Measurement of subregional vertebral bone mineral density in vitro using lateral projection dual-energy X-ray absorptiometry: validation with peripheral quantitative computed tomography

Briggs, Andrew M.; Perilli, Egon; Parkinson, Ian H.; Kantor, Susan; Wrigley, Tim V.; Fazzalari, Nicola L.; Wark, John D.

doi:10.1007/s00774-011-0307-3

Cited by 14 publications

(17 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Primarily, this study has shown that DXA can identify differences in srBMD within a vertebra, as displayed by the significant main effect for subregion ( P < 0.05), consistent with earlier data [38, 42, 43]. Secondly, it was found that the GIO group demonstrated significantly lower results for the anterior subregion : whole vertebra ratio (ROI 4 : ROI 1) and the anterior subregion : posterior subregion ratio (ROI 4 : ROI 2) when compared to both the primary osteoporosis and control groups.…”

Section: Discussionsupporting

confidence: 92%

“…Subsequent studies have further validated the subregional methodology, establishing high short-term in vivo precision [41], moderate to high intrarater and interrater precision [41], and concurrent validity when compared with pQCT and micro-CT [42]. Validation findings were later replicated using a much larger sample size [43], demonstrating that lateral DXA is valid when measuring heterogeneity in aBMD between intravertebral subregions. Lateral DXA measurement of aBMD has also been shown to be a better predictor of vertebral failure load at both the whole vertebral body [44] and within subregions [45], compared with standard PA DXA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

Manning

Briggs

Doornum

et al. 2013

International Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

Individuals with glucocorticoid-induced osteoporosis experience vertebral fractures at an increased rate and at higher vertebral areal bone mineral density (aBMD) than individuals with primary osteoporosis. Standard posteroanterior- (PA-) projection dual energy X-ray absorptiometry (DXA) lacks the diagnostic sensitivity required for reliable estimation of vertebral fracture risk in individuals. Assessment of subregional vertebral aBMD using lateral-projection DXA may improve the predictive value of DXA parameters for fracture. One hundred and four individuals were recruited and grouped for this study: primary osteoporosis with no history of vertebral fracture (n = 43), glucocorticoid-induced bone loss (n = 13), and healthy controls (n = 48). Standard PA-projection and supine-lateral scans were performed, and lateral scans were analysed according to an established protocol to measure aBMD within 6 subregions. Main effects for subregion and group were assessed and observed, by ANCOVA. Ratios were calculated between subregions and compared between groups, to overcome the potentially confounding influence of variability in subregional geometry. Significantly lower values were observed in the glucocorticoid group for the ratios of (i) anterior subregion: whole vertebral body and (ii) posterior: whole vertebral body when compared to the primary osteoporosis and control groups (P < 0.05). Lower anterior subregional aBMD in individuals on glucocorticoid therapy may help to explain the increased vertebral fracture risk in this patient group.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

Manning

Briggs

Doornum

et al. 2013

International Journal of Endocrinology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Another consequence of removing the posterior elements was that simulating anterior–posterior DXA measurements would be much less physiologic than simulating the less commonly used lateral DXA measurements. However, recent studies have shown that aBMD measured by lateral DXA is more strongly correlated with vertebral strength than PA DXA [8, 39], which suggests that the regression models with IQR BMD would also outperform a model using aBMD measured by PA DXA. Third, the applied loading was stepwise, and it is possible that the failure mechanisms differed as compared to the case of application of a steadily increasing load until failure.…”

