Dual-energy X-ray Absorptiometry Does Not Represent Bone Structure in Patients with Osteoporosis: A Comparison of Lumbar Dual-Energy X-Ray Absorptiometry with Vertebral Biopsies.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 Jul 2021
01 Jul 2021
Historique:
entrez:
8
6
2021
pubmed:
9
6
2021
medline:
10
7
2021
Statut:
ppublish
Résumé
Prospective cross-sectional exploratory study. To evaluate the correlation between in vivo lumbar dual-energy x-ray absorptiometry (DXA) and parameters of bone architecture in micro-computed tomography (micro-CT) in patients with osteoporosis. DXA is the current diagnostic standard for evaluating osteoporosis. However, there are various concerns regarding its validity, especially in the spine. No study has so far investigated whether in vivo DXA correlates with the actual lumbar bone architecture. Lumbar DXA scans were compared with micro-CT analysis of vertebral biopsies in patients with osteoporotic vertebral fractures (fracture group) and those without (control group). Preoperatively, all patients underwent a DXA scan (L1-L4). Intraoperative biopsies from nonfractured vertebrae (preferably L3) were analyzed by micro-CT regarding bone quantity and quality. The groups were compared regarding differences in DXA and micro-CT results. In each group, a correlation analysis was performed between DXA and micro-CT. The study included 66 patients (33 per group). Preoperative DXA results were worse in the fracture group than the control group (areal bone mineral density [aBMD] 0.95 vs. 1.31, T-score -1.97 vs. 0.92, each P < 0.001). Micro-CT analysis confirmed differences regarding quantitative parameters (bone/total volume: 0.09 vs. 0.12, P < 0.001) and qualitative parameters (connectivity index: 15.73 vs. 26.67, P < 0.001; structure model index: 2.66 vs. 2.27, P < 0.001; trabecular number: 2.11 vs. 2.28, P = 0.014) of bone architecture between both groups. The DXA results did not correlate with micro-CT parameters in the fracture group. In the control group, correlations were found for some parameters (bone/total volume vs. aBMD: r = 0.51, P = 0.005; trabecular number vs. aBMD: r = 0.56, P = 0.001). These data constitute the first comparison of DXA measurements with microstructural analysis of vertebral biopsies in patients with osteoporosis. Our results indicate that lumbar DXA neither qualitatively nor quantitatively represents microstructural bone architecture and is therefore not a reliable tool for the evaluation of bone quality in the spine.Level of Evidence: 3.
Sections du résumé
STUDY DESIGN
METHODS
Prospective cross-sectional exploratory study.
OBJECTIVE
OBJECTIVE
To evaluate the correlation between in vivo lumbar dual-energy x-ray absorptiometry (DXA) and parameters of bone architecture in micro-computed tomography (micro-CT) in patients with osteoporosis.
SUMMARY OF BACKGROUND DATA
BACKGROUND
DXA is the current diagnostic standard for evaluating osteoporosis. However, there are various concerns regarding its validity, especially in the spine. No study has so far investigated whether in vivo DXA correlates with the actual lumbar bone architecture.
METHODS
METHODS
Lumbar DXA scans were compared with micro-CT analysis of vertebral biopsies in patients with osteoporotic vertebral fractures (fracture group) and those without (control group). Preoperatively, all patients underwent a DXA scan (L1-L4). Intraoperative biopsies from nonfractured vertebrae (preferably L3) were analyzed by micro-CT regarding bone quantity and quality. The groups were compared regarding differences in DXA and micro-CT results. In each group, a correlation analysis was performed between DXA and micro-CT.
RESULTS
RESULTS
The study included 66 patients (33 per group). Preoperative DXA results were worse in the fracture group than the control group (areal bone mineral density [aBMD] 0.95 vs. 1.31, T-score -1.97 vs. 0.92, each P < 0.001). Micro-CT analysis confirmed differences regarding quantitative parameters (bone/total volume: 0.09 vs. 0.12, P < 0.001) and qualitative parameters (connectivity index: 15.73 vs. 26.67, P < 0.001; structure model index: 2.66 vs. 2.27, P < 0.001; trabecular number: 2.11 vs. 2.28, P = 0.014) of bone architecture between both groups. The DXA results did not correlate with micro-CT parameters in the fracture group. In the control group, correlations were found for some parameters (bone/total volume vs. aBMD: r = 0.51, P = 0.005; trabecular number vs. aBMD: r = 0.56, P = 0.001).
CONCLUSION
CONCLUSIONS
These data constitute the first comparison of DXA measurements with microstructural analysis of vertebral biopsies in patients with osteoporosis. Our results indicate that lumbar DXA neither qualitatively nor quantitatively represents microstructural bone architecture and is therefore not a reliable tool for the evaluation of bone quality in the spine.Level of Evidence: 3.
Identifiants
pubmed: 34100839
doi: 10.1097/BRS.0000000000003917
pii: 00007632-202107010-00008
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
861-866Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Références
Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging findings of metabolic bone disease. Radiographics 2016; 36:1871–1887.
Oden A, McCloskey EV, Kanis JA, et al. Burden of high fracture probability worldwide: secular increases 2010−2040. Osteoporos Int 2015; 26:2243–2248.
Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists and American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis - 2016. Endocr Pract 2016; 22:1–42.
Heaney RP. Is the paradigm shifting? Bone 2003; 33:457–465.
Li Z, Chines AA, Meredith MP. Statistical validation of surrogate endpoints: is bone density a valid surrogate for fracture? J Musculoskelet Neuronal Interact 2004; 4:64–74.
