200 results on '"van Rietbergen B"'
Search Results
2. Bone microarchitecture and strength assessment in adults with osteogenesis imperfecta using HR-pQCT: normative comparison and challenges
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Bevers, M S A M, primary, Harsevoort, A G J, additional, Gooijer, K, additional, Wyers, C E, additional, Feenstra, J, additional, van Rietbergen, B, additional, Boomsma, M F, additional, van den Bergh, J P, additional, and Janus, G J M, additional
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- 2024
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3. Image-based goal-oriented adaptive isogeometric analysis with application to the micro-mechanical modeling of trabecular bone
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Verhoosel, C.V., van Zwieten, G.J., van Rietbergen, B., and de Borst, R.
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- 2015
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4. An automated algorithm for the detection of cortical interruptions and its underlying loss of trabecular bone; a reproducibility study
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Peters, M., de Jong, J., Scharmga, A., van Tubergen, A., Geusens, P., Loeffen, D., Weijers, R., Boyd, S. K., Barnabe, C., Stok, K. S., van Rietbergen, B., and van den Bergh, J.
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- 2018
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5. Alterations to the subchondral bone architecture during osteoarthritis: bone adaptation vs endochondral bone formation
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Cox, L.G.E., van Donkelaar, C.C., van Rietbergen, B., Emans, P.J., and Ito, K.
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- 2013
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6. Reference data and calculators for second-generation HR-pQCT measures of the radius and tibia at anatomically standardized regions in White adults
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Warden, S.J., Liu, Z., Fuchs, R.K., van Rietbergen, B., Moe, S.M., Warden, S.J., Liu, Z., Fuchs, R.K., van Rietbergen, B., and Moe, S.M.
- Abstract
High-resolution peripheral quantitative computed tomography (HR-pQCT) is a powerful tool to assess bone health. To determine how an individual's or population of interest's HR-pQCT outcomes compare to expected, reference data are required. This study provides reference data for HR-pQCT measures acquired in a population of White adults.PURPOSE: To provide age- and sex-specific reference data for high-resolution peripheral quantitative computed tomography (HR-pQCT) measures of the distal and diaphyseal radius and tibia acquired using a second-generation scanner and percent-of-length offsets proximal from the end of the bone.METHODS: Data were acquired in White adults (aged 18-80 years) living in the Midwest region of the USA. HR-pQCT scans were performed at the 4% distal radius, 30% diaphyseal radius, 7.3% distal tibia, and 30% diaphyseal tibia. Centile curves were fit to the data using the LMS approach.RESULTS: Scans of 867 females and 317 males were included. The fitted centile curves reveal HR-pQCT differences between ages, sexes, and sites. They also indicate differences when compared to data obtained by others using fixed length offsets. Excel-based calculators based on the current data were developed and are provided to enable computation of subject-specific percentiles, z-scores, and t-scores and to plot an individual's outcomes on the fitted curves. In addition, regression equations are provided to convert estimated failure load acquired with the conventional criteria utilized with first-generation scanners and those specifically developed for second-generation scanners.CONCLUSION: The current study provides unique data and resources. The combination of the reference data and calculators provide clinicians and investigators an ability to assess HR-pQCT outcomes in an individual or population of interest, when using the described scanning and analysis procedure. Ultimately, the expectation is these data will be expanded over time
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- 2022
7. Bone structural changes in osteoarthritis as a result of mechanoregulated bone adaptation: a modeling approach
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Cox, L.G.E., van Rietbergen, B., van Donkelaar, C.C., and Ito, K.
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- 2011
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8. The Effect of Bolus Vitamin D3 Supplementation on Distal Radius Fracture Healing: A Randomized Controlled Trial using HR-pQCT
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Heyer, F.L., de Jong, J.J.A., Willems, P.C., Arts, J.J., Bours, S.G.P., van Kuijk, S.M.J., Bons, J.A.P., Poeze, M., Geusens, P.P., van Rietbergen, B., van den Bergh, J.P., Heyer, F.L., de Jong, J.J.A., Willems, P.C., Arts, J.J., Bours, S.G.P., van Kuijk, S.M.J., Bons, J.A.P., Poeze, M., Geusens, P.P., van Rietbergen, B., and van den Bergh, J.P.
- Abstract
Vitamin D is an important factor in bone metabolism. Animal studies have shown a positive effect of vitamin D3 supplementation on fracture healing, but evidence from clinical trials is inconclusive. A randomized controlled trial was performed to assess the effect of vitamin D3 supplementation on fracture healing using high-resolution peripheral quantitative computed tomography (HR-pQCT) based outcome parameters. Thirty-two postmenopausal women with a conservatively treated distal radius fracture were included within two weeks post-fracture and randomized to a low-dose (N = 10) and a high-dose (N = 11) vitamin D intervention group receiving a 6-week bolus dose, equivalent to 700 and 1,800 IU vitamin D3 supplementation per day respectively, in addition to a control group (N = 11) receiving no supplementation. After the baseline visit 1-2 weeks post-fracture, follow-up visits were scheduled at 3-4, 6-8 and 12 weeks post-fracture. At each visit, HR-pQCT scans of the fractured radius were performed. Cortical and trabecular bone density and microarchitectural parameters and μFEA derived torsion, compression and bending stiffness were assessed. Additionally, serum markers of bone resorption (C-terminal telopeptide of type I collagen; CTX) and bone formation (N-terminal propeptide of type I procollagen; PINP) were measured. Baseline serum levels of 25(OH)D3 were < 50 nmol/L in 33% of all participants and < 75 nmol/L in 70%. Compared to the control group, high-dose vitamin D3 supplementation resulted in a decreased trabecular number (regression coefficient B: -0.22; p < 0.01) and lower compression stiffness (B: -3.63; p < 0.05, together with an increase in the bone resorption marker CTX (B: 0.062; p < 0.05). No statistically significant differences were observed between the control and low-dose intervention group. In conclusion, the bolus equivalent of 700 U/day vitamin D3 supplementation in a Western postmenopausal population does not improve distal radius
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- 2021
9. A new semi-orthotopic bone defect model for cell and biomaterial testing in regenerative medicine
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Andrés Sastre, E. (author), Nossin, Y. (author), Jansen, I. (author), Kops, N. (author), Intini, C. (author), Witte-Bouma, J. (author), van Rietbergen, B. (author), Hofmann, S. (author), van Osch, G.J.V.M. (author), Andrés Sastre, E. (author), Nossin, Y. (author), Jansen, I. (author), Kops, N. (author), Intini, C. (author), Witte-Bouma, J. (author), van Rietbergen, B. (author), Hofmann, S. (author), and van Osch, G.J.V.M. (author)
- Abstract
In recent decades, an increasing number of tissue engineered bone grafts have been developed. However, expensive and laborious screenings in vivo are necessary to assess the safety and efficacy of their formulations. Rodents are the first choice for initial in vivo screens but their size limits the dimensions and number of the bone grafts that can be tested in orthotopic locations. Here, we report the development of a refined murine subcutaneous model for semi-orthotopic bone formation that allows the testing of up to four grafts per mouse one order of magnitude greater in volume than currently possible in mice. Crucially, these defects are also "critical size" and unable to heal within the timeframe of the study without intervention. The model is based on four bovine bone implants, ring-shaped, where the bone healing potential of distinct grafts can be evaluated in vivo. In this study we demonstrate that promotion and prevention of ossification can be assessed in our model. For this, we used a semi-automatic algorithm for longitudinal micro-CT image registration followed by histological analyses. Taken together, our data supports that this model is suitable as a platform for the real-time screening of bone formation, and provides the possibility to study bone resorption, osseointegration and vascularisation., Biomaterials & Tissue Biomechanics
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- 2021
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10. Assessment of the healing of conservatively-treated scaphoid fractures using HR-pQCT
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Bevers, M.S.A.M., Daniels, A.M., van Rietbergen, B., Geusens, P.P.M.M., van Kuijk, S.M.J., Sassen, S., Kaarsemaker, S., Hannemann, P.F.W., Poeze, M., Janzing, H.M.J., van den Bergh, J.P., Wyers, C.E., Bevers, M.S.A.M., Daniels, A.M., van Rietbergen, B., Geusens, P.P.M.M., van Kuijk, S.M.J., Sassen, S., Kaarsemaker, S., Hannemann, P.F.W., Poeze, M., Janzing, H.M.J., van den Bergh, J.P., and Wyers, C.E.
- Abstract
Improving the clinical outcome of scaphoid fractures may benefit from adequate monitoring of their healing in order to for example identify complications such as scaphoid nonunion at an early stage and to adjust the treatment strategy accordingly. However, quantitative assessment of the healing process is limited with current imaging modalities. In this study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used for the first time to assess the changes in bone density, microarchitecture, and strength during the healing of conservatively-treated scaphoid fractures. Thirteen patients with a scaphoid fracture (all confirmed on HR-pQCT and eleven on CT) received an HR-pQCT scan at baseline and three, six, twelve, and 26 weeks after first presentation at the emergency department. Bone mineral density (BMD) and trabecular microarchitecture of the scaphoid bone were quantified, and failure load (FL) was estimated using micro-finite element analysis. Longitudinal changes were evaluated with linear mixed-effects models. Data of two patients were excluded due to surgical intervention after the twelve-week follow-up visit. In the eleven fully evaluable patients, the fracture line became more apparent at three weeks. At six weeks, individual trabeculae at the fracture region became more difficult to identify and distinguish from neighboring trabeculae, and this phenomenon concerned a larger region around the fracture line at twelve weeks. Quantitative assessment showed that BMD and FL were significantly lower than baseline at all follow-up visits with the largest change from baseline at six weeks (-13.6% and -23.7%, respectively). BMD remained unchanged thereafter, while FL increased. Trabecular thickness decreased significantly from baseline at three (-3.9%), six (-6.7%), and twelve (-4.4%) weeks and trabecular number at six (-4.5%), twelve (-7.3%), and 26 (-7.9%) weeks. Trabecular separation was significantly higher than baseline at six (+13.3%)
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- 2021
11. Association of secondary displacement of distal radius fractures with cortical bone quality at the distal radius
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Daniels, A.M., Janzing, H.M.J., Wyers, C.E., van Rietbergen, B., Vranken, L., van der Velde, R.Y., Geusens, P.P.M.M., Kaarsemaker, S., Poeze, M., van den Bergh, J.P., Daniels, A.M., Janzing, H.M.J., Wyers, C.E., van Rietbergen, B., Vranken, L., van der Velde, R.Y., Geusens, P.P.M.M., Kaarsemaker, S., Poeze, M., and van den Bergh, J.P.
