Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography

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Whittier, D. E.^1,2; Boyd, S. K.^1,2; Burghardt, A. J.³; Paccou, J.⁴; Ghasem-Zadeh, A.⁵; Chapurlat, R.^6,7; Engelke, K.^8,9; Bouxsein, M. L.^10,11

Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography

Osteoporos Int. September 2020;31(9):1607-1627

©2020 International Osteoporosis Foundation and National Osteoporosis Foundation

Affiliations

¹McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada

²Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada

³Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA

⁴Department of Rheumatology, MABlab UR 4490, CHU Lille, Univ. Lille, Lille, France

⁵Departments of Endocrinology and Medicine, Austin Health, The University of Melbourne, Melbourne, Australia

⁶INSERM UMR 1033, Université de Lyon, Lyon, France

⁷Hôpital Edouard Herriot, Hospice Civils de Lyon, Lyon, France

⁸Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany

⁹Bioclinica, Inc., Hamburg, Germany

¹⁰Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, USA

¹¹Harvard Medical School, Boston, USA
Abstract and keywords

Introduction: The application of high-resolution peripheral quantitative computed tomography (HR-pQCT) to assess bone microarchitecture has grown rapidly since its introduction in 2005. As the use of HR-pQCT for clinical research continues to grow, there is an urgent need to form a consensus on imaging and analysis methodologies so that studies can be appropriately compared. In addition, with the recent introduction of the second-generation HrpQCT, which differs from the first-generation HR-pQCT in scan region, resolution, and morphological measurement techniques, there is a need for guidelines on appropriate reporting of results and considerations as the field adopts newer systems.

Methods: A joint working group between the International Osteoporosis Foundation, American Society of Bone and Mineral Research, and European Calcified Tissue Society convened in person and by teleconference over several years to produce the guidelines and recommendations presented in this document.

Results: An overview and discussion is provided for (1) standardized protocol for imaging distal radius and tibia sites using HR-pQCT, with the importance of quality control and operator training discussed; (2) standardized terminology and recommendations on reporting results; (3) factors influencing accuracy and precision error, with considerations for longitudinal and multi-center study designs; and finally (4) comparison between scanner generations and other high-resolution CT systems.

Conclusion: This article addresses the need for standardization of HR-pQCT imaging techniques and terminology, provides guidance on interpretation and reporting of results, and discusses unresolved issues in the field.

Keywords: Bone microarchitecture; Guidelines; High-resolution peripheral quantitative computed tomography; Imaging protocol
Links

DOI: 10.1007/s00198-020-05438-5

PubMed: 32458029

WoS: 000553568300001
History

Received: 2020-03-12

Accepted: 2020-04-23

Online: 2020-05-26

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2023	Schlickewei C, Schweizer C, Püschel K, Ondruschka B, Kleinertz H, Barg A, Rolvien T, Stürznickel J. Age-, sex-, and subregion-specific properties of distal fibular microarchitecture and strength: an ex vivo HR-pQCT study. J Orthop Res. February 2023;41(2):355-363.
2021	Du J, Hartley C, Brooke-Wavell K, Paggiosi MA, Walsh JS, Li S, Silberschmidt VV. High-impact exercise stimulated localised adaptation of microarchitecture across distal tibia in postmenopausal women. Osteoporos Int. May 2021;32(5):907-919.
2024	Lu S. Quantitative Analysis of Bone Microarchitecture in HR-PQCT Images for Fracture Discrimination [PhD thesis]. University of Southampton; August 2024.
2020	Plett RM. Enhanced Longitudinal Analysis of Bone Strength Estimated by 3D Bone Imaging and the Finite Element Method [Master's thesis]. Calgary, AB: University of Calgary; October 2020.
2021	Whittier DEW. The Assessment of Fragility Fracture Risk Using HR-PQCT as a Novel Tool for Diagnosis of Osteoporosis [PhD thesis]. Calgary, AB: University of Calgary; August 2021.
2022	Mielczarek CB. An Investigation of Local Microarchitecture Topology Changes in Long-Duration Spaceflight [Master's thesis]. Calgary, AB: University of Calgary; November 2022.
2022	Wyatt P. Bone Quality of Elite Winter Endurance Athletes [Master's thesis]. Calgary, AB: University of Calgary; April 2022.
2022	Sales EdS. The Spatio-Temporal Behavior of Basic Multicellular Units in a PTH-Induced Cortical Bone Remodeling Rabbit Model [Master's thesis]. University of Saskatchewan; August 2022.
2021	Kusins J. A Multi-Level Mechanical Assessment of the Shoulder Coupled With Evaluation of Upper Extremity Predictive Finite Element Models [PhD thesis]. University of Western Ontario; 2021.