Aims Even if densitometry is still currently considered to be the gold standard in bone quality assessment, however, the medical community has long been aware that two are the factors that increase bone weakness: bone mineralization loss and micro-architectural deterioration. In effect, without prejudice to the importance of the contribution to bone resistance provided by mineralization, it is well known that the ability of bone to resist the applied loads also depends on the structural architecture of trabeculae, an aspect that the techniques currently available are not able to take into account (Liu X.S. et al., 2009). Estimating bone density alone is not, therefore, a parameter sufficient for a complete evaluation of the load bearing capability of this tissue, which, instead, requires also the consideration of the spatial arrangement of its trabecular component. Micro-numerical models have already been developed to compute the elastic properties of 3D reconstructions of trabecular structures and to perform strength predictions. Nevertheless, a widespread clinical application of 3D methods seems unlikely in the next future, given the examination costs and computational requirements. Methods The approach followed in this work focuses on the characterization of the bone structure by numerical simulation, obtained from conventional radiographic images of suitable anatomical districts. In a few seconds, the test can quantify the possible pathological alterations of bone micro-architecture by means of a structural index (SI), which is calculated from the elastic response of the reconstructed structure and the normalized sum of gray tones, indicative of the mineralization in the region under examination (Cosmi, 2008). Results Here we present the results obtained by applying the test to a particular case of rapidly progressing osteoporosis, occurred in a Complex Regional Pain Syndrome (CRPS) of the hand. CRPS is a chronic progressive disease, formerly known as “reflex sympathetic dystrophy” and “causalgia” (now classified as CRPS type I and CRPS type II, respectively), whose pathophysiology is still currently poorly understood (de Mos et al., 2008). Conclusions The results obtained show how the developed tool may be able to open important prospective applications for the study of bone pathologies (namely osteoporotic ones), in regards to the assessment of the illness course and the efficacy of potential therapies. Moreover, interesting possibilities of application exist also in the medical forensic field, where this new method can help the physician in the quantification of the biological damage. References: Cosmi F. (2008). Method to identify the mechanical properties of a material. Patent: USA No.10509512, deposited by University of Trieste. de Mos, M., Huygen, F.J., Dieleman, J.P., Koopman, J.S., Stricker, B.H. & Sturkenboom, M.C. (2008). Medical history and the onset of complex regional pain syndrome (CRPS). Pain, 139, 458-466. Liu XS, Zhang XH, Guo XE (2009). Contributions of trabecular rods of various orientations in determining the elastic properties of human vertebral trabecular bone. Bone, 45, 158-63.

A new structural method permits the evaluation of bone quality and fracture risk in a case of rapid and progressive osteoporosis of the hand (CRPS type II)

COSMI, Francesca;
2013-01-01

Abstract

Aims Even if densitometry is still currently considered to be the gold standard in bone quality assessment, however, the medical community has long been aware that two are the factors that increase bone weakness: bone mineralization loss and micro-architectural deterioration. In effect, without prejudice to the importance of the contribution to bone resistance provided by mineralization, it is well known that the ability of bone to resist the applied loads also depends on the structural architecture of trabeculae, an aspect that the techniques currently available are not able to take into account (Liu X.S. et al., 2009). Estimating bone density alone is not, therefore, a parameter sufficient for a complete evaluation of the load bearing capability of this tissue, which, instead, requires also the consideration of the spatial arrangement of its trabecular component. Micro-numerical models have already been developed to compute the elastic properties of 3D reconstructions of trabecular structures and to perform strength predictions. Nevertheless, a widespread clinical application of 3D methods seems unlikely in the next future, given the examination costs and computational requirements. Methods The approach followed in this work focuses on the characterization of the bone structure by numerical simulation, obtained from conventional radiographic images of suitable anatomical districts. In a few seconds, the test can quantify the possible pathological alterations of bone micro-architecture by means of a structural index (SI), which is calculated from the elastic response of the reconstructed structure and the normalized sum of gray tones, indicative of the mineralization in the region under examination (Cosmi, 2008). Results Here we present the results obtained by applying the test to a particular case of rapidly progressing osteoporosis, occurred in a Complex Regional Pain Syndrome (CRPS) of the hand. CRPS is a chronic progressive disease, formerly known as “reflex sympathetic dystrophy” and “causalgia” (now classified as CRPS type I and CRPS type II, respectively), whose pathophysiology is still currently poorly understood (de Mos et al., 2008). Conclusions The results obtained show how the developed tool may be able to open important prospective applications for the study of bone pathologies (namely osteoporotic ones), in regards to the assessment of the illness course and the efficacy of potential therapies. Moreover, interesting possibilities of application exist also in the medical forensic field, where this new method can help the physician in the quantification of the biological damage. References: Cosmi F. (2008). Method to identify the mechanical properties of a material. Patent: USA No.10509512, deposited by University of Trieste. de Mos, M., Huygen, F.J., Dieleman, J.P., Koopman, J.S., Stricker, B.H. & Sturkenboom, M.C. (2008). Medical history and the onset of complex regional pain syndrome (CRPS). Pain, 139, 458-466. Liu XS, Zhang XH, Guo XE (2009). Contributions of trabecular rods of various orientations in determining the elastic properties of human vertebral trabecular bone. Bone, 45, 158-63.
2013
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11368/2721500
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