3-D Visualization and Prediction of Vertebral Fractures

椎骨骨折的 3D 可视化和预测

• 批准号: 10086296
• 负责人: Elise F Morgan
• 金额: $ 0.44万
• 依托单位: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS)
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10086296
• 关键词: 3-Dimensional; Address; Age; Area; Behavior; Biomechanics; Bone Density; Bone Tissue; Case-Control Studies; Characteristics; Clinical; Clinical assessments; Cluster Analysis; Communities; Cross-Sectional Studies; Data; Diagnostic radiologic examination; Elderly; Elements; Enrollment; Evaluation; Failure; Finite Element Analysis; Fracture; Framingham Heart Study; Future; Goals; Health; Heterogeneity; High Prevalence; Histologic; Histology; Imaging Device; Individual; Intervertebral disc structure; Investigation; Laboratory Study; Measurement; Measures; Mechanics; Methods; Modeling; Pain; Participant; Patients; Pattern; Population; Population Study; Quality of life; Research Design; Risk; Risk Estimate; Sampling; Scanning; Severities; Spatial Distribution; Spinal Fractures; Study Subject; Testing; Validation; Vertebral column; Visualization; Woman; Work; X-Ray Computed Tomography; base; bone; bone strength; clinical imaging; clinical translation; clinically relevant; cohort; cost effective; digital; experimental study; fracture risk; improved; intervertebral disk degeneration; knowledge translation; men; mortality; novel; osteoporosis with pathological fracture; population based; pressure; sex; simulation; spine bone structure; three-dimensional visualization; tool; validation studies

Vertebral fractures are the most common type of osteoporotic fracture, afflicting one in three women and one in six men over the age of 50. Despite their high prevalence, sensitive and specific estimates of vertebral fracture risk have remained elusive. The limitations of current approaches for estimating vertebral strength and fracture risk, which rely heavily on measurement of the average bone mineral density (BMD), are widely recognized. However, alternative methods have been lacking with respect to validation and clear advantages over the “average BMD” approach. Our recent data address this critical gap in knowledge and translation by demonstrating the use of clinically feasible measurements made from quantitative computed tomography (QCT) scans to enhance predictions of vertebral failure. Using QCT-derived measures of the distribution of bone tissue throughout the vertebra, we have found that the magnitude of the intra-vertebral heterogeneity in BMD provides improved predictions of vertebral strength and is lower in women with vs. without vertebral fracture. These data also indicate that multiple, characteristic spatial distributions (“patterns”) of BMD within the vertebra can confer high bone strength, and that the associations between these patterns and strength may be modulated by the severity of degeneration in the adjacent intervertebral discs (IVDs). We now propose to define relationships among intra-vertebral heterogeneity in BMD, vertebral failure, and IVD degeneration in population-based studies and complementary ex vivo studies. Aim #1 will use a case-control study design with previously acquired QCT scans in men and women enrolled in the Framingham Heart Study (FHS) Multidetector QCT study to test the hypothesis that decreased magnitude of heterogeneity is associated with increased risk of prevalent fracture. Aim #2 will use an age- and sex-stratified, random sample from the FHS QCT cohort to determine associations between the spatial distribution of BMD and IVD health, followed by ex vivo studies that define how these associations can influence vertebral strength. Our dual hypotheses in Aim #2 are that the spatial patterns of BMD are associated with IVD health and that vertebral strength depends on the congruence between the spatial BMD pattern and the load distribution supplied by the IVDs. Aim #3 will continue our clinically focused, biomechanical investigations via a novel experimental approach that provides much-needed evaluation of the accuracy of QCT-based finite element (FE) models of vertebral failure. This aim will test the hypothesis that the accuracy of the FE predictions is improved by incorporating clinically obtainable assessments of IVD health. Together, these Aims are a major step towards reducing the burden of vertebral fracture. This work partners a cost-effective study of the phenomenon of intra-vertebral heterogeneity in a community-dwelling population with case-control and laboratory studies of the biomechanical consequences of this heterogeneity. The results will provide a widely applicable, integrated assessment of vertebral health, complete with translatable tools to set a new standard for estimation of fracture risk.

椎骨骨折是最常见的骨质疏松性骨折类型，三分之一的女性和四分之一的人患有椎骨骨折。 六名 50 岁以上的男性。尽管其患病率很高，但对椎骨骨折的估计敏感且具体 目前评估椎骨强度和骨折的方法的局限性仍然难以捉摸。 风险在很大程度上依赖于平均骨矿物质密度（BMD）的测量，这一点已得到广泛认可。 然而，在验证方面缺乏替代方法，并且相对于现有方法具有明显的优势。 我们最近的数据通过“平均 BMD”解决了知识和翻译方面的这一关键差距。 展示使用定量计算机断层扫描进行的临床上可行的测量 (QCT) 扫描，使用 QCT 衍生的分布测量来增强对椎体衰竭的预测。 整个椎骨的骨组织，我们发现椎体内异质性的程度 BMD 提供了对椎骨强度的改进预测，并且有椎骨的女性与无椎骨的女性相比较低 这些数据还表明 BMD 存在多种特征空间分布（“模式”）。 椎骨可以赋予高骨强度，这些模式和强度之间的关联可能是 受相邻椎间盘（IVD）退变严重程度的调节。 定义椎体内 BMD 异质性、椎体衰竭和 IVD 退化之间的关系 基于人群的研究和补充性体外研究将采用病例对照研究设计。 之前对参与弗雷明汉心脏研究 (FHS) 的男性和女性进行的 QCT 扫描 多检测器 QCT 研究检验异质性程度降低与以下因素相关的假设： 目标 #2 将使用来自 FHS 的年龄和性别分层随机样本。 QCT 队列以确定 BMD 和 IVD 健康的空间分布之间的关联，然后进行前 体内研究定义了这些关联如何影响椎骨强度，我们在 Aim 中的双重假设。 #2 是 BMD 的空间模式与 IVD 健康相关，并且椎骨强度取决于 空间 BMD 模式与 IVD 目标 #3 提供的载荷分布之间的一致性。 通过一种新颖的实验方法继续我们以临床为重点的生物力学研究，该方法提供了 对基于 QCT 的椎体衰竭有限元 (FE) 模型的准确性进行急需的评估。 目标将检验以下假设：通过结合临床数据可以提高 FE 预测的准确性 这些目标共同构成了减轻医疗负担的重要一步。 这项工作与椎体内异质性现象的成本效益研究相结合。 在社区居住人群中进行病例对照和生物力学实验室研究 这种异质性的后果将提供广泛适用的综合评估。 椎骨健康状况，配有可翻译工具，为骨折风险评估设定新标准。