← Back to Search
Advanced CT Based In Vivo Methods For The Assessment Of Bone Density, Structure, And Strength
K. Engelke, C. Libanati, T. Fuerst, P. Zysset, H. Genant
Published 2013 · Medicine
Download PDFAnalyze on Scholarcy
Based on spiral 3D tomography a large variety of applications have been developed during the last decade to asses bone mineral density, bone macro and micro structure, and bone strength. Quantitative computed tomography (QCT) using clinical whole body scanners provides separate assessment of trabecular, cortical, and subcortical bone mineral density (BMD) and content (BMC) principally in the spine and hip, although the distal forearm can also be assessed. Further bone macrostructure, for example bone geometry or cortical thickness can be quantified. Special high resolution peripheral CT (hr-pQCT) devices have been introduced to measure bone microstructure for example the trabecular architecture or cortical porosity at the distal forearm or tibia. 3D CT is also the basis for finite element analysis (FEA) to determine bone strength. QCT, hr-pQCT, and FEM are increasingly used in research as well as in clinical trials to complement areal BMD measurements obtained by the standard densitometric technique of dual x-ray absorptiometry (DXA). This review explains technical developments and demonstrates how QCT based techniques advanced our understanding of bone biology.
This paper references
Prediction of proximal femur strength using a CT-based nonlinear finite element method: differences in predicted fracture load and site with changing load and boundary conditions.
M. Bessho (2009)
Correlations between orthogonal mechanical properties and density of trabecular bone: use of different densitometric measures.
J. Keyak (1994)
Multi-center precision of cortical and trabecular bone quality measures assessed by HR-PQCT
AJ • Burghardt (2012)
Biomechanical effects of teriparatide in women with osteoporosis treated previously with alendronate and risedronate: results from quantitative computed tomography-based finite element analysis of the vertebral body.
Y. Chevalier (2010)
Quantitative computed tomography (QCT) of the forearm using general purpose spiral whole-body CT scanners: accuracy, precision and comparison with dual-energy X-ray absorptiometry (DXA).
K. Engelke (2009)
Visual grading of motion induced image degradation in high resolution peripheral computed tomography: impact of image quality on measures of bone density and micro-architecture.
J. Pialat (2012)
A novel mechanism for induction of increased cortical porosity in cases of intracapsular hip fracture.
K. L. Bell (2000)
Comparisons of Noninvasive Bone Mineral Measurements in Assessing Age‐Related Loss, Fracture Discrimination, and Diagnostic Classification
S. Grampp (1997)
Proximal femoral density and geometry measurements by quantitative computed tomography: association with hip fracture.
X. Cheng (2007)
One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis
D. Black (2006)
density and microarchitecture
Y Pauchard (2012)
Cortical Thickness Mapping to Identify Focal Osteoporosis in Patients with Hip Fracture
K. Poole (2012)
Strontium ranelate and alendronate have differing effects on distal tibia bone microstructure in women with osteoporosis
R. Rizzoli (2010)
Assessment of volume fraction and fabric in the distal radius using HR-pQCT.
P. Varga (2009)
A patient-specific computer tomography-based finite element methodology to calculate the six dimensional stiffness matrix of human vertebral bodies.
Yan Chevalier (2012)
Differences in hip quantitative computed tomography (QCT) measurements of bone mineral density and bone strength between glucocorticoid-treated and glucocorticoid-naïve postmenopausal women
Kuo-Chiang Lian (2004)
Three-dimensional structural analysis of the proximal femur in an age-stratified sample of women.
Kristy M. Nicks (2013)
Comparison of QCT-derived and DXA-derived areal bone mineral density and T scores
B. C. C. Khoo (2008)
High‐Resolution pQCT Analysis at the Distal Radius and Tibia Discriminates Patients With Recent Wrist and Femoral Neck Fractures
L. Vico (2008)
Ronacaleret, a calcium‐sensing receptor antagonist, increases trabecular but not cortical bone in postmenopausal women
L. Fitzpatrick (2012)
Cross‐sectional analysis of the association between fragility fractures and bone microarchitecture in older men: The STRAMBO study
P. Szulc (2011)
Denosumab densitometric changes assessed by quantitative computed tomography at the spine and hip in postmenopausal women with osteoporosis.
M. Mcclung (2013)
Regional differences in cortical porosity in the fractured femoral neck.
