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Bone marrow edema and structural alterations in bone microarchitecture
Abstracts
P08 The impact of TBS and 40μCT transiliac bone biopsies in the analysis of gender specific differences in bone microarchitecture in females and males with fragility fractures A. Trubricha, Ch. Muschitza, R. Kocijana, J. Haschkaa, A. Zendelia, T. Grossb, D. Hansc, H. Rescha a The VINFORCE Study Group, St. Vincent Hospital, Medical Department II, Austria b Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria c Center of Bone Diseases, Lausanne University Hospital Switzerland Abstract: Trabecular Bone Score (TBS) is a novel grey-scale textural analysis to estimate microarchitecture from the Spine DXA. TBS correlates well with more direct measures of bone microarchitecture independent of BMD. The aim of the study was to compare gender specific structural characteristics with different imaging modalities. Materials and Methods: In this retrospective study we evaluated gender specific structural characteristics by micro-tomographic imaging system (μCT40, Scanco, Switzerland) in transiliac bone biopsies of 22 males and 14 females of similar age between 18 and 61 years having sustained fragility fractures but otherwise healthy. Furthermore AP spine was assessed by DXA (QDR 4500, Hologic Inc, USA), and sitematched spine TBS parameters were extracted from the DXA image using TBS iNsight software (v1.9, Medimaps SA, France). Results: Most of the μCT parameters were significantly correlated with the Spine TBS which tended to be higher in females. BMD of the lumbar spine was similar in both gender groups. Analysis of trabecular bone by μCT we did not observe, gender specific differences in the parameters of microstructure like BV/TV, ConnD, SMI, Tb.N, Tb.Th, Tb.Sp, TB.(1/N).SD. However, mean TBS of the spine was significantly higher in females than in males (1.288 ± 0.133 vs 1.165 ± 0.119; p b 0.005). Conclusions: Correlations between μCT parameters and TBS are mostly significant. In younger individuals with osteoporosis there are no significant differences between DXA BMD and 3D parameters between the two genders but with TBS, being higher in female than in male while it tends to be the opposite for BV/TV or ConnD parameters.
doi:10.1016/j.bone.2012.08.059
P09 Bone marrow edema and structural alterations in bone microarchitecture A. Zendeli, Ch. Muschitz, R. Kocijan, D. Stanek, D. Süss, H. Resch KH Barmherzige Schwestern Wien, VINFORCE, Austria Abstract: Background: Bone marrow edema (BME) is diagnosed by MRI. Less data are available on bone micro structure (BMS) measured by high-resolution peripheral quantitative computed tomography (HR-pQCT). The aim of this study was to investigate bone mineral density (BMD) measured by DXA, BMS and serum bone turn over markers (BTM) in patients with BME compared to age matched healthy controls (HC). Methods: We compared 11 patients (mean 50.2 ± 12 ys) with BME of lower limb to 22 HC. All subjects had DXA, HR-pQCT examination of radius and tibia and examinations of BTM. Results: In the HR-pQCT measurements BME patients compared to HC had increased total bone area (TotalArea) at the radius (285.7 ± 55 vs 248 ± 48 mm2, p b 0.05) and at the tibia (744.3 ± 242 vs 655.3 ± 122.1 mm2, p = 0.08) as well as a significantly increased cortical perimeter (Ct.Pm) and trabecular area (TrabArea) at the radius (p b 0.05), but a reduced density of the inner trabeculae (Dinn) and trabecular separation (Tb.Sp) (0.42 ± 0.15 vs 0.51 ± 0.07 mm, p b 0.05). At the tibia the trabecular thickness (Tb.Th) (0.07 ± 0.01 vs 0.08 ± 0.01 mm, p b 0.05) and the density of the compacta (Dcomp) (799.9 ± 69.8 vs 835.9 ± 72.7 mgHA/ccm, p = 0.092) was lower, but trabecular number (Tb.N) exceeded controls (1.81 ± 0.3 vs 1.67 ± 0.24 I/mm, p = 0.084). Conclusions: Our data show no predictive value of BMD measurements by DXA or BTM. HR-pQCT measurements detect structural differences at cortical, but to a greater extent at trabecular sites of radius and tibia with an increased number, but thinner structure of trabeculae. This distinction in microarchitecture could trigger the susceptibility to local bone marrow edema.
