(3):425–33.PubMed

56.

Vilayphiou N, Boutroy S, Szulc P, van Rietbergen B, Munoz F, Delmas PD, et al. Finite element analysis performed on radius and tibia HR-pQCT images and fragility fractures at all sites in men. J Bone Miner Res. 2011;26(5):965–73.PubMed

57.

Nishiyama KK, Macdonald HM, Hanley DA, Boyd SK. Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT. Osteoporos Int. 2013;27(5):1733–1740.

58.

• Melton III LJ, Riggs BL, Keaveny TM, Achenbach SJ, Kopperdahl D, Camp JJ, et al. Relation of vertebral deformities to bone density, structure, and strength. J Bone Miner Res. 2010;25(9):1922–30. Comparison of QCT, high resolution pQCT, FEA, and DXA for association with vertebral deformities in same study.PubMed

59.

Nicks KM, Amin E, Atkinson J, Riggs BL, Melton III LJ, Khosla S. Relationship of age to bone microstructure independent of areal bone mineral density. J Bone Miner Res. 2012;27(3):637–44.PubMed

60.

Chapurlat RD, Laroche M, Thomas T, Rouanet S, Delmas PD, de Vernejoul MC. Effect of oral monthly ibandronate on bone microarchitecture in women with osteopenia-a randomized placebo-controlled trial. Osteoporos Int. 2013;24(1):311–20.PubMed

61.

Rizzoli R, Chapurlat RD, Laroche JM, Krieg MA, Thomas T, Frieling I, et al. Effects of strontium ranelate and alendronate on bone microstructure in women with osteoporosis. Results of a 2-year study. Osteoporos Int. 2012;23(1):305–15.PubMed

62.

Rizzoli R, Laroche M, Krieg MA, Frieling I, Thomas T, Delmas PD, et al. Strontium ranelate and alendronate have differing effects on distal tibia bone microstructure in women with osteoporosis. Rheumatol Int. 2010;30(10):1341–8.PubMed

63.

Macdonald HM, Nishiyama KK, Hanley DA, Boyd DA. Changes in trabecular and cortical bone microarchitecture at peripheral sites associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis. Osteoporos Int. 2011;22(1):357–62.PubMed

64.

Burghardt AJ, Kazakia GJ, Sode M, de Papp AE, Link TM, Majumdar S. A longitudinal HR-pQCT study of alendronate treatment in postmenopausal women with low bone density: relations among density, cortical, and trabecular microarchitecture, biomechanics, and bone turnover. J Bone Miner Res. 2010;25(12):2558–71.PubMed

65.

Seeman E, Delmas PD, Hanley DA, Sellmeyer D, Cheung AM, Shane E, et al. Microarchitectural deterioration of cortical and trabecular bone: differing effects of denosumab and alendronate. J Bone Miner Res. 2010;25(8):1886–94.PubMed

66.

Belavy DL, Beller G, Ritter Z, Felsenberg D. Bone structure and density via HR-pQCT in 60d bed-rest, 2-years recovery with and without countermeasures. J Musculoskelet Neuronal Interact. 2011;11(3):215–26.PubMed

67.

Armbrecht G, Belavy DL, Backstrom M, Beller G, Alexandre C, Rizzoli R, et al. Trabecular and cortical bone density and architecture in women after 60 days of bed rest using high-resolution pQCT: WISE 2005. J Bone Miner Res. 2011;26(10):2399–410.PubMed

68.

Lam TP, Ng B.K, Cheung LW, Lee KM, Qin L, Cheng JC. Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial. Osteoporos Int. 2013;24(5):1623–1636.

69.

Burghardt AJ, Kazakia GJ, Majumdar S. A local adaptive threshold strategy for high resolution peripheral quantitative computed tomography of trabecular bone. Ann Biomed Eng. 2007;35(10):1678–86.PubMed

70.

Laib A, Ruegsegger P. Calibration of trabecular bone structure measurements of in vivo three-dimensional peripheral quantitative computed tomography with 28-microm-resolution microcomputed tomography. Bone. 1999;24(1):35–9.PubMed

71.

Valentinitsch A, Patsch JM, Burghardt AJ, Link TM, Majumdar S, Fischer L, et al. Computational identification and quantification of trabecular microarchitecture classes by 3-D texture analysis-based clustering. Bone. 2013;54(1):133–40.PubMed

72.

