Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck

Abstract

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Estimation of Cortical Bone Microstructure From Ultrasound Backscatter

“…2a). The estimations of tissue impedance and structural parameters from SAM images has been described in detail in previous studies [30,35,37]. Briefly, the bone matrix was segmented from the background using an adaptive threshold [38].…”

“…To our knowledge, this is the first non-ionizing method that can assess independently and noninvasively tissue impedance, pore density and characteristic features of the pore size distribution. The prevalence of large cortical pores and cortical thinning in the tibia have been shown to reflect a compromised femoral neck structure and reduced femur strength [1,37]. Except for the ultimate force under sideway fall conditions, the prediction accuracy of mechanical properties of the proximal femur was better using Ct.Th and backscatter parameters than that of areal bone mineral density.…”

“…We anticipate that the evaluation of the pore diameter distribution has the potential to establish novel biomarkers that are sensitive to discriminate pathological tissue remodeling from normal age and gender specific alterations prior to the reduction of bone strength. The latter is predominantly predicted by the reduction of cortical thickness [37], which can be measured with the same system [44] or similar multi-channel systems [4] in combination with the compressional sound velocity by means of refraction corrected imaging, or alternatively by means of axial transmission ultrasound [3,15]. Thus, the combined assessment of cortical thickness, sound velocity, and pore size distribution in a mobile, non-ionizing measurement system could have a major impact to prevent osteoporotic fractures.…”

Pore‐Size Distribution and Frequency‐Dependent Attenuation in Human Cortical Tibia Bone Discriminate Fragility Fractures in Postmenopausal Women With Low Bone Mineral Density

“…( 14 ) Postmenopausal women with osteopenia have higher cortical porosity and thinner cortices at the distal radius and tibia than women with normal aBMD. ( 15 ) In an ex vivo study, cortical thinning and the prevalence of large BMUs in the tibia were found to be associated with structural deterioration of the femoral neck ( 16 ) and proximal femur strength. ( 17 ) Although cortical porosity of the tibia was not associated with femoral stiffness or strength, the proportion of Ct.Po attributable to large pores (diameter >100 μm) was significantly associated with hip strength in both standing ( r = −0.61) and falling ( r = 0.48) conditions.…”

Cortical pore size distribution and viscoelastic tibia properties discriminate fragility fractures independent of bone mineral density

“…In the femoral neck of elderly people (age between 60 and 90 years), decreases of cortical thickness (Ct.Th) and porosity (Ct.Po) by ~4 % and ~32 %, respectively, per decade with no significant changes in pore density (Ct.Po.Dn) have been reported 15 . Decreased cortical thickness and the prevalence of large BMU's have been shown to reduce bone strength 16 and structural deterioration 17 . In contrast, cortical thinning is partially compensated by the apposition of new tissue matrix at the periosteal interface leading to an increased bone diameter and a further increase of the pore diameter gradient in the radial bone direction.…”