Messtechnische Verfahren im Kontext der DVO Leitlinie – neue
                    Entwicklungen

Klaus Engelke; Dirk Müller; Bjoern Bühring; Friederike Thomasius

doi:10.1055/a-2045-7222

Osteologie, Table of Contents

Osteologie 2023; 32(02): 97-103
DOI: 10.1055/a-2045-7222

Leitlinie

Messtechnische Verfahren im Kontext der DVO Leitlinie – neue Entwicklungen

Technical Methods in the Context of the DVO Guideline – New Developments

Authors

Klaus Engelke

¹Department of Medicine 3, FAU, Erlangen, Germany
Dirk Müller

²Department of Radiology, Kantonsspital Graubunden, Chur, Switzerland
Bjoern Bühring

³Bergisches Rheuma-Zentrum, Krankenhaus St. Josef, Wuppertal, Germany
Friederike Thomasius

⁴Frankfurt Center for Bone Health and Endocrinology, Frankfurt, Germany

Abstract

Zusammenfassung

Die Osteodensitometrie, die Bestimmung von Knochendichte und biochemischer Knochenumbauparameter sind ein integraler Bestandteil der DVO Leitlinie. Dieser Beitrag gibt einen Überblick über neue Studien und neue technische Entwicklungen soweit sie insbesondere im Kontext der Leitlinie, also für Diagnose, Bestimmung des Frakturrisikos und Verlaufskontrolle relevant sind. Dabei stehen zunächst die Verfahren im Vordergrund, die unmittelbar zur Anpassung von Empfehlungen geführt haben. Andere Techniken wie das sogenannte „opportunistic screening“ von Routine CT Aufnahmen haben zwar noch keinen Eingang in die Leitlinie gefunden, allerdings scheint aufgrund ihres Potentials, die Identifikation von Patienten mit hohem Frakturrisiko wesentlich zu verbessern, ein Überblick auch über diese Methoden im Rahmen dieses Beitrages gerechtfertigt.

Abstract

Osteodensitometry, the determination of bone density and biochemical bone remodeling parameters are an integral part of the DVO guideline. This article gives an overview of new studies and new technical developments as far as they are relevant especially in the context of the guideline, i. e. for diagnosis, determination of fracture risk and follow-up. The focus is in particular on those techniques that have directly led to the adaptation of recommendations. Other techniques, such as opportunistic screening of routine CT scans, have not yet found their way into the guideline, but their potential to significantly improve the identification of patients at high risk of fracture seems to justify an overview of these methods in the context of this article.

Schlüsselwörter

DVO Leitlinie - messtechnische Verfahren - DXA - VFA - QCT - HR-pQCT - Knochendichte und Struktur