- Abstract
INTRODUCTION: The aim of this study was to investigate the associations of patient characteristics, bone mineral density (BMD), bone microarchitecture and calculated bone strength with secondary displacement of a DRF based on radiographic alignment parameters.MATERIALS AND METHODS: Dorsal angulation, radial inclination and ulnar variance were assessed on conventional radiographs of a cohort of 251 patients, 38 men and 213 women, to determine the anatomic position of the DRF at presentation (primary position) and during follow-up. Secondary fracture displacement was assessed in the non-operatively treated patients (N = 154) with an acceptable position, preceded (N = 97) or not preceded (N = 57) by primary reduction (baseline position). Additionally, bone microarchitecture and calculated bone strength at the contralateral distal radius and tibia were assessed by HR-pQCT in a subset of, respectively, 63 and 71 patients.OUTCOME: Characteristics of patients with and without secondary fracture displacement did not differ. In the model with adjustment for primary reduction [OR 22.00 (2.27-212.86), p = 0.008], total [OR 0.16 (95% CI 0.04-0.68), p = 0.013] and cortical [OR 0.19 (95% CI 0.05-0.80], p = 0.024] volumetric BMD (vBMD) and cortical thickness [OR 0.13 (95% CI 0.02-0.74), p = 0.021] at the distal radius were associated with secondary DRF displacement. No associations were found for other patient characteristics, such as age gender, BMD or prevalent vertebral fractures.CONCLUSIONS: In conclusion, our study indicates that besides primary reduction, cortical bone quality may be important for the risk of secondary displacement of DRFs.
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- 2021
12. Associations between bone attenuation and prevalent vertebral fractures on chest CT scans differ with vertebral fracture locations
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Driessen, J.H.M., van Dort, M.J., Romme, E.A.P.M., Wouters, E.F.M., Smeenk, F.W.J.M., van Rietbergen, B., van den Bergh, J.P.W., Geusens, P., Driessen, J.H.M., van Dort, M.J., Romme, E.A.P.M., Wouters, E.F.M., Smeenk, F.W.J.M., van Rietbergen, B., van den Bergh, J.P.W., and Geusens, P.
- Abstract
Vertebral fracture (VF) locations are bimodally distributed in the spine. The association between VF and bone attenuation (BA) measured on chest CT scans varied according to the location of VFs, indicating that other factors than only BA play a role in the bimodal distribution of VFs.INTRODUCTION: Vertebral fractures (VFs) are associated with low bone mineral density but are not equally distributed throughout the spine and occur most commonly at T7-T8 and T11-T12 ("cVFs") and less commonly at T4-T6 and T9-T10 ("lcVF"). We aimed to determine whether associations between bone attenuation (BA) and VFs vary between subjects with cVFs only, with lcVFs only and with both cVFs and lcVFs.METHODS: Chest CT images of T4-T12 in 1237 smokers with and without COPD were analysed for prevalent VFs according to the method described by Genant (11,133 vertebrae). BA (expressed in Hounsfield units) was measured in all non-fractured vertebrae (available for 10,489 vertebrae). Linear regression was used to compare mean BA, and logistic regression was used to estimate the association of BA with prevalent VFs (adjusted for age and sex).RESULTS: On vertebral level, the proportion of cVFs was significantly higher than of lcVF (5.6% vs 2.0%). Compared to subjects without VFs, BA was 15% lower in subjects with cVFs (p < 0.0001), 25% lower in subjects with lcVFs (p < 0.0001) and lowest in subjects with cVFs and lcVFs (- 32%, p < 0.0001). The highest ORs for presence of VFs per - 1SD BA per vertebra were found in subjects with both cVFs and lcVFs (3.8 to 4.6).CONCLUSIONS: The association between VFs and BA differed according to VF location. ORs increased from subjects with cVFs to subjects with lcVFs and were highest in subjects with cVFs and lcVFs, indicating that other factors than only BA play a role in the bimodal VF distribution.TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT00292552.
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- 2021
13. Ultra-high-molecular-weight polyethylene sublaminar tape as semirigid fixation or pedicle screw augmentation to prevent failure in long-segment spine surgery: an ex vivo biomechanical study
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Doodkorte, R.J.P., Doodkorte, R.J.P., Belda, R., Roth, A.K., van Rietbergen, B., Arts, J.J., Lataster, L.M.A., van Rhijn, L.W., Willems, P.C., Doodkorte, R.J.P., Doodkorte, R.J.P., Belda, R., Roth, A.K., van Rietbergen, B., Arts, J.J., Lataster, L.M.A., van Rhijn, L.W., and Willems, P.C.
- Abstract
OBJECTIVE Complications after adult spinal deformity surgery are common, with implant-related complications occurring in up to 27.8% of cases. Sublaminar wire fixation strength is less affected by decreasing trabecular bone density in comparison to pedicle screw (PS) fixation due to the predominant cortical bone composition of the lamina. Sublaminar fixation may thus aid in decreasing implant-related complications. The goal of this study was to compare fixation characteristics of titanium sublaminar cables (SCs), ultra-high-molecular-weight polyethylene (UHMWPE) tape, PSs, and PSs augmented with UHMWPE tape in an ex vivo flexion-bending setup.METHODS Thirty-six human cadaver vertebrae were stratified into 4 different fixation groups: UHMWPE sublaminar tape (ST), PS, metal SC, and PS augmented with ST (PS + ST). Individual vertebrae were embedded in resin, and a flexion-bending moment was applied that closely resembles the in vivo loading pattern at transitional levels of spinal instrumentation.RESULTS The failure strength of PS + ST (4522 +/- 2314 N) was significantly higher compared to the SC (2931 +/- 751 N) and PS (2678 +/- 827 N) groups, which had p values of 0.028 and 0.015, respectively (all values expressed as the mean +/- SD). Construct stiffness was significantly higher for the PS groups compared to the stand-alone sublaminar wiring groups (p = 0.020). In contrast to SC, ST did not show any case of cortical breach.CONCLUSIONS The higher failure strength of PS + ST compared to PS indicates that PS augmentation with ST may be an effective measure to reduce the incidence of screw pullout, even in osteoporotic vertebrae. Moreover, the lower stiffness of sublaminar fixation techniques and the absence of damage to the cortices in the ST group suggest that ST as a stand-alone fixation technique in adult spinal deformity surgery may also be clinically feasible and offer clinical benefits.
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- 2021
14. Upscaling ofIn VivoHR-pQCT Images Enables Accurate Simulations of Human Microstructural Bone Adaptation
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Michael Blauth, Patrik Christen, Penny R. Atkins, Sebastian S, van Rietbergen B, Nicholas Ohs, Tourolle né Betts Dc, and Ralph Müller
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Ground truth ,medicine.diagnostic_test ,Bone disease ,In vivo ,Computer science ,ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION ,medicine ,Virtual Physiological Human ,Bone adaptation ,Quantitative computed tomography ,medicine.disease ,Ex vivo ,Biomedical engineering - Abstract
In silicotrials of treatments in a virtual physiological human (VPH) would revolutionize research in the biomedical field. Hallmarks of bone disease and treatments can already be simulated in pre-clinical models and inex vivodata of humans using microstructural bone adaptation simulations. The increasing availability ofin vivohigh resolution peripheral quantitative computed tomography (HR-pQCT) images provides novel opportunities to validate and ultimately utilize microstructural bone adaptation simulations to improve our understanding of bone diseases and move towardsin silicoVPH decision support systems for clinicians.In the present study, we investigated if microstructural bone adaptation simulations ofin vivohuman HR-pQCT images yielded accurate results. Since high-resolution ground truth images cannot be obtainedin vivo, we applied anex vivoapproach to study resolution dependence and the effect of upscaling on morphometric accuracy. To address simulation initialisation issues, we developed an input regularisation approach to reduce initialisation shocks observed in microstructural bone adaptation simulations and evaluated upscaling as a way to improve the accuracy of model inputs. Finally, we compared ourex vivoresults to simulations run onin vivoimages to investigate whetherin vivoimage artefacts further affect simulation outcomes.
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- 2020
15. The interobserver reliability of the diagnosis and classification of scaphoid fractures using high-resolution peripheral quantitative CT
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Daniels, A. M., Daniels, A. M., Wyers, C. E., Janzing, H. M. J., Sassen, S., Loeffen, D., Kaarsemaker, S., van Rietbergen, B., Hannemann, P. F. W., Poeze, M., van den Bergh, J. P., Daniels, A. M., Daniels, A. M., Wyers, C. E., Janzing, H. M. J., Sassen, S., Loeffen, D., Kaarsemaker, S., van Rietbergen, B., Hannemann, P. F. W., Poeze, M., and van den Bergh, J. P.
