Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk.
Bone Microarchitecture Phenotypes Identified in Older Adults Are Associated With Different Levels of Osteoporotic Fracture Risk.
复制标题
DOI：
10.1002/jbmr.4494
复制
发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
老年人中骨质疏松症的患病率超过50%，然而目前依赖于骨矿物质密度（aBMD）的临床诊断方法未能检测出大多数发生脆性骨折的个体。骨脆性可以以不同形式表现出来，对骨质疏松症采取“一刀切”的诊断和管理方法可能并不合适。高分辨率外周定量计算机断层扫描（HR - pQCT）通过获取有关体积密度和微结构的信息提供了补充信息，但由于所测量的众多特性之间复杂的相互作用，解读具有挑战性。在这项研究中，我们提出存在骨特性的常见组合，称为表型，它们易导致不同程度的骨折风险。利用来自一个跨国队列（n = 5873，71%为女性）年龄在40到96岁之间的HR - pQCT数据，我们采用模糊c - 均值聚类这一无监督机器学习方法来识别骨微结构的表型。确定了三个聚类，并且通过对HR - pQCT参数进行偏相关分析，我们将这些聚类特征描述为低密度、低体积和健康骨表型。大多数男性与健康骨表型相关，而女性更常与低体积或低密度骨表型相关。每种表型在主要骨质疏松性骨折（MOF）和任何偶发性骨质疏松性骨折方面都有显著不同的累积风险（p < 0.05）。在对协变量（队列、性别和年龄）进行调整后，低密度表型以及其次的低体积表型与MOF的相关性最高（风险比分别为2.96和2.35），并且在进一步对股骨颈aBMD进行调整时，显著相关性仍然保持（风险比分别为1.69和1.90）。此外，在每种表型内，确定了不同的骨折影像生物标志物。这些发现表明，骨质疏松性骨折风险与骨表型相关，这些表型捕捉到了骨退化的关键特征，而这些特征是aBMD无法区分的。
Prevalence of osteoporosis is more than 50% in older adults, yet current clinical methods for diagnosis that rely on areal bone mineral density (aBMD) fail to detect most individuals who have a fragility fracture. Bone fragility can manifest in different forms, and a “one-size-fits-all” approach to diagnosis and management of osteoporosis may not be suitable. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides additive information by capturing information about volumetric density and microarchitecture, but interpretation is challenging because of the complex interactions between the numerous properties measured. In this study, we propose that there are common combinations of bone properties, referred to as phenotypes, that are predisposed to different levels of fracture risk. Using HR-pQCT data from a multinational cohort (n = 5873, 71% female) between 40 and 96 years of age, we employed fuzzy c-means clustering, an unsupervised machine-learning method, to identify phenotypes of bone microarchitecture. Three clusters were identified, and using partial correlation analysis of HR-pQCT parameters, we characterized the clusters as low density, low volume, and healthy bone phenotypes. Most males were associated with the healthy bone phenotype, whereas females were more often associated with the low volume or low density bone phenotypes. Each phenotype had a significantly different cumulative hazard of major osteoporotic fracture (MOF) and of any incident osteoporotic fracture (p < 0.05). After adjustment for covariates (cohort, sex, and age), the low density followed by the low volume phenotype had the highest association with MOF (hazard ratio = 2.96 and 2.35, respectively), and significant associations were maintained when additionally adjusted for femoral neck aBMD (hazard ratio = 1.69 and 1.90, respectively). Further, within each phenotype, different imaging biomarkers of fracture were identified. These findings suggest that osteoporotic fracture risk is associated with bone phenotypes that capture key features of bone deterioration that are not distinguishable by aBMD.
登录
查看更多内容
外部骨骼大小可以识别男性人类股骨的不同强度轨迹轨迹。
影响因子：
3
作者：
Bolger MW;Romanowicz GE;Bigelow EMR;Ward FS;Ciarelli A;Jepsen KJ;Kohn DH
通讯作者：
Kohn DH
影响因子：
6.2
作者：
Bigelow, Erin M. R.;Patton, Daniella M.;Jepsen, Karl J.
通讯作者：
Jepsen, Karl J.
影响因子：
4
作者：
Fan, B.;Lu, Y.;Shepherd, J.
通讯作者：
Shepherd, J.
影响因子：
1.8
作者：
Hennig, Christian
通讯作者：
Hennig, Christian
影响因子：
4.1
作者：
Cheng, XG;Lowet, G;Dequeker, J
通讯作者：
Dequeker, J