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Semin Musculoskelet Radiol 2022; 26(04): 478-490
DOI: 10.1055/s-0042-1754340
Review Article

Imaging of Metabolic Bone Diseases: The Spine View, Part I

Alberto Bazzocchi
1   Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
,
Amanda Isaac
2   School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
,
Danoob Dalili
3   Academic Surgical Unit, South West London Elective Orthopaedic Centre (SWLEOC), Epsom, London, United Kingdom
4   Department of Diagnostic and Interventional Radiology, Epsom and St. Helier University Hospitals NHS Trust, London, United Kingdom
,
Anastasia Fotiadou
5   Royal National Orthopaedic Hospital, Stanmore, United Kingdom
,
Eleni P. Kariki
6   Manchester University NHS Foundation Trust, Manchester, United Kingdom
7   Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
,
Jan S. Kirschke
8   Interventional und Diagnostic Neuroradiology, School of Medicine, Technical University Munich, Munich, Germany
,
Christian R. Krestan
9   Department of Radiology, Favoriten Hospital, Vienna, Austria
,
Carmelo Messina
10   IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
,
Edwin H.G. Oei
11   Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Catherine M. Phan
12   Service de Radiologie Ostéo-Articulaire, APHP, Nord-Université de Paris, Hôpital Lariboisière, Paris, France
,
Mahesh Prakash
13   Department of Radiodiagnosis & Imaging, PGIMER, Chandigarh, India
,
Nuran Sabir
14   Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
,
Alberto Tagliafico
15   DISSAL, University of Genova, Genoa, Italy
16   Ospedale Policlinico San Martino, Genova, Italy
,
Francisco Aparisi
17   Department of Radiology, Hospital Vithas Nueve de Octubre, Valencia, Spain
,
Thomas Baum
18   Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
,
Thomas M. Link
19   Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California
,
Giuseppe Guglielmi
20   Department of Radiology, University of Foggia, Foggia, Italy
,
Maria Pilar Aparisi Gómez
21   Department of Radiology, Auckland City Hospital, Auckland, New Zealand
22   Department of Radiology, IMSKE, Valencia, Spain
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Abstract

Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).

This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.

We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.

Keywords

osteoporosis - vertebral fractures - dual-energy X-ray absorptiometry - quantitative computed tomography - radiofrequency echographic multi spectrometry


