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Endocrine Oct 2021Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually,... (Review)
Review
Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.
Topics: Absorptiometry, Photon; Bone Density; Cancellous Bone; Humans; Lumbar Vertebrae; Osteoporosis; Osteoporotic Fractures; Quality of Life; Risk Assessment
PubMed: 34245432
DOI: 10.1007/s12020-021-02806-x -
Biomechanics and Modeling in... Feb 2022Modeling of cancellous bone has important applications in the detection and treatment of fatigue fractures and diseases like osteoporosis. In this paper, we present a...
Modeling of cancellous bone has important applications in the detection and treatment of fatigue fractures and diseases like osteoporosis. In this paper, we present a fully coupled multiscale approach considering mechanical, electric and magnetic effects by using the multiscale finite element method and a two-phase material model on the microscale. We show numerical results for both scales, including calculations for a femur bone, comparing a healthy bone to ones affected by different stages of osteoporosis. Here, the magnetic field strength resulting from a small mechanical impact decreases drastically for later stages of the disease, confirming experimental research.
Topics: Bone and Bones; Cancellous Bone; Electricity; Finite Element Analysis; Stress, Mechanical
PubMed: 34652569
DOI: 10.1007/s10237-021-01525-6 -
Acta Bio-medica : Atenei Parmensis Jan 2018Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural... (Review)
Review
Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures.
Topics: Bone Density; Cancellous Bone; Femur; Humans; Lumbar Vertebrae; Osteoporosis; Osteoporotic Fractures; Spinal Fractures
PubMed: 29350648
DOI: 10.23750/abm.v89i1-S.7023 -
Advances in Experimental Medicine and... 2022Two theoretical models for ultrasonic scattering from cancellous bone have been extensively validated in human cancellous bone in vitro. Many metrics have been devised...
Two theoretical models for ultrasonic scattering from cancellous bone have been extensively validated in human cancellous bone in vitro. Many metrics have been devised to assess scattering in vivo. In the diagnostic frequency range (<1 MHz), multiple scattering is much weaker than single scattering. However, evidence for multiple scattering has been detected. At higher frequencies (>1 MHz), the effects of multiple scattering are more pronounced. Clinical trials indicate that backscatter parameters provide useful diagnostic information regarding bone status in adults and neonates. This chapter will emphasize developments in scattering research in the last decade since the previous volume Bone QUS was published.
Topics: Adult; Bone Density; Bone and Bones; Cancellous Bone; Humans; Infant, Newborn; Scattering, Radiation; Ultrasonics; Ultrasonography
PubMed: 35508875
DOI: 10.1007/978-3-030-91979-5_8 -
Journal of Medicine and Life 2020TBS (Trabecular Bone Score) is the latest tool for clinicians to evaluate bone micro-architecture based on a pixel greyscale, which is provided by lumbar dual-energy... (Review)
Review
TBS (Trabecular Bone Score) is the latest tool for clinicians to evaluate bone micro-architecture based on a pixel greyscale, which is provided by lumbar dual-energy X-ray absorptiometry (DXA). Its use enhances fracture prediction in addition to DXA-BMD (Bone Mineral Density). This is independent of fracture risk assessment (FRAX) and DXA results. We present a narrative review regarding the connection between TBS and Glucocorticoids (GC), either as a drug used for different conditions or as a tumor-produced endogenous excess. TBS is a better discriminator for GC-induced vertebral fractures compared to DXA-BMD. This aspect is similarly available for patients with osteoporosis diagnosed by DXA. TBS is inversely correlated with the cumulative dose of GC (systemic or inhaled), with disease duration, and positively correlated with respiratory function in patients with asthma. Low TBS values are found in females with a T-score at the hip within the osteoporosis range, with diabetes mellitus, or who use GC. Lumbar TBS is a screening tool in menopausal women with type 2 diabetes mellitus. TBS is an independent parameter that provides information regarding skeleton deterioration in diabetic patients receiving GC therapy in a manner complementary to DXA-BMD. TBS might become an essential step regarding the adrenalectomy decision in patients with adrenal incidentaloma in whom autonomous cortisol secretion might damage bone micro-architecture. TBS currently represents a standard tool of fracture risk evaluation in patients receiving GC therapy or with endogenous Cushing's syndrome, a tool easy to be applied by different practitioners since GCs are largely used.
