Experimental study exploring the factors that promote rib fragility in the elderly

AbstractRib fractures represent a common injury type due to blunt chest trauma, affecting hospital stay and mortality especially in elderly patients. Factors promoting rib fragility, however, are little investigated. The purpose of this in vitro study was to explore potential determinants of human rib fragility in the elderly. 89 ribs from 13 human donors (55–99 years) were loaded in antero-posterior compression until fracture using a material testing machine, while surface strains were captured using a digital image correlation system. The effects of age, sex, bone mineral density, rib level and side, four global morphological factors (e.g. rib length), and seven rib cross-sectional morphological factors (e.g. cortical thickness, determined by μCT), on fracture load were statistically examined using Pearson correlation coefficients, Mann–Whitney U test as well as Kruskal–Wallis test with Dunn-Bonferroni post hoc correction. Fracture load showed significant dependencies (p < 0.05) from bone mineral density, age, antero-posterior rib length, cortical thickness, bone volume/tissue volume ratio, trabecular number, trabecular separation, and both cross-sectional area moments of inertia and was significantly higher at rib levels 7 and 8 compared to level 4 (p = 0.001/0.013), whereas side had no significant effect (p = 0.989). Cortical thickness exhibited the highest correlation with fracture load (r = 0.722), followed by the high correlation of fracture load with the area moment of inertia around the longitudinal rib cross-sectional axis (r = 0.687). High correlations with maximum external rib surface strain were detected for bone volume/tissue volume ratio (r = 0.631) and trabecular number (r = 0.648), which both also showed high correlations with the minimum internal rib surface strain (r = − 0.644/ − 0.559). Together with rib level, the determinants cortical thickness, area moment of inertia around the longitudinal rib cross-sectional axis, as well as bone mineral density exhibited the largest effects on human rib fragility with regard to the fracture load. Sex, rib cage side, and global morphology, in contrast, did not affect rib fragility in this study. When checking elderly patients for rib fractures due to blunt chest trauma, patients with low bone mineral density and the mid-thoracic area should be carefully examined.

Download Full-text

Prediction of Femoral Fracture Load: Cross-sectional Study of Texture Analysis and Geometric Measurements on Plain Radiographs versus Bone Mineral Density

Radiology ◽

10.1148/radiol.10090232 ◽

2010 ◽

Vol 255 (2) ◽

pp. 536-543 ◽

Cited By ~ 26

Author(s):

Christine Chappard ◽

Valérie Bousson ◽

Catherine Bergot ◽

David Mitton ◽

Arnaud Marchadier ◽

...

Keyword(s):

Bone Mineral Density ◽

Texture Analysis ◽

Bone Mineral ◽

Femoral Fracture ◽

Cross Sectional Study ◽

Fracture Load ◽

Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

Plain Radiographs

Download Full-text

Effect of Tissue-Selective Estrogen Complex on Hip Structural Geometry in Postmenopausal Women: A 12-Month Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.649952 ◽

2021 ◽

Vol 12 ◽

Author(s):

Bo Mi Kim ◽

Sung Eun Kim ◽

Dong-Yun Lee ◽

DooSeok Choi

Keyword(s):

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Cortical Thickness ◽

Bone Geometry ◽

Cross Sectional Area ◽

Sectional Area ◽

Mineral Density ◽

Hip Geometry ◽

Cross Sectional

BackgroundHip structural analysis (HSA) is a method for evaluating bone geometry reflecting bone structural and biomechanical properties. However, tissue-selective estrogen complex (TSEC) treatment effects on HSA have not been investigated.ObjectiveThis study was performed to evaluate the effect of TSEC treatment on hip geometry in postmenopausal Korean women. The treatment was given for 12 months, and hip geometry was measured by HSA.Materials and MethodsA total of 40 postmenopausal women who received TSEC containing conjugated estrogen 0.45 mg and bazedoxifene 20 mg for treating vasomotor symptoms were included in this retrospective cohort study. The changes in bone mineral density and parameters of HSA including the outer diameter, cross-sectional area, cross-sectional moment of inertia, cortical thickness, section modulus, and buckling ratio as determined by dual-energy X-ray absorptiometry were compared before and after 12 months of TSEC treatment.ResultsMean age and years since menopause were 55.1 and 4.5 years, respectively. Total hip bone mineral density significantly increased by 0.74% after treatment (P=0.011). The changes in HSA were mainly demonstrated in the narrow femoral neck: cross-sectional area (P=0.003) and cortical thickness (P<0.001) increased significantly. For the shaft region, only SM decreased significantly after treatment (P=0.009). However, most parameters did not change significantly with TSEC treatment in the intertrochanteric and shaft regions.ConclusionsOur findings demonstrate that 12 months of TSEC treatment could improve bone geometry as measured by HSA. The findings suggest that TSEC might be an interesting option for the prevention of fracture as well as osteoporosis in postmenopausal women.