Varga P, Zysset PK. Assessment of volume fraction and fabric in the distal radius using HR-pQCT. Bone. 2009;45(5):909–17.PubMed

73.

Buie HR, Campbell GM, Klinck RJ, MacNeil JA, Boyd SK. Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis. Bone. 2007;41(4):505–15.PubMed

74.

• Tjong W, Kazakia GJ, Burghardt AJ, Majumdar S. The effect of voxel size on high-resolution peripheral computed tomography measurements of trabecular and cortical bone microstructure. Med Phys. 2012;39(4):1893–903. Technical paper providing an overview of the capability of HR-pQCT analysis to accurately measure trabecular and cortical bone parameters. At the standard clinical voxel size of 82 μm, measures of porosity were only moderately correlated to gold standard μCT data suggesting cautious interpretation of HR-pQCT measures of cortical microstructure.PubMed

75.

Pialat JB, Burghardt AJ, Sode M, Link TM, Majumdar S. Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture. Bone. 2012;50(1):111–8.PubMed

76.

Pauchard Y, Ayres FJ, Boyd SK. Automated quantification of three-dimensional subject motion to monitor image quality in high-resolution peripheral quantitative computed tomography. Phys Med Biol. 2011;56(20):6523–43.PubMed

77.

Sode M, Burghardt AJ, Pialat JB, Link TM, Majumdar S. Quantitative characterization of subject motion in HR-pQCT images of the distal radius and tibia. Bone. 2011;48(6):1291–7.PubMed

78.

Engelke K, Stampa B, Timm W, Dardzinski B, de Papp AE, Genant HK, et al. Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia. Osteoporos Int. 2012;23(8):2151–8.PubMed

79.

Khosla S. Pathogenesis of age-related bone loss in humans. J Gerontol A Biol Sci Med Sci. 2012.

80.

Riggs BL, Melton III LJ, Robb RA, Camp JJ, Atkinson EJ, Peterson JM, et al. Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res. 2004;19(12):1945–54.PubMed

81.

Bousson V, Bergot C, Meunier A, Barbot F, Parlier-Cuau C, Laval-Jeantet AM, et al. CT of the middiaphyseal femur: cortical bone mineral density and relation to porosity. Radiology. 2000;217(1):179–87.PubMed

82.

Parfitt AM. Age-related structural changes in trabecular and cortical bone: cellular mechanisms and biochemical consequences. Calcif Tissue Int. 1984;36:S123–8.PubMed

83.

Simmons Jr ED, Pritzker KP, Grynpas MD. Age-related changes in the human femoral cortex. J Orthop Res. 1991;9(2):155–67.PubMed

84.

Bell KL, Loveridge N, Jordan GR, Power J, Constant CR, Reeve J. A novel mechanism for induction of increased cortical porosity in cases of intracapsular hip fracture. Bone. 2000;27(2):297–304.PubMed

85.

Bell KL, Loveridge N, Power J, Garrahan N, Meggitt BF, Reeve J. Regional differences in cortical porosity in the fractured femoral neck. Bone. 1999;24(1):57–64.PubMed

86.

Burghardt AJ, Buie HR, Laib A, Majumdar S, Boyd SK. Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT. Bone. 2010;47(3):519–28.PubMed

87.

• Zebaze R, Zadeh AG, Mbala A, Seeman E. A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images. Bone. 2013;54(1):8–20. Technical paper describing the segmentation and analysis of a transitional or cortico-trabecular junctional zone in hr-pQCT images.

88.

Zebaze RM, Ghasem-Zadeh A, Bohte A, Iuliano-Burns S, Mirams M, Price RI, et al. Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a cross-sectional study. Lancet. 2010;375(9727):1729–36.PubMed

89.

Mueller TL, Christen D, Sandercott S, Boyd SK, van Rietbergen B, Eckstein F, et al. Computational finite element bone mechanics accurately predicts mechanical competence in the human radius of an elderly population. Bone. 2011;48(6):1232–8.PubMed

90.

Dalzell N, Kaptoge S, Morris N, Berthier A, Koller B, Braak L, et al. Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT. Osteoporos Int. 2009;20(10):1683–94.PubMed

91.

