Structural patterns of the proximal femur in relation to age and hip fracture risk in women.
Structural patterns of the proximal femur in relation to age and hip fracture risk in women.
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DOI：
10.1016/j.bone.2013.08.017
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发表时间：
2013-11
期刊：
影响因子：
4.1
通讯作者：
Lang, Thomas F.
中科院分区：
文献类型：
--
作者：
Carballido-Gamio, Julio;Harnish, Roy;Saeed, Isra;Streeper, Timothy;Sigurdsson, Sigurdur;Amin, Shreyasee;Atkinson, Elizabeth J.;Therneau, Terry M.;Siggeirsdottir, Kristin;Cheng, Xiaoguang;Melton, L. Joseph, III;Keyak, Joyce H.;Gudnason, Vilmundur;Khosla, Sundeep;Harris, Tamara B.;Lang, Thomas F.
关键词：
股骨近端骨折是骨质疏松症最具破坏性的后果。人们普遍认为，与年龄相关的髋部结构变化会增加风险，但很少有人将健康受试者与髋部骨折患者的这种变化进行明确的比较。在这项研究中，我们使用定量计算机断层扫描和基于张量的形态测量（TBM）来识别与年龄和髋部骨折相关的股骨近端的三维内部结构模式。本研究纳入了 349 名年龄范围广泛（21-97 岁）女性的人群队列，以及 222 名发生髋部骨折（n=74）和未发生髋部骨折（n=148）的老年女性（平均年龄 79±7 岁）。将图像在空间上标准化为标准化空间，并根据描述为骨体积局部变化的形状特征的统计图来识别年龄和骨折特异性的形态测量特征。形态特征被可视化为局部收缩和扩张的图，显着性被显示为学生 t 检验统计图。与年龄相关的显着变化包括体积骨矿物质密度（vBMD）低的区域的局部扩张和vBMD高的区域的局部收缩。一些与骨折相关的显着特征类似于加速的老化过程，包括股骨颈骨小梁室上部的局部扩张，以及相邻皮质骨的收缩。然而，其他特征仅在髋部骨折受试者与年龄匹配的对照组的比较中观察到，包括股骨颈上部皮质骨的局灶性收缩、大转子下方的外侧皮质骨以及前转子间区域。这项研究的结果支持这样的观点，即形态特征的空间分布与年龄相关的骨骼变化有关，但与骨折风险无关。在女性中，通过 TBM 识别股骨近端骨折特异性形态改变，结合 vBMD 和临床危险因素，可以改善髋部骨折的预测。
Fractures of the proximal femur are the most devastating outcome of osteoporosis. It is generally understood that age-related changes in hip structure confer increased risk, but there have been few explicit comparisons of such changes in healthy subjects to those with hip fracture. In this study, we used quantitative computed tomography and tensor-based morphometry (TBM) to identify three-dimensional internal structural patterns of the proximal femur associated with age and with incident hip fracture. A population-based cohort of 349 women representing a broad age range (21–97 years) were included in this study, along with a cohort of 222 older women (mean age 79±7 years) with (n=74) and without (n=148) incident hip fracture. Images were spatially normalized to a standardized space, and age- and fracture-specific morphometric features were identified based on statistical maps of shape features described as local changes of bone volume. Morphometric features were visualized as maps of local contractions and expansions, and significance was displayed as Student’s t-test statistical maps. Significant age-related changes included local expansions of regions low in volumetric bone mineral density (vBMD) and local contractions of regions high in vBMD. Some significant fracture-related features resembled an accentuated aging process, including local expansion of the superior aspect of the trabecular bone compartment in the femoral neck, with contraction of the adjoining cortical bone. However, other features were observed only in the comparison of hip fracture subjects with age-matched controls including focal contractions of the cortical bone at the superior aspect of the femoral neck, the lateral cortical bone just inferior to the greater trochanter, and the anterior intertrochanteric region. Results of this study support the idea that the spatial distribution of morphometric features is relevant to age-related changes in bone and independently to fracture risk. In women, the identification by TBM of fracture-specific morphometric alterations of the proximal femur, in conjunction with vBMD and clinical risk factors, may improve hip fracture prediction.
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