Trabecular Bone Microarchitecture, Bone Mineral Density, and Vertebral Fractures in Male Osteoporosis

Legrand, Érick; Chappard, Daniel; Pascaretti, C.; Duquenne, M.; Krebs, Stéphanie; Rohmer, V.; Basle, Michel‐Félix; Audran, Maurice

doi:10.1359/jbmr.2000.15.1.13

Cited by 352 publications

(191 citation statements)

References 32 publications

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“…Increased apoptosis of osteoblasts and osteocytes and decreased osteocyte viability may lead to bone microdamage and, ultimately, bone fragility (16)(17)(18)(19). Damage to the microarchitecture of trabecular bone has been shown to be a risk factor for vertebral deformities (20). In addition, it has been suggested that the degree of disruption of the trabecular network of bone correlates with cumulative exposure to oral GCs (21).…”

Section: Discussionmentioning

confidence: 99%

Fracture risk with intermittent high‐dose oral glucocorticoid therapy

Vries

Bracke²,

Leufkens

et al. 2007

Arthritis & Rheumatism

252

171

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Objective. To evaluate the risk of fracture in patients receiving intermittent therapy with high-dose oral glucocorticoids (GCs).Methods. The study group comprised 191,752 patients from the UK General Practice Database who were 40 years of age and older and received therapy with GCs. The followup time period was divided into the categories of "current" and "no exposure." The daily dose and cumulative dose for each time period were determined. Relative risks were estimated using Cox proportional hazards models, adjusted for age, sex, body mass index, smoking, disease history, and drug history. Fractures of the radius/ulna, humerus, rib, femur/hip, pelvis, or vertebrae were included in the evaluation.Results. Patients who intermittently received high-dose GCs (daily dose >15 mg) and had no or little previous exposure to GCs (cumulative exposure <1 gm) had a small increased risk of osteoporotic (but not hip/femur) fracture; this risk increased substantially with increasing cumulative exposure. Among patients who received a daily dose >30 mg and whose cumulative exposure was >5 gm, the relative risk (RR) of osteoporotic fracture was 3.63 (95% confidence interval [95% CI] 2.54-5.20), the RR of fracture of the hip/femur was 3.13 (95% CI 1.49-6.59), and the RR of vertebral fracture was 14.42 (95% CI 8.29-25.08).Conclusion. Intermittent use of high-dose oral GCs (daily dose >15 mg and cumulative exposure <1 gm) may result in a small increased risk of osteoporotic fracture. Conversely, patients who receive several courses of high-dose GCs (daily dose >15 mg and cumulative exposure >1 gm) have a substantially increased risk of fracture.

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Section: Discussionmentioning

confidence: 99%

Fracture risk with intermittent high‐dose oral glucocorticoid therapy

Vries

Bracke²,

Leufkens

et al. 2007

Arthritis & Rheumatism

252

171

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“…However, since all element properties are averaged over a 4-mm spherical region around the element, there is a lot of overlap in the analyzed region between neighboring elements. The actual number of non-overlapping samples is much less, and closer to 500, assuming a vertebral volume of around 32,000 mm 3 and a sample of around 64 mm 3 . It can be argued that the Bonferroni correction as calculated above is too conservative and that it should correct for only 500 hypotheses, corresponding to a level of significance of 1E-4.…”

Section: Statistical Analysis and Visualizationmentioning

confidence: 98%

“…complications associated with fragility fractures [1][2][3]. It has been demonstrated that the clinical diagnostic standard approach based on site-specific BMD measurements using dualenergy X-ray absorptiometry (DXA) is not a satisfactory predictor of vertebral fractures [4,5], and in general more than 50 % of the osteoporotic fractures occur in patients with a DXAT-scores that do not meet the diagnostic criterion (≤ −2.5 SD) [6,7].…”

Section: Introductionmentioning

confidence: 99%

Locally measured microstructural parameters are better associated with vertebral strength than whole bone density

et al. 2013

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Locally measured microstructural parameters are better associated with vertebral strength than whole bone densityHazrati Marangalou, J.; Eckstein, F.; Kuhn, V.; Ito, K.; Cataldi, M.; Taddei, F.; van Rietbergen, B. Published in: Osteoporosis International DOI:10.1007/s00198-013-2591-3Published: 01/01/2014 Document VersionAccepted manuscript including changes made at the peer-review stage Please check the document version of this publication:• A submitted manuscript is the author's version of the article upon submission and before peer-review. There can be important differences between the submitted version and the official published version of record. People interested in the research are advised to contact the author for the final version of the publication, or visit the DOI to the publisher's website.• The final author version and the galley proof are versions of the publication after peer review.• The final published version features the final layout of the paper including the volume, issue and page numbers. Link to publication Citation for published version (APA):Hazrati Marangalou, J., Eckstein, F., Kuhn, V., Ito, K., Cataldi, M., Taddei, F., & Rietbergen, van, B. (2014). Locally measured microstructural parameters are better associated with vertebral strength than whole bone density. Osteoporosis International, 25(4), 1285 -1296 . DOI: 10.1007 /s00198-013-2591 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Abstract Summary Whole vertebrae areal and volumetric bone mineral density (BMD) measurements are not ideal predictors of vertebral fractures. We introduce a technique which enables quantification of bone microstructural parameters at precisely defined anatomical locations. Results show that local assessment of bone volume fraction at the optimal location can substantially improve the prediction of vertebral strength. Introduction Whole vertebrae areal and volumetric BMD measurements are not ideal predictors of vertebral osteoporotic fractures. Recent studies have shown that sampling bone microstructural parameters in smaller regions may permit better predictions. In such studies, however, the sampling location is described only in general anatomical terms. Here, we introduce a technique that enables the quantification of bone volume fraction and microstructural paramet...

