ANALYSIS OF CORRELATION BETWEEN TRABECULAR MICROSTRUCTURE AND CLINICAL IMAGING PARAMETERS IN FRACTURE REGION OF OSTEOPOROTIC HIP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PENGJing , ZHOUYong , MINLi , ZHANGWenli , LUOYi , ZHANGXuelei , ZOUChang ,  SHIRui ,  TUChongqi

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

SHIRui, Email: dr.shirui@hotmail.com; TUChongqi, Email: tuchongqi@163.com

Keywords：

Osteoporosis; Hip fracture; Bone microstructure; Micro-CT

DOI：

10.7507/1002-1892.20140129

Video：

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Objective To analyze the correlation between the trabecular microstructure and the clinical imaging parameters in the fracture region of osteoporotic hip so as to provide a simple method to evaluate the trabecular microstructure by a non-invasive way. Methods Between June 2012 and January 2013, 16 elderly patients with femoral neck fracture underwent hip arthroplasty were selected as the trial group; 5 young patients with pelvic fracture were selected as the control group. The hip CT examination was done, and cancellous bone volume/marrow cavity volume (CV/MV) was analyzed with Mimics 10.01 software in the control group. The CT scan and bone mineral density (BMD) measurement were performed on normal hips of the trial group, and cuboid specimens were gained from the femoral necks at the place of the tensional trabeculae to evaluate the trabecular microstructure parameters by Micro-CT, including bone volume fraction (BV/TV), trabecular number (Tb. N), trabecular spacing (Tb.Sp), trabecular thickness (Tb.Th), connect density (Conn.D), and structure model index (SMI). The correlation between imaging parameters and microstructure parameters was analyzed. Results In the trial group, the BMD value was 0.491-0.698 g/cm² (mean, 0.601 g/cm²); according to World Health Organization (WHO) standard, 10 cases were diagnosed as having osteoporosis, and 6 cases as having osteopenia. The CV/MV of the trial group (0.670 1±0.102 0) was significantly lower than that of the control group (0.885 0±0.089 1) (t=-4.567, P=0.000). In the trial group, CV/MV had correlation with BV/TV, Tb.Th, and SMI (P<0.05); however, CV/MV had no correlation with Tb.N, Tb.Sp, or Conn.D (P>0.05). BV/TV had correlation with Tb.Th, Tb.N, Tb.Sp, and SMI (P<0.05), but it had no correlation with Conn.D (P=0.075). There was no correlation between BMD and microstructure parameters (P>0.05). Conclusion CV/MV obviously decreases in the osteoporotic hip, and there is a correlation between CV/MV and the microstructure parameters of BV/TV, Tb.Th, and SMI, to some extent, which can reflect the variety of the microstructure of the trabeculae. There is no correlation between BMD of femoral neck and microstructure parameters.

Citation： PENGJing, ZHOUYong, MINLi, ZHANGWenli, LUOYi, ZHANGXuelei, ZOUChang, SHIRui, TUChongqi. ANALYSIS OF CORRELATION BETWEEN TRABECULAR MICROSTRUCTURE AND CLINICAL IMAGING PARAMETERS IN FRACTURE REGION OF OSTEOPOROTIC HIP. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 576-580. doi: 10.7507/1002-1892.20140129 Copy

1.	[No authors listed]. Consensus development conference:diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med, 1994, 94(6):646-650.
2.	Johnell O, Kanis JA, Oden E, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res, 2005, 20(7):1185-1194.
3.	Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women:the Rotterdam Study. Bone, 2004, 34(1):195-202.
4.	Hans D, Goertzen AL, Krieg MA, et al. Bone microarchitecture assessed by TBS predicts osteoporotic fracture independent of bone density:the Manitoba study. J Bone Miner Res, 2011, 26(11):2762-2769.
5.	中华医学会. 临床诊疗指南:骨质疏松症和骨矿盐疾病分册. 北京:人民卫生出版社, 2006:1-3.
6.	Yamada M, Briot J, Pedrono A, et al. Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg, 2007, 16(5):596-602.
7.	van Rietbergen B, Huiskes R, Eckstein F, et al. Trabecular bone tissue strains in the healthy and osteoporotic humam femur. J Bone Miner Res, 2003, 18(10):1781-1788.
8.	Verhulp E, van Rietbergen B, Huiskes R. Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side. Bone, 2008, 42(1):30-35.
9.	de Bakker PM, Manske SL, Ebacher V, et al. During sideways falls proximal femur fracture initiate in the superolateral cortex:evidence from high-speed video of simulated fractures. J Biomech, 2009, 42(12):1917-1925.
10.	金明柱, 郑洪新. 骨髓脂肪细胞与骨质疏松症. 中国骨质疏松杂志, 2006, 12(6):645-649.
11.	王晨光, 肖湘生, 陈星荣, 等. 人腰椎体松质骨CT值与组织形态指标的相关性研究. 中国医学计算机成像杂志, 1998, 4(4):250-253.
12.	Legrand E, Chappard D, Pascaretti C, et al. Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res, 2000, 15(1):13-19.
13.	李建赤, 徐自强, 黄必留, 等. 老年性髋部骨折骨密度与骨形态计量学的关系. 中国骨质疏松杂志, 2011, 17(11):977-980.
14.	Chappard D, Guggenbuhl P, Legrand E, et al. Texture analysis of X-ray radiographs is correlated with bone histomorphometry. J Bone Miner Metab, 2005, 23(1):24-29.
15.	Cortet B, Chappard D, Boutry N, et al. Relationship between computed tomographic image analysis and histomorphometry for microarchitecture characterization of human calcaneus. Calcif Tissue Int, 2004, 75(1):23-31.
16.	Boutry N, Cortet B, Chappard D, et al. Bone structure of the calcaneus:analysis with magnetic resonance imaging and correlation with histomorphometric study. Osteoporos Int, 2004, 15(10):827-833.
17.	吴燕平, 靳激扬. 重视骨质疏松症的影像学评估. 实用老年医学, 2011, 25(4):284-287, 291.
18.	Wirth AJ, Goldhahn J, Flaig C, et al. Implant stability is affected by local bone microstructural quality. Bone, 2011, 49(3):473-478.