Section: Discussionmentioning

confidence: 99%

The intravertebral distribution of bone density: correspondence to intervertebral disc health and implications for vertebral strength

et al. 2013

View full text Add to dashboard Cite

Summary This study's goal was to determine associations among the intravertebral heterogeneity in bone density, bone strength, and intervertebral disc (IVD) health. Results indicated that predictions of vertebral strength can benefit from considering the magnitude of the density heterogeneity and the congruence between the spatial distribution of density and IVD health. Introduction This study aims to determine associations among the intravertebral heterogeneity in bone density, bone strength, and IVD health Methods Regional measurements of bone density were performed throughout 30 L1 vertebral bodies using microcomputed tomography (μCT) and quantitative computed tomography (QCT). The magnitude of the intravertebral heterogeneity in density was defined as the interquartile range and quartile coefficient of variation in regional densities. The spatial distribution of density was quantified using ratios of regional densities representing different anatomical zones (e.g., anterior to posterior regional densities). Cluster analysis was used to identify groups of vertebrae with similar spatial distributions of density. Vertebral strength was measured in compression. IVD health was assessed using two scoring systems. Results QCT- and μCT-based measures of the magnitude of the intravertebral heterogeneity in density were strongly correlated with each other (p<0.005). Accounting for the interquartile range in regional densities improved predictions of vertebral strength as compared to predictions based only on mean density (R2=0.59 vs. 0.43; F-test p-value=0.018). Specifically, after adjustment for mean density, vertebral bodies with greater heterogeneity in density exhibited higher strength. No single spatial distribution of density was associated with high vertebral strength. Analyses of IVD scores suggested that the health of the adjacent IVDs may modulate the effect of a particular spatial distribution of density on vertebral strength. Conclusions Noninvasive measurements of the intravertebral distribution of bone density, in conjunction with assessments of IVD health, can aid in predictions of bone strength and in elucidating biomechanical mechanisms of vertebral fracture.

show abstract

“…Evidence from literature suggests that the heterogeneity of volumetric BMD within a vertebra, in addition to the average volumetric BMD, may be an important determinant of the mechanical properties of a vertebra (Cody et al, 1991; McCubbrey et al, 1995; Yerramshetty et al, 2009) and risk of a clinical vertebral fracture (Dougherty, 1996; Briggs et al, 2012). Much of the experimental evidence comes from tests, in which vertebrae are monotonically loaded and relates BMD heterogeneity to the quasi-static properties of a vertebra (Cody et al, 1991; Yerramshetty et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Heterogeneity of bone mineral density and fatigue failure of human vertebrae

Yeni

Poisson

Flynn

2013

Journal of Biomechanics

View full text Add to dashboard Cite

There is increasing interest in using the heterogeneity of tissue properties in a bone for predicting its fracture risk. Heterogeneity of volum etric bone mineral density (BMD) as measured from quantitative computed tomography (QCT) is of particular interest as these measurements are clinically feasible. Previous examinations of the relationship between the BMD heterogeneity and the mechanical behavior of human vertebrae considered quasistatic strength only and were with limited number of samples. McCubbrey et al. studied the value of regional BMDs for predicting vertebral fatigue life, determined from short-cycle tests at force levels scaled with the estimated strength of the vertebra, but the focus of that work was in best predictor subsets without a specific focus on the heterogeneity of BMD or the positive vs negative direction of the relationships. The previous analysis also did not take into account the censored nature of the fatigue life data. As such, whether BMD heterogeneity is positively or negatively associated with fatigue life and whether this is independent from the average or minimum BMD are not clear. In the present work, we revisite d the McCubbrey data for a preliminary examination of the relationship between BMD heterogeneity and fatigue life using survival analysis. The analysis suggests that BMD heterogeneity measured as the intra-vertebral standard deviation of BMDs in a vertebra is negatively associated with short cycle (high-amplitude) fatigue life independent from the average BMD. The results motivate further studies on the role of BMD heterogeneity in fatigue failure and clinical fracture risk of human vertebrae.

show abstract

Measurement of subregional vertebral bone mineral density in vitro using lateral projection dual-energy X-ray absorptiometry: validation with peripheral quantitative computed tomography

Cited by 14 publications

References 51 publications

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

The intravertebral distribution of bone density: correspondence to intervertebral disc health and implications for vertebral strength

Heterogeneity of bone mineral density and fatigue failure of human vertebrae

Contact Info

Product

Resources

About