Reliability of HR-pQCT Derived Cortical Bone Structural Parameters When Using Uncorrected Instead of Corrected Automatically Generated Endocortical Contours in a Cross-Sectional Study: The Maastricht Study

Waard, Ellis A. C. de; Sarodnik, Cindy; Pennings, Alexander J.; Jong, Joost J.A. de; Savelberg, Hans; Geel, Tineke van; Kallen, Carla; Stehouwer, Coen D. A.; Schram, Miranda T.; Schaper, Nicolaas C.; Dagnelie, Pieter C.; Geusens, Piet; Koster, Annemarie; Rietbergen, Bert van; Bergh, Joop van den

doi:10.1007/s00223-018-0416-2

Cited by 12 publications

(7 citation statements)

References 26 publications

(40 reference statements)

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“…Towards the epiphyses of the tibia, cortical bone becomes thinner and is increasingly replaced by a trabecular core, rising concerns about the precision error of cortical bone structural and density measurements performed at distal and ultradistal sites with HR-pQCT [43,44]. Due to the different measurement site (midshaft, here, instead of distal shaft) we observed a cortical thickness of the tibia that was 2 to 3 times larger than values reported from HR-pQCT studies [15,18,45–47]. In this sense, the tibia midshaft provided a much larger and homogeneous volume of interest for cortical bone microstructural characterization than the distal shaft.…”

Section: Discussionmentioning

confidence: 62%

Large cortical bone pores in the tibia are associated with proximal femur strength

et al. 2019

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Alterations of structure and density of cortical bone are associated with fragility fractures and can be assessed in vivo in humans at the tibia. Bone remodeling deficits in aging women have been recently linked to an increase in size of cortical pores. In this ex vivo study, we characterized the cortical microarchitecture of 19 tibiae from human donors (aged 69 to 94 years) to address, whether this can reflect impairments of the mechanical competence of the proximal femur, i.e., a major fracture site in osteoporosis. Scanning acoustic microscopy (12 μm pixel size) provided reference microstructural measurements at the left tibia, while the bone vBMD at this site was obtained using microcomputed tomography (microCT). The areal bone mineral density of both left and right femoral necks (aBMD neck ) was measured by dual‐energy X‐ray absorptiometry (DXA), while homogenized nonlinear finite element models based on high-resolution peripheral quantitative computed tomography provided hip stiffness and strength for one-legged standing and sideways falling loads. Hip strength was associated with aBMD neck (r = 0.74 to 0.78), with tibial cortical thickness (r = 0.81) and with measurements of the tibial cross-sectional geometry (r = 0.48 to 0.73) of the same leg. Tibial vBMD was associated with hip strength only for standing loads (r = 0.59 to 0.65). Cortical porosity (Ct.Po) of the tibia was not associated with any of the femoral parameters. However, the proportion of Ct.Po attributable to large pores (diameter > 100 μm) was associated with hip strength in both standing (r = -0.61) and falling (r = 0.48) conditions. When added to aBMD neck , the prevalence of large pores could explain up to 17% of the femur ultimate force. In conclusion, microstructural characteristics of the tibia reflect hip strength as well as femoral DXA, but it remains to be tested whether such properties can be measured in vivo.

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Section: Discussionmentioning

confidence: 62%

Large cortical bone pores in the tibia are associated with proximal femur strength

et al. 2019

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“…Therefore, the negative results (absence of associations) in this study should be interpreted with caution and larger studies are needed to confirm our results. Third, we used the uncorrected automatically generated endocortical contour for cortical bone analysis, which results in lower values of porosity-related parameters due to less inclusion of the transitional zone [40]. However, a study by Heilmeier et al showed that differences in Ct.Po between patients with T2DM with and without fragility fractures were present in the periosteal and midcortical layer of the cortex, but not in the endosteal layer [41].…”

Section: Discussionmentioning

confidence: 99%

The association between diabetes status, HbA1c, diabetes duration, microvascular disease, and bone quality of the distal radius and tibia as measured with high-resolution peripheral quantitative computed tomography—The Maastricht Study

et al. 2018

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SummaryIn this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites.IntroductionTo examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally—in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters.MethodsCross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history.ResultsAfter full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (− 4%) in prediabetes and smaller cross-sectional area of the tibia (− 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (− 5%), cortical thickness (− 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (− 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters.ConclusionsIn this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.Electronic supplementary materialThe online version of this article (10.1007/s00198-018-4678-3) contains supplementary material, which is available to authorized users.

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“…An image processing pipeline using a combination of adaptive histogram equalization, watershed segmentation, iterative Gaussian blurred energy landscapes, and 3D-GAC was established such that 56 out of 60 images were automatically contoured successfully. In our hand-contoured reference dataset, we observed clear inter-operator variability, which is a known issue of hand-contouring bone [27]. On average, the automatically generated contours by the 3D-GAC algorithm agreed well with operators.…”

Section: Discussionmentioning

confidence: 83%

“…Both approaches were affected by image quality, as expected. However, the 3D-GAC approach only failed for one image with sufficient image quality to be considered for inclusion in HR-pQCT studies [8,27,30]. Trabecular morphometric indices generated using the successful 3d-GAC contours agreed well with those generated using the default manufacturer pipeline with deviations well below the precision error of these indices [31].…”

Section: Discussionmentioning

confidence: 99%

Automated Segmentation of Fractured Distal Radii by 3D Geodesic Active Contouring ofin vivoHR-pQCT Images

Ohs

Tourolle

Atkins

et al. 2020

Preprint

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Radius fractures are among the most common fracture types; however, there is limited consensus on the standard of care. A better understanding of the fracture healing process could help to shape future treatment protocols and thus improve functional outcomes of patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) allows monitoring and evaluation of the radius on the micro-structural level, which is crucial to our understanding of fracture healing. However, current radius fracture studies using HR-pQCT are limited by the lack of automated contouring routines, hence only including small number of patients due to the prohibitively time-consuming task of manually contouring HR-pQCT images. In the present study, a new method to automatically contour images of distal radius fractures based on 3D morphological geodesic active contours (3D-GAC) is presented. Contours of 60 HR-pQCT images of fractured and conservatively treated radii spanning the healing process up to one year post-fracture are compared to the current gold standard, hand-drawn 2D contours, to assess the accuracy of the algorithm. Furthermore, robustness was established by applying the algorithm to HR-pQCT images of intact radii of 73 patients and comparing the resulting morphometric indices to the gold standard patient evaluation. Reproducibility was evaluated using repeat scans of intact radii of 19 patients. The new 3D-GAC approach offers accurate contours within inter-operator variability for images of fractured distal radii. The generated contours for images of intact radii yielded morphometric indices within in vivo reproducibility limits compared to the current gold standard. Additionally, the 3D-GAC approach shows an improved robustness against failure when dealing with cortical interruptions, fracture fragments, etc. Using the 3D-GAC approach assures consistent results, while reducing the need for time-consuming semi-automatic contouring.

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Reliability of HR-pQCT Derived Cortical Bone Structural Parameters When Using Uncorrected Instead of Corrected Automatically Generated Endocortical Contours in a Cross-Sectional Study: The Maastricht Study

Cited by 12 publications

References 26 publications

Large cortical bone pores in the tibia are associated with proximal femur strength

Large cortical bone pores in the tibia are associated with proximal femur strength

The association between diabetes status, HbA1c, diabetes duration, microvascular disease, and bone quality of the distal radius and tibia as measured with high-resolution peripheral quantitative computed tomography—The Maastricht Study

Automated Segmentation of Fractured Distal Radii by 3D Geodesic Active Contouring ofin vivoHR-pQCT Images

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