Implications of local osteoporosis on the efficacy of anti-resorptive drug treatment: a 3-year follow-up finite element study in risedronate-treated women

Anitha, D; Kim, K. J.; Lim, Sung Kil; Lee, T.

doi:10.1007/s00198-013-2424-4

Cited by 11 publications

(11 citation statements)

References 44 publications

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“…Hence, understanding the decline in BMD due to MM-induced osteoporosis may be unreliable. Second, BMD has been challenged as a limited tool for the diagnosis of osteoporosis itself as it only partially predicts fracture risk, [18] which renders its use in the diagnostic evaluation of MM less valid. Also, routine assessment of BMD in MM patients has not been recommended due to methodological difficulties of this technique in these patients and the frequent use of bisphosphonates in all symptomatic MM patients.…”

Section: Introductionmentioning

confidence: 99%

Risk of vertebral compression fractures in multiple myeloma patients

2017

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The purpose of this study was to develop and validate a finite element (FE) model to predict vertebral bone strength in vitro using multidetector computed tomography (MDCT) images in multiple myeloma (MM) patients, to serve as a complementing tool to assess fracture risk. In addition, it also aims to differentiate MM patients with and without vertebral compression fractures (VCFs) by performing FE analysis on vertebra segments (T1–L5) obtained from in vivo routine MDCT imaging scans. MDCT-based FE models were developed from the in vitro vertebrae samples and were then applied to the in vivo vertebrae segments of MM patients (n = 4) after validation. Predicted fracture load using FE models correlated significantly with experimentally measured failure load (r = 0.85, P < 0.001). Interestingly, an erratic behavior was observed in patients with fractures (n = 2) and a more gradual change in FE-predicted strength values in patients without fractures (n = 2). Severe geometric deformations were also observed in models that have already attained fractures. Since BMD is not a reliable parameter for fracture risk prediction in MM subjects, it is necessary to use advanced tools such as FE analysis to predict individual fracture risk. If peaks are observed between adjacent segments in an MM patient, it can be safe to conclude that the spine is experiencing regions of structural instability. Such an FE visualization may have therapeutic consequences to prevent MM associated vertebral fractures.

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Section: Introductionmentioning

confidence: 99%

Risk of vertebral compression fractures in multiple myeloma patients

2017

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“…trabecular-level changes, which may produce different results. However, the accuracy and reliability of FE-predicted bone strength have been demonstrated in several studies162945. Also, this study only considered CT dose reduction via the variation of tube current but dose can also be reduced by reducing tube voltage or increasing pitch38 for instance.…”

Section: Discussionmentioning

confidence: 98%

“…Finite-element (FE) modeling has increasingly been used to perform structural analysis of bones to assess strength and understand the mechanism underlying bone fracture1516. FE analysis acts as a non-invasive alternative to assess bone strength in-vivo , where radiological scan data of patients are translated into patient-specific three-dimensional (3D) anatomical models.…”

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confidence: 99%

Effects of dose reduction on bone strength prediction using finite element analysis

Anitha

Subburaj

Mei

et al. 2016

Sci Rep

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This study aimed to evaluate the effect of dose reduction, by means of tube exposure reduction, on bone strength prediction from finite-element (FE) analysis. Fresh thoracic mid-vertebrae specimens (n = 11) were imaged, using multi-detector computed tomography (MDCT), at different intensities of X-ray tube exposures (80, 150, 220 and 500 mAs). Bone mineral density (BMD) was estimated from the mid-slice of each specimen from MDCT images. Differences in image quality and geometry of each specimen were measured. FE analysis was performed on all specimens to predict fracture load. Paired t-tests were used to compare the results obtained, using the highest CT dose (500 mAs) as reference. Dose reduction had no significant impact on FE-predicted fracture loads, with significant correlations obtained with reference to 500 mAs, for 80 mAs (R2 = 0.997, p < 0.001), 150 mAs (R2 = 0.998, p < 0.001) and 220 mAs (R2 = 0.987, p < 0.001). There were no significant differences in volume quantification between the different doses examined. CT imaging radiation dose could be reduced substantially to 64% with no impact on strength estimates obtained from FE analysis. Reduced CT dose will enable early diagnosis and advanced monitoring of osteoporosis and associated fracture risk.