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- 2020
16. The Feasibility of High-Resolution Peripheral Quantitative Computed Tomography (HR-pQCT) in Patients with Suspected Scaphoid Fractures
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Bevers, M S A M, Bevers, M S A M, Daniels, A M, Wyers, C E, van Rietbergen, B, Geusens, P P M M, Kaarsemaker, S, Janzing, H M J, Hannemann, P F W, Poeze, M, van den Bergh, J P W, Bevers, M S A M, Bevers, M S A M, Daniels, A M, Wyers, C E, van Rietbergen, B, Geusens, P P M M, Kaarsemaker, S, Janzing, H M J, Hannemann, P F W, Poeze, M, and van den Bergh, J P W
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- 2020
17. Improved Detection of Scaphoid Fractures with High-Resolution Peripheral Quantitative CT Compared with Conventional CT
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Daniels, A. M., Daniels, A. M., Bevers, M. S. A. M., Sassen, S., Wyers, C. E., van Rietbergen, B., Geusens, P. P. M. M., Kaarsemaker, S., Hannemann, P. F. W., Poeze, M., van den Bergh, J. P., Janzing, H. M. J., Daniels, A. M., Daniels, A. M., Bevers, M. S. A. M., Sassen, S., Wyers, C. E., van Rietbergen, B., Geusens, P. P. M. M., Kaarsemaker, S., Hannemann, P. F. W., Poeze, M., van den Bergh, J. P., and Janzing, H. M. J.
- Abstract
Background: Computed tomography (CT), magnetic resonance imaging, and bone scintigraphy are second-line imaging techniques that are frequently used for the evaluation of patients with a clinically suspected scaphoid fracture. However, as a result of varying diagnostic performance results, no true reference standard exists for scaphoid fracture diagnosis. We hypothesized that the use of high-resolution peripheral quantitative CT (HR-pQCT) in patients with a clinically suspected scaphoid fracture could improve scaphoid fracture detection compared with conventional CT in the clinical setting.Methods: The present study included 91 consecutive patients (>= 18 years of age) who presented to the emergency department with a clinically suspected scaphoid fracture between December 2017 and October 2018. All patients were clinically reassessed within 14 days after first presentation, followed by CT and HR-pQCT. If a scaphoid fracture was present, the fracture type was determined according to the Herbert classification system and correlation between CT and HR-pQCT was estimated with use of the Kendall W statistic or coefficient of concordance (W) (the closer to 1, the higher the correlation).Results: The cohort included 45 men and 46 women with a median age of 52 years (interquartile range, 29 to 67 years). HR-pQCT revealed a scaphoid fracture in 24 patients (26%), whereas CT revealed a scaphoid fracture in 15 patients (16%). Patients with a scaphoid fracture were younger and more often male. The correlation between CT and HR-pQCT was high for scaphoid fracture type according to the Herbert classification system (W = 0.793; 95% confidence interval [CI], 0.57 to 0.91; p < 0.001) and very high for scaphoid fracture location (W = 0.955; 95%, CI 0.90 to 0.98; p < 0.001).Conclusions: In the present study, the number of patients diagnosed with a scaphoid fracture was 60% higher when using HR-pQCT as compared with CT. These findings imply that a substa
- Published
- 2020
18. Consensus approach for 3D joint space width of metacarpophalangeal joints of rheumatoid arthritis patients using high-resolution peripheral quantitative computed tomography
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Stok, KS, Burghardt, AJ, Boutroy, S, Peters, MPH, Manske, SL, Stadelmann, V, Vilayphiou, N, van den Bergh, JP, Geusens, P, Li, X, Marotte, H, van Rietbergen, B, Boyd, SK, Barnabe, C, Stok, KS, Burghardt, AJ, Boutroy, S, Peters, MPH, Manske, SL, Stadelmann, V, Vilayphiou, N, van den Bergh, JP, Geusens, P, Li, X, Marotte, H, van Rietbergen, B, Boyd, SK, and Barnabe, C
- Abstract
Background: Joint space assessment for rheumatoid arthritis (RA) by ordinal conventional radiographic scales is susceptible to floor and ceiling effects. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides superior resolution, and may detect earlier changes. The goal of this work was to compare existing 3D methods to calculate joint space width (JSW) metrics in human metacarpophalangeal (MCP) joints with HR-pQCT and reach consensus for future studies. Using the consensus method, we established reproducibility with repositioning as well as feasibility for use in second-generation HR-pQCT scanners. Methods: Three published JSW methods were compared using datasets from individuals with RA from three research centers. A SPECTRA consensus method was developed to take advantage of strengths of the individual methods. Using the SPECTRA method, reproducibility after repositioning was tested and agreement between scanner generations was also established. Results: When comparing existing JSW methods, excellent agreement was shown for JSW minimum and mean (ICC 0.987–0.996) but not maximum and volume (ICC 0.000–0.897). Differences were identified as variations in volume definitions and algorithmic differences that generated high sensitivity to boundary conditions. The SPECTRA consensus method reduced this sensitivity, demonstrating good scan-rescan reliability (ICC >0.911) except for minimum JSW (ICC 0.656). There was strong agreement between results from first- and second-generation HR-pQCT (ICC >0.833). Conclusions: The SPECTRA consensus method combines unique strengths of three independently-developed algorithms and leverages underlying software updates to provide a mature analysis to measure 3D JSW. This method is robust with respect to repositioning and scanner generations, suggesting its suitability for detecting change.
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- 2020
19. Fractures in Healthy Females Followed from Childhood to Early Adulthood Are Associated with Later Menarcheal Age and with Impaired Bone Microstructure at Peak Bone Mass
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Chevalley, T., Bonjour, J. P., van Rietbergen, B., Rizzoli, R., and Ferrari, S.
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- 2012
20. Fractures during Childhood and Adolescence in Healthy Boys: Relation with Bone Mass, Microstructure, and Strength
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Chevalley, T., Bonjour, J. P., van Rietbergen, B., Ferrari, S., and Rizzoli, R.
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- 2011
21. The SPECTRA Collaboration OMERACT Special Interest Group: Current Research and Future Directions
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Stok, K.S., Finzel, S., Burghardt, A.J., Conaghan, P.G., Barnabe, C., Boyd, S.K., Martin, L., Barr, S.G., Feehan, L., Van Veenendaal, M., Cheung, A., Yeung, R., Schett, G., Tzaribachev, N., Engelke, K., Li, X., Pedoia, V., Jiang, Y., Troy, K., Baker, J., Van Den Bergh, J., Geusens, P., van Rietbergen, B., Willems, P.C., de Jong, J., Marotte, H., Chapurlat, R., and Orthopaedic Biomechanics
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0301 basic medicine ,Pathology ,Radiography ,Rheumatology/trends ,Rheumatic Diseases/diagnostic imaging ,Radiographic computed tomography ,Severity of Illness Index ,METACARPOPHALANGEAL JOINT ,Metacarpophalangeal Joint/diagnostic imaging ,0302 clinical medicine ,STRENGTH ,Immunology and Allergy ,Medicine ,Quantitative computed tomography ,Tomography ,Reliability (statistics) ,medicine.diagnostic_test ,OMERACT ,PERIARTICULAR BONE ,X-Ray Computed ,Systematic review ,Metacarpophalangeal joint ,HR-PQCT ,Disease Progression ,Omeract ,musculoskeletal diseases ,medicine.medical_specialty ,Immunology ,3-D imaging ,03 medical and health sciences ,Rheumatology ,Rheumatic Diseases ,Criterion validity ,Humans ,Medical physics ,Rheumatoid arthritis ,030203 arthritis & rheumatology ,EROSIONS ,business.industry ,QUANTITATIVE COMPUTED-TOMOGRAPHY ,Reproducibility of Results ,Special Interest Group ,JOINT SPACE WIDTH ,METACARPOPHALANGEAL ,RHEUMATOID-ARTHRITIS ,Clinical trial ,030104 developmental biology ,PSORIATIC-ARTHRITIS ,Observational study ,MICROSTRUCTURE ,Tomography, X-Ray Computed ,business - Abstract
Objective.High-resolution peripheral quantitative computed tomography (HR-pQCT) has the potential to improve radiographic progression determination in clinical trials and longitudinal observational studies. The goal of this work was to describe the current state of research presented at Outcome Measures in Rheumatology (OMERACT) 2016 and ensuing future directions outlined during discussion among attendees.Methods.At OMERACT 2016, SPECTRA (Study grouP for xtrEme-Computed Tomography in Rheumatoid Arthritis) introduced efforts to (1) validate the HR-pQCT according to OMERACT guidelines, focusing on rheumatoid arthritis (RA), and (2) find alternatives for automated joint space width (JSW) analysis. The Special Interest Group (SIG) was presented to patient research partners, physicians/researchers, and SIG leaders followed by a 40-min discussion on future directions.Results.A consensus definition for RA erosion using HR-pQCT was demonstrated through a systematic literature review and a Delphi exercise. Histopathology and perfusion studies were presented that analyzed the true characteristics of cortical breaks in HR-pQCT images, and to provide criterion validity. Results indicate that readers were able to discriminate between erosion and small vascular channels. Moderate reliability (ICC 0.206–0.871) of direct erosion size measures was shown, which improved (> 0.9) only when experienced readers were considered. Quantification of erosion size was presented for scoring, direct measurement, and volumetric approaches, as well as a reliability exercise for direct measurement. Three methods for JSW measurement were compared, all indicating excellent reproducibility with differences at the extremes (i.e., near-zero and joint edge thickness).Conclusion.Initial reports on HR-pQCT are promising; however, to consider its use in clinical trials and longitudinal observational studies, it is imperative to assess the responsiveness of erosion measurement quantification.
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- 2017
22. Long-term functional outcome of distal radius fractures is associated with early post-fracture bone stiffness of the fracture region: An HR-pQCT exploratory study
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Heyer, F. L., Heyer, F. L., de Jong, J. J. A., Willems, P. C., Arts, J. J., Bours, S. G. P., van Kuijk, S. M. J., Poeze, M., Geusens, P. P., van Rietbergen, B., van den Bergh, J. P., Heyer, F. L., Heyer, F. L., de Jong, J. J. A., Willems, P. C., Arts, J. J., Bours, S. G. P., van Kuijk, S. M. J., Poeze, M., Geusens, P. P., van Rietbergen, B., and van den Bergh, J. P.
