High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis
High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis
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DOI：
10.1016/j.bone.2012.10.036
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发表时间：
2013-02-01
期刊：
影响因子：
4.1
通讯作者：
Glueer, Claus-Christian
中科院分区：
文献类型：
--
作者：
Graeff, Christian;Marin, Fernando;Glueer, Claus-Christian
采用基于高分辨率定量计算机断层扫描（HRQCT）的脊柱骨密度和微观结构分析、有限元分析（FEA）和DXA研究糖皮质激素性骨质疏松症（GIO）患者的椎体骨状况。73名GIO患者（54.6±14.0岁）可获得L1-L3和全髋关节的DXA， L1-L3的QCT和T12的HRQCT。采用半定量（SQ）评分（正常= 0至严重骨折= 3）和脊柱畸形指数（SDI）评分（T4至L4椎体SQ评分之和）在x线片上评估椎骨骨折的普遍情况。31例（42.4%）患者普遍存在椎体骨折。皮质骨密度（Ct.BMD）和厚度（Ct.BMD）。骨小梁骨密度（Tb）；HRQCT分析骨密度（BMD）、表观骨小梁体积分数（app.BV/TV）、表观骨小梁分离（app.Tb.Sp）。采用基于hrqct的非线性有限元法计算T12轴压、前弯和轴扭的刚度和强度。在调整了年龄、糖皮质激素剂量和骨质疏松治疗的logistic回归中，Tb。骨密度与椎体骨折状态关系最为密切(标准化优势比[sOR]: Tb。BMD T12: 4.05 [95% Cl: 1.8-9.0]；骨密度11 - 13:3.95[1.8-8.9])。在有限元分析变量中，强度除以轴压截面积与脊柱骨折状态的相关性最为显著（2.56[1.29-5.07]）。Ct显微结构模型是预测SDI的最佳方法。与app.Tb.Sp (r(2) = 0.57
High-resolution quantitative computed tomography (HRQCT)-based analysis of spinal bone density and microstructure, finite element analysis (FEA), and DXA were used to investigate the vertebral bone status of men with glucocorticoid-induced osteoporosis (GIO). DXA of L1-L3 and total hip, QCT of L1-L3, and HRQCT of T12 were available for 73 men (54.6 +/- 14.0 years) with GIO. Prevalent vertebral fracture status was evaluated on radiographs using a semi-quantitative (SQ) score (normal = 0 to severe fracture = 3), and the spinal deformity index (SDI) score (sum of SQ scores of T4 to L4 vertebrae). Thirty-one (42.4%) subjects had prevalent vertebral fractures. Cortical BMD (Ct.BMD) and thickness (Ct.Th), trabecular BMD (Tb.BMD), apparent trabecular bone volume fraction (app.BV/TV), and apparent trabecular separation (app.Tb.Sp) were analyzed by HRQCT. Stiffness and strength of T12 were computed by HRQCT-based nonlinear FEA for axial compression, anterior bending and axial torsion. In logistic regressions adjusted for age, glucocorticoid dose and osteoporosis treatment, Tb.BMD was most closely associated with vertebral fracture status (standardized odds ratio [sOR]: Tb.BMD T12: 4.05 [95% Cl: 1.8-9.0], Tb.BMD L1-L3: 3.95 [1.8-8.9]). Strength divided by cross-sectional area for axial compression showed the most significant association with spine fracture status among FEA variables (2.56 [1.29-5.07]). SDI was best predicted by a microstructural model using Ct.Th and app.Tb.Sp (r(2) = 0.57, p