K. L. Bell (1999)
Changes in trabecular and cortical bone microarchitecture at peripheral sites associated with 18 months of teriparatide therapy in postmenopausal women with osteoporosis
H. M. Macdonald (2010)
Multicenter precision of cortical and trabecular bone quality measures assessed by high‐resolution peripheral quantitative computed tomography
A. Burghardt (2013)
Microarchitectural deterioration of cortical and trabecular bone: Differing effects of denosumab and alendronate
E. Seeman (2010)
Vertebral strength changes in rheumatoid arthritis patients treated with alendronate, as assessed by finite element analysis of clinical computed tomography scans: a prospective randomized clinical trial.
T. Mawatari (2008)
Teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPS trial
C. Glüer (2012)
Effect of oral monthly ibandronate on bone microarchitecture in women with osteopenia—a randomized placebo-controlled trial
R. Chapurlat (2012)
Population‐Based Study of Age and Sex Differences in Bone Volumetric Density, Size, Geometry, and Structure at Different Skeletal Sites
B. Riggs (2004)
A Randomized Trial
S. V. Desai (2013)
Severity of Vertebral Fractures Is Associated With Alterations of Cortical Architecture in Postmenopausal Women
E. Sornay-Rendu (2009)
Association of hip strength estimates by finite‐element analysis with fractures in women and men
S. Amin (2011)
Alterations of Cortical and Trabecular Architecture Are Associated With Fractures in Postmenopausal Women, Partially Independent of Decreased BMD Measured by DXA: The OFELY Study
E. Sornay-Rendu (2007)
Quantitative bone mineral analysis using dual energy computed tomography.
H. Genant (1977)
Mathematical relationships between bone density and mechanical properties: a literature review.
B. Helgason (2008)
Relative strength of thoracic vertebrae in axial compression versus flexion.
J. Buckley (2009)
Automatic segmentation of cortical and trabecular compartments based on a dual threshold technique for in vivo micro-CT bone analysis.
H. Buie (2007)
Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography.
R. Crawford (2003)
Predicting vertebral fracture incidence from prevalent fractures and bone density among non-black, osteoporotic women
P. Ross (2005)
Reproducibility of direct quantitative measures of cortical bone microarchitecture of the distal radius and tibia by HR-pQCT.
A. Burghardt (2010)
Automated quantification of three-dimensional subject motion to monitor image quality in high-resolution peripheral quantitative computed tomography.
Y. Pauchard (2011)
CT of the middiaphyseal femur: cortical bone mineral density and relation to porosity.
V. Bousson (2000)
Effect of Recombinant Human Parathyroid Hormone (1-84) on Vertebral Fracture and Bone Mineral Density in Postmenopausal Women with Osteoporosis
S. Greenspan (2007)
Assessment of vertebral fracture risk and therapeutic effects of alendronate in postmenopausal women using a quantitative computed tomography-based nonlinear finite element method
K. Imai (2008)
Intracortical remodelling and porosity in the distal radius and post-mortem femurs of women: a cross-sectional study
R. Zebaze (2010)
Mechanistic fracture criteria for the failure of human cortical bone
R. K. Nalla (2003)
Abnormal Microarchitecture and Reduced Stiffness at the Radius and Tibia in Postmenopausal Women With Fractures
E. Stein (2010)
Imaging the femoral cortex: Thickness, density and mass from clinical CT
Graham M. Treece (2012)
In vivo discrimination of hip fracture with quantitative computed tomography: Results from the prospective European Femur Fracture Study (EFFECT)
V. Bousson (2011)
Finite Element Analysis of the Proximal Femur and Hip Fracture Risk in Older Men
E. Orwoll (2009)
Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: the MrOS study
L Yang (2012)
Femoral strength is better predicted by finite element models than QCT and DXA.
D. Cody (1999)
density , geometry and biomechanical properties of the proximal femur : CT - based 3 D hip structure analysis in normal post - menopausal women
V Bousson (2011)
Use of finite element analysis to assess bone strength
E. Morgan (2005)
Quantitative characterization of subject motion in HR-pQCT images of the distal radius and tibia.
M. Sode (2011)
Processing and Analysis of In Vivo High-Resolution MR Images of Trabecular Bone for Longitudinal Studies: Reproducibility of Structural Measures and Micro-Finite Element Analysis Derived Mechanical Properties
D. Newitt (2002)
Accuracy of CT-based thickness measurement of thin structures: modeling of limited spatial resolution in all three dimensions.
S. Prevrhal (2003)
Calibration of trabecular bone structure measurements of in vivo three-dimensional peripheral quantitative computed tomography with 28-microm-resolution microcomputed tomography.