Topics: Bone Density; Cancellous Bone; Cushing Syndrome; Glucocorticoids; Humans
PubMed: 33456590
DOI: 10.25122/jml-2019-0131 -
IEEE Transactions on Ultrasonics,... Mar 2020Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of... (Review)
Review
Ultrasound is now a clinically accepted modality in the management of osteoporosis. The most common commercial clinical devices assess fracture risk from measurements of attenuation and sound speed in cancellous bone. This review discusses fundamental mechanisms underlying the interaction between ultrasound and cancellous bone. Because of its two-phase structure (mineralized trabecular network embedded in soft tissue-marrow), its anisotropy, and its inhomogeneity, cancellous bone is more difficult to characterize than most soft tissues. Experimental data for the dependencies of attenuation, sound speed, dispersion, and scattering on ultrasound frequency, bone mineral density, composition, microstructure, and mechanical properties are presented. The relative roles of absorption, scattering, and phase cancellation in determining attenuation measurements in vitro and in vivo are delineated. Common speed of sound metrics, which entail measurements of transit times of pulse leading edges (to avoid multipath interference), are greatly influenced by attenuation, dispersion, and system properties, including center frequency and bandwidth. However, a theoretical model has been shown to be effective for correction for these confounding factors in vitro and in vivo. Theoretical and phantom models are presented to elucidate why cancellous bone exhibits negative dispersion, unlike soft tissue, which exhibits positive dispersion. Signal processing methods are presented for separating "fast" and "slow" waves (predicted by poroelasticity theory and supported in cancellous bone) even when the two waves overlap in time and frequency domains. Models to explain dependencies of scattering on frequency and mean trabecular thickness are presented and compared with measurements. Anisotropy, the effect of the fluid filler medium (marrow in vivo or water in vitro), phantoms, computational modeling of ultrasound propagation, acoustic microscopy, and nonlinear properties in cancellous bone are also discussed.
Topics: Animals; Bone Density; Calcaneus; Cancellous Bone; Cattle; Femur; Humans; Osteoporosis; Phantoms, Imaging; Signal Processing, Computer-Assisted; Ultrasonography
PubMed: 31634127
DOI: 10.1109/TUFFC.2019.2947755 -
Journal of Orthopaedic Surgery and... May 2020What is the right surface for an implant to achieve biological fixation? Surface technologies can play important roles in encouraging interactions between the implant...
BACKGROUND
What is the right surface for an implant to achieve biological fixation? Surface technologies can play important roles in encouraging interactions between the implant surface and the host bone to achieve osseointegration. Preclinical animal models provide important insight into in vivo performance related to bone ongrowth and implant fixation.
METHODS
A large animal model was used to compare the in vivo response of HA and plasma-sprayed titanium coatings in a well-reported adult ovine model to evaluate bone ongrowth in terms of mechanical properties in cortical sites, and histology and histomorphometry in cortical and cancellous sites at 4 and 12 weeks.
RESULTS
Titanium plasma-sprayed surfaces outperformed the HA-coated samples in push-out testing in cortical sites while both surfaces supported new bone ongrowth and remodeling in cortical and cancellous sites.
CONCLUSIONS
While both HA and Ti plasma provided an osteoconductive surface for bone ongrowth, the Ti plasma provided a more robust bone-implant interface that ideally would be required for load transfer and implant stability in the longer term.
Topics: Animals; Biomechanical Phenomena; Bone Plates; Cancellous Bone; Cortical Bone; Shear Strength; Sheep; Titanium
PubMed: 32408885
DOI: 10.1186/s13018-020-01696-5 -
Menopause (New York, N.Y.) Nov 2022The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis.
OBJECTIVES
The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis.
METHODS
A total of 1,915 postmenopausal women with lumbar spine and hip bone mineral density (BMD) and spine TBS were enrolled from a single medical center into this study. The women's BMD and TBS were measured using dual x-ray absorptiometry (Discovery Wi; Hologic, Bedford, Mass) and iNsight software (Med-Imaps SASU, Merignac, France), respectively. The women's demographic characteristics; lumbar spine, total hip, and femoral neck BMD; and lumbar spine TBS were recorded, and correlations among the parameters were identified using a 2-tailed Pearson test, in which a P value less than 0.05 was considered statistically significant. We developed simple linear regression models to represent changes related to TBS and performed an analysis of variance on the selected variables.
RESULTS
The average age of the women was 62.5 ± 9.1 years (range, 25.7-93.7 years). The mean TBS was 1.300 ± 0.086 (range, 1.015-1.596). The TBS was weakly and negatively correlated with body mass index ( r = -0.078) and moderately and positively correlated with the lumbar spine BMD ( r = 0.619). The patients' lowest BMD values among those measured at multiple sites revealed a higher rate of osteoporosis (32.5%) than those measured at individual sites. Degraded TBS were noted in 21.2% of the participants, and a combination of BMD and TBS results predicted more individuals (7.8%) at a high risk of fracture than did the BMD result only. The rates of both osteoporosis and degraded TBS increased with age.
