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Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study

BACKGROUND: Osteoporotic fractures are a major cause of morbidity in the elderly. Menopausal women represent the population with the highest risk of early osteoporosis onset, often accompanied by vertebral fractures (VF). Bone mineral density (BMD) is commonly assessed by dual-energy X-ray absorptio...

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Autores principales: Zaia, Annamaria, Rossi, Roberto, Galeazzi, Roberta, Sallei, Manuela, Maponi, Pierluigi, Scendoni, Pietro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827988/
https://www.ncbi.nlm.nih.gov/pubmed/33485322
http://dx.doi.org/10.1186/s12891-021-03966-7
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author Zaia, Annamaria
Rossi, Roberto
Galeazzi, Roberta
Sallei, Manuela
Maponi, Pierluigi
Scendoni, Pietro
author_facet Zaia, Annamaria
Rossi, Roberto
Galeazzi, Roberta
Sallei, Manuela
Maponi, Pierluigi
Scendoni, Pietro
author_sort Zaia, Annamaria
collection PubMed
description BACKGROUND: Osteoporotic fractures are a major cause of morbidity in the elderly. Menopausal women represent the population with the highest risk of early osteoporosis onset, often accompanied by vertebral fractures (VF). Bone mineral density (BMD) is commonly assessed by dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnosis; however, BMD alone does not represent a significant predictor of fracture risk. Bone microarchitecture, instead, arises as a determinant of bone fragility independent of BMD. High-resolution magnetic resonance imaging (MRI) is an effective noninvasive/nonionizing tool for in vivo characterisation of trabecular bone microarchitecture (TBA). We have previously set up an MRI method able to characterise TBA changes in aging and osteoporosis by one parameter, trabecular bone lacunarity parameter β (TBLβ). Fractal lacunarity was used for TBA texture analysis as it describes discontinuity of bone network and size of bone marrow spaces, changes of which increase the risk of bone fracture. This study aims to assess the potential of TBLβ method as a tool for osteoporotic fracture risk. METHODS: An observational, cross-sectional, and prospective study on over-50s women at risk for VF was designed. TBLβ, our index of osteoporotic fracture risk, is the main outcome measure. It was calculated on lumbar vertebra axial images, acquired by 1.5 T MRI spin-echo technique, from 279 osteopenic/osteoporotic women with/without prior VF. Diagnostic power of TBLβ method, by Receiver Operating Characteristics (ROC) curve and other diagnostic accuracy measurements were compared with lumbar spine DXA-BMD. RESULTS: Baseline results show that TBLβ is able to discriminate patients with/without prevalent VF (p = 0.003). AUC (area under the curve from ROC) is 0.63 for TBLβ, statistically higher (p = 0.012) than BMD one (0.53). Contribution of TBLβ to prevalent VF is statistically higher (p < 0.001) than BMD (sensitivity: 66% vs. 52% respectively; OR: 3.20, p < 0.0001 for TBLβ vs. 1.31, p = 0.297 for BMD). Preliminary 1-year prospective results suggest that TBA contribution to incident VF is even higher (sensitivity: 73% for TBLβ vs. 55% for BMD; RR: 3.00, p = 0.002 for TBLβ vs. 1.31, p = 0.380 for BMD). CONCLUSION: Results from this study further highlight the usefulness of TBLβ as a biomarker of TBA degeneration and an index of osteoporotic fracture risk.
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spelling pubmed-78279882021-01-26 Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study Zaia, Annamaria Rossi, Roberto Galeazzi, Roberta Sallei, Manuela Maponi, Pierluigi Scendoni, Pietro BMC Musculoskelet Disord Research Article BACKGROUND: Osteoporotic fractures are a major cause of morbidity in the elderly. Menopausal women represent the population with the highest risk of early osteoporosis onset, often accompanied by vertebral fractures (VF). Bone mineral density (BMD) is commonly assessed by dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnosis; however, BMD alone does not represent a significant predictor of fracture risk. Bone microarchitecture, instead, arises as a determinant of bone fragility independent of BMD. High-resolution magnetic resonance imaging (MRI) is an effective noninvasive/nonionizing tool for in vivo characterisation of trabecular bone microarchitecture (TBA). We have previously set up an MRI method able to characterise TBA changes in aging and osteoporosis by one parameter, trabecular bone lacunarity parameter β (TBLβ). Fractal lacunarity was used for TBA texture analysis as it describes discontinuity of bone network and size of bone marrow spaces, changes of which increase the risk of bone fracture. This study aims to assess the potential of TBLβ method as a tool for osteoporotic fracture risk. METHODS: An observational, cross-sectional, and prospective study on over-50s women at risk for VF was designed. TBLβ, our index of osteoporotic fracture risk, is the main outcome measure. It was calculated on lumbar vertebra axial images, acquired by 1.5 T MRI spin-echo technique, from 279 osteopenic/osteoporotic women with/without prior VF. Diagnostic power of TBLβ method, by Receiver Operating Characteristics (ROC) curve and other diagnostic accuracy measurements were compared with lumbar spine DXA-BMD. RESULTS: Baseline results show that TBLβ is able to discriminate patients with/without prevalent VF (p = 0.003). AUC (area under the curve from ROC) is 0.63 for TBLβ, statistically higher (p = 0.012) than BMD one (0.53). Contribution of TBLβ to prevalent VF is statistically higher (p < 0.001) than BMD (sensitivity: 66% vs. 52% respectively; OR: 3.20, p < 0.0001 for TBLβ vs. 1.31, p = 0.297 for BMD). Preliminary 1-year prospective results suggest that TBA contribution to incident VF is even higher (sensitivity: 73% for TBLβ vs. 55% for BMD; RR: 3.00, p = 0.002 for TBLβ vs. 1.31, p = 0.380 for BMD). CONCLUSION: Results from this study further highlight the usefulness of TBLβ as a biomarker of TBA degeneration and an index of osteoporotic fracture risk. BioMed Central 2021-01-23 /pmc/articles/PMC7827988/ /pubmed/33485322 http://dx.doi.org/10.1186/s12891-021-03966-7 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Zaia, Annamaria
Rossi, Roberto
Galeazzi, Roberta
Sallei, Manuela
Maponi, Pierluigi
Scendoni, Pietro
Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title_full Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title_fullStr Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title_full_unstemmed Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title_short Fractal lacunarity of trabecular bone in vertebral MRI to predict osteoporotic fracture risk in over-fifties women. The LOTO study
title_sort fractal lacunarity of trabecular bone in vertebral mri to predict osteoporotic fracture risk in over-fifties women. the loto study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827988/
https://www.ncbi.nlm.nih.gov/pubmed/33485322
http://dx.doi.org/10.1186/s12891-021-03966-7
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