A. Laib (1999)
Predictive Value of BMD for Hip and Other Fractures
O. Johnell (2005)
Once-monthly oral ibandronate improves biomechanical determinants of bone strength in women with postmenopausal osteoporosis.
E. Lewiecki (2009)
A nonlinear QCT-based finite element model validation study for the human femur tested in two configurations in vitro.
E. Dallara (2013)
Male-female differences in the association between incident hip fracture and proximal femoral strength: a finite element analysis study.
J. Keyak (2011)
Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone
D. Kopperdahl (2002)
Stephen Morrisson (2004)
Discordance in patient classification using T-scores.
K. Faulkner (1999)
Structural Determinants of Vertebral Fracture Risk
L. J. Melton (2007)
Age-related changes in bone density, geometry and biomechanical properties of the proximal femur: CT-based 3D hip structure analysis in normal postmenopausal women.
M. Ito (2011)
Quantitative CT for determination of bone mineral density: a review.
C. Cann (1988)
Relationship of Age to Bone Microstructure Independent of Areal Bone Mineral Density
B. Clarke (2012)
Effects of strontium ranelate and alendronate on bone microstructure in women with osteoporosis
R. Rizzoli (2011)
Image-based micro-finite-element modeling for improved distal radius strength diagnosis: moving from bench to bedside.
W. Pistoia (2004)
Pathogenesis of age-related bone loss in humans.
S. Khosla (2013)
Age‐related changes in the human femoral cortex
E. Simmons (1991)
A new method of segmentation of compact-appearing, transitional and trabecular compartments and quantification of cortical porosity from high resolution peripheral quantitative computed tomographic images.
R. Zebaze (2013)
High resolution computed tomography of the vertebrae yields accurate information on trabecular distances if processed by 3D fuzzy segmentation approaches.
A. Krebs (2009)
Improvements in Vertebral Body Strength Under Teriparatide Treatment Assessed In Vivo by Finite Element Analysis: Results From the EUROFORS Study
C. Graeff (2009)
Multi‐Detector Row CT Imaging of Vertebral Microstructure for Evaluation of Fracture Risk
M. Ito (2005)
Monitoring Teriparatide‐Associated Changes in Vertebral Microstructure by High‐Resolution CT In Vivo: Results From the EUROFORS Study
C. Graeff (2007)
Bone structure and density via HR-pQCT in 60d bed-rest, 2-years recovery with and without countermeasures.
D. Belavy (2011)
Comparison of in situ and in vitro CT scan-based finite element model predictions of proximal femoral fracture load.
J. Keyak (2003)
Distribution of cortical bone in bovine limbs.
S. Choi (2006)
Quantitative computed tomographic assessment of the effects of 24 months of teriparatide treatment on 3D femoral neck bone distribution, geometry, and bone strength: Results from the EUROFORS study
J. Borggrefe (2010)
Age-Dependence of Femoral Strength in White Women and Men
T. M. Keaveny (2010)
Women with previous fragility fractures can be classified based on bone microarchitecture and finite element analysis measured with HR-pQCT
K. Nishiyama (2012)
Predicting the compressive mechanical behavior of bone.
T. Keller (1994)
In vivo assessment of trabecular bone microarchitecture by high-resolution peripheral quantitative computed tomography.
S. Boutroy (2005)
Effect of once-yearly zoledronic acid on the spine and hip as measured by quantitative computed tomography: results of the HORIZON Pivotal Fracture Trial
R. Eastell (2009)
mineral density as measured by volumetric quantitative computed tomography
MR McClung (2004)
In Vivo Assessment of Architecture and Micro-Finite Element Analysis Derived Indices of Mechanical Properties of Trabecular Bone in the Radius
D. Newitt (2002)
Finite element analysis performed on radius and tibia HR‐pQCT images and fragility fractures at all sites in men
N. Vilayphiou (2011)
Distribution of cortical bone in the femoral neck and hip fracture: a prospective case-control analysis of 143 incident hip fractures; the AGES-REYKJAVIK Study.
F. Johannesdottir (2011)
in the femoral neck and hip fracture : a prospective case - control analysis of 143 incident hip fractures ; the AGES - REYKJAVIK Study
DM Black (2011)
Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions.
K. Engelke (2008)
Validation of an anatomy specific finite element model of Colles' fracture.