- Abstract
Identifying determinants of long-term functional outcome after a distal radius fracture is challenging. Previously, we reported on the association between early HR-pQCT measurements and clinical outcome 12 weeks after a conservatively treated distal radius fracture. We extended the follow-up and assessed functional outcome after two years in relation to early HR-pQCT derived bone parameters.HR-pQCT scans of the fracture region were performed in 15 postmenopausal women with a distal radius fracture at 1-2 (baseline), 3-4 weeks and 26 months post-fracture. Additionally, the contralateral distal radius was scanned at baseline. Bone density, micro-architecture parameters and bone stiffness using micro-finite element analysis (FEA) were evaluated. During all visits, wrist pain and function were assessed using the patient-rated wrist evaluation questionnaire (PRWE), quantifying functional outcome with a score between 0 and 100.Two-year PRWE was associated with torsional and bending stiffness 3-4 weeks post-fracture (R-2: 0.49, p = 0.006 and R-2: 0.54, p = 0.003, respectively). In contrast, early micro-architecture parameters of the fracture region or contralateral bone parameters did not show any association with long-term outcome.This exploratory study indicates that HR-pQCT with mu FEA performed within four weeks after a distal radius fracture captures biomechanical fracture characteristics that are associated with long-term functional outcome and therefore could be a valuable early outcome measure in clinical trials and clinical practice.
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- 2019
23. Prospective follow-Up of cortical interruptions, bone density, and micro-structure detected on HR-pQCT: A study in patients with rheumatoid arthritis and healthy subjects
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Peters, M., van den Bergh, J.P., Geusens, P., Scharmga, A., Loeffen, D., Weijers, R., van Rietbergen, B., van Tubergen, A., Peters, M., van den Bergh, J.P., Geusens, P., Scharmga, A., Loeffen, D., Weijers, R., van Rietbergen, B., and van Tubergen, A.
- Abstract
Objectives: The purpose of the study was to prospectively investigate change (repair or progression) in the number, surface area and volume of cortical interruptions, bone density (vBMD) and micro-structural parameters assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) in finger joints of patients with rheumatoid arthritis (RA) treated with synthetic disease modifying anti-rheumatic drugs (sDMARDs) and/or biologic DMARDs (bDMARDs) over a 1-year follow-up period, and in comparison with healthy subjects (HS). Methods: Thirty-two patients with RA (221 joints, 53% on bDMARDs) and 32 HS (117 joints) were assessed at baseline and after 1 year using semi-automatic analysis of HR-pQCT images. Mean changes (group level) and the proportion of joints (joint level) with changes beyond the least significant change were calculated. Results: At baseline, 530 interruptions were identified in patients, and 136 in HS. The mean of the interruption parameters did not significantly change in either group Mean vBMD decreased more in patients than in HS (− 4.4 versus − 1.1 mgHA/cm3, respectively). In patients versus HS, proportionally more joints showed repair in interruption volume (6.6% versus 1.7%, respectively) and loss of vBMD (26.7% versus 12.9%, respectively). In patients on sDMARDs versus patients on bDMARDs, proportionally more joints showed progression in the number of interruptions and loss of vBMD (6.1% versus 1.8% and 31.3% versus 17.2%, respectively). Conclusions: HR-pQCT is able to quantify bone repair and progression. Cortical interruption-, vBMD-, and micro-structure were impaired in RA, of which vBMD and micro-structure further deteriorated, particularly in patients on sDMARDs.
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- 2019
24. Fractures prospectively recorded in healthy children and adolescents are predictive of radial peak bone mass and strength fragility in females but not in males
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Chevalley, T., Bonjour, J., Audet, M., Merminod, F., van Rietbergen, B., Rizzoli, R., Ferrari, S., and Orthopaedic Biomechanics
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SDG 3 - Good Health and Well-being - Published
- 2017
25. Peripheral bone microstructure and strength improve the prediction of incident clinical low-trauma fractures beyond DXA and FRAX in postmenopausal women
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Biver, E., Durosier-Izart, C., Chevalley, T., van Rietbergen, B., Rizzoli, R., Ferrari, S., and Orthopaedic Biomechanics
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Journal Article - Published
- 2017
26. Structural damage and inflammation on radiographs or magnetic resonance imaging are associated with cortical interruptions on high-resolution peripheral quantitative computed tomography: a study in finger joints of patients with rheumatoid arthritis and healthy subjects
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Scharmga, A., Geusens, P.P.M.M., Peters, M., van den Bergh, J.P.W., Loeffen, D., Schoonbrood, T., van Rietbergen, B., Vosse, D, Weijers, R.A.M., van Tubergen, A., Scharmga, A., Geusens, P.P.M.M., Peters, M., van den Bergh, J.P.W., Loeffen, D., Schoonbrood, T., van Rietbergen, B., Vosse, D, Weijers, R.A.M., and van Tubergen, A.
- Abstract
Objectives: To study the relationship between structural damage and inflammatory features on magnetic resonance imaging (MRI) or radiography and other risk factors [anti-citrullinated protein antibody (ACPA) and/or rheumatoid factor (RF) seropositivity, hand dominance, disease duration] and the presence or number of cortical interruptions in finger joints on high-resolution peripheral quantitative computed tomography (HR-pQCT). Method: Finger joints of 38 healthy subjects and 39 patients with rheumatoid arthritis (RA) were examined through radiographs, MRI, and HR-pQCT. Radiographs were scored according to the Sharp/van der Heijde (SvH) method; MRI for the presence of cortical interruptions, bone marrow oedema (BMO), and synovitis; and HR-pQCT images for cortical interruptions. Descriptive statistics were calculated and associations examined using generalized estimating equations. Results: Cortical interruptions were found in healthy subjects and patients with RA on HR-pQCT (mean ± sd 0.33 ± 0.63 vs 0.38 ± 0.64 per joint quadrant, respectively, p < 0.01). Structural damage on MRI (cortical interruptions) or radiographs (SvH ≥ 1) was associated with the presence of cortical interruptions on HR-pQCT [odds ratio (OR) 12.4, 95% confidence interval (CI) 7.5–21.4, p < 0.01 and OR 4.8, 95% CI 1.9–11.7, respectively, p < 0.01]. The presence of BMO or synovitis was associated with more cortical interruptions on HR-pQCT (β 0.47, 95% CI 0.4–0.6, p < 0.01 and β 1.9, 95% CI 0.6–3.1, p < 0.01). In patients with RA, ACPA, and/or RF seropositivity, hand dominance and disease duration were not associated with more cortical interruptions on HR-pQCT. Conclusion: Structural damage and inflammatory features on MRI and radiographs are associated with cortical interruptions on HR-pQCT. No association between other risk factors and cortical interruptions was demonstrated.
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- 2018
27. Reliability of HR-pQCT derived cortical bone structural parameters when using uncorrected instead of corrected automatically generated endocortical contours in a cross-sectional study: the Maastricht study
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de Waard, E.A.C., Sarodnik, C., Pennings, A., de Jong, J.J.A., Savelberg, H.H.C.M., van Geel, T.A., van der Kallen, C.J., Stehouwer, C.D.A., Schram, M.T., Schaper, N., Dagnelie, P.C., Geusens, P.P.M.M., Koster, A., van Rietbergen, B., van den Bergh, J.P.W., de Waard, E.A.C., Sarodnik, C., Pennings, A., de Jong, J.J.A., Savelberg, H.H.C.M., van Geel, T.A., van der Kallen, C.J., Stehouwer, C.D.A., Schram, M.T., Schaper, N., Dagnelie, P.C., Geusens, P.P.M.M., Koster, A., van Rietbergen, B., and van den Bergh, J.P.W.
- Abstract
Most HR-pQCT studies examining cortical bone use an automatically generated endocortical contour (AUTO), which is manually corrected if it visually deviates from the apparent endocortical margin (semi-automatic method, S-AUTO). This technique may be prone to operator-related variability and is time consuming. We examined whether the AUTO instead of the S-AUTO method can be used for cortical bone analysis. Fifty scans of the distal radius and tibia from participants of The Maastricht Study were evaluated with AUTO, and subsequently with S-AUTO by three independent operators. AUTO cortical bone parameters were compared to the average parameters obtained by the three operators (S-AUTOmean). All differences in mean cortical bone parameters between AUTO and S-AUTOmean were < 5%, except for lower AUTO cortical porosity of the radius (− 16%) and tibia (− 6%), and cortical pore volume (Ct.Po.V) of the radius (− 7%). The ICC of S-AUTOmean and AUTO was > 0.90 for all parameters, except for cortical pore diameter of the radius (0.79) and tibia (0.74) and Ct.Po.V of the tibia (0.89), without systematic errors on the Bland–Altman plots. The precision errors (RMS-CV%) of the radius parameters between S-AUTOmean and AUTO were comparable to those between the individual operators, whereas the tibia RMS-CV% between S-AUTOmean and AUTO were higher than those of the individual operators. Comparison of the three operators revealed clear inter-operator variability. This study suggests that the AUTO method can be used for cortical bone analysis in a cross-sectional study, but that the absolute values—particularly of the porosity-related parameters—will be lower.
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- 2018
28. Localisation of mineralised tissue in a complex spinner flask environment correlates with predicted wall shear stress level localisation
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Melke, J., Zhao, F., van Rietbergen, B., Ito, K., Hofmann, S., Melke, J., Zhao, F., van Rietbergen, B., Ito, K., and Hofmann, S.
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Spinner flask bioreactors have often been employed for bone tissue engineering. However, the reasons for their success in facilitating bone growth remain inconclusive. It was hypothesised that engineered bone tissue formation can be attributed to mechanical stimuli, which can be predicted in the tissue engineered construct. To test the hypothesis and draw conclusions as to how mechanical stimulation affects cell behaviour, a multi- disciplinary approach using cell culture experiments and computational fluid dynamics (CFD) to simulate the complex flow within the spinner flask and scaffold was employed. Micro-computed tomography and histology showed that statically cultured human bone marrow derived stromal cells on silk fibroin scaffolds did not form extracellular matrix (ECM) or deposit minerals. However, constructs cultured at 60 rpm resulted in ECM formation and mineralisation, mainly at the bottom of the scaffold (bottom: 78 ± 7 %, middle: 17 ± 5 %, top: 5 ± 2 % of total mineralised volume). Culturing at 300 rpm led to a more homogeneously distributed ECM (bottom: 40 ± 14 %, middle: 33 ± 1 %, top: 27 ± 14 % of total mineralised volume). These observations were in agreement (Pearson correlation coefficient: 97 %) with the computational simulations that predicted maximal scaffold mineralisation, based on wall shear stress stimulation, in the bottom at 60 rpm and in the main body at 300 rpm. Such combinations of CFD modelling and experimentation could advance our knowledge of the mechanical stimuli that cells experience in vitro and link them to biological responses.
