Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck
Site-Dependent Reference Point Microindentation Complements Clinical Measures for Improved Fracture Risk Assessment at the Human Femoral Neck
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DOI：
10.1002/jbmr.2605
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发表时间：
2016-01-01
影响因子：
6.2
通讯作者：
Thurner, Phillipp J.
中科院分区：
文献类型：
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作者：
Jenkins, Thomas;Coutts, Louise V.;Thurner, Phillipp J.
与使用临床危险因素和骨矿物质密度（BMD）进行骨折风险评估的传统方法相比，一种新技术，参考点微压痕（RPI），可以直接评估骨质量；体内胫骨RPI测量似乎可以将脆性骨折患者与对照组区分开来。然而，目前尚不清楚这与临床上最具破坏性的骨折部位（股骨颈）之间的关系，以及RPI是否提供了与现有评估相补充的信息。低创伤性髋部骨折术后采集股骨颈样本（46例，男性17例，年龄83岁[四分位间距77-87]岁），并使用RPI （Biodent Hfc）与16例无骨病的尸体对照样本（男性7例，年龄65岁[IQR 61-74]岁）进行比较。一部分骨折患者返回进行双能x线吸收仪（DXA）评估（Hologic Discovery），对照组使用微型计算机断层扫描装置（HMX, Nikon）复制DXA扫描。骨质疏松性骨折患者股骨颈标本的压痕深度大于对照组（p < 0.001），这种压痕深度随年龄、性别、体重指数（BMI）和身高的调整而持续存在（p < 0.001），但与部位相关，在内侧区域不太明显。通过受试者操作特征（ROC）分析（曲线下面积[AUC] = 0.79至0.89），RPI在骨折和对照组之间表现出良好的区分能力，将RPI与临床危险因素或骨密度相结合的模型（AUC = 0.88至0.99）表现优于单独成分（AUC = 0.88至0.99）。综上所述，股骨颈的RPI与骨密度和传统危险因素无关，但与位置有关。因此，临床RPI装置可以补充风险评估，需要在前瞻性队列中进行测试，并在临床可及的胫骨和股骨颈之间进行比较。(c) 2015年美国骨与矿物研究学会。
In contrast to traditional approaches to fracture risk assessment using clinical risk factors and bone mineral density (BMD), a new technique, reference point microindentation (RPI), permits direct assessment of bone quality; in vivo tibial RPI measurements appear to discriminate patients with a fragility fracture from controls. However, it is unclear how this relates to the site of the most clinically devastating fracture, the femoral neck, and whether RPI provides information complementary to that from existing assessments. Femoral neck samples were collected at surgery after low-trauma hip fracture (n = 46; 17 male; aged 83 [interquartile range 77-87] years) and compared, using RPI (Biodent Hfc), with 16 cadaveric control samples, free from bone disease (7 male; aged 65 [ IQR 61-74] years). A subset of fracture patients returned for dual-energy X-ray absorptiometry (DXA) assessment (Hologic Discovery) and, for the controls, a micro-computed tomography setup (HMX, Nikon) was used to replicate DXA scans. The indentation depth was greater in femoral neck samples from osteoporotic fracture patients than controls (p < 0.001), which persisted with adjustment for age, sex, body mass index (BMI), and height (p < 0.001) but was site-dependent, being less pronounced in the inferomedial region. RPI demonstrated good discrimination between fracture and controls using receiver-operating characteristic (ROC) analyses (area under the curve [AUC] = 0.79 to 0.89), and a model combining RPI to clinical risk factors or BMD performed better than the individual components (AUC = 0.88 to 0.99). In conclusion, RPI at the femoral neck discriminated fracture cases from controls independent of BMD and traditional risk factors but dependent on location. The clinical RPI device may, therefore, supplement risk assessment and requires testing in prospective cohorts and comparison between the clinically accessible tibia and the femoral neck. ((c)) 2015 American Society for Bone and Mineral Research.