P. Varga (2009)
Age-related structural changes in trabecular and cortical bone: Cellular mechanisms and biomechanical consequences
A. Parfitt (2006)
Effect of bone distribution on vertebral strength: assessment with patient-specific nonlinear finite element analysis.
K. Faulkner (1991)
QCT-based finite element models predict human vertebral strength in vitro significantly better than simulated DEXA
E. Dall’Ara (2011)
Bone density, turnover, and estimated strength in postmenopausal women treated with odanacatib: a randomized trial.
K. Brixen (2013)
Bone strength at the distal radius can be estimated from high-resolution peripheral quantitative computed tomography and the finite element method.
J. A. MacNeil (2008)
Comparison of the elastic and yield properties of human femoral trabecular and cortical bone tissue.
Harun H. Bayraktar (2004)
A Longitudinal HR-pQCT Study of Alendronate Treatment in Postmenopausal Women With Low Bone Density: Relations Among Density, Cortical and Trabecular Microarchitecture, Biomechanics, and Bone Turnover
A. Burghardt (2010)
Effects of Teriparatide and Alendronate on Vertebral Strength as Assessed by Finite Element Modeling of QCT Scans in Women With Osteoporosis
T. M. Keaveny (2007)
Trabecular and cortical bone density and architecture in women after 60 days of bed rest using high‐resolution pQCT: WISE 2005
G. Armbrecht (2011)
Relation of Vertebral Deformities to Bone Density, Structure, and Strength
L. J. Melton (2010)
Regional distribution of spine and hip QCT BMD responses after one year of once-monthly ibandronate in postmenopausal osteoporosis.
K. Engelke (2010)
Volumetric quantitative computed tomography of the proximal femur: relationships linking geometric and densitometric variables to bone strength. Role for compact bone
V. Bousson (2006)
Evaluation of high-resolution peripheral quantitative computed tomography, finite element analysis and biomechanical testing in a pre-clinical model of osteoporosis: a study with odanacatib treatment in the ovariectomized adult rhesus monkey.
Richa Y. Jayakar (2012)
High resolution cortical bone thickness measurement from clinical CT data
Graham M. Treece (2010)
A comparison of spinal quantitative computed tomography with dual energy X-ray absorptiometry in European women with vertebral and nonvertebral fractures
C. Bergot (2007)
Femoral Bone Strength and Its Relation to Cortical and Trabecular Changes After Treatment With PTH, Alendronate, and Their Combination as Assessed by Finite Element Analysis of Quantitative CT Scans
T. M. Keaveny (2008)
Proximal Femoral Structure and the Prediction of Hip Fracture in Men: A Large Prospective Study Using QCT
D. Black (2008)
Effect of whole body vibration (WBV) therapy on bone density and bone quality in osteopenic girls with adolescent idiopathic scoliosis: a randomized, controlled trial
T. Lam (2012)
A 3D damage model for trabecular bone based on fabric tensors.
P. Zysset (1996)
Accuracy limits for the determination of cortical width and density: the influence of object size and CT imaging parameters.
S. Prevrhal (1999)
Quantification of bone mineralization using computed tomography.
P. Rüegsegger (1976)
Calibration of trabecular
Femoral strength in osteoporotic women treated with teriparatide or alendronate.
T. M. Keaveny (2012)
Treatment with raloxifene for 2 years increases vertebral bone mineral density as measured by volumetric quantitative computed tomography.
H. Genant (2004)
Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: The osteoporotic fractures in men (MrOS) study
L. Yang (2012)
Finite Element Analysis Based on In Vivo HR‐pQCT Images of the Distal Radius Is Associated With Wrist Fracture in Postmenopausal Women
S. Boutroy (2008)
HR-pQCT based FE analysis of the most distal radius section provides an improved prediction of Colles' fracture load in vitro.
P. Varga (2010)
Bone micro-architecture and determinants of strength in the radius and tibia: age-related changes in a population-based study of normal adults measured with high-resolution pQCT
N. Dalzell (2008)
Computational identification and quantification of trabecular microarchitecture classes by 3-D texture analysis-based clustering.
A. Valentinitsch (2013)
High resolution quantitative computed tomography-based assessment of trabecular microstructure and strength estimates by finite-element analysis of the spine, but not DXA, reflects vertebral fracture status in men with glucocorticoid-induced osteoporosis.
C. Graeff (2013)
The effect of voxel size on high-resolution peripheral computed tomography measurements of trabecular and cortical bone microstructure.
