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.

椎骨骨折是骨质疏松性骨折的最常见类型，三分之一的妇女和一名 六名50岁以上的男性。尽管患病率很高，椎骨骨折的敏感和特定估计值 风险仍然难以捉摸。当前估计椎骨强度和断裂的方法的局限性 在很大程度上依赖平均骨矿物质密度（BMD）的风险被广泛认可。 但是，在验证和明确的优势方面缺乏替代方法 “平均BMD”方法。我们最近的数据解决了知识和翻译方面的关键差距 证明使用定量计算机断层扫描的临床可行测量 （QCT）扫描以增强椎骨衰竭的预测。使用QCT衍生的分布量度 骨组织整个椎骨，我们发现脊椎内异质性的大小 BMD提供了改进的椎骨强度的预测，并且在没有椎骨的女性中较低 断裂。这些数据还表明，BMD的多个特征空间分布（“模式”） 椎骨可以赋予高骨强度，并且这些模式与强度之间的关联可能是 由相邻椎间盘（IVD）中的变性严重程度调节。我们现在建议 在BMD，椎骨衰竭和IVD变性中定义脊椎内异质性之间的关系 基于人群的研究和完整的离体研究。 AIM＃1将使用案例对照研究设计 先前在弗雷明汉心脏研究（FHS）中入学的男女中获得了QCT扫描 多探测器QCT研究测试了降低异质性的假设与 普遍断裂的风险增加。 AIM＃2将使用FHS的年龄和性别分层的随机样本 QCT队列确定BMD和IVD健康的空间分布之间的关联，然后是EX 体内研究定义了这些关联如何影响椎骨强度。我们的双重假设 ＃2是BMD的空间模式与IVD健康有关，并且椎骨强度取决于 空间BMD模式与IVD提供的负载分布之间的一致性。 AIM＃3 Will 通过一种提供的新型实验方法，继续我们的临床专注，生物力学研究 急需评估椎体故障的基于QCT的有限元（FE）模型的准确性。这 AIM将测试通过临床合并来提高FE预测的准确性的假设 可获得IVD健康的可获得评估。这些目标在一起是迈向减少燃烧的主要一步 椎骨骨折。这项工作合作伙伴对脊椎内异质性现象的经济有效研究 在社区居民中，有病例对照和实验室研究生物力学 这种异质性的后果。结果将提供广泛适用的集成评估 椎体健康，配有可翻译工具，为估计骨折风险的新标准设定了新标准。