Krause M, Museyko O, Breer S, Wulff B, Duckstein C, Vettorazzi E, Glueer C, Püschel K, Engelke K, Amling M
Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Osteoporos Int. 2014 May;25(5):1595-606. doi: 10.1007/s00198-014-2650-4. Epub 2014 Feb 25.
Despite an increasing use of high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone morphology in vivo, there are reservations about its applicability in patients with osteoporosis and antiresorptive therapy. This study shows that HR-pQCT provides acceptable in vivo accuracy for bone volume fraction (BV/TV) in patients with osteoporosis and bisphosphonate (BP) treatment.
The primary aim was to analyze agreement of trabecular structure between HR-pQCT and gold standard microtomography (μCT) in patients with osteoporosis and long-term BP therapy.
In the BioAsset study, we analyzed cadaver radii and tibiae of 34 postmenopausal females (81.1 ± 7.1 years) with osteoporosis (no BP n = 22, 1-5 years BP n = 5, >5 years BP n = 7). Two HR-pQCT protocols (patient-mode and μCT-mode) were compared with gold standard μCT after image registration. Undecalcified histological sections were obtained to quantify nonmineralized bone matrix. Bland-Altman plots illustrated methodological agreement. Multiple regression analysis was used to test for variables associated with method agreement.
In the radius and tibia, patient-mode HR-pQCT derived indices including bone volume fraction, trabecular number, and trabecular separation correlated well with gold standard μCT (R(2) = 0.78 - 0.88) except for trabecular thickness (R(2) = 0.11). Bland-Altman plots illustrated adequate agreement for bone volume fraction. Lower agreement of trabecular number and trabecular separation improved with decreasing structural impairment at the tibia only. Trabecular thickness was not appropriately assessed with HR-pQCT at both skeletal sites. Higher agreement for bone volume fraction was associated with increasing tissue mineral density in the tibia.
HR-pQCT provides acceptable in vivo accuracy for BV/TV in patients with osteoporosis and BP treatment. Higher TMD was associated with higher BV/TV accuracy in vivo. Overall, methodological agreement got less accurate with increasing structural impairment in the tibia.
尽管高分辨率外周定量计算机断层扫描（HR-pQCT）在体内评估骨形态方面的应用日益增加，但对于其在骨质疏松症患者和抗吸收治疗中的适用性仍存在保留意见。本研究表明，HR-pQCT在骨质疏松症患者和双膦酸盐（BP）治疗中，对骨体积分数（BV/TV）提供了可接受的体内准确性。
主要目的是分析骨质疏松症患者和长期BP治疗患者中HR-pQCT与金标准显微断层扫描（μCT）之间小梁结构的一致性。
在生物资产研究中，我们分析了34名绝经后女性（81.1±7.1岁）患有骨质疏松症（未使用BP的n = 22，使用BP 1 - 5年的n = 5，使用BP超过5年的n = 7）的尸体桡骨和胫骨。在图像配准后，将两种HR-pQCT方案（患者模式和μCT模式）与金标准μCT进行比较。获取未脱钙的组织学切片以量化非矿化骨基质。Bland-Altman图说明了方法学上的一致性。使用多元回归分析来测试与方法一致性相关的变量。
在桡骨和胫骨中，患者模式HR-pQCT得出的指标，包括骨体积分数、小梁数量和小梁间距，与金标准μCT相关性良好（R² = 0.78 - 0.88），但小梁厚度除外（R² = 0.11）。Bland-Altman图显示骨体积分数具有足够的一致性。仅在胫骨处，小梁数量和小梁间距的一致性随着结构损伤的减少而改善。在两个骨骼部位，HR-pQCT均未适当评估小梁厚度。胫骨中较高的组织矿物质密度与骨体积分数的较高一致性相关。
HR-pQCT在骨质疏松症患者和BP治疗中，对BV/TV提供了可接受的体内准确性。较高的TMD与体内较高的BV/TV准确性相关。总体而言，随着胫骨结构损伤的增加，方法学上的一致性准确性降低。