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“…Indeed, recent studies have demonstrated that reductions in the QCT-assessed BR are well correlated with improvements in the CSMI, CSA, and BMD. 30,31) Despite these limitations, our study has clearly demonstrated the longterm therapeutic efficacy of risedronate. DXA with AHA may ensure easy and accurate measurement of the BMD and bone geometry in terms of bone quality in clinical practice, both of which reflect bone strength.…”

Section: Discussionmentioning

confidence: 81%

Five-Year Experience with Risedronate Therapy for Patients with Increased Fracture Risk: A Practice-Based Observational Study

Takakuwa¹,

Iwamoto

2015

Biol. Pharm. Bull.

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The purpose of this practice-based observational study was to examine the effects of long-term treatment with risedronate in patients with an increased fracture risk. Seventy patients (4 men and 66 postmenopausal women; mean age, 68.0 years) with osteoporosis or osteopenia and clinical risk factors for fractures were treated with risedronate at either 2.5 mg/d or 17.5 mg/week for 5 years. The bone mineral density (BMD) of the lumbar spine and proximal femur, and the structural geometric parameters of the proximal femur were evaluated by dual-energy X-ray absorptiometry with advanced hip assessment software at baseline and after each year of treatment. The lumbar spine BMD rapidly increased during the first year of the treatment and steadily increased throughout the 5-year treatment period. The BMD of the femoral neck and total hip also significantly increased during the first 3 and 2 years of treatment, respectively, then gradually declined and reached the baseline level after 5 years of treatment. The cross-sectional moment of inertia, cross-sectional area, and mean width of the femoral neck region of interest significantly increased during the first 2 years, and these increases were maintained throughout the 5-year treatment period. The femur strength index and section modulus also significantly increased following time courses similar to those of the above three parameters. These results suggest that risedronate produced both a sustained increase in the lumbar spine BMD and improvement in the femoral structural geometric parameters for 5 years of treatment.Key words risedronate; geometry; bone mineral density; advanced hip assessment; femur strength index Osteoporosis is a skeletal disease characterized by a decrease in bone strength and is associated with an increased fracture risk.1) Bone strength depends on two factors: bone mineral density (BMD) and bone quality. Bone quality is determined by both structural and material factors; structural factors include the macroscopic structure of cancellous bone and the porosity of cortical bone, whereas material factors include the extent of calcification, crystal size, matrix content, and microdamage. 1)Clinical assessment of bone geometry and microstructure has recently become possible because of marked progress in imaging technology. Software for advanced hip assessment (AHA) installed in dual-energy X-ray absorptiometry (DXA) systems is now widely used to noninvasively determine the structural geometric parameters of the proximal femur. 2,3)These structural parameters include the cross-sectional moment of inertia (CSMI) and cross-sectional area (CSA), from which the femur strength index (FSI) can be calculated. The FSI has predictive power for fracture risks in patients along with the BMD, 2,3) and the FSI obtained by DXA with AHA is reportedly well correlated with that obtained by quantitative computed tomography (QCT). 4,5) Risedronate has been widely used as a first-line drug in the treatment of osteoporosis. Current evidence based strictly on the principles ...

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Implications of local osteoporosis on the efficacy of anti-resorptive drug treatment: a 3-year follow-up finite element study in risedronate-treated women

Cited by 11 publications

References 44 publications

Risk of vertebral compression fractures in multiple myeloma patients

Risk of vertebral compression fractures in multiple myeloma patients

Effects of dose reduction on bone strength prediction using finite element analysis

Five-Year Experience with Risedronate Therapy for Patients with Increased Fracture Risk: A Practice-Based Observational Study

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