Boutroy S, Van Rietbergen B, Sornay-Rendu E, Munoz F, Bouxsein ML, Delmas PD. Finite element analysis based on in vivo HR-pQCT images of the distal radius is associated with wrist fracture in postmenopausal women. J Bone Miner Res. 2008;23(3):392–9.PubMed

92.

Pistoia W, van Rietbergen B, Lochmuller EM, Lill CA, Eckstein F, Ruegsegger P. Image-based micro-finite-element modeling for improved distal radius strength diagnosis: moving from bench to bedside. J Clin Densitom. 2004;7(2):153–60.PubMed

93.

Jayakar RY, Cabal A, Szumiloski J, Sardesai S, Phillips EA, Laib A, et al. Evaluation of high-resolution peripheral quantitative computed tomography, finite element analysis and biomechanical testing in a pre-clinical model of osteoporosis: a study with odanacatib treatment in the ovariectomized adult rhesus monkey. Bone. 2012;50(6):1379–88.PubMed

94.

Varga P, Baumbach S, Pahr D, Zysset PK. Validation of an anatomy specific finite element model of Colles' fracture. J Biomech. 2009;42(11):1726–31.PubMed

95.

Newitt DC, van Rietbergen B, Majumdar S. Processing and analysis of in vivo high-resolution MR images of trabecular bone for longitudinal studies: reproducibility of structural measures and micro-finite element analysis derived mechanical properties. Osteoporos Int. 2002;13(4):278–87.PubMed

96.

Newitt DC, Majumdar S, van Rietbergen B, von Ingersleben G, Harris ST, Genant HK, et al. In vivo assessment of architecture and micro-finite element analysis derived indices of mechanical properties of trabecular bone in the radius. Osteoporos Int. 2002;13(1):6–17.PubMed

97.

MacNeil JA, Boyd SK. Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method. Bone. 2008;42(6):1203–13.PubMed

98.

Varga P, Pahr DH, Baumbach S, Zysset PK. HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles' fracture load in vitro. Bone. 2010;47(5):982–8.PubMed

99.

Zysset PK, Curnier A. A 3D damage model for trabecular bone based on fabric tensors. J Biomech. 1996;29(12):1549–58.PubMed

100.

Nalla RK, Kinney JH, Ritchie RO. Mechanistic fracture criteria for the failure of human cortical bone. Nat Mater. 2003;2(3):164–8.PubMed

101.

Keyak JH, Lee IY, Skinner HB. Correlations between orthogonal mechanical properties and density of trabecular bone: use of different densitometric measures. J Biomed Mater Res. 1994;28(11):1329–36.PubMed

102.

Keller TS. Predicting the compressive mechanical behavior of bone. J Biomech. 1994;27(9):1159–68.PubMed

103.

•• Dall'Ara E, Luisier B, Schmidt R, Kainberger F, Zysset P, Pahr D. A nonlinear QCT-based finite element model validation study for the human femur tested in two configurations in vitro. Bone. 2013;52(1):27–38. Elaborate in vitro study to compare correlations of QCT BMD and BMC and FEA with ultimate force and stiffness in stance and lateral loading conditions.PubMed

104.

Keyak JH, Falkinstein Y. Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load. Med Eng Phys. 2003;25(9):781–7.PubMed

105.

Bayraktar HH, Morgan EF, Niebur GL, Morris GE, Wong EK, Keaveny TM. Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue. J Biomech. 2004;37(1):27–35.PubMed

106.

Kopperdahl DL, Morgan EF, Keaveny TM. Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res. 2002;20(4):801–5.PubMed

107.

Helgason B, Perilli E, Schileo E, Taddei F, Brynjolfsson S, Viceconti M. Mathematical relationships between bone density and mechanical properties: a literature review. Clin Biomech. 2008;23(2):135–46.

108.

Amin S, Kopperdhal DL, Melton III LJ, Achenbach SJ, Therneau TM, Riggs BL, et al. Association of hip strength estimates by finite-element analysis with fractures in women and men. J Bone Miner Res. 2011;26(7):1593–600.PubMed

109.

Orwoll ES, Marshall LM, Nielson CM, Cummings SR, Lapidus J, Cauley JA, et al. Finite element analysis of the proximal femur and hip fracture risk in older men. J Bone Miner Res. 2009;24(3):475–83.PubMed

110.

