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: 8075450
• 负责人: THOMAS F LANG
• 金额: $ 24.7万
• 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 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8075450
• 关键词: Accounting; Age; Algorithms; Area; Bone Density; Clinical; Cohort Studies; Complex; Computational algorithm; Data; Development; Diagnostic; Elderly; Environment; Etiology; Fatty acid glycerol esters; Feasibility Studies; Fracture; Gender; Goals; Health; 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; Physical therapy exercises; Procedures; Reaction; Registries; Research; Risk; Risk Factors; Scanning; Site; 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; fall risk; falls; frailty; functional decline; improved; interest; meter; muscle strength; osteoporosis with pathological fracture; programs; prospective; skeletal; 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、跌倒风险以及跌倒后的反应受损。目前，双 X 射线吸收测定法 (DXA) 和定量计算机断层扫描 (QCT) 等定量骨骼评估可作为骨骼强度的替代指标，但作为骨折风险替代指标的价值有限，因为它们不提供非骨骼风险因素的信息比如跌倒。研究表明，跌倒风险与肌肉力量下降有关，尤其是股骨近端肌肉组织的力量下降。髋部的 QCT 图像提供了有关近端股骨肌肉的大小和组成的信息，并且对各个骨骼部位的研究显示了肌肉力量与 X 射线 CT 测量的肌肉大小和衰减之间的相关性。在我们的实验室中，我们最近表明，将肌肉大小和衰减数据与 CT 骨骼测量相结合，可显着提高 CT 测量的辨别力。在这里，我们建议开发计算机算法来评估 QCT 髋部图像的肌肉大小和衰减，前瞻性地验证这些措施与髋部 QCT 骨变量结合使用时可以改善骨折预测，并确定它们预测骨折的机制。研究队列将从 5000 名老年人中选出，这些老年人在前瞻性年龄基因/环境-雷克雅未克 (AGES-R) 研究中接受过基线 QCT 检查，目前正在对他们的髋部和其他骨骼部位骨折事件进行跟踪。该研究计划的最终目标是对重要的非骨骼风险因素进行定量评估，该评估可以与 QCT 骨骼测量相结合，从而显着提高诊断效果，而无需额外的手术费用。公共卫生相关性：基于临床可用的髋部 QCT 骨骼成像开发肌肉量化程序是改善髋部骨折风险评估的重要途径。通过提供反映跌倒风险的额外非骨骼测量方法，它可能会改变对髋部骨折风险患者的管理。这种定量测量是可以修改的，并且可以成为特定运动或药物治疗的治疗终点。