3-D Visualization and Prediction of Vertebral Fractures

椎骨骨折的 3D 可视化和预测

• 批准号: 8843784
• 负责人: Elise F Morgan
• 金额: $ 42.18万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-07-07 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8843784
• 关键词: 3-Dimensional; Address; Age; Area; Behavior; Biomechanics; Bone Density; Bone Tissue; Case-Control Studies; Characteristics; Clinical; Clinical assessments; Cluster Analysis; Communities; Cross-Sectional Studies; Data; Elderly; Elements; Enrollment; Evaluation; Failure; Finite Element Analysis; Fracture; Framingham Heart Study; Future; Goals; Health; Heterogeneity; High Prevalence; Histology; Imagery; Imaging Device; Individual; Intervertebral disc structure; Investigation; Laboratory Study; Measurement; Measures; Mechanics; Methods; Modeling; Pain; Participant; Patients; Pattern; Population; Quality of life; Research Design; Risk; Risk Estimate; Sampling; Scanning; Severities; Spatial Distribution; Spinal Fractures; Study Subject; Testing; Validation; Vertebral column; Woman; Work; X-Ray Computed Tomography; base; bone; bone strength; clinically relevant; cohort; cost effective; digital; improved; intervertebral disk degeneration; knowledge translation; men; mortality; novel; osteoporosis with pathological fracture; population based; pressure; research study; sex; simulation; spine bone structure; tool; validation studies

DESCRIPTION (provided by applicant): Vertebral fractures are the most common type of osteoporotic fracture, afflicting one in three women and one in six men over the age of 50. Despite their high prevalence, sensitive and specific estimates of vertebral fracture risk have remained elusive. The limitations of current approaches for estimating vertebral strength and fracture risk, which rely heavily on measurement of the average bone mineral density (BMD), are widely recognized. However, alternative methods have been lacking with respect to validation and clear advantages over the "average BMD" approach. Our recent data address this critical gap in knowledge and translation by demonstrating the use of clinically feasible measurements made from quantitative computed tomography (QCT) scans to enhance predictions of vertebral failure. Using QCT-derived measures of the distribution of bone tissue throughout the vertebra, we have found that the magnitude of the intra-vertebral heterogeneity in BMD provides improved predictions of vertebral strength and is lower in women with vs. without vertebral fracture. These data also indicate that multiple, characteristic spatial distributions ("patterns") of BMD within the vertebra can confer high bone strength, and that the associations between these patterns and strength may be modulated by the severity of degeneration in the adjacent intervertebral discs (IVDs). We now propose to define relationships among intra-vertebral heterogeneity in BMD, vertebral failure, and IVD degeneration in population-based studies and complementary ex vivo studies. Aim 1 will use a case-control study design with previously acquired QCT scans in men and women enrolled in the Framingham Heart Study (FHS) Multidetector QCT study to test the hypothesis that decreased magnitude of heterogeneity is associated with increased risk of prevalent fracture. Aim 2 will use an age- and sex-stratified, random sample from the FHS QCT cohort to determine associations between the spatial distribution of BMD and IVD health, followed by ex vivo studies that define how these associations can influence vertebral strength. Our dual hypotheses in Aim #2 are that the spatial patterns of BMD are associated with IVD health and that vertebral strength depends on the congruence between the spatial BMD pattern and the load distribution supplied by the IVDs. Aim 3 will continue our clinically focused, biomechanical investigations via a novel experimental approach that provides much-needed evaluation of the accuracy of QCT-based finite element (FE) models of vertebral failure. This aim will test the hypothesis that the accurac of the FE predictions is improved by incorporating clinically obtainable assessments of IVD health. Together, these Aims are a major step towards reducing the burden of vertebral fracture. This work partners a cost-effective study of the phenomenon of intra-vertebral heterogeneity in a community-dwelling population with case-control and laboratory studies of the biomechanical consequences of this heterogeneity. The results will provide a widely applicable, integrated assessment of vertebral health, complete with translatable tools to set a new standard for estimation of fracture risk.

描述（由申请人提供）：椎骨骨折是骨质疏松性骨折的最常见类型，遭受了三分之一的女性和50岁以上的六分之一的男性。尽管椎骨较高，椎骨骨折风险的敏感和特定估计值仍然难以捉摸。当前估计椎骨强度和断裂风险的方法的局限性在很大程度上取决于平均骨矿物质密度（BMD）的测量。但是，对于验证和“平均BMD”方法的验证和明确的优势，缺乏替代方法。我们最近的数据通过证明使用定量计算机断层扫描（QCT）扫描的临床可行测量来提高椎体衰竭的预测，从而解决了知识和翻译方面的关键差距。使用QCCT衍生的骨组织分布的测量，我们发现BMD中脊椎内异质性的大小提供了改进的椎骨强度的预测，并且在没有椎骨裂缝的女性中，较低的女性较低。这些数据还表明，椎骨内BMD的多个特征空间分布（“模式”）可以赋予高骨强度，并且这些模式与强度之间的关联可能受到相邻椎间盘（IVD）的变性的严重性调节。现在，我们建议在基于人群的研究和互补的离体研究中定义BMD，椎骨衰竭和IVD变性的脊椎内异质性之间的关系。 AIM 1将使用案例对照研究设计，并在弗雷明汉心脏研究（FHS）多探测器QCT研究中入学的男性和女性中先前获得的QCT扫描来检验假说，即异质性降低与患病的风险增加有关。 AIM 2将使用来自FHS QCT队列的年龄和性别分层的随机样本来确定BMD和IVD健康的空间分布之间的关联，然后进行过实出研究，这些研究定义了这些关联如何影响椎骨强度。 AIM＃2中的双重假设是，BMD的空间模式与IVD健康有关，并且椎骨强度取决于空间BMD模式与IVDS提供的负载分布之间的一致性。 AIM 3将通过一种新型的实验方法继续进行临床专注的生物力学研究，该方法对基于QCT的有限元（FE）模型的准确性进行了急需的评估。该目标将检验以下假设，即通过纳入临床上可获得的IVD健康评估来改善FE预测的准确性。这些目标共同迈出了减轻椎骨骨折负担的主要一步。这项工作是对社区居民人群中脊椎内异质性现象进行成本效益的研究，该现象对这种异质性的生物力学后果进行了病例对照和实验室研究。结果将为椎体健康提供广泛适用的综合评估，并配有可翻译工具，以设定估计断裂风险的新标准。