Determinants of bone damage: An ex-vivo study on porcine vertebrae

Mirzaali, Mohammad J.; Libonati, Flavia; Ferrario, Davide L.; Rinaudo, Luca; Messina, Carmelo; Ulivieri, Fabio Massimo; Cesana, Bruno Mario; Strano, Matteo; Vergani, L.

doi:10.1371/journal.pone.0202210

Cited by 31 publications

(26 citation statements)

References 85 publications

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“…Recently, the trabecular bone score (TBS) has been found to be more accurate than spinal BMD alone as an index of trabecular bone strength able to detect the presence of damage accumulation [16]. TBS is a gray-level texture measurement based on the use of experimental variograms of two-dimensional (2D) projection images acquired during a dual-energy X-ray absorptiometry (DXA) of the lumbar spine (LS).…”

Section: Introductionmentioning

confidence: 99%

Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1)

et al. 2018

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In patients with neurofibromatosis type 1 (NF1), decreased bone mineral density (BMD) and low levels of 25-hydroxy vitamin D3 (25OHD) have been reported. Recently, the trabecular bone score (TBS) measurement has been proposed as index of bone microarchitecture and fracture risk. In 74 NF1 patients (48 females, 26 males, age 41 ± 12), we measured TBS and investigated clinical stage, lifestyle, vitamin D, serum bone turnover markers, vertebral and femoral BMD. A homogenous cohort of 61 healthy subjects was used as control group. TBS was lower in NF1 patients (1.266 ± 0.113 vs. 1.346 ± 0.105) without differences between sexes. No correlations with 25OHD, low exercise, low calcium intake, reduced sun exposure, and number of skin neurofibromas were observed. As expected, hypovitaminosis D was common (98.6%), as well as BMD reduction in hip and spine sites: In NF1 patients, bone texture evaluated by TBS was low in both sexes without any correlation with clinical or metabolic parameters, suggesting a direct role of the fibromin mutation.

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Section: Introductionmentioning

confidence: 99%

Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1)

et al. 2018

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“…The experimental procedure is described in detail in a previous work [32] and includes the following steps (Fig 1a–1c):…”

Section: Methodsmentioning

confidence: 99%

“…The nominal diameter of the cylindrical samples was 13.8 mm and the nominal height 30 mm. However, for the following analyses and as in [32], the duplicates, i.e. specimens extracted from the same lumbar vertebra, were removed.…”

Section: Methodsmentioning

confidence: 99%

A new finite element based parameter to predict bone fracture

Colombo

Libonati

Rinaudo³

et al. 2019

PLoS ONE

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Dual Energy X-Ray Absorptiometry (DXA) is currently the most widely adopted non-invasive clinical technique to assess bone mineral density and bone mineral content in human research and represents the primary tool for the diagnosis of osteoporosis. DXA measures areal bone mineral density, BMD, which does not account for the three-dimensional structure of the vertebrae and for the distribution of bone mass. The result is that longitudinal DXA can only predict about 70% of vertebral fractures. This study proposes a complementary tool, based on Finite Element (FE) models, to improve the DXA accuracy. Bone is simulated as elastic and inhomogeneous material, with stiffness distribution derived from DXA greyscale images of density. The numerical procedure simulates a compressive load on each vertebra to evaluate the local minimum principal strain values. From these values, both the local average and the maximum strains are computed over the cross sections and along the height of the analysed bone region, to provide a parameter, named Strain Index of Bone (SIB), which could be considered as a bone fragility index. The procedure is initially validated on 33 cylindrical trabecular bone samples obtained from porcine lumbar vertebrae, experimentally tested under static compressive loading. Comparing the experimental mechanical parameters with the SIB, we could find a higher correlation of the ultimate stress, σULT, with the SIB values (R2adj = 0.63) than that observed with the conventional DXA-based clinical parameters, i.e. Bone Mineral Density, BMD (R2adj = 0.34) and Trabecular Bone Score, TBS (R2adj = -0.03). The paper finally presents a few case studies of numerical simulations carried out on human lumbar vertebrae. If our results are confirmed in prospective studies, SIB could be used—together with BMD and TBS—to improve the fracture risk assessment and support the clinical decision to assume specific drugs for metabolic bone diseases.

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“…TBS is a grey level textural-architectural index derived from lumbar spine DXA able to predict fragility fractures also independently from BMD in retrospective and longitudinal studies [4]. However, TBS does not provide appropriate indications about bone strength and fatigue that characterise the resistance of a structure to loads over time [5].…”

Section: Introductionmentioning

confidence: 99%

Bone strain index in the prediction of vertebral fragility refracture

Ulivieri

Piodi

Rinaudo³

et al. 2020

Eur Radiol Exp

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Dual-energy x-ray absorptiometry (DXA) can provide quantitative (bone mineral density, BMD) and qualitative (trabecular bone score, TBS) indexes of bone status, able to predict fragility fractures in most osteoporotic patients. A new qualitative index of bone strength, based on finite element analysis and named bone strain index (BSI), has been recently developed from lumbar DXA scan. We present the preliminary results about the BSI ability to predict a refracture in patients with fragility fractures. A total of 143 consecutive fractured patients with primary osteoporosis (121 females) performed a spine x-ray examination for the calculation of spine deformity index (SDI) and a DXA densitometry for BMD, TBS, and BSI at basal time and in the follow-up. A refracture was considered as a one-unit increase in SDI. For each unit increase of the investigated indexes, the hazard ratio of refracture, 95% confidence interval, p value, and proportionality test p value were for BSI 1.201, 0.982−1.468, 0.074, and 0.218; for lumbar BMD 0.231, 0.028−1.877, 0.170, and 0.305; and for TBS 0.034, 0.001 −2.579, 0.126, and 0.518, respectively. BSI was the index predictive of refracture nearest to statistical significance. If confirmed, it may be used for a better risk assessment of osteoporotic patients.

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Determinants of bone damage: An ex-vivo study on porcine vertebrae

Cited by 31 publications

References 85 publications

Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1)

Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1)

A new finite element based parameter to predict bone fracture

Bone strain index in the prediction of vertebral fragility refracture

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