3-D Visualization and Prediction of Vertebral Fractures

椎骨骨折的 3D 可视化和预测

• 批准号: 9070193
• 负责人: Elise F Morgan
• 金额: $ 1.19万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9070193
• 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）：椎骨骨折是最常见的椎骨骨折类型，50岁以上的女性有三分之一，男性有六分之一。尽管其患病率很高，但对椎体骨折风险的敏感和特异性估计仍然难以捉摸。目前评估脊椎强度和骨折风险的方法严重依赖于平均骨矿物质密度（BMD）的测量，其局限性已被广泛认可。然而，替代方法一直缺乏验证和明显优于“平均BMD”的方法。我们最近的数据通过证明使用定量计算机断层扫描（QCT）扫描进行的临床可行测量来增强对椎体失效的预测，从而解决了知识和翻译方面的这一关键差距。使用QCT导出的测量整个椎骨骨组织分布的方法，我们发现BMD的椎体内异质性的大小提供了对椎骨强度的更好的预测，并且在有与没有椎骨骨折的女性中更低。这些数据还表明，椎骨内BMD的多个特征性空间分布（“模式”）可以赋予高骨强度，并且这些模式和强度之间的关联可以通过相邻椎间盘（IVD）中退变的严重程度来调节。我们现在建议在基于人群的研究和补充的离体研究中确定椎体内BMD异质性、椎体失效和IVD退变之间的关系。目标1将使用病例对照研究设计，在入组FHS多探测器QCT研究的男性和女性中进行既往获得的QCT扫描，以检验异质性程度降低与普遍骨折风险增加相关的假设。目标2将使用来自FHS QCT队列的年龄和性别分层的随机样本，以确定BMD空间分布与IVD健康之间的关联，然后进行体外研究，以确定这些关联如何影响椎骨强度。我们在目标#2中的双重假设是，BMD的空间模式与IVD健康相关，椎体强度取决于空间BMD模式与IVD提供的载荷分布之间的一致性。目标3将继续我们的临床重点，生物力学研究通过一种新的实验方法，提供急需的评估的准确性的QCT为基础的有限元（FE）模型的椎骨故障。该目的将检验通过纳入临床可获得的IVD健康评估来提高FE预测准确性的假设。总之，这些目标是朝着减轻脊椎骨折负担迈出的重要一步。这项工作的合作伙伴的椎体内异质性的现象，在社区居住的人口与这种异质性的生物力学后果的病例对照和实验室研究的成本效益的研究。研究结果将提供一个广泛适用的、综合的脊椎健康评估，并配有可翻译的工具，为骨折风险的估计建立一个新的标准。