CONCLUSIONS
Bone mineral density and TBS can be used in combination to predict osteoporosis in a greater number of postmenopausal Taiwanese women. Because the incidence of osteoporosis is the highest among older women, clinicians should pay careful attention to TBS degradation among older patients without low BMD.
Topics: Humans; Female; Aged; Adult; Middle Aged; Aged, 80 and over; Bone Density; Cancellous Bone; Postmenopause; Absorptiometry, Photon; Osteoporosis; Lumbar Vertebrae; Osteoporotic Fractures
PubMed: 36126233
DOI: 10.1097/GME.0000000000002058 -
Current Osteoporosis Reports Dec 2019Individuals with type 1 and type 2 diabetes mellitus (T1DM, T2DM) have an increased risk of bone fracture compared to non-diabetic controls that is not explained by... (Review)
Review
PURPOSE OF REVIEW
Individuals with type 1 and type 2 diabetes mellitus (T1DM, T2DM) have an increased risk of bone fracture compared to non-diabetic controls that is not explained by differences in BMD, BMI, or falls. Thus, bone tissue fracture resistance may be reduced in individuals with DM. The purpose of this review is to summarize work that analyzes the effects of T1DM and T2DM on bone tissue compositional and mechanical properties.
RECENT FINDINGS
Studies of clinical T2DM specimens revealed increased mineralization and advanced glycation endproduct (AGE) concentrations and significant relationships between mechanical performance and composition of cancellous bone. Specifically, in femoral cancellous tissue, compressive stiffness and strength increased with mineral content; and post-yield properties decreased with AGE concentration. In addition, cortical resistance to in vivo indentation (bone material strength index) was lower in patients with T2DM vs. age-matched non-diabetic controls, and this resistance decreased with worsening glycemic control. Recent studies on patients with T1DM and history of a prior fragility fracture found greater mineral content and concentrations of AGEs in iliac trabecular bone and correspondingly stiffer, harder bone at the nanosacle. Recent observational data showed greater AGE and mineral content in surgically retrieved bone from patients with T2DM vs. non-DM controls, consistent with reduced bone remodeling. Limited data on human T1DM bone tissue also showed higher mineral and AGE content in patients with prior fragility fractures compared to non-DM and non-fracture controls.
Topics: Animals; Biomechanical Phenomena; Blood Glucose; Bone Density; Bone Remodeling; Bone and Bones; Cancellous Bone; Cortical Bone; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Fractures, Bone; Glycation End Products, Advanced; Humans
PubMed: 31713179
DOI: 10.1007/s11914-019-00538-6 -
PloS One 2022Bone quality is a critical factor that, along with bone quantity, determines bone strength. Image-based parameters are used for assessing bone quality non-invasively....
Bone quality is a critical factor that, along with bone quantity, determines bone strength. Image-based parameters are used for assessing bone quality non-invasively. The trabecular bone score (TBS) is used to assess quality of trabecular bone and femur geometry for cortical bone. Little is known about the associations between these two bone quality parameters and whether they show differences in the relationships with age and body mass index (BMI). We investigated the associations between the trabecular bone score (TBS) and femur cortical geometry. Areal bone mineral density (BMD) was assessed using dual energy X-ray absorptiometry (DXA) and the TBS was assessed using iNsight software and, femur geometry using APEX (Hologic). A total of 452 men and 517 women aged 50 years and older with no medical history of a condition affecting bone metabolism were included. Z-scores for TBS and cortical thickness were calculated using the age-specific mean and SD for each parameter. A 'discrepancy group' was defined as patients whose absolute Z-score difference between TBS and cortical thickness was > 1 point. TBS and cortical thickness correlated negatively with age both in men and women, but the associations were stronger in women. Regarding the associations with BMI, TBS provided significant negative correlation with BMI in the range of BMI > 25 kg/m2. By contrast, cortical thickness correlated positively with BMI for all BMI ranges. These bone quality-related parameters, TBS and cortical thickness, significantly correlated, but discordance between these two parameters was observed in about one-third of the men and women (32.7% and 33.4%, respectively). Conclusively, image-based bone quality parameters for trabecular and cortical bone exhibit both similarities and differences in terms of their associations with age and BMI. These different profiles in TBS and FN cortical thickness might results in different risk profiles for the vertebral fractures or hip fractures in a certain percentage of people.
Topics: Absorptiometry, Photon; Aged; Body Mass Index; Bone Density; Cancellous Bone; Cross-Sectional Studies; Female; Femur; Hip; Humans; Male; Middle Aged; Osteoporosis; Postmenopause
PubMed: 35015756
DOI: 10.1371/journal.pone.0260924