1. [No authors listed]. Consensus development conference:diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med, 1994, 94(6):646-650.
2. Johnell O, Kanis JA, Oden E, et al. Predictive value of BMD for hip and other fractures. J Bone Miner Res, 2005, 20(7):1185-1194.
3. Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women:the Rotterdam Study. Bone, 2004, 34(1):195-202.
4. Hans D, Goertzen AL, Krieg MA, et al. Bone microarchitecture assessed by TBS predicts osteoporotic fracture independent of bone density:the Manitoba study. J Bone Miner Res, 2011, 26(11):2762-2769.
5. 中华医学会. 临床诊疗指南:骨质疏松症和骨矿盐疾病分册. 北京:人民卫生出版社, 2006:1-3.
6. Yamada M, Briot J, Pedrono A, et al. Age- and gender-related distribution of bone tissue of osteoporotic humeral head using computed tomography. J Shoulder Elbow Surg, 2007, 16(5):596-602.
7. van Rietbergen B, Huiskes R, Eckstein F, et al. Trabecular bone tissue strains in the healthy and osteoporotic humam femur. J Bone Miner Res, 2003, 18(10):1781-1788.
8. Verhulp E, van Rietbergen B, Huiskes R. Load distribution in the healthy and osteoporotic human proximal femur during a fall to the side. Bone, 2008, 42(1):30-35.
9. de Bakker PM, Manske SL, Ebacher V, et al. During sideways falls proximal femur fracture initiate in the superolateral cortex:evidence from high-speed video of simulated fractures. J Biomech, 2009, 42(12):1917-1925.
10. 金明柱, 郑洪新. 骨髓脂肪细胞与骨质疏松症. 中国骨质疏松杂志, 2006, 12(6):645-649.
11. 王晨光, 肖湘生, 陈星荣, 等. 人腰椎体松质骨CT值与组织形态指标的相关性研究. 中国医学计算机成像杂志, 1998, 4(4):250-253.
12. Legrand E, Chappard D, Pascaretti C, et al. Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res, 2000, 15(1):13-19.
13. 李建赤, 徐自强, 黄必留, 等. 老年性髋部骨折骨密度与骨形态计量学的关系. 中国骨质疏松杂志, 2011, 17(11):977-980.
14. Chappard D, Guggenbuhl P, Legrand E, et al. Texture analysis of X-ray radiographs is correlated with bone histomorphometry. J Bone Miner Metab, 2005, 23(1):24-29.
15. Cortet B, Chappard D, Boutry N, et al. Relationship between computed tomographic image analysis and histomorphometry for microarchitecture characterization of human calcaneus. Calcif Tissue Int, 2004, 75(1):23-31.
16. Boutry N, Cortet B, Chappard D, et al. Bone structure of the calcaneus:analysis with magnetic resonance imaging and correlation with histomorphometric study. Osteoporos Int, 2004, 15(10):827-833.
17. 吴燕平, 靳激扬. 重视骨质疏松症的影像学评估. 实用老年医学, 2011, 25(4):284-287, 291.
18. Wirth AJ, Goldhahn J, Flaig C, et al. Implant stability is affected by local bone microstructural quality. Bone, 2011, 49(3):473-478.

Chinese Journal of Reparative and Reconstructive Surgery

ANALYSIS OF CORRELATION BETWEEN TRABECULAR MICROSTRUCTURE AND CLINICAL IMAGING PARAMETERS IN FRACTURE REGION OF OSTEOPOROTIC HIP

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