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- 2018
29. Mechanical behavior of a soft hydrogel reinforced with three-dimensional printed microfibre scaffolds
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Castilho, M., Hochleitner, G., Wilson, W.E., van Rietbergen, B., Dalton, P.D., Groll, J., Malda, J., Ito, K., Castilho, M., Hochleitner, G., Wilson, W.E., van Rietbergen, B., Dalton, P.D., Groll, J., Malda, J., and Ito, K.
- Abstract
Reinforcing hydrogels with micro-fibre scaffolds obtained by a Melt-Electrospinning Writing (MEW) process has demonstrated great promise for developing tissue engineered (TE) constructs with mechanical properties compatible to native tissues. However, the mechanical performance and reinforcement mechanism of the micro-fibre reinforced hydrogels is not yet fully understood. In this study, FE models, implementing material properties measured experimentally, were used to explore the reinforcement mechanism of fibre-hydrogel composites. First, a continuum FE model based on idealized scaffold geometry was used to capture reinforcement effects related to the suppression of lateral gel expansion by the scaffold, while a second micro-FE model based on micro-CT images of the real construct geometry during compaction captured the effects of load transfer through the scaffold interconnections. Results demonstrate that the reinforcement mechanism at higher scaffold volume fractions was dominated by the load carrying-ability of the fibre scaffold interconnections, which was much higher than expected based on testing scaffolds alone because the hydrogel provides resistance against buckling of the scaffold. We propose that the theoretical understanding presented in this work will assist the design of more effective composite constructs with potential applications in a wide range of TE conditions.
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- 2018
30. Least-detectable and age-related local in vivo bone remodelling assessed by time-lapse HR-pQCT
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Christen, P., Boutroy, S., Ellouz, R., Chapurlat, R., van Rietbergen, B., Christen, P., Boutroy, S., Ellouz, R., Chapurlat, R., and van Rietbergen, B.
- Abstract
We previously developed an image analysis approach for the determination of local sites of bone remodelling using time-lapse in vivo HR-pQCT. The involved image filtering for removing noise was chosen rather aggressively, and also removed some effects of the bone remodelling. In this paper, we quantify these filtering settings using ex vivo reproducibility HR-pQCT images, and determine the least-detectable bone remodelling using in vivo reproducibility HR-pQCT images, as well as testing whether the approach is capable of capturing age-related bone remodelling by use of in vivo long-term HR-pQCT images. We found that a threshold value of 225 mg HA/cm3 for the filtering led to acceptable results with falsely determined bone remodelling of less than 0.5%, and that the least-detectable bone formation and bone resorption are 2.0 ± 1.0% and 2.2 ± 0.7% respectively. We also found that age-related local bone remodelling can be captured satisfactorily in postmenopausal women. The latter revealed new insights into the effect of ageing on bone remodelling, and showed that bone remodelling seems to take place through a few small formation packets and many large resorption volumes leading to a net bone loss. We conclude that local in vivo bone remodelling can be successfully assessed with time-lapse in vivo HR-pQCT capable of assessing age-related changes in bone remodelling.
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- 2018
31. An automated algorithm for the detection of cortical interruptions and its underlying loss of trabecular bone; a reproducibility study
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Peters, M, de Jong, J, Scharmga, A, van Tubergen, A, Geusens, P, Loeffen, D, Weijers, R, Boyd, SK, Barnabe, C, Stok, KS, van Rietbergen, B, van den Bergh, J, Peters, M, de Jong, J, Scharmga, A, van Tubergen, A, Geusens, P, Loeffen, D, Weijers, R, Boyd, SK, Barnabe, C, Stok, KS, van Rietbergen, B, and van den Bergh, J
- Abstract
BACKGROUND: We developed a semi-automated algorithm that detects cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT), and extended it with trabecular void volume measurement. In this study we tested the reproducibility of the algorithm using scan/re-scan data. METHODS: Second and third metacarpophalangeal joints of 21 subjects (mean age 49 (SD 11) years, 17 early rheumatoid arthritis and 4 undifferentiated arthritis, all diagnosed < 1 year ago) were imaged twice by HR-pQCT on the same day with repositioning between scans. The images were analyzed twice by one operator (OP1) and once by an additional operator (OP2), who independently corrected the bone contours when necessary. The number, surface and volume of interruptions per joint were obtained. Intra- and inter-operator reliability and intra-operator reproducibility were determined by intra-class correlation coefficients (ICC). Intra-operator reproducibility errors were determined as the least significant change (LSCSD). RESULTS: Per joint, the mean number of interruptions was 3.1 (SD 3.6), mean interruption surface 4.2 (SD 7.2) mm2, and mean interruption volume 3.5 (SD 10.6) mm3 for OP1. Intra- and inter-operator reliability was excellent for the cortical interruption parameters (ICC ≥0.91), except good for the inter-operator reliability of the interruption surface (ICC = 0.70). The LSCSD per joint was 4.2 for the number of interruptions, 5.8 mm2 for interruption surface, and 3.2 mm3 for interruption volume. CONCLUSIONS: The algorithm was highly reproducible in the detection of cortical interruptions and their volume. Based on the LSC findings, the potential value of this algorithm for monitoring structural damage in the joints in early arthritis patients needs to be tested in clinical studies.
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- 2018
32. Trabecular and subchondral bone development of the talus and distal tibia from foal to adult in the warmblood horse
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Gorissen, B. M. (B. M. C.), Wolschrijn, C. F. (C. F.), van Rietbergen, B. (B.), Rieppo, L. (L.), Saarakkala, S. (S.), van Weeren, P. R. (P. R.), Gorissen, B. M. (B. M. C.), Wolschrijn, C. F. (C. F.), van Rietbergen, B. (B.), Rieppo, L. (L.), Saarakkala, S. (S.), and van Weeren, P. R. (P. R.)
- Abstract
Horses are precocial animals and able to stand and walk within hours after birth. To cope with associated loading, intrauterine bone development has shown to be anticipative. This study provides further insight into the post‐natal development of structurally important features of trabecular and subchondral bone of the talus and sagittal ridge of the tibia of warm‐blooded horses. In all areas studied, the average bone volume fraction showed a gradual increase over time, which was the result of a significant increase in trabecular thickness, without significant changes in the degree of anisotropy. Similar to the mineralised part of the bone, collagen content, measured as average retardation using polarised light microscopy, increased significantly, but the degree of anisotropy of the collagen type I network did not. At birth, the subchondral bone layer had a more trabecular aspect, gradually changing to an even surface with only a few vascular canals at an age of 2 months. Presented results indicate the necessity for a stronger structure, but not for a different structural design after birth, providing further evidence for anticipatory bone development in the horse. More knowledge about the strategies used to cope with mechanical loading after birth might be helpful in understanding the developmental bone and joint diseases.
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- 2018
33. Alterations of bone microstructure and strength in end-stage renal failure
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Trombetti, A., Stoermann, C., Chevalley, T., Van Rietbergen, B., Herrmann, F., Martin, P.-Y, Rizzoli, R., Trombetti, A., Stoermann, C., Chevalley, T., Van Rietbergen, B., Herrmann, F., Martin, P.-Y, and Rizzoli, R.
