Article Text

  1. N. K. Hetzer1,
  2. A. Favia2,
  3. R. K. Rude3,
  4. A. Nattiv1,
  5. A. Lomovtsev1,
  6. M.-G. Ascenzi1
  1. 1David Geffen School of Medicine, Department of Orthopaedic Surgery, Biomechanics Research, University of California at Los Angeles, Los Angeles, CA
  2. 2Department of Human Anatomy, University of Bari, Bari, Italy
  3. 3University of Southern California and the Orthopaedic Hospital, Los Angeles, CA.


Introduction Adequacy of bone tissue for mechanical function is currently assessed on patients by either DEXA or CT scan in vivo or by micro-CT on biopsies from the iliac crest. However, bone density per se does not fully describe bone tissue's quality. Attention to alteration of parameters that describe the microstructure of bone is required to be able to assess quality of tissue and predict occurrence of fractures. This study devises an analysis that assesses two of the microstructural parameters in the proximal femur: trabecular density and trabecular thickness.

Materials and Methods This study refers to donors of selected medical history free of metabolic agents that could alter the bone structure beyond the natural aging process. The femurs of nine Caucasian female donors aged 52 to 70 were subjected to DEXA scan to assess bone density in the currently employed regions: neck, Ward's triangle, greater trochanter, and intermediate. Such bone density data allowed classification of proximal femurs as either normal, osteopenic, or osteoporotic. After sectioning along a longitudinal plane through the center of the femoral head and along the femoral neck axis, 40× images were analyzed using vector graphic and analysis software. Trabecular density and trabecular thickness were assessed separately in selected regions by semiautomatic histomorphometry.

Results The parametric values for each of trabecular density and trabecular thickness vary significantly among anatomic sites at any given age. Decline with age occurs independently for trabecular density and trabecular thickness and is characteristic of site. Osteopenia and osteoporosis alter variations of trabecular density and trabecular thickness in terms of site and age.

Conclusion These findings point to the necessity for newly defined regions for DEXA and CT scan use to closely reflect the underlying microstructural characteristics. This will provide additional information on bone density relative to patient's bone quality.

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