High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures
High-resolution-cone beam tomography analysis of bone microarchitecture in patients with acromegaly and radiological vertebral fractures
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DOI：
10.1007/s12020-016-1078-3
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发表时间：
2016-11-01
期刊：
影响因子：
3.7
通讯作者：
Giustina, Andrea
中科院分区：
文献类型：
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作者：
Maffezzoni, Filippo;Maddalo, Michele;Giustina, Andrea
椎体骨折是肢端肥大症的一个新出现的并发症，但即使在骨密度正常的患者中，也很难预测骨折的发生。在这项研究中，我们评估了高分辨率锥束计算机断层扫描在肢端肥大症中提供与脊椎骨折相关的骨骼异常信息的能力。40例患者(女性24例，男性16例；年龄中位数57岁，范围25~72岁)和21例健康志愿者(女性10例，男性11例；年龄中位数60岁，范围25~68岁)用高分辨率锥束计算机断层扫描系统测量了骨小梁(骨体积/骨小梁体积比、平均骨小梁间距和平均小梁厚度)和皮质(厚度和孔隙度)参数。所有肢端肥大症患者均接受腰椎、全髋关节、股骨颈和桡骨远端骨密度双能X线骨密度仪的形态测量和骨密度评估。肢端肥大症合并椎体骨折患者(15例)与未骨折患者相比，骨体积/骨小梁体积比显著降低(p<；0.05)，平均骨小梁间距增大，皮质孔隙度增加，但平均骨小梁厚度和皮质厚度差异无统计学意义。骨折和非骨折肢端肥大症患者在两个骨骼部位的骨密度均无显著差异。肢端肥大症患者的骨体积/骨小梁体积比(p=0.003)和平均骨小梁厚度(p<；0.001)低于对照组，平均骨小梁间距大于对照组(p=0.02)，而皮质厚度和孔隙度无显著差异。这项研究首次表明，在肢端肥大症中，骨微结构的异常与放射性椎体骨折有关。桡骨远端的高分辨率锥束计算机断层扫描可能有助于评估和预测肢端肥大症对骨微结构的影响。
Vertebral fractures are an emerging complication of acromegaly but their prediction is still difficult occurring even in patients with normal bone mineral density. In this study we evaluated the ability of high-resolution cone-beam computed tomography to provide information on skeletal abnormalities associated with vertebral fractures in acromegaly. 40 patients (24 females, 16 males; median age 57 years, range 25-72) and 21 healthy volunteers (10 females, 11 males; median age 60 years, range: 25-68) were evaluated for trabecular (bone volume/trabecular volume ratio, mean trabecular separation, and mean trabecular thickness) and cortical (thickness and porosity) parameters at distal radius using a high-resolution cone-beam computed tomography system. All acromegaly patients were evaluated for morphometric vertebral fractures and for mineral bone density by dual-energy X-ray absorptiometry at lumbar spine, total hip, femoral neck, and distal radius. Acromegaly patients with vertebral fractures (15 cases) had significantly (p < 0.05) lower bone volume/trabecular volume ratio, greater mean trabecular separation, and higher cortical porosity vs. nonfractured patients, without statistically significant differences in mean trabecular thickness and cortical thickness. Fractured and nonfractured acromegaly patients did not have significant differences in bone density at either skeletal site. Patients with acromegaly showed lower bone volume/trabecular volume ratio (p = 0.003) and mean trabecular thickness (p < 0.001) and greater mean trabecular separation (p = 0.02) as compared to control subjects, without significant differences in cortical thickness and porosity. This study shows for the first time that abnormalities of bone microstructure are associated with radiological vertebral fractures in acromegaly. High-resolution cone-beam computed tomography at the distal radius may be useful to evaluate and predict the effects of acromegaly on bone microstructure.