- Abstract
Summary: End-stage renal disease (ESRD) patients have a high risk of fractures. We evaluated bone microstructure and finite-element analysis-estimated strength and stiffness in patients with ESRD by high-resolution peripheral computed tomography. We observed an alteration of cortical and trabecular bone microstructure and of bone strength and stiffness in ESRD patients. Introduction: Fragility fractures are common in ESRD patients on dialysis. Alterations of bone microstructure contribute to skeletal fragility, independently of areal bone mineral density. Methods: We compared microstructure and finite-element analysis estimates of strength and stiffness by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 33 ESRD patients on dialysis (17 females and 16 males; mean age, 47.0 ± 12.6years) and 33 age-matched healthy controls. Results: Dialyzed women had lower radius and tibia cortical density with higher radius cortical porosity and lower tibia cortical thickness, compared to controls. Radius trabecular number was lower with higher heterogeneity of the trabecular network. Male patients displayed only a lower radius cortical density. Radius and tibia cortical thickness correlated negatively with bone-specific alkaline phosphatase (BALP). Microstructure did not correlate with parathyroid hormone (PTH) levels. Cortical porosity correlated positively with "Kidney Disease: Improving Global Outcomes” working group PTH level categories (r = 0.36, p < 0.04). BMI correlated positively with trabecular number (r = 0.4, p < 0.02) and negatively with trabecular spacing (r = −0.37, p < 0.03) and trabecular network heterogeneity (r = −0.4, p < 0.02). Biomechanics positively correlated with BMI and negatively with BALP. Conclusion: Cortical and trabecular bone microstructure and calculated bone strength are altered in ESRD patients, predominantly in women. Bone microstructure and biomechanical assessment by HR-pQCT may be of major clinical relevance in the evalu
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- 2018
34. Evaluation of Radius Microstructure and Areal Bone Mineral Density Improves Fracture Prediction in Postmenopausal Women
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Biver, E., Durosier-Izart, C., Chevalley, T., van Rietbergen, B., Rizzoli, R., Ferrari, S., and Orthopaedic Biomechanics
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musculoskeletal diseases ,Tibia/pathology ,BONE QCT/µCT ,Kaplan-Meier Estimate ,OSTEOPOROSIS ,Fractures, Bone ,SDG 3 - Good Health and Well-being ,Bone Density ,Humans ,Radius/pathology ,Aged ,Proportional Hazards Models ,ddc:616 ,FRACTURE RISK ASSESSMENT ,Tibia ,Incidence ,Postmenopause/physiology ,Middle Aged ,Osteoporotic Fractures/epidemiology ,Postmenopause ,Radius ,ROC Curve ,Fractures, Bone/epidemiology ,ddc:618.97 ,Multivariate Analysis ,GENERAL POPULATION STUDIES ,Female ,Bone Density/physiology ,Osteoporotic Fractures - Abstract
A majority of low-trauma fractures occur in subjects with only moderate decrease of areal bone mineral density (aBMD), ie, osteopenia, assessed by dual-energy X-ray absorptiometry (DXA) or low fracture probability assessed by FRAX. We investigated whether peripheral bone microstructure and estimated strength improve the prediction of incident fractures beyond central DXA and FRAX. In this population-based study of 740 postmenopausal women (aged 65.0 ± 1.4 years) from the Geneva Retirees Cohort (ISRCTN registry 11865958), we assessed at baseline cortical (Ct) and trabecular (Tb) volumetric bone mineral density (vBMD) and microstructure by peripheral quantitative computed tomography (HR-pQCT); bone strength by micro-finite element analysis; aBMD and trabecular bone score (TBS) by DXA; and FRAX fracture probability. Eighty-five low-trauma fractures occurred in 68 women over a follow-up of 5.0 ± 1.8 years. Tb and Ct vBMD and microstructure predicted incident fractures, independently of each other and of femoral neck (FN) aBMD and FRAX (with BMD ± TBS). However, the associations were markedly attenuated after adjustment for ultra-distal radius aBMD (same bone site). The best discrimination between women with and without fracture was obtained at the radius with total vBMD, the combination of a Tb with a Ct parameter, or with failure load, which improved the area under the curve (AUC) for major osteoporotic fracture when added to FN aBMD (0.760 versus 0.695, p = 0.022) or to FRAX-BMD (0.759 versus 0.714, p = 0.015). The replacement of failure load by ultra-distal aBMD did not significantly decrease the AUC (0.753, p = 0.747 and 0.750, p = 0.509, respectively). In conclusion, peripheral bone microstructure and strength improve the prediction of fractures beyond central DXA and FRAX but are partially captured in aBMD measured by DXA at the radius. Because HR-pQCT is not widely available for clinical purposes, assessment of ultra-distal radius aBMD by DXA may meanwhile improve fracture risk estimation. © 2017 American Society for Bone and Mineral Research.
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- 2017
35. A fast homogenized finite element approach for distal radius strength calculations from HRpQCT images
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Arias Moreno, A.J., Hosseini, H.S., Ito, K., Zysset, Ph.K., van Rietbergen, B., and Orthopaedic Biomechanics
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- 2017
36. Assessment of bone density, structure, and cortical interruptions of finger joints in patients with rheumatoid arthritis using high-resolution peripheral quantitative CT
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Peters, M., Scharmga, A., van Tubergen, A., Loeffen, D., Weijers, R., van Rietbergen, B., Geusens, P., van den Bergh, J., and Orthopaedic Biomechanics
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musculoskeletal diseases - Abstract
Background Rheumatoid arthritis (RA) is characterized by peri-articular bone loss. In patients with RA, lower bone density and structural integrity, and an increased number of erosions compared to healthy controls (HCs) has been demonstrated using High-Resolution peripheral Quantitative CT (HR-pQCT) (1,2). To further characterize RA-related changes, we recently introduced a method for quantifying small cortical interruptions in finger joints (3). Objectives To investigate the cortical and trabecular bone density, structure, and cortical interruptions in MCP joints in early and late RA patients compared to HCs using HR-pQCT imaging. Methods The 2nd and 3rd MCP joint of 70 subjects (mean age 53.1 (SD 9.2) years) were evaluated by HR-pQCT (82μm isotropic voxel size): 38 HCs, 10 early RA (diagnosis ≤2 years ago) and 22 late RA (diagnosis ≥10 years ago). Images were analyzed for cortical interruptions, and for cortical and trabecular bone density and structure. Descriptives were analyzed per joint by one-way ANOVA with Bonferroni post-hoc testing or Kruskal-Wallis with Mann-Whitney post-hoc testing, as appropriate. Results Significant differences with respect to all parameters were found across the groups (Table 1). In early and late RA, the percentage of joints with at least 1 interruption was higher, and number of trabeculae, cortical thickness, total density and cortical density were lower than in HC. In addition, in late RA, number of interruptions, interruption volume and trabecular separation were higher, and trabecular density was lower than in HC. Bone loss at the cortical and trabecular bone was primarily observed at the rim of the joint (Figure 1, arrows
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- 2017
37. Cortical and Trabecular Bone Microstructure Did Not Recover at Weight-Bearing Skeletal Sites and Progressively Deteriorated at Non-Weight-Bearing Sites During the Year Following International Space Station Missions
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Vico, L., van Rietbergen, B., Vilayphiou, N., Linossier, M.T., Locrelle, H., Normand, M., Zouch, M., Gerbaix, M., Bonnet, N., Novikov, V., Thomas, T., Vassilieva, G., and Orthopaedic Biomechanics
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Adult ,ddc:616 ,BONE HR-pQCT ,Radius/anatomy & histology ,Walking ,Middle Aged ,Space Flight ,BONE RECOVERY ,MICROGRAVITY ,Biomechanical Phenomena ,Tibia/anatomy & histology ,Cortical Bone/anatomy & histology ,Weight-Bearing ,SDG 3 - Good Health and Well-being ,Cancellous Bone/anatomy & histology ,PERIOSTIN ,Humans ,Bone Density/physiology ,Tomography, X-Ray Computed ,SPACEFLIGHT ,Biomarkers/blood - Abstract
Risk for premature osteoporosis is a major health concern in astronauts and cosmonauts; the reversibility of the bone lost at the weight-bearing bone sites is not established, although it is suspected to take longer than the mission length. The bone three-dimensional structure and strength that could be uniquely affected by weightlessness is currently unknown. Our objective is to evaluate bone mass, microarchitecture, and strength of weight-bearing and non-weight-bearing bone in 13 cosmonauts before and for 12 months after a 4-month to 6-month sojourn in the International Space Station (ISS). Standard and advanced evaluations of trabecular and cortical parameters were performed using high-resolution peripheral quantitative computed tomography. In particular, cortical analyses involved determination of the largest common volume of each successive individual scan to improve the precision of cortical porosity and density measurements. Bone resorption and formation serum markers, and markers reflecting osteocyte activity or periosteal metabolism (sclerostin, periostin) were evaluated. At the tibia, in addition to decreased bone mineral densities at cortical and trabecular compartments, a 4% decrease in cortical thickness and a 15% increase in cortical porosity were observed at landing. Cortical size and density subsequently recovered and serum periostin changes were associated with cortical recovery during the year after landing. However, tibial cortical porosity or trabecular bone failed to recover, resulting in compromised strength. The radius, preserved at landing, unexpectedly developed postflight fragility, from 3 months post-landing onward, particularly in its cortical structure. Remodeling markers, uncoupled in favor of bone resorption at landing, returned to preflight values within 6 months, then declined farther to lower than preflight values. Our findings highlight the need for specific protective measures not only during, but also after spaceflight, because of continuing uncertainties regarding skeletal recovery long after landing.
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- 2017
38. Anti-rheumatic agents naproxen and methotrexate affect skeletal development in skeletally immature mice
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Caron, M.M., primary, Castermans, T.M., additional, van Rietbergen, B., additional, Haartmans, M.J., additional, van Rhijn, L.W., additional, Welting, T.J., additional, and Witlox, A.M., additional
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- 2018
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39. Impairment of the chondrogenic phase of endochondral ossification in vivo by inhibition of cyclooxygenase-2
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Janssen, M.P.F., Caron, M.M.J., Van Rietbergen, B., Surtel, D.A.M., van Rhijn, L.W., Welting, T.J.M., Emans, P.J., Janssen, M.P.F., Caron, M.M.J., Van Rietbergen, B., Surtel, D.A.M., van Rhijn, L.W., Welting, T.J.M., and Emans, P.J.
- Abstract
Many studies have reported on the effects of cyclooxygenase-2 (COX-2) inhibition on osteogenesis. However, far less is known about the effects of COX-2 inhibition on chondrogenic differentiation. Previous studies conducted by our group show that COX-2 inhibition influences in vitro chondrogenic differentiation. Importantly, this might have consequences on endochondral ossification processes occurring in vivo, such as bone fracture healing, growth plate development and ectopic generation of cartilage. The goal of our study was to investigate, in vivo, the effect of COX-2 inhibition by celecoxib on the cartilaginous phase of three different endochondral ossification scenarios. 10 mg/kg/d celecoxib or placebo were orally administered for 25 d to skeletally-immature New Zealand White rabbits (n = 6 per group). Endochondral ossification during fracture healing of a non-critical size defect in the ulna, femoral growth plate and ectopically-induced cartilaginous tissue were examined by radiography, micro-computed tomography (μ-CT), histology and gene expression analysis. Celecoxib treatment resulted in delayed bone fracture healing, alterations in growth plate development and progression of mineralisation. In addition, chondrogenic differentiation of ectopically-induced cartilaginous tissue was severely impaired by celecoxib. In conclusion, we found that celecoxib impaired the chondrogenic phase of endochondral ossification.
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- 2017
40. Composition dependent mechanical behaviour of S53P4 bioactive glass putty for bone defect grafting
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van Gestel, N.A.P., Hulsen, D.J.W., Geurts, J.A.P., Hofmann, S., Ito, K., Arts, J.J.C., van Rietbergen, B., van Gestel, N.A.P., Hulsen, D.J.W., Geurts, J.A.P., Hofmann, S., Ito, K., Arts, J.J.C., and van Rietbergen, B.
