The Proximal Femoral Musculature: A new Risk Factor for Hip Fracture

股骨近端肌肉组织：髋部骨折的新危险因素

• 批准号: 7462562
• 负责人: THOMAS F LANG
• 金额: $ 24.06万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7462562
• 关键词: Accounting; Age; Algorithms; Area; Bone Density; Clinical; Cohort Studies; Complex; Computers; Data; Development; Diagnostic; Elderly; End Point; Environment; Etiology; Exercise; Fatty acid glycerol esters; Feasibility Studies; Fracture; Gender; Goals; Height; Hip Fractures; Hip region structure; Image; Individual; Intramuscular; Isometric Exercise; Laboratories; Leg; Lower Extremity; Measurement; Measures; Mediating; Methods; Muscle; Pathway interactions; Patients; Performance; Pharmacotherapy; Physical Function; Procedures; Public Health; Reaction; Registries; Research; Risk; Risk Factors; Scanning; Site; Skeletal system; Testing; Thigh structure; Time; Visit; Walking; Weight; X-Ray Computed Tomography; age group; age related; aging gene; attenuation; base; bone; bone imaging; cohort; cost; disability; falls; frailty; functional decline; improved; interest; meter; muscle strength; osteoporosis with pathological fracture; programs; prospective; size; software development; subcutaneous; technology development

DESCRIPTION (provided by applicant): Osteoporotic fracture has a complex etiology involving skeletal fragility, risk of falling, and impaired reaction to a fall once it is initiated. Currently, quantitative bone assessments such as dual x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) act as surrogates for skeletal strength but are of limited value as surrogates of fracture risk because they do not provide information on non-skeletal risk factors such as falls. Studies have shown that fall risk is associated with reduced muscle strength, particularly of the proximal femoral musculature. The QCT image of the hip provides information on the size and composition of the proximal femoral muscles, and studies at various skeletal sites have shown correlations between muscle strength and muscle size and attenuation measured by x-ray CT. In our laboratory, we have recently shown that combination of muscle size and attenuation data with the CT skeletal measures markedly improves the discriminatory power of the CT measurement. Here, we propose to develop computer algorithms to assess muscle size and attenuation from QCT hip images, prospectively validate that these measures improve fracture prediction when used in combination with hip QCT bone variables, and determine the mechanism by which they predict fracture. The study cohort will be selected from 5000 elderly individuals who have had baseline QCT examinations in the prospective Age Gene/Environment -Reykjavik (AGES-R) study and who are now being followed for incident fractures of the hip and other skeletal sites. The ultimate goal of this research program is to develop a quantitative assessment of an important non-skeletal risk factor that can be combined with QCT bone measurements, thus significantly improving diagnostic efficacy without the cost of an additional procedure. PUBLIC HEALTH RELEVENCE: Development of a muscle quantification procedure based on clinically available hip QCT skeletal imaging is an important pathway to improving estimation of hip fracture risk. It would potentially modify management of patients at risk for hip fractures by providing an additional non-skeletal measure reflective of fall risk. This quantitative measurement is modifiable and could become a treatment endpoint for specific exercise or drug therapies.

描述（由申请人提供）：骨质疏松性骨折具有复杂的病因，涉及骨骼脆弱性，跌落的风险以及对跌落的降落后的反应受损。当前，诸如双重X射线吸收仪（DXA）和定量计算机断层扫描（QCT）等定量骨评估是骨骼强度的替代物，但作为骨折风险的替代物的价值有限，因为它们不提供有关诸如下落型跌倒因素的非骨架风险因素的信息。研究表明，跌落风险与肌肉强度降低有关，尤其是股骨近端肌肉组织。髋关节的QCT图像提供了有关股骨近端肌肉大小和组成的信息，并且在各种骨骼部位的研究表明，肌肉强度与肌肉大小和X射线CT测量的衰减之间的相关性。在我们的实验室中，我们最近表明，肌肉大小和衰减数据与CT骨骼测量的组合显着提高了CT测量的歧视能力。在这里，我们建议开发计算机算法，以评估QCT髋关节图像的肌肉大小和衰减，前瞻性地验证这些措施与髋关节QCT骨变量结合使用时会改善断裂预测，并确定它们预测骨折的机制。该研究队列将从5000名在预期年龄基因/环境中进行基线QCT检查的老年人 - Reykjavik（Ages -R）研究，现在正在遵循髋关节和其他骨骼部位的入射骨折。该研究计划的最终目标是对可以与QCT骨测量值结合的重要非骨骼风险因素进行定量评估，从而显着提高诊断功效，而无需额外的程序成本。公共卫生相关性：基于临床可用的HIP QCT骨骼成像的肌肉定量程序的开发是改善髋部骨折风险估计的重要途径。它可能会通过提供反映跌倒风险的其他非骨骼措施来改变患有髋部骨折风险的患者的治疗。这种定量测量是可修改的，可能成为特定运动或药物疗法的治疗终点。