Tothill P, Hannan WJ. Precision and accuracy of measuring changes in bone mineral density by dual-energy X-ray absorptiometry. Osteoporos Int 2007; 18:1515–1523.
Bolotin HH. DXA in vivo BMD methodology: an erroneous and misleading research and clinical gauge of bone mineral status, bone fragility, and bone remodelling. Bone 2007; 41:138–154.
Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA 2002; 288:1889–1897.
Steiger P, Cummings SR, Black DM, et al. Age-related decrements in bone mineral density in women over 65. J Bone Miner Res 1992; 7:625–632.
Johanson NA, Litrenta J, Zampini JM, Kleinbart F, Goldman HM. Surgical treatment options in patients with impaired bone quality. Clin Orthop Relat Res 2011; 469:2237–2247.
Konstantinidis L, Helwig P, Hirschmuller A, Langenmair E, Südkamp NP, Augat P. When is the stability of a fracture fixation limited by osteoporotic bone? Injury 2016; 47: (suppl 2): S27–S32.
Dodwad SM, Khan SN. Surgical stabilization of the spine in the osteoporotic patient. Orthop Clin North Am 2013; 44:243–249.
Goldstein CL, Brodke DS, Choma TJ. Surgical management of spinal conditions in the elderly osteoporotic spine. Neurosurgery 2015; 77: (suppl 4): S98–S107.
Lehman RA Jr, Kang DG, Wagner SC. Management of osteoporosis in spine surgery. J Am Acad Orthop Surg 2015; 23:253–263.
Bissinger O, Kirschke JS, Probst FA, et al. Micro-CT vs. whole body multirow detector CT for analysing bone regeneration in an animal model. PLoS One 2016; 11:e0166540.
Hsu JT, Chen YJ, Ho JT, et al. A comparison of micro-CT and dental CT in assessing cortical bone morphology and trabecular bone microarchitecture. PLoS One 2014; 9:e107545.
Ruegsegger P, Koller B, Muller R. A microtomographic system for the nondestructive evaluation of bone architecture. Calcif Tissue Int 1996; 58:24–29.
Gielkens PF, Schortinghuis J, de Jong JR, et al. A comparison of micro-CT, microradiography and histomorphometry in bone research. Arch Oral Biol 2008; 53:558–566.
Muller R, Van Campenhout H, Van Damme B, et al. Morphometric analysis of human bone biopsies: a quantitative structural comparison of histological sections and micro-computed tomography. Bone 1998; 23:59–66.
Jiang Y, Zhao J, Liao EY, Dai RC, Wu XP, Genant HK. Application of micro-CT assessment of 3-D bone microstructure in preclinical and clinical studies. J Bone Miner Metab 2005; 23: (suppl): 122–131.
Bodic F, Amouriq Y, Gayet-Delacroix M, et al. Relationships between bone mass and micro-architecture at the mandible and iliac bone in edentulous subjects: a dual X-ray absorptiometry, computerised tomography and microcomputed tomography study. Gerodontology 2012; 29:e585–e594.
Mak IL, DeGuire JR, Lavery P, Agellon S, Weiler HA. Dual-energy x-ray absorptiometry, peripheral quantitative computed tomography, and micro-computed tomography techniques are discordant for bone density and geometry measurements in the guinea pig. J Bone Miner Metab 2016; 34:266–276.
Mittra E, Rubin C, Gruber B, et al. Evaluation of trabecular mechanical and microstructural properties in human calcaneal bone of advanced age using mechanical testing, microCT, and DXA. J Biomech 2008; 41:368–375.
Perilli E, Briggs AM, Kantor S, et al. Failure strength of human vertebrae: prediction using bone mineral density measured by DXA and bone volume by micro-CT. Bone 2012; 50:1416–1425.
Wegrzyn J, Roux JP, Arlot ME, et al. Determinants of the mechanical behavior of human lumbar vertebrae after simulated mild fracture. J Bone Miner Res 2011; 26:739–746.
Bogoch ER, Elliot-Gibson V, Beaton D, Sale J, Josse RG. Fracture prevention in the orthopaedic environment: outcomes of a coordinator-based fracture liaison service. J Bone Joint Surg Am 2017; 99:820–831.
Malluche HH, Porter DS, Mawad H, et al. Low-energy fractures without low T-scores characteristic of osteoporosis: a possible bone matrix disorder. J Bone Joint Surg Am 2013; 95:e1391–e1396.
Karlsson MK, Kherad M, Hasserius R, et al. Characteristics of prevalent vertebral fractures predict new fractures in elderly men. J Bone Joint Surg Am 2016; 98:379–385.
Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int 2005; 16: (suppl 2): S3–S7.
Kanis JA, Johansson H, Harvey NC, McCloskey EV. A brief history of FRAX. Arch Osteoporos 2018; 13:118.
Gausden EB, Nwachukwu BU, Schreiber JJ, Lorich DG, Lane JM, et al. Opportunistic use of CT imaging for osteoporosis screening and bone density assessment: a qualitative systematic review. J Bone Joint Surg Am 2017; 99:1580–1590.
Patterson J, Rungprai C, Den Hartog T, et al. Cortical bone thickness of the distal part of the tibia predicts bone mineral density. J Bone Joint Surg Am 2016; 98:751–760.
Ripamonti C, Lisi L, Buffa A, et al. The trabecular bone score predicts spine fragility fractures in postmenopausal Caucasian women without osteoporosis independently of bone mineral density. Med Arch 2018; 72:46–50.