Publication History

Article published online:
14 September 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Kanis JA, McCloskey EV, Johansson H, Cooper C, Rizzoli R, Reginster JY. Scientific Advisory Board of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and the Committee of Scientific Advisors of the International Osteoporosis Foundation (IOF). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 2013; 24 (01) 23-57
    CrossrefPubMedGoogle Scholar
  • 2 Hernlund E, Svedbom A, Ivergård M. et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 2013; 8 (1–2): 136
    CrossrefPubMedGoogle Scholar
  • 3 Guglielmi G, Muscarella S, Bazzocchi A. Integrated imaging approach to osteoporosis: state-of-the-art review and update. Radiographics 2011; 31 (05) 1343-1364
    CrossrefPubMedGoogle Scholar
  • 4 Cauley JA, Hochberg MC, Lui LY. et al. Long-term risk of incident vertebral fractures. JAMA 2007; 298 (23) 2761-2767
    CrossrefPubMedGoogle Scholar
  • 5 Bennett J, Suliburk JW, Morón FE. Osseous manifestations of primary hyperparathyroidism: imaging findings. Int J Endocrinol 2020; 2020: 3146535
    CrossrefPubMedGoogle Scholar
  • 6 Murphey MD, Sartoris DJ, Quale JL, Pathria MN, Martin NL. Musculoskeletal manifestations of chronic renal insufficiency. Radiographics 1993; 13 (02) 357-379
    CrossrefPubMedGoogle Scholar
  • 7 Theodorou DJ, Theodorou SJ, Kakitsubata Y. Imaging of Paget disease of bone and its musculoskeletal complications: review. AJR Am J Roentgenol 2011; 196 (6, Suppl): S64-S75
    CrossrefPubMedGoogle Scholar
  • 8 Aparisi Gómez MP, Trisolino G, Sangiorgi L, Guglielmi G, Bazzocchi A. Imaging of congenital skeletal disorders. Semin Musculoskelet Radiol 2021; 25 (01) 22-38
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging findings of metabolic bone disease. Radiographics 2016; 36 (06) 1871-1887
    CrossrefPubMedGoogle Scholar
  • 10 Messina C, Sconfienza LM, Bandirali M, Guglielmi G, Ulivieri FM. Adult dual-energy X-ray absorptiometry in clinical practice: how I report it. Semin Musculoskelet Radiol 2016; 20 (03) 246-253
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions Part 2: Trabecular bone score. J Clin Densitom 2015; 18 (03) 309-330
    CrossrefPubMedGoogle Scholar
  • 12 Broy SB, Cauley JA, Lewiecki ME, Schousboe JT, Shepherd JA, Leslie WD. Fracture risk prediction by non-BMD DXA measures: the 2015 ISCD official positions Part 1: Hip geometry. J Clin Densitom 2015; 18 (03) 287-308
    CrossrefPubMedGoogle Scholar
  • 13 Ulivieri FM, Rinaudo L. Beyond bone mineral density: a new dual X-ray absorptiometry index of bone strength to predict fragility fractures, the Bone Strain Index. Front Med (Lausanne) 2021; 7: 590139
    CrossrefPubMedGoogle Scholar
  • 14 Messina C, Rinaudo L, Cesana BM. et al. Prediction of osteoporotic fragility re-fracture with lumbar spine DXA-based derived bone strain index: a multicenter validation study. Osteoporos Int 2021; 32 (01) 85-91
    CrossrefPubMedGoogle Scholar
  • 15 Tabacco G, Naciu AM, Messina C. et al. DXA-based Bone Strain Index: a new tool to evaluate bone quality in primary hyperparathyroidism. J Clin Endocrinol Metab 2021; 106 (08) 2304-2312
    CrossrefPubMedGoogle Scholar
  • 16 McCloskey EV, Odén A, Harvey NC. et al. A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX. J Bone Miner Res 2016; 31 (05) 940-948
    CrossrefPubMedGoogle Scholar
  • 17 Bandirali M, Poloni A, Sconfienza LM. et al. Short-term precision assessment of trabecular bone score and bone mineral density using dual-energy X-ray absorptiometry with different scan modes: an in vivo study. Eur Radiol 2015; 25 (07) 2194-2198
    CrossrefPubMedGoogle Scholar
  • 18 Krohn K, Schwartz EN, Chung YS, Lewiecki EM. Dual-energy X-ray absorptiometry monitoring with Trabecular Bone Score: 2019 ISCD official position. J Clin Densitom 2019; 22 (04) 501-505
    CrossrefPubMedGoogle Scholar
  • 19 Li N, Li XM, Xu L, Sun WJ, Cheng XG, Tian W. Comparison of QCT and DXA: osteoporosis detection rates in postmenopausal women. Int J Endocrinol 2013; 2013: 895474
    PubMedGoogle Scholar
  • 20 Adams JE. Quantitative computed tomography. Eur J Radiol 2009; 71 (03) 415-424
    CrossrefPubMedGoogle Scholar
  • 21 Shuhart CR, Yeap SS, Anderson PA. et al. Executive summary of the 2019 ISCD Position Development Conference on Monitoring Treatment, DXA Cross-calibration and Least Significant Change, Spinal Cord Injury, Peri-prosthetic and Orthopedic Bone Health, Transgender Medicine, and Pediatrics. J Clin Densitom 2019; 22 (04) 453-471
