BONEQUAL

Assessment of Bone Quality in Metabolic Bone Diseases

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 Obiettivo del progetto (Objective)

'Osteoporosis, currently diagnosed by measuring bone mineral density (BMD) using dual-energy X.-ray absorptiometry, is the most common metabolic bone disease in Europe. It results in highly increased fracture risk, which is not optimally predicted by BMD. Bisphosphonates are used for medical treatment of osteoporosis. They have an advantageous impact on bone microarchitecture, but long term treatment can lead to deterioration of bone structural integrity and increased fracture risk, despite high BMD. Several factors related to bone quality. i.e. bone architecture, geometry, turnover and mineralization and accumulation of microfractures contribute significantly to fracture risk. Development of new coherent methods for evaluating bone quality is necessary to improve diagnostics, and to monitor treatments and assessment of fracture risk. The aims are to 1) improve the understanding of bone quality in health and disease, 2) diagnose more effectively early osteoporosis and 3) predict more accurately fracture risk. Specifically, we assess the effects of aging, osteoporosis, and long term bisphosphonate treatment on structural, compositional and mechanical properties of trabecular bone from human cadavers. MicroCT is used to analyze trabecular microarchitecture and spatial BMD. Cellular events and bone remodeling processes are analyzed histomorphometrically. Microscopic and spectroscopic methods are used to study composition of organic and non-organic components. Also, novel backscattered ultrasound methods are used for trabecular bone diagnostics and to assess their feasibility for clinical practice. Interrelationships between bone characteristics will be addressed using statistical and modeling techniques. The techniques will provide quantitative information on bone quality, not previously possible. University of Kuopio provides excellent facilities to carry out this study, including well-known bone researchers (profs Jurvelin and Kröger), who will act as supervisors.'

Introduzione (Teaser)

Osteoporosis affects 30 % of post-menopausal women in the EU. European research has developed new diagnostic methods to improve the treatment of this debilitating disease.

Descrizione progetto (Article)

Osteoporosis is currently diagnosed by measuring bone mineral density (BMD) and treated with biphosphonates. Long-term treatment with biphosphonates can lead to deterioration of bone structural integrity and increased fracture risk despite high BMD.

There are many factors related to bone quality including bone architecture, geometry and accumulation of microfractures. Development of new methods to evaluate bone quality aim to improve diagnosis and to keep track of treatment effectiveness.

The 'Assessment of bone quality in metabolic bone diseases' (Bonequal) project aimed to assess the effects of ageing and osteoporosis on the structure, composition and mechanical properties of spongy or trabecular bone. To achieve this, Bonequal researchers took bone biopsies from cadavers of clinical patients who had suffered with metabolic bone diseases.

Bonequal scientists developed a new method to estimate the 3D shape of the femur based on a 2D BMD image combined with a template from a computerised tomography (CT) scan. Further development of this technology should provide a more sensitive assessment of fracture risk in osteoporosis.

From new methods developed to determine the viscoelastic properties of bone, Bonequal determined that viscoelasticity decreases with age, explaining increase in bone fragility in the elderly. Furthermore, the project scientists investigated infrared spectroscopic methods to pinpoint changes in bone composition in patients and have recommended this as a potentially valuable diagnostic tool.

For the future research path in quantitative imaging tools, Bonequal investigated the quality of image needed to separate structural parameters in spongy bone comparing normal with osteoporotic bone. Voxels of up to 100 micrometres must be used for the required resolution.

Bonequal have developed new imaging systems to diagnose the onset of osteoporosis at its earlier stages. Moreover, the novel technology gives an improved prediction of fracture risk.