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Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Assessing bone mineral density and cortical geometry using high-resolution peripheral quantitative computed
Sonia Gera1, Michelle Guo2, Yang Xie1
1Children's Hospital of Philadelphia, 3500 Civic Center Boulevard, 12th Floor, Philadelphia, PA 19104, USA.
Insights
High-risk neuroblastoma (HR-NBL) survivors showed normal bone density but persistent muscle deficits impacting bone structure. These findings highlight the long-term skeletal effects of HR-NBL therapy.
Area of Science:
- Pediatric oncology
- Skeletal biology
- Medical imaging
Background:
- Multimodal therapy has improved survival for high-risk neuroblastoma (HR-NBL) in children.
- cis-Retinoic acid (cis-RA), a key HR-NBL treatment, can lead to osteoporosis and premature physeal closure.
- High-resolution peripheral quantitative computed tomography (HR-pQCT) allows detailed 3D assessment of bone mineral density (BMD) and microarchitecture.
Purpose of the Study:
- To assess the long-term impact of HR-NBL therapy on skeletal structure using HR-pQCT.
- To compare bone microarchitecture and density in HR-NBL survivors versus healthy controls.
- To investigate the relationship between muscle deficits and bone geometry in HR-NBL survivors.
Main Methods:
- Prospective enrollment of 20 HR-NBL survivors and 20 matched healthy controls.
- Assessment of leg lean mass (DXA) and strength (Biodex dynamometer).
- HR-pQCT scans of the tibia to evaluate cortical and trabecular bone microarchitecture and volumetric BMD (vBMD).
Main Results:
- HR-NBL survivors had significantly shorter tibia length and lower height Z-scores compared to controls.
- Cortical area and perimeter were reduced in survivors, but these differences became non-significant after adjusting for tibia length.
- No significant differences in total, cortical, or trabecular vBMD were observed between groups.
- Cortical geometry deficits were associated with muscle deficits, even after adjusting for leg lean mass.
Conclusions:
- Bone density is not severely impacted in HR-NBL survivors.
- Persistent muscle deficits years after treatment are linked to impaired cortical geometry.
- HR-pQCT is valuable for detailed skeletal assessment in pediatric cancer survivors.
Introduction:
Survival of children with high-risk neuroblastoma (HR-NBL) has increased with multimodal therapy. cis-Retinoic acid (cis-RA), cornerstone of HR-NBL therapy, can cause osteoporosis and premature physeal closure. This study utilized high-resolution peripheral quantitative computed tomography (HR-pQCT), for 3D measures of volumetric bone mineral density (BMD) and microarchitecture, to assess impact of HR-NBL therapy on skeletal structure.
Methods:
We prospectively enrolled 20 HR-NBL survivors and 20 age-, sex-, and race-matched healthy reference participants. We assessed leg lean mass adjusted for leg length by DXA and strength using a Biodex dynamometer. Tibia bone microarchitecture was assessed via HR-pQCT scans at 4 % of tibia length and a cortical site at 30 %. We compared tibia length (cm), cortical and trabecular vBMD (mg HA/cm3), geometric and structural parameters between groups. Linear regression models assessed group differences in bone microarchitecture adjusted for leg lean mass.
Results:
Compared to reference participants, tibia length was significantly shorter in HR-NBL survivors (31.6 cm [27.7,39.5] vs. 36.1 cm [30.4,40], p < 0.005), consistent with significantly lower height Z-score in the HR-NBL cohort (p < 0.001). HR-NBL survivors demonstrated lower cortical area (178.3mm2 [121.9273.5] vs. 214.6mm2 [159.4326.9], p < 0.05) and cortical perimeter (60.0 mm [51.9,82.5] vs. 68.8 mm [57.7,90.8], p < 0.01). After adjusting for tibia length, these differences were no longer significant. Total, cortical, and trabecular volumetric BMD, were not significantly different between groups. Cortical geometry and peak torque deficits were associated with muscle deficits when adjusted for leg lean mass (p < 0.001).
Conclusion:
Bone density was not severely impacted in HR-NBL survivors. Muscle deficits persisted years after treatment and underscored cortical geometry deficits.
