HRâ pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Metaâ Analysis
Mikolajewicz, Nicholas; Bishop, Nick; Burghardt, Andrew J; Folkestad, Lars; Hall, Anthony; Kozloff, Kenneth M; Lukey, Pauline T; Molloy‐bland, Michael; Morin, Suzanne N; Offiah, Amaka C; Shapiro, Jay; Rietbergen, Bert; Wager, Kim; Willie, Bettina M; Komarova, Svetlana V; Glorieux, Francis H
2020-03
Citation
Mikolajewicz, Nicholas; Bishop, Nick; Burghardt, Andrew J; Folkestad, Lars; Hall, Anthony; Kozloff, Kenneth M; Lukey, Pauline T; Molloy‐bland, Michael ; Morin, Suzanne N; Offiah, Amaka C; Shapiro, Jay; Rietbergen, Bert; Wager, Kim; Willie, Bettina M; Komarova, Svetlana V; Glorieux, Francis H (2020). "HRâ pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Metaâ Analysis." Journal of Bone and Mineral Research 35(3): 446-459.
Abstract
Highâ resolution peripheral quantitative computed tomography (HRâ pQCT) is a noninvasive imaging modality for assessing volumetric bone mineral density (vBMD) and microarchitecture of cancellous and cortical bone. The objective was to (1) assess fractureâ associated differences in HRâ pQCT bone parameters; and (2) to determine if HRâ pQCT is sufficiently precise to reliably detect these differences in individuals. We systematically identified 40 studies that used HRâ pQCT (39/40 used XtremeCT scanners) to assess 1291 to 3253 and 3389 to 10,687 individuals with and without fractures, respectively, ranging in age from 10.9 to 84.7â years with no comorbid conditions. Parameters describing radial and tibial bone density, microarchitecture, and strength were extracted and percentage differences between fracture and control subjects were estimated using a random effects metaâ analysis. An additional metaâ analysis of shortâ term in vivo reproducibility of bone parameters assessed by XtremeCT was conducted to determine whether fractureâ associated differences exceeded the least significant change (LSC) required to discern measured differences from precision error. Radial and tibial HRâ pQCT parameters, including failure load, were significantly altered in fracture subjects, with differences ranging from â 2.6% (95% confidence interval [CI] â 3.4 to â 1.9) in radial cortical vBMD to â 12.6% (95% CI â 15.0 to â 10.3) in radial trabecular vBMD. Fractureâ associated differences reported by prospective studies were consistent with those from retrospective studies, indicating that HRâ pQCT can predict incident fracture. Assessment of study quality, heterogeneity, and publication biases verified the validity of these findings. Finally, we demonstrated that fractureâ associated deficits in total and trabecular vBMD and certain tibial cortical parameters can be reliably discerned from HRâ pQCTâ related precision error and can be used to detect fractureâ associated differences in individual patients. Although differences in other HRâ pQCT measures, including failure load, were significantly associated with fracture, improved reproducibility is needed to ensure reliable individual crossâ sectional screening and longitudinal monitoring. In conclusion, our study supports the use of HRâ pQCT in clinical fracture prediction. © 2019 American Society for Bone and Mineral Research.Publisher
John Wiley & Sons, Inc.
ISSN
0884-0431 1523-4681
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