The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions

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Bonaretti, S.; Majumdar, S.; Lang, T. F.; Khosla, S.; Burghardt, A. J.

The comparability of HR-pQCT bone measurements is improved by scanning anatomically standardized regions

Osteoporos Int. July 2017;28(7):2115-2128

©2017 International Osteoporosis Foundation and National Osteoporosis Foundation

Affiliations

¹Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California, QB3 Building, Suite 203, 1700 4th St, San Francisco, CA 94158, USA

²Department of Radiology, Stanford University, Stanford, CA, USA

³Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
Abstract

Summary: We investigated the sensitivity of distal bone density, structure, and strength measurements by high-resolution peripheral quantitative computed tomography (HR-pQCT) to variability in limb length. Our results demonstrate that HR-pQCT should be performed at a standard %-of-total-limb-length to avoid substantial measurement bias in population study comparisons and the evaluation of individual skeletal status in a clinical context.

Introduction: High-resolution peripheral quantitative computed tomography (HR-pQCT) measures of bone do not account for anatomic variability in bone length: a 1-cm volume is acquired at a fixed offset from an anatomic landmark. Our goal was to evaluate HR-pQCT measurement variability introduced by imaging fixed vs. proportional volumes and to propose a standard protocol for relative anatomic positioning.

Methods: Double-length (2-cm) scans were acquired in 30 adults. We compared measurements from 1-cm sub-volumes located at the default fixed offset, and the average %-of-length offset. The average position corresponded to 4.0% ± 1.1 mm for radius, and 7.2% ± 2.2 mm for tibia. We calculated the RMS difference in bone parameters and T-scores to determine the measurement variability related to differences in limb length. We used anthropometric ratios to estimate the mean limb length for published HR-pQCT reference data, and then calculated mean %-of-length offsets.

Results: Variability between fixed vs. relative scan positions was highest in the radius, and for cortical bone in general (RMS difference Ct.Th = 19.5%), while individuals had T-score differentials as high as +3.0 SD (radius Ct.BMD). We estimated that average scan position for published HR-pQCT reference data corresponded to 4.0% at the radius, and 7.3% at tibia.

Conclusion: Variability in limb length introduces significant bias to HR-pQCT measures, confounding cross-sectional analyses and limiting the clinical application for individual assessment of skeletal status. We propose to standardize scan positioning using 4.0 and 7.3% of total bone length for the distal radius and tibia, respectively.
Links

DOI: 10.1007/s00198-017-4010-7

PubMed: 28391447

WoS: 000404237600010
History

Received: 2016-08-12

Accepted: 2017-03-13

Online: 2017-04-08

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