Fracture Discrimination

It has been demonstrated that 3D cortical and trabecular bone measurements (3D-SHAPER®, Galgo Medical) can discriminate fractured patients from non-fractured patients. This is key to a long-term approach as knowing the status of both bone compartments would allow physicians to target and monitor the effects of the most relevant treatment. (see section on treatments).

Distribution of the average differences in cortical sBMD between Hip Fx and controls

Hip Fracture Discrimination: Dr Humbert and colleagues (CETIR, Pompeu Fabra University and Galgo Medical, Barcelona, Spain) presented a retrospective case-control study demonstrating the association of 3D-SHAPER® measurements with hip fracture in 64 post-menopausal women compared to age-matched controls followed for 6 years.

If both the cortical and trabecular compartments were impaired and significantly lower in fractured patients, the trabecular compartment appeared as the best predictor of fracture.

Indeed, differences between hip fractured patients and controls in volumetric BMD, as measured by 3D-SHAPER®, were more pronounced in the trabecular compartment (-23.3%) than in the cortex (-8.2%).

The area under the receiver operating curve was 0.742 for trabecular volumetric BMD, 0.706 for cortical volumetric BMD and 0.712 for total hip areal BMD.

Also, differences in the cortex were locally more pronounced at the medial aspect of the shaft, the lateral aspect of the greater trochanter, and the superolateral aspect of the neck. And marked differences in volumetric BMD were observed in the greater trochanter.

Reference: “DXA-based 3D analysis of the cortical and trabecular bone of hip fracture postmenopausal women: a case-control study”, L. Humbert et al.

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Distribution of the average differences in vBMD between Hip Fx and controls observed in the mid coronal plane

Differences are shown in the mid-coronal plane (bottom left), neck (top right), intertrochanteric region (middle right) and shaft (bottom right)

Vertebral Fracture Discrimination: In 2017, Dra Galich (Hospital Italiano de Buenos Aires, Argentina) presented a multicentric study, analyzing the association of vertebral fractures with cortical and trabecular bone of the femur, as assessed by 3D-SHAPER®, in 29 fractured patients and 133 controls. The results suggested that the trabecular volumetric density was the best predictor of fracture, even in the context of vertebral fractures, and that 3D-SHAPER® measurements at the hip could be useful to better manage patients at risk of future osteoporotic fracture, including vertebral fractures.

Reference: “Analyzing the cortical and trabecular bone of the femur of patients with vertebral fractures using DXA-based 3D modeling” ASBMR 2017, Galich et al.

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