Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck

Gianluca Iori; Johannes Schneider; Andreas Reisinger; Frans Heyer; Laura Peralta; Caroline Wyers; Claus C. Glueer; J. P. van den Bergh; Dieter Pahr; Kay Raum

doi:10.1016/j.bone.2020.115446

Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck

Gianluca Iori, Johannes Schneider, Andreas Reisinger, Frans Heyer, Laura Peralta, Caroline Wyers, Claus C. Glueer, J. P. van den Bergh, Dieter Pahr, Kay Raum^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Introduction: Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck.

Methods: The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 mu m voxel size. Cortical thickness (Ct.Th-tibia), porosity (Ct.Po-tibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 mu m pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models.

Results: Femur strength was associated with the total (vBMD(tot); R-2 = 0.23, p <0.01) and trabecular (vBMD(trab); R-2 = 0.26, p <0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.Th-FN; R-2 = 0.29, p <0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R-2 = 0.34, p <0.001), separation (Tb.Sp(FN); R-2 = 0.25, p <0.01) and number (Tb.N-FN; R-2 = 0.32, p <0.001) of the femoral neck. Moreover, smaller Ct.Th-tibia was associated with smaller CLThFN (R-2 = 0.31, p <0.05), lower Tb.BV/TVFN (R-2 = 0.29, p <0.05), higher Tb.Sp(FN) (R-2 = 0.33, p <0.05) and lower Tb.N-FN (R-2 = 0.42, p <0.01). A higher prevalence of pores with diameter > 100 mu m in tibial cortical bone (relCt.Po100 mu m-tibia) indicated higher Tb.Sp(FN) (R-2 = 0.36, p <0.01) and lower Tb.N-FN (R-2 = 0.45, p <0.01).

Conclusion: Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.

Original language	English
Article number	115446
Number of pages	9
Journal	Bone
Volume	137
DOIs	https://doi.org/10.1016/j.bone.2020.115446
Publication status	Published - Aug 2020

Keywords

Cortical bone
Porosity
Bone strength
Finite element analysis
Hip fragility
REVERSAL PHASE ARREST
HUMAN PROXIMAL FEMUR
BONE MICROARCHITECTURE
TRABECULAR BONE
HIGH-RESOLUTION
DISTAL RADIUS
POSTMENOPAUSAL WOMEN
HIP-FRACTURES
POROSITY
STRENGTH

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Cite this

@article{b2721c4c64784be08b1997e6fdabc0a8,

title = "Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck",

abstract = "Introduction: Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck.Methods: The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 mu m voxel size. Cortical thickness (Ct.Th-tibia), porosity (Ct.Po-tibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 mu m pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models.Results: Femur strength was associated with the total (vBMD(tot); R-2 = 0.23, p <0.01) and trabecular (vBMD(trab); R-2 = 0.26, p <0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.Th-FN; R-2 = 0.29, p <0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R-2 = 0.34, p <0.001), separation (Tb.Sp(FN); R-2 = 0.25, p <0.01) and number (Tb.N-FN; R-2 = 0.32, p <0.001) of the femoral neck. Moreover, smaller Ct.Th-tibia was associated with smaller CLThFN (R-2 = 0.31, p <0.05), lower Tb.BV/TVFN (R-2 = 0.29, p <0.05), higher Tb.Sp(FN) (R-2 = 0.33, p <0.05) and lower Tb.N-FN (R-2 = 0.42, p <0.01). A higher prevalence of pores with diameter > 100 mu m in tibial cortical bone (relCt.Po100 mu m-tibia) indicated higher Tb.Sp(FN) (R-2 = 0.36, p <0.01) and lower Tb.N-FN (R-2 = 0.45, p <0.01).Conclusion: Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.",

keywords = "Cortical bone, Porosity, Bone strength, Finite element analysis, Hip fragility, REVERSAL PHASE ARREST, HUMAN PROXIMAL FEMUR, BONE MICROARCHITECTURE, TRABECULAR BONE, HIGH-RESOLUTION, DISTAL RADIUS, POSTMENOPAUSAL WOMEN, HIP-FRACTURES, POROSITY, STRENGTH",

author = "Gianluca Iori and Johannes Schneider and Andreas Reisinger and Frans Heyer and Laura Peralta and Caroline Wyers and Glueer, {Claus C.} and {van den Bergh}, {J. P.} and Dieter Pahr and Kay Raum",

note = "Funding Information: JB reports grants and personal fees from Eli Lilly, grants and personal fees from Amgen, grants from Will Pharma, outside the submitted work. Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2020",

month = aug,

doi = "10.1016/j.bone.2020.115446",

language = "English",

volume = "137",

journal = "Bone",

issn = "8756-3282",

publisher = "Elsevier Science",

}

TY - JOUR

T1 - Cortical thinning and accumulation of large cortical pores in the tibia reflect local structural deterioration of the femoral neck

AU - Iori, Gianluca

AU - Schneider, Johannes

AU - Reisinger, Andreas

AU - Heyer, Frans

AU - Peralta, Laura

AU - Wyers, Caroline

AU - Glueer, Claus C.