- Abstract
To improve the handling properties of S53P4 bioactive glass granules for clinical applications, bioactive glass putty formulations were developed. These formulations contain both granules and a synthetic binder to form an injectable material that is easy to shape. To explore its applicability in load-bearing bone defect grafting, the relation between the putty composition and its mechanical behaviour was assessed in this study. Five putty formulations with variations in synthetic binder and granule content were mechanically tested in confined compression. The results showed that the impaction strains significantly decreased and the residual strains significantly increased with an increasing binder content. The stiffness of all tested formulations was found to be in the same range as the reported stiffness of cancellous bone. The measured creep strains were low and no significant differences between formulations were observed. The stiffness significantly increased when the samples were subjected to a second loading stage. The residual strains calculated from this second loading stage were also significantly different from the first loading stage, showing an increasing difference with an increasing binder content. Since residual strains are detrimental for graft layer stability in load-bearing defects, putty compositions with a low binder content would be most beneficial for confined, load-bearing bone defect grafting., To improve the handling properties of S53P4 bioactive glass granules for clinical applications, bioactive glass putty formulations were developed. These formulations contain both granules and a synthetic binder to form an injectable material that is easy to shape. To explore its applicability in load-bearing bone defect grafting, the relation between the putty composition and its mechanical behaviour was assessed in this study. Five putty formulations with variations in synthetic binder and granule content were mechanically tested in confined compression. The results showed that the impaction strains significantly decreased and the residual strains significantly increased with an increasing binder content. The stiffness of all tested formulations was found to be in the same range as the reported stiffness of cancellous bone. The measured creep strains were low and no significant differences between formulations were observed. The stiffness significantly increased when the samples were subjected to a second loading stage. The residual strains calculated from this second loading stage were also significantly different from the first loading stage, showing an increasing difference with an increasing binder content. Since residual strains are detrimental for graft layer stability in load-bearing defects, putty compositions with a low binder content would be most beneficial for confined, load-bearing bone defect grafting.
- Published
- 2017
41. Vascular channels in metacarpophalangeal joints: a comparative histologic and high-resolution imaging study
- Author
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Scharmga, A., Keller, K.K., Peters, M., van Tubergen, A., van den Bergh, J.P.W., van Rietbergen, B., Weijers, R., Loeffen, D., Hauge, E.M., Geusens, P.P.M.M., Scharmga, A., Keller, K.K., Peters, M., van Tubergen, A., van den Bergh, J.P.W., van Rietbergen, B., Weijers, R., Loeffen, D., Hauge, E.M., and Geusens, P.P.M.M.
- Abstract
We evaluated whether cortical interruptions classified as vascular channel (VC) on high-resolution peripheral quantitative computed tomography (HR-pQCT) could be confirmed by histology. We subsequently evaluated the image characteristics of histologically identified VCs on matched single and multiplane HR-pQCT images. Four 3-mm thick portions in three anatomic metacarpophalangeal joint specimens were selected for histologic sectioning. First, VCs identified with HR-pQCT were examined for confirmation on histology. Second and independently, VCs identified by histology were matched to single and multiplane HR-pQCT images to assess for presence of cortical interruptions. Only one out of five cortical interruptions suggestive for VC on HR-pQCT could be confirmed on histology. In contrast, 52 VCs were identified by histology of which 39 (75%) could be classified as cortical interruption or periosteal excavation on matched single HR-pQCT slices. On multiplane HR-pQCT images, 11 (21%) showed a cortical interruption in at least two consecutive slices in two planes, 36 (69%) in at least one slice in two planes and five (10%) showed no cortical interruption. Substantially more VCs were present in histology sections than initially suggested by HR-pQCT. The small size and heterogeneous presentation, limit the identification as VC on HR-pQCT.
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- 2017
42. The reliability of a semi-automated algorithm for detection of cortical interruptions in finger joints on high resolution CT compared to microCT
- Author
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Peters, M., Scharmga, A., van Tubergen, A., Arts, J., Loeffen, D., Weijers, R., van Rietbergen, B., Geusens, P.P.M.M., van den Bergh, J.P.W, Peters, M., Scharmga, A., van Tubergen, A., Arts, J., Loeffen, D., Weijers, R., van Rietbergen, B., Geusens, P.P.M.M., and van den Bergh, J.P.W
- Abstract
We developed a semi-automated algorithm for the detection of cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT). Here, we tested its reliability compared to microCT (µCT) as gold standard. Nineteen joints of 10 female anatomic index fingers were imaged by HR-pQCT and µCT (82 and 18 µm isotropic voxel sizes, respectively). The algorithm was applied for detection of cortical interruptions of different minimum diameters (range >0.16 to >0.50 mm). Reliability was tested at the joint level with intra-class correlation coefficient (ICC) for the number of interruptions and interruption surface, and at the level of a single interruption for matching between HR-pQCT and µCT with a fixed interruption diameter (>0.10 mm) on µCT. The positive predictive value (PPV0.10mm) and sensitivity0.10mm were evaluated. The mean number of interruptions per joint depended on the diameter cut-off and ranged from 3.4 to 53.5 on HR-pQCT and from 1.8 to 45.1 on µCT for interruptions >0.50 to >0.16 mm, respectively. Reliability at the joint level was almost perfect (ICC ≥0.81) for both the number and surface of interruptions >0.16 and >0.33 mm. As expected, the PPV0.10mm increased with increasing interruption diameter from 84.9 to 100%, for interruptions >0.16 and >0.50 mm, respectively. However, the sensitivity0.10mm decreased with increasing interruption diameter from 62.4 to 4.7%. This semi-automated algorithm for HR-pQCT in finger joints performed best for the detection of cortical interruptions with a minimum diameter of >0.16 or >0.33 mm, showing almost perfect reliability at the joint level and interruptions matched with those on µCT.
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- 2017
43. An automated algorithm for the detection of cortical interruptions on high resolution peripheral quantitative computed tomography images of finger joints
- Author
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Peters, M., Scharmga, A., de Jong, J., van Tubergen, A., Geusens, P.P.M.M., Arts, J.A., Loeffen, D., Weijers, R., van Rietbergen, B., van den Bergh, J., Peters, M., Scharmga, A., de Jong, J., van Tubergen, A., Geusens, P.P.M.M., Arts, J.A., Loeffen, D., Weijers, R., van Rietbergen, B., and van den Bergh, J.
- Abstract
OBJECTIVES: To introduce a fully-automated algorithm for the detection of small cortical interruptions (≥0.246mm in diameter) on high resolution peripheral quantitative computed tomography (HR-pQCT) images, and to investigate the additional value of manual correction of the automatically obtained contours (semi-automated procedure).METHODS: Ten metacarpophalangeal joints from seven patients with rheumatoid arthritis (RA) and three healthy controls were imaged with HR-pQCT. The images were evaluated by an algorithm according to the fully- and semi-automated procedure for the number and surface of interruptions per joint. Reliability between the fully- and semi-automated procedure and between two independent operators was tested using intra-class correlation coefficient (ICC) and the proportion of matching interruptions. Validity of single interruptions detected was tested by comparing it to visual scoring, as gold standard. The positive predictive value (PPV) and sensitivity were calculated.RESULTS: The median number of interruptions per joint was 14 (range 2 to 59) and did not significantly differ between the fully- and semi-automated procedure (p = 0.37). The median interruption surface per joint was significantly higher with the fully- vs. semi-automated procedure (respectively, 8.6mm2 vs. 5.8mm2 and 6.1mm2, p = 0.01). Reliability was almost perfect between the fully- and semi-automated procedure for both the number and surface of interruptions (ICC≥0.95) and the proportion of matching interruptions was high (≥76%). Also the inter-operator reliability was almost perfect (ICC≥0.97, proportion of matching interruptions 92%). The PPV ranged from 27.6% to 29.9%, and sensitivity from 69.7% to 76.3%. Most interruptions detected with the algorithm, did show an interruption on a 2D grayscale image. However, this interruption did not meet the criteria of an interruption with visual scoring.CONCLUSION: The algorithm for HR-pQCT images detects cortica
- Published
- 2017
44. Distal radius plate of CFR-PEEK has minimal effect compared to titanium plates on bone parameters in high-resolution peripheral quantitative computed tomography: a pilot study
- Author
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de Jong, J.J.A., Lataster, A., van Rietbergen, B., Arts, J.J.C., Geusens, P.P.M.M., van den Bergh, J.P.W., Willems, P.C., de Jong, J.J.A., Lataster, A., van Rietbergen, B., Arts, J.J.C., Geusens, P.P.M.M., van den Bergh, J.P.W., and Willems, P.C.
- Abstract
BACKGROUND: Carbon-fiber-reinforced poly-ether-ether-ketone (CFR-PEEK) has superior radiolucency compared to other orthopedic implant materials, e.g. titanium or stainless steel, thus allowing metal-artifact-free postoperative monitoring by computed tomography (CT). Recently, high-resolution peripheral quantitative CT (HRpQCT) proved to be a promising technique to monitor the recovery of volumetric bone mineral density (vBMD), micro-architecture and biomechanical parameters in stable conservatively treated distal radius fractures. When using HRpQCT to monitor unstable distal radius fractures that require volar distal radius plating for fixation, radiolucent CFR-PEEK plates may be a better alternative to currently used titanium plates to allow for reliable assessment. In this pilot study, we assessed the effect of a volar distal radius plate made from CFR-PEEK on bone parameters obtained from HRpQCT in comparison to two titanium plates.METHODS: Plates were instrumented in separate cadaveric human fore-arms (n = 3). After instrumentation and after removal of the plates duplicate HRpQCT scans were made of the region covered by the plate. HRpQCT images were visually checked for artifacts. vBMD, micro-architectural and biomechanical parameters were calculated, and compared between the uninstrumented and instrumented radii.RESULTS: No visible image artifacts were observed in the CFR-PEEK plate instrumented radius, and errors in bone parameters ranged from -3.2 to 2.6%. In the radii instrumented with the titanium plates, severe image artifacts were observed and errors in bone parameters ranged between -30.2 and 67.0%.CONCLUSIONS: We recommend using CFR-PEEK plates in longitudinal in vivo studies that monitor the healing process of unstable distal radius fractures treated operatively by plating or bone graft ingrowth.