S19
AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria b Universitätsklinik für Unfallchirurgie, AKH Vienna, Medizinische Universität Wien, Austria Abstract: In osteochondrosis dissecans a therapeutically approach is to extract cylinders from the defect tissue and refill it with autologous bone material from the iliac crest and in-vitro cultured autologous cartilage cell layers. In this study, the extraction cylinder as well as remaining refill material from three patients (two males, age 23 and 24 yrs and one female, age 32 yrs) with defect knee joints were investigated by histological methods and by quantitative backscattered electron imaging (qBEI). The study was approved by the ethics committee at the Medical University of Vienna. The samples were embedded undecalcified in polymethylmethacrylate. The bone mineralization density distribution (BMDD) of the extraction and refill material was determined and compared. Further, these BMDD data were related to a previously published normative reference database. Strong deviations from normal BMDD were found in the extraction tissue as well as in the refill iliac crest material. The BMDD curve was distinctly shifted to lower and more heterogeneous mineralization. This was in line with the histological observation of increased bone turnover together with enhanced osteoid seams. The data indicate, that these patients might have not only a focal but more likely a systemic bone disease, which was not diagnosed before. This deviation from normal mineralization might contribute to the loss of mechanical competence of the subchondral plate leading to a progressive fragmentation of the articular cartilage. In conclusion, the bone metabolic state of patients with osteochondrosis dissecans should be also taken into account in clinical and therapeutically approaches.
doi:10.1016/j.bone.2012.08.061
P11 Elevated CKIP-1 expression within osteoblasts accompanied by decreased bone formation in bone erosion lesion in mice with collagen-induced arthritis X. Hea, C. Lua, H. Zhaob, C. Xiaoc, G. Zhangd, A. Lua,d a Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, China b Institute of Basic Theory, China Academy of Chinese Medical Sciences, Dongzhimen, China c Institute of Clinical Medicine, China-Japan Friendship Hospital, China d Joint Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China Abstract: The objective of this study is to investigate the time-course changes in CKIP-1 expression within osteoblasts, bone formation, bone erosion and local trabecular architecture in mice with collagen-induced arthritis (CIA). Male C57BL/6 mice were divided into CIA group and control (CON) group. CIA mice were immunized with chicken type II collagen. After immunization, bone architecture was quantified by in vivo microCT on days 21, 35 and 49 post primary immunization, respectively. At each time point, the hind limbs of ten mice in each group were separated for detecting CKIP-1 mRNA and protein expression within osteoblasts by laser capture in combination with Q-PCR and immunohistochemistry respectively, bone formation by dynamic bone histomorphometry and bone erosion by histology. The CKIP-1 mRNA and protein expression within osteoblasts from CIA group showed a continuous increase over time after day 21, and it also showed significantly higher than that in CON group at days 35 and 49. However, the BMD, BV, BMC, BFR/BS, MS/BS, MAR and O.Pm/ T.Pm in tarsal bone were decreased over time after day 21 in CIA group, whereas those were not apparently changed in CON group. Furthermore, the levels of those examined parameters were all significantly lower in CIA group than those in CON group at days 35 and 49, respectively. On the other hand, the score for bone erosion was continuously increased after day 21 in CIA group. These results indicated that CKIP-1 might play a role in failure of osteoblastmediated repair for articular bone erosion in rheumatoid arthritis.
