The QUALYOR (QUalité Osseuse LYon Orléans) study: a new cohort for non invasive evaluation of bone quality in postmenopausal osteoporosis. Rationale and study design

Chapurlat, Roland; Pialat, Jean‐Baptiste; Merle, Blandine; Confavreux, E.; Duvert, F.; Fontanges, Élisabeth; Khacef, Farida; Peres, S. Loiseau; Schott, Anne-Marie; Lespessailles, Éric

doi:10.1007/s11657-017-0412-6

Cited by 12 publications

(6 citation statements)

References 36 publications

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“…Individuals in this study are members of eight cohorts comprising the Bone Microarchitecture International Consortium, or BoMIC, including the Framingham Study 17 , Qualyor (Qualite Osseuse Lyon Orleans) 18 , GERICO (Geneva Retirees Cohort) 19 , CaMos (Canadian Multicentre Osteoporosis Study) 20 , STRAMBO (Structure of Aging Men's Bones) 21 , OFELY (Os des Femmes de Lyon) 22 , MrOS (Osteoporotic Fractures in Men Study) Sweden 23 , and Mayo Clinic 24 (Table 1). Each of the BoMIC cohorts was established to study risk factors for osteoporosis, conducting comprehensive clinical examinations, administering standardized questionnaires, and prospectively ascertaining incident fractures.…”

Section: Methodsmentioning

confidence: 99%

Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study

Samelson

Broe

et al. 2019

The Lancet Diabetes & Endocrinology

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Background: Although dual-energy x-ray absorptiometry (DXA) assessed areal bone density (aBMD) is the clinical standard for determining fracture risk, the majority of older adults who sustain a fracture do not have osteoporosis (T-score < −2.5). Importantly, bone fragility results not only from low BMD, but also from deterioration in bone structure. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) data from eight cohorts to evaluate whether HR-pQCT indices were associated with fracture risk independently of femoral neck (FN) aBMD and FRAX (Fracture Risk Assessment Tool) score. Methods: Participants included 7,254 individuals (66% women) from cohorts in the USA (Framingham, Mayo Clinic), France (QUALYOR, STRAMBO, OFELY), Switzerland (GERICO), Canada (CaMos), and Sweden (MrOS). We used Cox proportional hazards models to estimate hazards ratios (HRs) for the association between bone parameters (per standard deviation, SD, deficit) and incident fracture, adjusting for age, sex, height, weight and cohort. Findings: Mean baseline age was 69 (±9) years (range, 40 to 96). Cumulative incidence of fracture was 11% (n=765) over a mean follow-up time of 4.6 (± 2.4) years. The majority of participants (92%) had a femoral neck T-score >−2.5, and thus did not meet diagnostic criteria for osteoporosis. Failure load was the bone measure most strongly associated with risk of fracture: tibia HR=2.40 (1.98-2.91), radius HR=2.13 (1.77-2.56), per SD decrease in failure load. HRs for other bone indices ranged from HR=1.12 (1.03-1.23) per SD increase in tibia cortical porosity to HR=1.58 (1.45-1.72) per SD decrease in radius trabecular volumetric bone density (vBMD). After further adjustment for FN aBMD or FRAX, HRs were attenuated, but most bone parameters remained significantly associated with fracture. Cortical density, trabecular number, and trabecular thickness at the distal radius were the best set of predictors of fracture; while the same indices plus cortical area were identified for the tibia. These HR-pQCT indices and failure load improved prediction of fracture, beyond FN aBMD alone or FRAX. Interpretation: Results from this large international cohort of women and men confirm prior studies showing that deficits in trabecular and cortical bone density and structure contribute to fracture risk independently of aBMD and FRAX. Measurements of cortical and trabecular bone density and morphology at the peripheral skeleton may improve identification of those at highest risk for fracture. Funding: National Institutes of Health, National Institute of Arthritis Musculoskeletal and Skin Diseases, R01AR061445

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Section: Methodsmentioning

confidence: 99%

Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study

Samelson

Broe

et al. 2019

The Lancet Diabetes & Endocrinology

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282

196

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“…The strongest association was found for Tt.BMD and Tb.N at the radius [58,59] and tibial Ct.Ar and mass [57]. The Bone Microarchitecture International Consortium (BoMIC) pooled HR-pQCT data of 7254 participants (66% women and 34% men, with a mean age of 69 years) from eight cohorts assembled in the USA (Framingham, Mayo Clinic) [60], France (QUALYOR) [61], STRAMBO [62], OFELY [40], Switzerland (GERICO) [63], Canada (CaMos) [39], and Sweden (MrOS) [64] for a combined prospective analysis of incident fracture risk [65]. All HR-pQCT data were obtained with the XtremeCT I device.…”

