Vertebral fracture risk: Combined assessment through clinical 2D-osteodensitometry tools and experimental high-resolution micro-CT analyses to pinpoint regional 3D bone quality characteristics
Final Report Abstract
Bone densitometry (DXA) fails to identify nearly half of elderly patients at immediate risk of vertebral fracture. To improve clinical assessment of vertebral fracture risk, we aimed to determine how the DXA-based 2D parameters – areal bone mineral density (aBMD) and trabecular bone score (TBS) – relate to subregional variability in 3D trabecular microarchitecture of T12 vertebra in young and elderly women. DXA assessment in anterior-posterior and lateral projections and high-resolution CT scanning demonstrated age-related deterioration in vertebral bone. Specifically, aBMD was significantly decreased in the aged group, whereas TBS values did not show significant differences between the groups. Bone microarchitecture parameters also showed notable reduction in the aged group. Regression analysis showed that aBMD was able to predict bone volume fraction (BV/TV) in both scan projections and both age groups, as well as trabecular number (Tb.N) in both projections in the aged and in lateral projection in the young. TBS was a significant predictor in lateral projections of the aged group for BV/TV and Tb.N, but presented lower coefficients of determination than aBMD. Subregional 3D assessment of bone microarchitecture showed significant differences in trabecular parameters for both age groups among the horizontal subregions (e.g., BV/TV was lowest superiorly) and vertical subregions (e.g., BV/TV was highest posteriorly). Regression analysis showed aBMD as a predictor explained more of the variance in subregional 3D microarchitecture compared to TBS. Stepwise multi-regression analysis revealed only three combinations of subregion, projection, and group where aBMD and TBS were both significant predictors. Subregional aBMD reflects variations in trabecular bone microstructure better than subregional TBS for trisected regions. Specifically, lateral aBMD identifies microstructural heterogeneities independent of age and may improve prediction of vertebral strength and susceptibility to specific fracture types. Thus, our findings confirm the great capacity for improved fracture risk assessment using lateral scans and additionally highlight the potential for assessing the susceptibility to specific fracture types by subregional evaluation. Further studies extending subregional evaluation of BMD from lateral DXA-scans to larger cohorts and investigating more detailed subregions related to typical vertebral failure regions could aid in improving vertebral fracture risk assessment, specifically for the osteopenic at-risk population.
Publications
- Region-Specific Assessment of Bone Mineral Density and Trabecular Bone Score in Lateral Projection Identifies Local Decay in Trabecular Bone Microstructure of the Vertebral Body. ASBMR 2017, Denver, Colorado, USA, A17018076
Milovanovic P, vom Scheidt A, Grisolia Seifert EF, Püschel K, Amling M, Busse B
- Improved prediction of regional trabecular bone volume fraction in the vertebral body by application of regional BMD and TBS measurement in lateral projection. WCO-IOF-ESCEO 2018, Krakow, Poland, P965, Osteoporosis International 29(S1)
Milovanovic P, vom Scheidt A, Grisolia Seifert EF, Pokrant C, Püschel K, Amling M, Busse B
- Influence of osteophytes and regional microstructural heterogeneity on BMD and TBS in human thoracic vertebrae. 8th World Congress of Biomechanics 2018, Dublin, Ireland, O0509
vom Scheidt A, Milovanovic P, Grisolia Seifert EF, Pokrant C, Amling M, Püschel K, Busse B
- Detailed Lateral Subregional Analysis of BMD Reveals Microstructural Heterogeneity in Human Vertebrae. ORS 2019, Austin, Texas, USA, 0799
vom Scheidt A, Milovanovic P, Grisolia Seifert EF, Pokrant C, Püschel K, Busse B
- Subregional areal bone mineral density (aBMD) is a better predictor of heterogeneity in trabecular microstructure of vertebrae in young and aged women than subregional trabecular bone score (TBS). Bone. 2019; 122:156-65
vom Scheidt A, Grisolia Seifert EF, Pokrant C, Püschel K, Amling M, Busse B, Milovanovic P
(See online at https://doi.org/10.1016/j.bone.2019.02.014)