doi:10.1016/j.bone.2012.08.062 doi:10.1016/j.bone.2012.08.060
P10 Evidence of systemic deterioration of bone material quality in cases of osteochondrosis dissecans P. Messmera, G. Vekszlerb, P. Roschgera, K. Klaushofera a Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and
P12 Changes of circulating sclerostin levels after different kinds of physical exercise with high impact on musculoskeletal system in healthy young females J. Haschkaa, R. Kocijana, C. Muschitza, J.M. Patschb, C. Bittighofera, A. Trubricha, W. Woloszczukc, S. Dinud, S. Kapiotisd, H. Rescha
P08 The impact of TBS and 40μCT transiliac bone biopsies in the analysis of gender specific differences in bone microarchitecture in females and males with fragility fractures A. Trubricha, Ch. Muschitza, R. Kocijana, J. Haschkaa, A. Zendelia, T. Grossb, D. Hansc, H. Rescha a The VINFORCE Study Group, St. Vincent Hospital, Medical Department II, Austria b Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria c Center of Bone Diseases, Lausanne University Hospital Switzerland Abstract: Trabecular Bone Score (TBS) is a novel grey-scale textural analysis to estimate microarchitecture from the Spine DXA. TBS correlates well with more direct measures of bone microarchitecture independent of BMD. The aim of the study was to compare gender specific structural characteristics with different imaging modalities. Materials and Methods: In this retrospective study we evaluated gender specific structural characteristics by micro-tomographic imaging system (μCT40, Scanco, Switzerland) in transiliac bone biopsies of 22 males and 14 females of similar age between 18 and 61 years having sustained fragility fractures but otherwise healthy. Furthermore AP spine was assessed by DXA (QDR 4500, Hologic Inc, USA), and sitematched spine TBS parameters were extracted from the DXA image using TBS iNsight software (v1.9, Medimaps SA, France). Results: Most of the μCT parameters were significantly correlated with the Spine TBS which tended to be higher in females. BMD of the lumbar spine was similar in both gender groups. Analysis of trabecular bone by μCT we did not observe, gender specific differences in the parameters of microstructure like BV/TV, ConnD, SMI, Tb.N, Tb.Th, Tb.Sp, TB.(1/N).SD. However, mean TBS of the spine was significantly higher in females than in males (1.288 ± 0.133 vs 1.165 ± 0.119; p b 0.005). Conclusions: Correlations between μCT parameters and TBS are mostly significant. In younger individuals with osteoporosis there are no significant differences between DXA BMD and 3D parameters between the two genders but with TBS, being higher in female than in male while it tends to be the opposite for BV/TV or ConnD parameters.
doi:10.1016/j.bone.2012.08.059
P09 Bone marrow edema and structural alterations in bone microarchitecture A. Zendeli, Ch. Muschitz, R. Kocijan, D. Stanek, D. Süss, H. Resch KH Barmherzige Schwestern Wien, VINFORCE, Austria Abstract: Background: Bone marrow edema (BME) is diagnosed by MRI. Less data are available on bone micro structure (BMS) measured by high-resolution peripheral quantitative computed tomography (HR-pQCT). The aim of this study was to investigate bone mineral density (BMD) measured by DXA, BMS and serum bone turn over markers (BTM) in patients with BME compared to age matched healthy controls (HC). Methods: We compared 11 patients (mean 50.2 ± 12 ys) with BME of lower limb to 22 HC. All subjects had DXA, HR-pQCT examination of radius and tibia and examinations of BTM. Results: In the HR-pQCT measurements BME patients compared to HC had increased total bone area (TotalArea) at the radius (285.7 ± 55 vs 248 ± 48 mm2, p b 0.05) and at the tibia (744.3 ± 242 vs 655.3 ± 122.1 mm2, p = 0.08) as well as a significantly increased cortical perimeter (Ct.Pm) and trabecular area (TrabArea) at the radius (p b 0.05), but a reduced density of the inner trabeculae (Dinn) and trabecular separation (Tb.Sp) (0.42 ± 0.15 vs 0.51 ± 0.07 mm, p b 0.05). At the tibia the trabecular thickness (Tb.Th) (0.07 ± 0.01 vs 0.08 ± 0.01 mm, p b 0.05) and the density of the compacta (Dcomp) (799.9 ± 69.8 vs 835.9 ± 72.7 mgHA/ccm, p = 0.092) was lower, but trabecular number (Tb.N) exceeded controls (1.81 ± 0.3 vs 1.67 ± 0.24 I/mm, p = 0.084). Conclusions: Our data show no predictive value of BMD measurements by DXA or BTM. HR-pQCT measurements detect structural differences at cortical, but to a greater extent at trabecular sites of radius and tibia with an increased number, but thinner structure of trabeculae. This distinction in microarchitecture could trigger the susceptibility to local bone marrow edema.