Section: Bone Microarchitecture and Bone Strength As Predictors Of Incident Fracturesmentioning

confidence: 99%

The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions

et al. 2021

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High-resolution peripheral computed tomography (HR-pQCT) was developed to image bone microarchitecture in vivo at peripheral skeletal sites. Since the introduction of HR-pQCT in 2005, clinical research to gain insight into pathophysiology of skeletal fragility and to improve prediction of fractures has grown. Meanwhile, the second-generation HR-pQCT device has been introduced, allowing novel applications such as hand joint imaging, assessment of subchondral bone and cartilage thickness in the knee, and distal radius fracture healing. This article provides an overview of the current clinical applications and guidance on interpretation of results, as well as future directions. Specifically, we provide an overview of (1) the differences and reference data for HR-pQCT variables by age, sex, and race/ethnicity;(2) fracture risk prediction using HR-pQCT; (3) the ability to monitor response of anti-osteoporosis therapy with HR-pQCT; (4) the use of HR-pQCT in patients with metabolic bone disorders and diseases leading to secondary osteoporosis; and (5) novel applications of HR-pQCT imaging. Finally, we summarize the status of the application of HR-pQCT in clinical practice and discuss future directions. From the clinical perspective, there are both challenges and opportunities for more widespread use of HR-pQCT. Assessment of bone microarchitecture by HR-pQCT improves fracture prediction in mostly normal or osteopenic elderly subjects beyond DXA of the hip, but the added value is marginal. The prospects of HR-pQCT in clinical practice need further study with respect to medication effects, metabolic bone disorders, rare bone diseases, and other applications such as hand joint imaging and fracture healing. The mostly unexplored potential may be the differentiation of patients with only moderately low BMD but severe microstructural deterioration, which would have important implications for the decision on therapeutical interventions.

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“…Participants We studied (i) 568 postmenopausal women, median age 68.2 years, range 42-94 of Os des FEmmes de LYon, OFELY, France followed for a median [interquartile range] of 9.4 [1.0] years, 9,28,29 (ii) 1427 women of the Qualité Osseuse Lyon Orléans, QUALYOR cohort (1042 recruited in Lyon, 497 in Orléans), median age 65.9 (range 50-87) years followed for 5 years 30 and (iii) 671 women of the Geneva Retirees Cohort, GERICO, in Switzerland median age 65 (range 63-68) years followed 5.7 years (range 2-8). 31 The studies were approved by the institutional review boards.…”

Section: Methodsmentioning

confidence: 99%

Deep Learning Using High-Resolution Images of Forearm Predicts Fracture

Chapurlat

Ferrari

Li³

et al. 2023

Preprint

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Importance Fragility fractures are a public health problem. Over 70% of women having fractures have osteopenia or normal BMD, but they remain unidentified and untreated because the definition of ‘osteoporosis’, a bone mineral density (BMD) T-Score ≤ -2.5SD, is often used to signal bone fragility.Objective As deep learning facilitates investigation of bone’s multi-level hierarchical structure and soft tissue, we tested whether this approach might better identify women at risk of fracture before fracture.Design We pooled data from three French and Swiss prospective population-based cohorts (OFELY, QUALYOR, GERICO) that collected clinical risk factors for fracture, areal BMD and distal radius measurements with high resolution peripheral quantitative tomography (HRpQCT). Using only three-dimensional images of the distal radius, ulna and soft tissue acquired by HRpQCT, an algorithm, a Structural Fragility Score-Artificial Intelligence (SFS-AI), was trained to distinguish 277 women having fractures from 1401 remaining fracture-free during 5 years and then was tested in a validation cohort of 422 women.Setting European postmenopausal womenParticipants We have studied postmenopausal women considered as representative of the general population, who were followed for a median 9.4 years in OFELY, 5.4 years in QUALYOR and 5.7 years in GERICO.Main outcome and measure All types of incident fragility fracturesResults We used data from 2666 postmenopausal women, with age range of 42-94. In women ≥ 65 years having ‘All Fragility Fractures’ or ‘Major Fragility Fractures’, SFS-AI generated an AUC of 66-70%, sensitivities of 60-68% and specificity of 71%. Sensitivities were greater than achieved by the fracture risk assessment (FRAX) with BMD or BMD (6.7-26.7%) with lower specificities than these diagnostics (~95%).Conclusion The SFS-AI is a holistic surrogate of fracture risk that pre-emptively identifies most women needing prompt treatment to avert a first fracture.

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The QUALYOR (QUalité Osseuse LYon Orléans) study: a new cohort for non invasive evaluation of bone quality in postmenopausal osteoporosis. Rationale and study design

Abstract: QUALYOR will provide important information on the relationship between bone quality variables and fracture risk in women with moderately decreased BMD.

Cited by 12 publications

References 36 publications

Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study

Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study

The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions

Deep Learning Using High-Resolution Images of Forearm Predicts Fracture

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