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1-14 Osteoporosis Presentations - DR

Bone densitometry techniques such as DEXA are commonly used to detect osteoporosis by measuring bone mineral density (BMD), but new approaches are being developed. Traditional BMD testing includes techniques like radiography and DEXA. Non-traditional methods include new DEXA techniques, quantitative CT, MRI, and finite element analysis, which provide additional data on bone microstructure and strength beyond BMD. Assessing other factors like vertebral fractures, bone marrow composition, and bone geometry and architecture can improve osteoporosis evaluation and prediction of fracture risk.

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56 views4 pages

1-14 Osteoporosis Presentations - DR

Bone densitometry techniques such as DEXA are commonly used to detect osteoporosis by measuring bone mineral density (BMD), but new approaches are being developed. Traditional BMD testing includes techniques like radiography and DEXA. Non-traditional methods include new DEXA techniques, quantitative CT, MRI, and finite element analysis, which provide additional data on bone microstructure and strength beyond BMD. Assessing other factors like vertebral fractures, bone marrow composition, and bone geometry and architecture can improve osteoporosis evaluation and prediction of fracture risk.

Uploaded by

tarikeops
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Bone densitometry:The ideal

detector for Osteoporosis


New Approaches

By:
Omar Hussein Omar
Professor of Radiodiagnosis
Ain Shams University

BMD Testing Techniques


A. Traditional methods
• Conventional radiography
• Radiographic absorptiometry (RA)
• Ultrasound densitometry
• Dual-energy X-ray absorptiometry(DEXA)

B. Non traditional methods


• New DEXA techniques
• Quantitative computed tomography (QCT) and
Finite Element Analysis
• MRI

Reference Graph
Young Adult T-score
Compares subject’s BMD to average Young Adult BMD (PBM)
• 1T = 1 Standard Deviation (SD)
• Example
If T-score = -2.3, then subject’s BMD is 2.3 SD below average Young
Adult BMD

T-score = (Subject BMD -PBM )


Peak Bone Mass
PBM
SD

BMD
Age-matched Z-score
• Compares subject’s BMD to average Age-Matched BMD
• 1 Z = 1 Standard Deviation (SD)
• Example:
▫ Z-score = -2.3, then patient's BMD is 2.3 SD below average Age-
Matched BMD
▫ Z-score = +0.9, then patient's BMD is 0.9 SD above average Age-
Matched BMD

Zscore =Subj. BMD - BMD Ref AgeMatched


SD

Vertebral fracture Analysis ( VFA )

• For both women and men, a prior vertebral


fracture is a strong independent risk factor for
future vertebral and nonvertebral
fractures
 Women with vertebral fractures have a 5-fold
increased risk of a new vertebral fracture and a
2-fold increased risk of hip fracture
• Black et al., J Bone Miner Res 1999
• Melton et al, Osteoporos Int 1999

Advanced Hip Assessment


(AHA)
Includes all the standard femoral regions
of interest previously available. In addition,
AHA provides a measurement of two new
regions of interest-upper and lower femoral
neck, automated determination of hip
axis length, and hip strength values.
1. Lower Femoral Neck
2. Trochanter
3. Ward's
4. Shaft
5. Total Hip (defined as the density of
the combined region of the femoral
neck, trochanter, and shaft regions.
6. Upper Femoral Neck
7. Hip axis length (HAL)
Bone around
prosthesis

• (DXA) has proven to be a useful technique for quantifying


periprosthetic (BMD) changes around proximal femoral
implants, but relatively few studies have assessed BMD
changes in bone surrounding knee implants.

•Tibial bone loss may result from altered loading conditions


imposed by the implant (stress shielding) and periprosthetic
bone resorption caused by a variety of factors .

•These factors may contribute to aseptic loosening and


ultimate implant failure. Measurement of BMD change can
detect any biological change over time.

What is bone “quality”?


• Bone quality may be defined as the set of
structural variables of the skeleton, not
measurable by DEXA, having an influence on its
strength.

• DEXA gives us an estimate of the amount of


mineral tissue in bone.

• Other factor influencing bone strength is the way


that bone tissue is arranged in its tridimensional
space, that is, the bone microstructure. This is
what is called bone quality.

Quantitative Computed Tomography

• Advantages
▫ Flexible measurements: pure trabecular bone or mix
of cortical and trabecular

• Disadvantages
▫ spine forearm femur only
▫ relatively high radiation dose (100-1000 mR for
spine)
▫ Low precision (2-5% error)
▫ expensive
▫ No validation of results (WHO, …)
MRI
 Magnetic Resonance Microscopy (MMR):
High resolution images provide information about
trabecular microarchitecture
MR Spectroscopy of bone marrow
Provides information about bone marrow chemical
composition

MR Spectroscopy of
bone marrow

• Now, a new technique MR spectroscopy can


evaluate bone marrow fat non invasively and
serially.

• Many researchers have shown that the majority


of subjects with weakened vertebrae have a
high percentage of bone marrow fat fraction
( %FF)
( Schellinger et al, 2001)

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