S19
AUVA Trauma Center Meidling, 1st Medical Department Hanusch Hospital, Vienna, Austria b Universitätsklinik für Unfallchirurgie, AKH Vienna, Medizinische Universität Wien, Austria Abstract: In osteochondrosis dissecans a therapeutically approach is to extract cylinders from the defect tissue and refill it with autologous bone material from the iliac crest and in-vitro cultured autologous cartilage cell layers. In this study, the extraction cylinder as well as remaining refill material from three patients (two males, age 23 and 24 yrs and one female, age 32 yrs) with defect knee joints were investigated by histological methods and by quantitative backscattered electron imaging (qBEI). The study was approved by the ethics committee at the Medical University of Vienna. The samples were embedded undecalcified in polymethylmethacrylate. The bone mineralization density distribution (BMDD) of the extraction and refill material was determined and compared. Further, these BMDD data were related to a previously published normative reference database. Strong deviations from normal BMDD were found in the extraction tissue as well as in the refill iliac crest material. The BMDD curve was distinctly shifted to lower and more heterogeneous mineralization. This was in line with the histological observation of increased bone turnover together with enhanced osteoid seams. The data indicate, that these patients might have not only a focal but more likely a systemic bone disease, which was not diagnosed before. This deviation from normal mineralization might contribute to the loss of mechanical competence of the subchondral plate leading to a progressive fragmentation of the articular cartilage. In conclusion, the bone metabolic state of patients with osteochondrosis dissecans should be also taken into account in clinical and therapeutically approaches.
doi:10.1016/j.bone.2012.08.061
P11 Elevated CKIP-1 expression within osteoblasts accompanied by decreased bone formation in bone erosion lesion in mice with collagen-induced arthritis X. Hea, C. Lua, H. Zhaob, C. Xiaoc, G. Zhangd, A. Lua,d a Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, China b Institute of Basic Theory, China Academy of Chinese Medical Sciences, Dongzhimen, China c Institute of Clinical Medicine, China-Japan Friendship Hospital, China d Joint Institute for Advancing Translational Medicine in Bone & Joint Diseases, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong SAR, China Abstract: The objective of this study is to investigate the time-course changes in CKIP-1 expression within osteoblasts, bone formation, bone erosion and local trabecular architecture in mice with collagen-induced arthritis (CIA). Male C57BL/6 mice were divided into CIA group and control (CON) group. CIA mice were immunized with chicken type II collagen. After immunization, bone architecture was quantified by in vivo microCT on days 21, 35 and 49 post primary immunization, respectively. At each time point, the hind limbs of ten mice in each group were separated for detecting CKIP-1 mRNA and protein expression within osteoblasts by laser capture in combination with Q-PCR and immunohistochemistry respectively, bone formation by dynamic bone histomorphometry and bone erosion by histology. The CKIP-1 mRNA and protein expression within osteoblasts from CIA group showed a continuous increase over time after day 21, and it also showed significantly higher than that in CON group at days 35 and 49. However, the BMD, BV, BMC, BFR/BS, MS/BS, MAR and O.Pm/ T.Pm in tarsal bone were decreased over time after day 21 in CIA group, whereas those were not apparently changed in CON group. Furthermore, the levels of those examined parameters were all significantly lower in CIA group than those in CON group at days 35 and 49, respectively. On the other hand, the score for bone erosion was continuously increased after day 21 in CIA group. These results indicated that CKIP-1 might play a role in failure of osteoblastmediated repair for articular bone erosion in rheumatoid arthritis.
doi:10.1016/j.bone.2012.08.062 doi:10.1016/j.bone.2012.08.060
P10 Evidence of systemic deterioration of bone material quality in cases of osteochondrosis dissecans P. Messmera, G. Vekszlerb, P. Roschgera, K. Klaushofera a Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and
P12 Changes of circulating sclerostin levels after different kinds of physical exercise with high impact on musculoskeletal system in healthy young females J. Haschkaa, R. Kocijana, C. Muschitza, J.M. Patschb, C. Bittighofera, A. Trubricha, W. Woloszczukc, S. Dinud, S. Kapiotisd, H. Rescha