Toward the use of MRI measurements of bound and pore water in fracture risk assessment

Nyman, Jeffry S.<sup>1,2,3,4</sup>; Ketsiri, Thammathida<sup>2,5</sup>; Louie, Elizabeth A.<sup>5</sup>; Harkins, Kevin D.<sup>2,5,6</sup>; Manhard, Mary Kate<sup>7</sup>; Gochberg, Daniel F.<sup>5,6</sup>; Lee, Donald H.<sup>1</sup>; Desai, Mihir J.<sup>1</sup>; Maslow, Jed<sup>1</sup>; Tanner, S. Bobo<sup>4,8</sup>; Does, Mark D.<sup>2,5,6,9</sup>

Affiliations

¹Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave. S., Suite 4200, Nashville, TN 37232, USA

²Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN 37232, USA

³Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24th Ave. S., Nashville, TN 37212, USA

⁴Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center,1211 Medical Center Dr., Nashville, TN 37212, USA

⁵Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN 37232, USA

⁶Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN 37232, USA

⁷Imaging Research Center, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA

⁸Department of Medicine, Division of Rheumatology, Vanderbilt University Medical Center, 1161 21st Ave. S., Nashville, TN 37232, USA

⁹Department of Electrical Engineering and Computer Science, Vanderbilt University, 400 24th Ave. S., Nashville, TN 37212, USA

Abstract

The current clinical assessment of fracture risk lacks information about the inherent quality of a person's bone tissue. Working toward an imaging-based approach to quantify both a bone tissue quality marker (tissue hydration as water bound to the matrix) and a bone microstructure marker (porosity as water in pores), we hypothesized that the concentrations of bound water (C_bw) are lower and concentrations of pore water (C_pw) are higher in patients with osteoporosis (OP) than in age- and sex-matched adults without the disease. Using recent developments in ultrashort echo time (UTE) magnetic resonance imaging (MRI), maps of C_bw and C_pw were acquired from the uninjured distal third radius (Study 1) of 20 patients who experienced a fragility fracture of the distal radius (Fx) and 20 healthy controls (Non-Fx) and from the tibia mid-diaphysis (Study 2) of 30 women with clinical OP (low T-scores) and 15 women without OP (normal T-scores). In Study 1, C_bw was significantly lower (p = 0.0018) and C_pw was higher (p = 0.0022) in the Fx than in the Non-Fx group. In forward stepwise, logistic regression models using Bayesian Information Criterion for selecting the best set of predictors (from imaging parameters, age, BMI, and DXA scanner type), the area-under-the-receiver operator characteristics-curve (AUC with 95 % confidence intervals) was 0.73 (0.56, 0.86) for hip aBMD (best predictors without MRI) and 0.86 (0.70, 0.95) for the combination of C_bw and C_pw (best predictors overall). In Study 2, C_bw was significantly lower (p = 0.0005) in women with OP (23.8 ± 4.3 ¹H mol/L) than in women without OP (29.9 ± 6.4 1H mol/L); C_pw was significantly higher by estimate of 2.9 1H mol/L (p = 0.0298) with clinical OP, but only when accounting for the type of UTE-MRI scan with 3D providing higher values than 2D (p < 0.0001). Lastly, C_bw, but not C_pw, was sensitive to bone forming osteoporosis medications over 12-months. UTE-MRI-derived measurements of bound and pore water concentrations are potential, aBMD-independent predictors of fracture risk.

Links

DOI: 10.1016/j.bone.2023.116863

PubMed: 37527697

WoS: 001066232700001

History

Received: 2023-06-7

Revised: 2023-07-26

Accepted: 2023-07-28

Online: 2023-07-30

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