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“…In the subsequent pulse sequence cycle, at time t 4 , two echoes (generated via pathways labeled I and III) contribute to the signal at the center of k-space and a single stimulated echo at time t 5 (generated via pathway II) produces the artifactual signal T E /2 after the main echo. Note that the artifactual echo is not affected by the crusher gradient following the refocusing pulse, since at that time the magnetization for that pathway is longitudinal.…”

Section: Coherence Pathway Of Artifactual Signalmentioning

confidence: 99%

“…There is growing evidence that the mechanical competence of trabecular bone (the type of bone in which the majority of osteoporotic fractures occur), and thus its resistance to fracture, is significantly determined by the bone's architectural make-up (1)(2)(3)(4)(5). In vivo MR microimaging has proven its potential for assessing the bone's 3D structure.…”

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confidence: 99%

Coherence‐induced artifacts in large‐flip‐angle steady‐state spin‐echo imaging

Vasilic

Song

Wehrli

2004

Magnetic Resonance in Med

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High-resolution imaging of trabecular bone aimed at analyzing the bone's microarchitecture is preferably performed with spinecho-type pulse sequences. Unlike gradient echoes, spin-echoes are immune to artifactual broadening of trabeculae caused by local static field gradients near the bone-bone marrow interface and signal loss from chemical shift dephasing at kspace center. However, the previously practiced 3D fast largeangle spin-echo (FLASE) pulse sequence was found to be prone to a low-frequency modulation artifact in both the readout and slice direction. The artifact is caused by deviations in the effective flip angle of the nonselective 180°pulse, which converts a fraction of the phase-encoded transverse magnetization to longitudinal magnetization. The latter recurs as transverse magnetization in the subsequent pulse sequence cycle forming a spurious stimulated echo. There is growing evidence that the mechanical competence of trabecular bone (the type of bone in which the majority of osteoporotic fractures occur), and thus its resistance to fracture, is significantly determined by the bone's architectural make-up (1-5). In vivo MR microimaging has proven its potential for assessing the bone's 3D structure. Nevertheless, obtaining reproducible structural parameters strongly depends on achieving artifact-free images in a resolution regime on the order of 100 -150 m (6).The magnetic properties of bone and the chemical composition of bone marrow pose stringent requirements on pulse sequences appropriate for MR microimaging of trabecular bone. Strong susceptibility-induced gradients as well as the multiple spectral components of triacyl glycerides in fatty bone marrow cause dephasing that diminishes the marrow signal. At the interface with the trabeculae the susceptibility-induced local gradients lead to signal loss that causes the trabeculae to appear artifactually thickened in the reconstructed image (7). In a spin-echo sequence, the signal loss caused by local susceptibilityinduced gradients is fully recovered and the isochromats from the various spectral components of fat are rephased at k-space center. These two reasons make spin-echo type sequences particularly well suited for imaging trabecular bone. However, patient comfort and the large number of pulse sequence cycles inherent to 3D imaging put limits on the allowable repetition time, TR.Two previous publications from this laboratory introduced 3D FLASE (fast large-angle spin echo), a pulse sequence optimized for the purpose of imaging trabecular bone (8,9). The pulse sequence has been used in prior trabecular bone imaging studies (5,10) and is an integral element of the virtual bone biopsy (6). 3D FLASE is a large-flip-angle, 3D spin-echo sequence, shown in Fig. 1a). The fundamental principle of FLASE is the dual function of the 180°pulse that serves both for phase-reversal and for restoration of the inverted longitudinal magnetization created by the initial excitation pulse. A slice-selective excitation with a flip angle of 140°, used in 3D FLASE give...

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Trabecular Bone Microarchitecture, Bone Mineral Density, and Vertebral Fractures in Male Osteoporosis

Cited by 352 publications

References 32 publications

Fracture risk with intermittent high‐dose oral glucocorticoid therapy

Fracture risk with intermittent high‐dose oral glucocorticoid therapy

Locally measured microstructural parameters are better associated with vertebral strength than whole bone density

Coherence‐induced artifacts in large‐flip‐angle steady‐state spin‐echo imaging

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