Key words

DVO Guideline - DXA - QCT - VFA - Biochemical Markers

Full Text

References

Literatur
1 Shuhart CR, Yeap SS, Anderson PA. et al. Executive Summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019; 22: 453-471
2 Bilezikian JP, Khan AA, Potts JT. et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the third international workshop. J Clin Endocrinol Metab 2009; 94: 335-339
3 Bouxsein ML, Eastell R, Lui LY. et al. Change in Bone Density and Reduction in Fracture Risk: A Meta-Regression of Published Trials. J Bone Miner Res 2019; 34: 632-642
4 Gluer CC. Monitoring skeletal changes by radiological techniques. J Bone Miner Res 1999; 14: 1952-1962
5 Leslie WD, Morin SN, Martineau P. et al. Association of Bone Density Monitoring in Routine Clinical Practice With Anti-Osteoporosis Medication Use and Incident Fractures: A Matched Cohort Study. J Bone Miner Res 2019; 34: 1808-1814
6 Chapurlat RD, Duboeuf F, Marion-Audibert HO. et al. Effectiveness of instant vertebral assessment to detect prevalent vertebral fracture. Osteoporos Int 2006; 17: 1189-1195
7 Domiciano DS, Figueiredo CP, Lopes JB. et al. Vertebral fracture assessment by dual X-ray absorptiometry: a valid tool to detect vertebral fractures in community-dwelling older adults in a population-based survey. Arthritis care & research 2013; 65: 809-815
8 Lewiecki EM, Laster AJ. Clinical review: Clinical applications of vertebral fracture assessment by dual-energy x-ray absorptiometry. J Clin Endocrinol Metab 2006; 91: 4215-4222
9 Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis. Bone 2020; 136: 115358
10 Kanis JA, Cooper C, Rizzoli R. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2019; 30: 3-44
11 Cosman F, de Beur SJ, LeBoff MS. et al. Clinician's Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int 2014; 25: 2359-2381
12 Leslie WD, Lix LM, Binkley N. Targeted vertebral fracture assessment for optimizing fracture prevention in Canada. Archives of osteoporosis 2020; 15: 65
13 Diacinti D, Guglielmi G, Pisani D. et al. Vertebral morphometry by dual-energy X-ray absorptiometry (DXA) for osteoporotic vertebral fractures assessment (VFA). La Radiologia medica 2012; 117: 1374-1385
14 Fuerst T, Wu C, Genant HK. et al. Evaluation of vertebral fracture assessment by dual X-ray absorptiometry in a multicenter setting. Osteoporos Int 2009; 20: 1199-1205
15 Lee JH, Lee YK, Oh SH. et al. A systematic review of diagnostic accuracy of vertebral fracture assessment (VFA) in postmenopausal women and elderly men. Osteoporos Int 2016; 27: 1691-1699
16 Mostert JM, Romeijn SR, Dibbets-Schneider P. et al. Inter-observer agreement of vertebral fracture assessment with dual-energy x-ray absorptiometry equipment. Archives of osteoporosis 2021; 17: 4
17 Bazzocchi A, Spinnato P, Fuzzi F. et al. Vertebral fracture assessment by new dual-energy X-ray absorptiometry. Bone 2012; 50: 836-841
18 Bouxsein ML, Delmas PD. Vertebral fracture assessment using standard bone densitometry equipment predicts incident fractures in women. Nature clinical practice Endocrinology & metabolism 2008; 4: 652-653
19 McCloskey EV, Vasireddy S, Threlkeld J. et al. Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 2008; 23: 1561-1568
20 Schousboe JT, Lix LM, Morin SN. et al. Prevalent vertebral fracture on bone density lateral spine (VFA) images in routine clinical practice predict incident fractures. Bone 2019; 121: 72-79
21 Johansson L, Johansson H, Axelsson KF. et al. Improved fracture risk prediction by adding VFA-identified vertebral fracture data to BMD by DXA and clinical risk factors used in FRAX. Osteoporos Int 2022; 33: 1725-1738
22 Samelson EJ, Broe KE, Xu H. et al. Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol 2019; 7: 34-43
23 Cheung WH, Hung VW, Cheuk KY. et al Best Performance Parameters of HR-pQCT to Predict Fragility Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res 2021; 10.1002/jbmr.4449
24 Mikolajewicz N, Bishop N, Burghardt AJ. et al. HR-pQCT Measures of Bone Microarchitecture Predict Fracture: Systematic Review and Meta-Analysis. J Bone Miner Res 2020; 35: 446-459
25 van den Bergh JP, Szulc P, Cheung AM. et al. The clinical application of high-resolution peripheral computed tomography (HR-pQCT) in adults: state of the art and future directions. Osteoporos Int 2021; 32: 1465-1485
26 Whittier DE, Boyd SK, Burghardt AJ. et al. Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31: 1607-1627
27 Engelke K, Chaudry O, Bartenschlager S. Opportunistic Screening Techniques for Analysis of CT Scans. Curr Osteoporos Rep 2022; 10.1007/s11914-022-00764-5
28 Chettrit D, Meir T, Lebel H. et al. 3D convolutional sequence to sequence model for vertebral compression fractures identification in CT. In, International Conference on Medical Image Computing and Computer-Assisted Intervention. Springer; 2020: 743-752