    CrossrefPubMedGoogle Scholar
  • 22 Yu W, Glüer CC, Grampp S. et al. Spinal bone mineral assessment in postmenopausal women: a comparison between dual X-ray absorptiometry and quantitative computed tomography. Osteoporos Int 1995; 5 (06) 433-439
    CrossrefPubMedGoogle Scholar
  • 23 Engelke K, Adams JE, Armbrecht G. et al. Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults: the 2007 ISCD Official Positions. J Clin Densitom 2008; 11 (01) 123-162
    CrossrefPubMedGoogle Scholar
  • 24 Lang TF, Li J, Harris ST, Genant HK. Assessment of vertebral bone mineral density using volumetric quantitative CT. J Comput Assist Tomogr 1999; 23 (01) 130-137
    CrossrefPubMedGoogle Scholar
  • 25 Krug R, Carballido-Gamio J, Burghardt AJ. et al. Assessment of trabecular bone structure comparing magnetic resonance imaging at 3 Tesla with high-resolution peripheral quantitative computed tomography ex vivo and in vivo. Osteoporos Int 2008; 19 (05) 653-661
    CrossrefPubMedGoogle Scholar
  • 26 Krug R, Stehling C, Kelley DAC, Majumdar S, Link TM. Imaging of the musculoskeletal system in vivo using ultra-high field magnetic resonance at 7 T. Invest Radiol 2009; 44 (09) 613-618
    CrossrefPubMedGoogle Scholar
  • 27 Krug R, Burghardt AJ, Majumdar S, Link TM. High-resolution imaging techniques for the assessment of osteoporosis. Radiol Clin North Am 2010; 48 (03) 601-621
    CrossrefPubMedGoogle Scholar
  • 28 Fazeli PK, Horowitz MC, MacDougald OA. et al. Marrow fat and bone—new perspectives. J Clin Endocrinol Metab 2013; 98 (03) 935-945
    CrossrefPubMedGoogle Scholar
  • 29 Soldati E, Rossi F, Vicente J. et al. Survey of MRI usefulness for the clinical assessment of bone microstructure. Int J Mol Sci 2021; 22 (05) 2509
    CrossrefPubMedGoogle Scholar
  • 30 Bandirali M, Di Leo G, Papini GDE. et al. A new diagnostic score to detect osteoporosis in patients undergoing lumbar spine MRI. Eur Radiol 2015; 25 (10) 2951-2959
    CrossrefPubMedGoogle Scholar
  • 31 Ehresman J, Schilling A, Yang X. et al. Vertebral bone quality score predicts fragility fractures independently of bone mineral density. Spine J 2021; 21 (01) 20-27
    CrossrefPubMedGoogle Scholar
  • 32 Caffarelli C, Tomai Pitinca MD, Al Refaie A, Ceccarelli E, Gonnelli S. Ability of radiofrequency echographic multispectrometry to identify osteoporosis status in elderly women with type 2 diabetes. Aging Clin Exp Res 2022; 34 (01) 121-127
    CrossrefPubMedGoogle Scholar
  • 33 Diez-Perez A, Brandi ML, Al-Daghri N. et al. Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art-outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res 2019; 31 (10) 1375-1389
    CrossrefPubMedGoogle Scholar
  • 34 Wang CY, Chu SY, Lin YC. et al. Quantitative imaging of ultrasound backscattered signals with information entropy for bone microstructure characterization. Sci Rep 2022; 12 (01) 414
    CrossrefPubMedGoogle Scholar
  • 35 Cho S, Park HS, Kim DY, Kim CH, Chung RK, Kim YJ. Percutaneous sacroplasty under fluoroscopic guidance combined with epidurogram for sacral insufficiency fracture resulting from metastatic tumor and osteoporosis. Pain Physician 2016; 19 (03) E473-E480
    PubMedGoogle Scholar
  • 36 Tsoumakidou G, Too CW, Koch G. et al. CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol 2017; 40 (03) 331-342
    CrossrefPubMedGoogle Scholar
  • 37 Vanni D, Pantalone A, Magliani V, Salini V, Berjano P. Corpectomy and expandable cage replacement versus third generation percutaneous augmentation system in case of vertebra plana: rationale and recommendations. J Spine Surg 2017; 3 (03) 379-386
    CrossrefPubMedGoogle Scholar
  • 38 Yang JS, Zou P, Chai X, Li QD, Zhao YT, Hao DJ. In response to RE: “Can Additional Facet Joint Block Improve the Clinical Outcome of Kyphoplasty for Acute Osteoporotic Vertebral Compression Fractures?”. Pain Physician 2021; 24 (06) E898
    CrossrefPubMedGoogle Scholar
  • 39 Klazen CAH, Lohle PNM, de Vries J. et al. Vertebroplasty versus conservative treatment in acute osteoporotic vertebral compression fractures (Vertos II): an open-label randomised trial. Lancet 2010; 376 (9746): 1085-1092
    CrossrefPubMedGoogle Scholar
  • 40 McConnell Jr CT, Wippold II FJ, Ray Jr CE. et al. ACR appropriateness criteria management of vertebral compression fractures. J Am Coll Radiol 2014; 11 (08) 757-763
    CrossrefPubMedGoogle Scholar