Download Full-text

A Densitometric and Morphometric Analysis of the Skeleton in Adults with Varying Degrees of Growth Hormone Deficiency

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2005-0897 ◽

2006 ◽

Vol 91 (2) ◽

pp. 432-438 ◽

Cited By ~ 41

Author(s):

Robert D. Murray ◽

Judith E. Adams ◽

Stephen M. Shalet

Keyword(s):

Bone Mineral Density ◽

Bone Density ◽

Cortical Bone ◽

Bone Mineral ◽

Cortical Thickness ◽

Controlled Study ◽

Bone Area ◽

Mineral Density ◽

Cross Sectional ◽

Cortical Density

Context: Low bone mass is a characteristic feature of the adult GH deficiency (GHD) syndrome, but recent dual-energy x-ray absorptiometry (DXA) studies in patients with GH-receptor and GHRH-receptor gene mutations suggest that the situation is more complex. Objective: The objective was to define bone areal and volumetric densities and morphometry in hypopituitary adults. Design: The study was a cross-sectional case-controlled study performed between 1999 and 2001. Setting: The study was undertaken at an endocrine tertiary referral center. Patients: Thirty patients with GHD, 24 with GH insufficiency (GHI) [peak GH, 3–7 μg/liter (9–21 mU/liter)], and 30 age- and sex-matched controls were included for study. Main Outcome Measures: DXA and peripheral quantitative computed tomography (pQCT) derived bone density and morphometry were measured. Results: No densitometric or morphometric abnormalities were detected in GHD patients who acquired their deficiency during adult life. GHD adults of childhood-onset (CO-GHD) showed decreased bone mineral density at the lumbar spine and hip on DXA. pQCT of the radius showed that CO-GHD patients have normal trabecular bone mineral density and only a 2% decrease in cortical density. Radial bone area was reduced 14.5%, cortical thickness 20%, and cortical cross-sectional area 23%, culminating in a reduction in cortical bone of 25%. The “apparent” low DXA bone density in CO-GHD adults therefore relates primarily to reduced cortical thickness and smaller bone area. DXA and pQCT data derived from adults with GHI revealed no evidence of densitometric or morphometric abnormalities. Conclusions: 1) Adult-onset GHD patients have normal bone density and size. 2) CO-GHD adults have marginally reduced cortical density but significantly reduced cortical bone as a result of reduced cortical thickness and bone size. 3) GHI has no measurable impact on the skeleton.

Download Full-text

Bone Mineral Density in the Noninstitutionalized Elderly: Influence of Sociodemographic and Anthropometric Factors

Current Gerontology and Geriatrics Research ◽

10.1155/2016/4946593 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Ellen Cristina de Sousa e Silva Araujo ◽

Valéria Pagotto ◽

Erika Aparecida Silveira

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Age Groups ◽

The Elderly ◽

Cross Sectional Study ◽

Normal Weight ◽

Age Group ◽

Mineral Density ◽

Cross Sectional ◽

Total Body

Objective. Analysis of bone mineral density (BMD) in the elderly and its associated factors according to sex.Methods. A cross-sectional study is presented herein, with a random sample of 132 noninstitutionalized elderly people. Individuals who did not use diuretics were excluded. BMD was obtained from examination of total body densitometry and its association with sociodemographic variables, lifestyle, anthropometric, and body composition was verified.Results. Mean BMD for men was1.17±0.12 g/cm2and for women was1.04±0.11 g/cm2. Higher education was associated with higher BMD values in men (p<0.05). There was a reduction in BMD in the age group 75–79 years of age in women and over 80 years of age in men (p<0.05). Underweight was associated with significantly low BMD for both sexes (p<0.01), while normal weight was associated with low BMD in women (p<0.001).Discussion. The elderly with low schooling and in older age groups are more probable to also present low BMD. Lower levels of body mass index also indicated towards low BMD.

Download Full-text

Association between reproductive factors and postmenopausal osteoporosis

Osteologie/Osteology ◽

10.1055/s-0037-1620001 ◽

2011 ◽

Vol 20 (03) ◽

pp. 248-251

Author(s):

H. R. Meybodi ◽

N. Khalili ◽

P. Khashayar ◽

R. Heshmat ◽

A. Hossein-nezhad ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Reproductive Factors ◽

Population Based ◽

Age At Menarche ◽

Mineral Density ◽

Cross Sectional ◽

Number Of Children ◽

Menstrual History ◽

Duration Of Breastfeeding

SummaryThe present cross-sectional research was designed to study possible correlations between clinical reproductive factors and bone mineral density (BMD) values.Using the data gathered by the population-based Iranian Multicenter Osteoporosis Study (IMOS), we investigated the correlation found between reproductive factors and osteoporosis. Subjects were recruited from five major cities of Iran. Bone mineral density was measured using Dual-Energy X-ray Absorptiometry and the results were analyzed against the age at menarche and at menopause, number of pregnancies, children and abortions, and the history (and duration) of breastfeeding.Data was available for 2528 women. Gravidity and number of children were reversely correlated with BMD. Younger age at menarche was associated with higher BMD values, whereas there was no significant correlation between age at menopause and menstrual history and BMD.Our study suggests that clinical reproductive factors, particularly number of children and breastfeeding, could be incorporated as predictors of BMD levels in women. Given the controversial results obtained in different studies, longitudinal studies should be carried out to enlighten the importance of these factors and the rationale of their use to predict BMD values in different settings.

Download Full-text