29 Hempe H, Yilmaz EB, Meyer C. et al. Opportunistic CT screening for degenerative deformities and osteoporotic fractures with 3D DeepLab. In, Medical Imaging 2022: Image Processing. SPIE; 2022: 127-134
30 Loffler MT, Jacob A, Scharr A. et al. Automatic opportunistic osteoporosis screening in routine CT: improved prediction of patients with prevalent vertebral fractures compared to DXA. Eur Radiol 2021; 31: 6069-6077
31 Yilmaz EB, Buerger C, Fricke T. et al. Automated deep learning-based detection of osteoporotic fractures in CT images. In, International Workshop on Machine Learning in Medical Imaging. Springer; 2021: 376-385
32 Gudmundsdottir H, Jonsdottir B, Kristinsson S. et al. Vertebral bone density in Icelandic women using quantitative computed tomography without an external reference phantom. Osteoporos Int 1993; 3: 84-89
33 Lee DC, Hoffmann PF, Kopperdahl DL. et al. Phantomless calibration of CT scans for measurement of BMD and bone strength-Inter-operator reanalysis precision. Bone 2017; 103: 325-333
34 Michalski AS, Besler BA, Michalak GJ. et al. CT-based internal density calibration for opportunistic skeletal assessment using abdominal CT scans. Med Eng Phys 2020; 78: 55-63
35 Mueller DK, Kutscherenko A, Bartel H. et al. Phantom-less QCT BMD system as screening tool for osteoporosis without additional radiation. Eur J Radiol 2011; 79: 375-381
36 Bartenschlager S, Dankerl P, Chaudry O. et al. BMD accuracy errors specific to phantomless calibration of CT scans of the lumbar spine. Bone 2022; 157: 116304
37 Rebello D, Anjelly D, Grand DJ. et al Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients. Osteoporos Int 2018; 10.1007/s00198-018-4444-6
38 Park SH, Jeong YM, Lee HY. et al. Opportunistic use of chest CT for screening osteoporosis and predicting the risk of incidental fracture in breast cancer patients: A retrospective longitudinal study. PloS one 2020; 15: e0240084
39 Jang S, Graffy PM, Ziemlewicz TJ. et al. Opportunistic Osteoporosis Screening at Routine Abdominal and Thoracic CT: Normative L1 Trabecular Attenuation Values in More than 20 000 Adults. Radiology 2019; 291: 360-367
40 Pickhardt PJ, Pooler BD, Lauder T. et al. Opportunistic screening for osteoporosis using abdominal computed tomography scans obtained for other indications. Ann Intern Med 2013; 158: 588-595
41 Flohr T, Petersilka M, Henning A. et al. Photon-counting CT review. Phys Med 2020; 79: 126-136
42 Hsieh SS, Leng S, Rajendran K. et al. Photon Counting CT: Clinical Applications and Future Developments. IEEE Trans Radiat Plasma Med Sci 2021; 5: 441-452
43 Sartoretti T, Wildberger JE, Flohr T. et al Photon-Counting detector CT: Early clinical experience review. Br J Radiol 2023; 10.1259/bjr.20220544
44 Pena JA, Klein L, Maier J. et al. Dose-efficient assessment of trabecular microstructure using ultra-high-resolution photon-counting CT. Z Med Phys 2022; 32: 403-416
45 Bauer DC, Black DM, Bouxsein ML. et al. Treatment-Related Changes in Bone Turnover and Fracture Risk Reduction in Clinical Trials of Anti-Resorptive Drugs: A Meta-Regression. J Bone Miner Res 2018; 33: 634-642
46 Elbers LPB, Raterman HG, Lems WF. Bone Mineral Density Loss and Fracture Risk After Discontinuation of Anti-osteoporotic Drug Treatment: A Narrative Review. Drugs 2021; 81: 1645-1655
47 Shrimpton PC, Wall BF, Jones DG. et al. Doses to patients from routine diagnostic X-ray examinations in England. Br J Radiol 1986; 59: 749-758
48 Schegerer A, Loose R, Heuser LJ. et al. Diagnostic Reference Levels for Diagnostic and Interventional X-Ray Procedures in Germany: Update and Handling. Rofo 2019; 191: 739-751
49 Blake GM, Rea JA, Fogelman I. Vertebral morphometry studies using dual-energy x-ray absorptiometry. Semin Nucl Med 1997; 27: 276-290
50 Ferrar L, Eastell R. Identification of vertebral deformities in men: comparison of morphometric radiography and morphometric X-ray absorptiometry. Osteoporos Int 1999; 10: 167-174
51 Vokes T, Bachman D, Baim S. et al. Vertebral fracture assessment: the 2005 ISCD Official Positions. J Clin Densitom 2006; 9: 37-46
52 Blake GM, Naeem M, Boutros M. Comparison of effective dose to children and adults from dual X-ray absorptiometry examinations. Bone 2006; 38: 935-942
53 Patel R, Blake GM, Batchelor S. et al. Occupational dose to the radiographer in dual X-ray absorptiometry: a comparison of pencil-beam and fan-beam systems. Br J Radiol 1996; 69: 539-543
54 Engelke K, Adams JE, Armbrecht G. et al. Clinical Use of Quantitative Computed Tomography and Peripheral Quantitative Computed Tomography in the Management of Osteoporosis in Adults: The 2007 ISCD Official Positions. J Clin Densitom 2008; 11: 123-162
55 Engelke K, Lang T, Khosla S. et al. Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part I. J Clin Densitom 2015; 18: 338-358