Willy Tjong (2012)
Prediction of new clinical vertebral fractures in elderly men using finite element analysis of CT scans
Xiang Wang (2012)
Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia
K. Engelke (2011)
A Local Adaptive Threshold Strategy for High Resolution Peripheral Quantitative Computed Tomography of Trabecular Bone
A. Burghardt (2007)
Precise measurement of vertebral mineral content using computed tomography.
C. Cann (1980)
A comparison of bone densitometry measurements of the central skeleton in post-menopausal women with and without vertebral fracture.
F. Duboeuf (1995)
Computational finite element bone mechanics accurately predicts mechanical competence in the human radius of an elderly population.
T. L. Mueller (2011)
This paper is referenced by
Modalities for Visualization of Cortical Bone Remodeling: The Past, Present, and Future
Kimberly D. Harrison (2015)
Characterization of a pluripotent stem cell-derived matrix with powerful osteoregenerative capabilities
Eoin P. McNeill (2020)
Predicting mouse vertebra strength with micro-computed tomography-derived finite element analysis.
J. Nyman (2015)
CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone
Yuegao Liu (2020)
Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score.
B. C. Silva (2015)
Use Case V: Imaging Biomarkers in Musculoskeletal Disorders
Julio Carballido-Gamio (2017)
Bone strength and muscle properties in postmenopausal women with and without a recent distal radius fracture
K. Crockett (2015)
Vibrational spectroscopic techniques to assess bone quality
E. Paschalis (2017)
Association between osteoporotic femoral neck fractures and DXA-derived 3D measurements at lumbar spine: a case-control study
Mirella López Picazo (2020)
Current imaging techniques in osteoporosis.
J. Carey (2018)
Bone Microarchitecture and Distal Radius Fracture Pattern Complexity
A. Daniels (2019)
QCT of the proximal femur—which parameters should be measured to discriminate hip fracture?
O. Museyko (2015)
Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture
S. Ferrari (2016)
MUSCULOSKELETAL STRENGTH, FALL AND FRACTURE RISK IN EARLY POSTMENOPAUSAL WOMEN
Katie L. Crockett (2015)
Efficient materially nonlinear [Formula: see text]FE solver for simulations of trabecular bone failure.
Monika Stipsitz (2019)
Imaging of axial spondyloarthritis. New aspects and differential diagnoses.
J. Braun (2018)
Effects of a Third Year of Exercise Training Preceded by Two Years of Exercise Training with Isoflavone Supplementation on Bone in Postmenopausal Women
Muhedeen Omar Abdulmula (2018)
Effects of Romosozumab Compared With Teriparatide on Bone Density and Mass at the Spine and Hip in Postmenopausal Women With Low Bone Mass
H. Genant (2017)
A historical perspective of allogeneic and autologous immunohaematopoietic stem cell transplantation in South Africa and a study of the non-haematologic consequences
Lucille Wood (2015)
A new algorithm to improve assessment of cortical bone geometry in pQCT.
Tomas Cervinka (2015)
Patient-Specific Bone Multiscale Modelling, Fracture Simulation and Risk Analysis—A Survey
Amadeus C S de Alcântara (2019)
Prediction of the risk of vertebral fracture in patients with metastatic bone lesions as a tool for more effective patients' management
Ferreira Costa (2018)
Effects of dose reduction on bone strength prediction using finite element analysis
D. Anitha (2016)
Quantitative and Qualitative Changes of Bone in Psoriasis and Psoriatic Arthritis Patients
R. Kocijan (2015)
Quantitative relationships between microdamage and cancellous bone strength and stiffness.
C. Hernandez (2014)
FEA to Measure Bone Strength: A Review
K. Engelke (2016)
Prediction of Hip Failure Load: In Vitro Study of 80 Femurs Using Three Imaging Methods and Finite Element Models-The European Fracture Study (EFFECT).
P. Pottecher (2016)
A Digital Model to Simulate Effects of Bone Architecture Variations on Texture at Spatial Resolutions of CT, HR-pQCT, and μCT Scanners
T. Lowitz (2014)
Effect of the lipoxygenase-inhibitors baicalein and zileuton on the vertebra in ovariectomized rats.
D. Saul (2017)
Osteoporosis: the evolution of a diagnosis
M. Lorentzon (2015)
Comprehensive Assessment of Osteoporosis and Bone Fragility with CT Colonography.
J. Fidler (2016)
Anorexia Nervosa: Analysis of Trabecular Texture with CT.
Azadeh Tabari (2017)See more