- Published
- 2017
45. Prepubertal impact of protein intake and physical activity on weight bearing peak bone mass and strength in males
- Author
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Chevalley, T., Bonjour, J.P., Audet, M.-C., Merminod, F., van Rietbergen, B., Rizzoli, R., Ferrari, S.L., Chevalley, T., Bonjour, J.P., Audet, M.-C., Merminod, F., van Rietbergen, B., Rizzoli, R., and Ferrari, S.L.
- Abstract
CONTEXT: Peak bone mass (PBM) and strength are important determinants of fragility fracture risk in later life. During growth bone is responsive to changes in nutrition and physical activity (PA), particularly when occuring before pubertal maturation.OBJECTIVE: In prepubertal healthy boys, protein intake (Prot-Int) enhances the impact of PA on weight-bearing bone. We hypothesized that the synergism between Prot-Int and PA on proximal femur as recorded at mean age of 7.4 years would track until PBM.METHODS: 124 boys were followed from 7.4 to 15.2 and 22.6 years. At 7.4 years they were dichotomized according to the median of both PA and Prot-Int.RESULTS: In boys with PA > Median (310 vs 169 kcal.d(-1)), higher vs low Prot-Int (57.7 vs 38.0 g.d(-1)) was associated with +9.8% greater femoral neck (FN) BMC (P=0.027) at 7.4 years. At 15.2 and 22.6 years, this difference was maintained: FN BMC: +12.7% (P=0.012) and +11.3% (P=0.016), respectively. With PA > Median, in Prot-Int > vs < Median, differences in FN BMC Z-scores were +0.60, +0.70 and +0.68 at 7.4, 15.2 and 22.6 years, respectively, and also associated with greater FN width. Micro-finite element analysis of the distal tibia at 15.2 and 22.6 years indicated that in the two groups with PA > Median, CSA, stiffness and failure load were greater in Prot-Int > vs < Median.CONCLUSIONS: This study demonstrates the crucial influence of Prot-Int on the response to enhanced PA and the importance of prepubertal years for modifiying, by environmental factors, the bone growth trajectory and, thereby, for achieving higher PBM and greater strength in healthy male subjects.
- Published
- 2017
46. Moderately degenerated lumbar motion segments: are they truly unstable?
- Author
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van Rijsbergen, M.M., Barthelemy, V.M.P., Vrancken, A.C.T., Crijns, S.P.M., Wilke, H.J., Wilson, W., van Rietbergen, B., Ito, K., van Rijsbergen, M.M., Barthelemy, V.M.P., Vrancken, A.C.T., Crijns, S.P.M., Wilke, H.J., Wilson, W., van Rietbergen, B., and Ito, K.
- Abstract
The two main load bearing tissues of the intervertebral disc are the nucleus pulposus and the annulus fibrosus. Both tissues are composed of the same basic components, but differ in their organization and relative amounts. With degeneration, the clear distinction between the two tissues disappears. The changes in biochemical content lead to changes in mechanical behaviour of the intervertebral disc. The aim of the current study was to investigate if well-documented moderate degeneration at the biochemical and fibre structure level leads to instability of the lumbar spine. By taking into account biochemical and ultrastructural changes to the extracellular matrix of degenerating discs, a set of constitutive material parameters were determined that described the individual tissue behaviour. These tissue biomechanical models were then used to simulate dynamic behaviour of the degenerated spinal motion segment, which showed instability in axial rotation, while a stabilizing effect in the other two principle bending directions. When a shear load was applied to the degenerated spinal motion segment, no sign of instability was found. This study found that reported changes to the nucleus pulposus and annulus fibrosus matrix during moderate degeneration lead to a more stable spinal motion segment and that such biomechanical considerations should be incorporated into the general pathophysiological understanding of disc degeneration and how its progress could affect low back pain and its treatments thereof.
- Published
- 2017
47. Enhanced prediction of bone strength by micro-finite element simulation of 3-point bending tests
- Author
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Arias Moreno, A.J., Ito, K., van Rietbergen, B., and Orthopaedic Biomechanics
- Published
- 2016
48. Fracture Repair in the Distal Radius in Post-Menopausal Women: A Follow-Up Two Years Post-Fracture Using HRpQCT
- Author
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de Jong, J., Heyer, F.L., Arts, J.J., Poeze - van Bokhoven, Martijn, Keszei, Andras, Willems, P.C., van Rietbergen, B., Geusens, P.P., van den Bergh, J.P., RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Promovendi NTM, RS: NUTRIM - R2 - Gut-liver homeostasis, Interne Geneeskunde, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Orthopedie, MUMC+: MA Orthopedie (9), Surgery, MUMC+: TPZ Netwerk Acute Zorg Limburg (9), MUMC+: MA Heelkunde (9), Epidemiologie, RS: CAPHRI - R5 - Optimising Patient Care, RS: NUTRIM - HB/BW section A, and RS: NUTRIM - HB/BW section B
- Subjects
musculoskeletal diseases ,PRECISION ,POSTMENOPAUSAL WOMEN ,ACCURACY ,QUANTITATIVE COMPUTED-TOMOGRAPHY ,BONE-DENSITY ,musculoskeletal system ,DISTAL RADIUS ,HRpQCT ,FRACTURE REPAIR ,MICROARCHITECTURE - Abstract
Fracture healing is characterized by an intense increase in modeling and remodeling of bone, which allows removal of the cast after a stable distal radius fracture within 3-5 weeks. However, at that time bone strength has not recovered yet. We studied the changes in BMD, micro-architecture and bone stiffness after a distal radius fracture during a two-year follow-up in comparison to the contra-lateral side, and the association between the two-year stiffness and baseline BMD, micro-architecture, and early changes in these parameters. The fractured side of fourteen post-menopausal women (mean age 64 +/- 8) with a conservatively treated distal radius fracture was scanned by HRpQCT at 1-2, 3-4, 6-8 and 12 weeks and two years post-fracture. The same region contra-laterally was scanned as well at the two-year visit. BMD, micro-architecture and stiffness parameters were determined and the fracture side was compared to the contra-lateral side using a linear mixed-effect model. Spearman's correlation was used to correlate the two-year bone stiffness with baseline BMD, micro-architecture, and early three-month changes in these parameters. Two years post-fracture, cortical and trabecular thickness and torsional and bending stiffness were significantly higher at the fractured side as compared to the non-fractured side (21%, 55%, 31% and 29%, respectively, p < 0.05), while BMD was similar. Two-year torsional and bending stiffness correlated significantly with baseline BMD and cortical perimeter (|rho|>/=0.63, p < 0.016), but not with early changes in bone parameters. Using HRpQCT, this study illustrates that fracture healing is not completed by the time the cast is removed. We showed that from six weeks to two years post-fracture large changes occur in BMD, micro-architecture and biomechanical parameters at the fractured side, which were fully recovered after two years in comparison to the non-fractured contra-lateral side. Interestingly, higher two-year torsional and bending stiffness were associated with lower BMD and higher cortical perimeter at baseline. This article is protected by copyright. All rights reserved.
- Published
- 2016
49. Fracture repair in the distal radius in postmenopausal women: a follow-up 2 years postfracture using HRpQCT
- Author
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de Jong, J.J., Heyer, F.L., Arts, J.J.C., Poeze, M., Keszei, A.P., Willems, P.C., van Rietbergen, B., Geusens, P.P., van den Bergh, J.P.W., and Orthopaedic Biomechanics
- Subjects
musculoskeletal diseases ,Journal Article ,musculoskeletal system - Abstract
Fracture healing is characterized by an intense increase in modeling and remodeling of bone, which allows removal of the cast after a stable distal radius fracture within 3 to 5 weeks. However, at that time, bone strength has not recovered yet. We studied the changes in bone mineral density (BMD), microarchitecture, and bone stiffness after a distal radius fracture during a 2-year follow-up in comparison to the contralateral side and the association between the 2-year stiffness and baseline BMD, microarchitecture, and early changes in these parameters. The fractured side of 14 postmenopausal women (mean age 64 ± 8 years) with a conservatively treated distal radius fracture was scanned by high-resolution peripheral quantitative computed tomography (HRpQCT) at 1 to 2, 3 to 4, 6 to 8, and 12 weeks and 2 years postfracture. The same region contralaterally was scanned as well at the 2-year visit. BMD, microarchitecture, and stiffness parameters were determined and the fracture side was compared with the contralateral side using a linear mixed-effect model. Spearman's correlation was used to correlate the 2-year bone stiffness with baseline BMD, microarchitecture, and early 3-month changes in these parameters. Two years postfracture, cortical and trabecular thickness and torsional and bending stiffness were significantly higher at the fractured side compared with the nonfractured side (21%, 55%, 31%, and 29%, respectively, p < 0.05), whereas BMD was similar. Two-year torsional and bending stiffness correlated significantly with baseline BMD and cortical perimeter (|rho| ≥ 0.63, p < 0.016) but not with early changes in bone parameters. Using HRpQCT, this study illustrates that fracture healing is not completed by the time the cast is removed. We showed that from 6 weeks to 2 years postfracture, large changes occur in BMD, microarchitecture, and biomechanical parameters at the fractured side, which were fully recovered after 2 years in comparison to the nonfractured contralateral side. Interestingly, higher 2-year torsional and bending stiffness were associated with lower BMD and higher cortical perimeter at baseline. © 2015 American Society for Bone and Mineral Research.
- Published
- 2016
50. The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy
- Author
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Soyka, R.P. Widmer, Helgason, B., Marangalou, J.H., Van den Bergh, J.P., van Rietbergen, B., Ferguson, S.J., and Orthopaedic Biomechanics
- Abstract
Purpose: Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods: A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results: The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions: We conclude that the effectiveness of vertebroplasty is sensitive to the patient's condition and the treatment strategy.
- Published
- 2016
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