Keyak JH, Sigurdsson S, Karlsdottir G, Oskarsdottir D, Sigmarsdottir A, Zhao S, et al. Male-female differences in the association between incident hip fracture and proximal femoral strength: a finite element analysis study. Bone. 2011;48(6):1239–45.PubMed

111.

Keaveny TM, Kopperdahl DL, Melton III LJ, Hoffmann PF, Amin S, Riggs BL, et al. Age-dependence of femoral strength in white women and men. J Bone Miner Res. 2010;25(5):994–1001.PubMed

112.

Mawatari T, Miura H, Hamai S, Shuto T, Nakashima Y, Okazaki K, et al. Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: a prospective randomized clinical trial. Arthritis Rheum. 2008;58(11):3340–9.PubMed

113.

Graeff C, Chevalier Y, Charlebois M, Varga P, Pahr D, Nickelsen TN, et al. Improvements in vertebral body strength under teriparatide treatment assessed in vivo by finite element analysis: results from the EUROFORS study. J Bone Miner Res. 2009;24(10):1672–80.PubMed

114.

Chevalier Y, Quek E, Borah B, Gross G, Stewart J, Lang T, et al. Biomechanical effects of teriparatide in women with osteoporosis treated previously with alendronate and risedronate: results from quantitative computed tomography-based finite element analysis of the vertebral body. Bone. 2010;46(1):41–8.PubMed

115.

Lian KC, Lang TF, Keyak JH, Modin GW, Rehman Q, Do L, et al. Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naive postmenopausal women. Osteoporos Int. 2005;16(6):642–50.PubMed

116.

Buckley JM, Kuo CC, Cheng LC, Loo K, Motherway J, Slyfield C, et al. Relative strength of thoracic vertebrae in axial compression vs flexion. Spine J. 2009;9(6):478–85.PubMed

117.

Bessho M, Ohnishi I, Matsumoto T, Ohashi S, Matsuyama J, Tobita K, et al. Prediction of proximal femur strength using a CT-based nonlinear finite element method: differences in predicted fracture load and site with changing load and boundary conditions. Bone. 2009;45(2):226–31.PubMed

118.

Chevalier Y, Zysset PK. A patient-specific computer tomography-based finite element methodology to calculate the six dimensional stiffness matrix of human vertebral bodies. J Biomech Eng. 2012;134(5):051006.PubMed

119.

•• Dall'Ara E, Pahr D, Varga P, Kainberger F, Zysset P. QCT-based finite element models predict human vertebral strength in vitro significantly better than simulated DEXA. Osteoporos Int. 2012;23(2):563–72. Comparison of BMC, BMD as measured by QCT, and DXA as well as of FEA estimates with bone strength related material (ultimate strength and Young's modulus) and structure properties (ultimate force and stiffness).PubMed

120.

Crawford RP, Cann CE, Keaveny TM. Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone. 2003;33(4):744–50.PubMed

121.

Cody DD, Gross GJ, Hou FJ, Spencer HJ, Goldstein SA, Fyhrie DP. Femoral strength is better predicted by finite element models than QCT and DXA. J Biomech. 1999;32(10):1013–20.PubMed

122.

Johnell O, Kanis JA, Oden A, Johansson H, De Laet C, Delmas P, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res. 2005;20(7):1185–94.PubMed

Title: Advanced CT based In Vivo Methods for the Assessment of Bone Density, Structure, and Strength
Authors: K. Engelke
C. Libanati
T. Fuerst
P. Zysset
H. K. Genant
Publication date: 01-09-2013
Publisher: Springer US
Published in: Current Osteoporosis Reports / Issue 3/2013
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI: https://doi.org/10.1007/s11914-013-0147-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Advanced CT based In Vivo Methods for the Assessment of Bone Density, Structure, and Strength

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2013

Osteoporosis and Cancer

Computational Anatomy in the Study of Bone Structure

The Women’s Health Initiative: Hormone Therapy and Calcium/Vitamin D Supplementation Trials

Influence of Hormonal Appetite and Energy Regulators on Bone

Vitamin B12, Folic Acid, and Bone

Impact of the Environment on the Skeleton: Is it Modulated by Genetic Factors?