AU - van den Bergh, J. P.

AU - Pahr, Dieter

AU - Raum, Kay

N1 - Funding Information: JB reports grants and personal fees from Eli Lilly, grants and personal fees from Amgen, grants from Will Pharma, outside the submitted work. Publisher Copyright: © 2020 Elsevier Inc.

PY - 2020/8

Y1 - 2020/8

N2 - Introduction: Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck.Methods: The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 mu m voxel size. Cortical thickness (Ct.Th-tibia), porosity (Ct.Po-tibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 mu m pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models.Results: Femur strength was associated with the total (vBMD(tot); R-2 = 0.23, p <0.01) and trabecular (vBMD(trab); R-2 = 0.26, p <0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.Th-FN; R-2 = 0.29, p <0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R-2 = 0.34, p <0.001), separation (Tb.Sp(FN); R-2 = 0.25, p <0.01) and number (Tb.N-FN; R-2 = 0.32, p <0.001) of the femoral neck. Moreover, smaller Ct.Th-tibia was associated with smaller CLThFN (R-2 = 0.31, p <0.05), lower Tb.BV/TVFN (R-2 = 0.29, p <0.05), higher Tb.Sp(FN) (R-2 = 0.33, p <0.05) and lower Tb.N-FN (R-2 = 0.42, p <0.01). A higher prevalence of pores with diameter > 100 mu m in tibial cortical bone (relCt.Po100 mu m-tibia) indicated higher Tb.Sp(FN) (R-2 = 0.36, p <0.01) and lower Tb.N-FN (R-2 = 0.45, p <0.01).Conclusion: Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.

AB - Introduction: Cortical bone thinning and a rarefaction of the trabecular architecture represent possible causes of increased femoral neck (FN) fracture risk. Due to X-ray exposure limits, the bone microstructure is rarely measurable in the FN of subjects but can be assessed at the tibia. Here, we studied whether changes of the tibial cortical microstructure, which were previously reported to be associated with femur strength, are also associated with structural deteriorations of the femoral neck.Methods: The cortical and trabecular architectures in the FN of 19 humans were analyzed ex vivo on 3D microcomputed tomography images with 30.3 mu m voxel size. Cortical thickness (Ct.Th-tibia), porosity (Ct.Po-tibia) and pore size distribution in the tibiae of the same subjects were measured using scanning acoustic microscopy (12 mu m pixel size). Femur strength during sideways falls was simulated with homogenized voxel finite element models.Results: Femur strength was associated with the total (vBMD(tot); R-2 = 0.23, p <0.01) and trabecular (vBMD(trab); R-2 = 0.26, p <0.01) volumetric bone mineral density (vBMD), with the cortical thickness (Ct.Th-FN; R-2 = 0.29, p <0.001) and with the trabecular bone volume fraction (Tb.BV/TVFN; R-2 = 0.34, p <0.001), separation (Tb.Sp(FN); R-2 = 0.25, p <0.01) and number (Tb.N-FN; R-2 = 0.32, p <0.001) of the femoral neck. Moreover, smaller Ct.Th-tibia was associated with smaller CLThFN (R-2 = 0.31, p <0.05), lower Tb.BV/TVFN (R-2 = 0.29, p <0.05), higher Tb.Sp(FN) (R-2 = 0.33, p <0.05) and lower Tb.N-FN (R-2 = 0.42, p <0.01). A higher prevalence of pores with diameter > 100 mu m in tibial cortical bone (relCt.Po100 mu m-tibia) indicated higher Tb.Sp(FN) (R-2 = 0.36, p <0.01) and lower Tb.N-FN (R-2 = 0.45, p <0.01).Conclusion: Bone resorption and structural decline of the femoral neck may be identified in vivo by measuring cortical bone thickness and large pores in the tibia.

KW - Cortical bone

KW - Porosity

KW - Bone strength

KW - Finite element analysis

KW - Hip fragility

KW - REVERSAL PHASE ARREST

KW - HUMAN PROXIMAL FEMUR

KW - BONE MICROARCHITECTURE

KW - TRABECULAR BONE

KW - HIGH-RESOLUTION

KW - DISTAL RADIUS

KW - POSTMENOPAUSAL WOMEN

KW - HIP-FRACTURES

KW - POROSITY

KW - STRENGTH

U2 - 10.1016/j.bone.2020.115446

DO - 10.1016/j.bone.2020.115446

M3 - Article

C2 - 32450342

SN - 8756-3282

VL - 137

JO - Bone

JF - Bone

M1 - 115446

ER -