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      HR-pQCT imaging in children, adolescents and young adults: Systematic review and subgroup meta-analysis of normative data

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          Abstract

          We aimed to investigate the methodologies on image acquisition of normative data of high-resolution peripheral quantitative computed tomography (HR-pQCT) in children, adolescents and/or young adults (up to 25 years) and to determine their normative data based on available literature. A literature search was conducted in MEDLINE, EMBASE and Web of Science from 1947 to July 2019. Quality of articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and Modified Newcastle-Ottawa scale (NOS). Articles which fitted the following criteria were combined to meta-analysis: age range (15 to 22.6 years), references at tibia (22.5mm) and/or radius (9.0 to 9.5mm). Eight articles were ultimately included in the systematic review and 4 of them that filled the criteria were summarised in meta-analysis. The results of random effects model of HR-pQCT parameters of the 4 articles were as follows: 1)Radius: bone volume fraction (BT/BV) [estimate 0.17:0.1229(lower)-0.2115 (upper); trabecular number (Tb_N):2.08(2.03–2.12); trabecular thickness (Tb.Th):0.07 (0.07–0.0.08); trabecular separation (Tb.Sp):0.41 (0.38–0.42); cortical thickness (Ct.Th):0.85 (0.76–0.94); cortical porosity (Ct.Po):1.53 (0.63–2.44); total area (Tt.Ar):263.66(-385.3–912.6); total bone density (Tt-vBMD):280.5 (73.1–487.7); Trabecular density (Tb-vBMD):223.6 (47.1–400.09), and cortical density (CT.vBMD):765.9 (389.1–1142.8). 2)Tibia: BT/BV:0.18 (0.17–0.19); Tb_N:2.02 (1.83–2.2); Tb.Th:0.08 (0.80–0.09); Tb.Sp:0.40(0.36–0.44); Ct.Th:1.32(1.26–1.38); Ct.Po:3.15 (1.1–5.2); Tt.Ar:693.1(150.2–1235.8); Tt-vBMD:343.76 (335.5–352.1); Tb-vBMD:223.6 (213.37 (193.5–233.2), and CT.vBMD:894.3 (857.6–931.1). There is overall ‘fair’ evidence on reporting of results of normative data of HR-pQCT parameters in children, adolescents and/or young adults. However, data are scarce pointing out to the urgent need for standardization of acquisition parameters and guidelines on the use of HR-PQCT in these populations.

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          The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.

          Alessandro Liberati, Douglas G Altman, Jennifer Tetzlaff … (2009)
          Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions. The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
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            Accuracy of high-resolution peripheral quantitative computed tomography for measurement of bone quality.

            Eric Boyd, Craig Macneil (2007)
            The introduction of three-dimensional high-resolution peripheral in vivo quantitative computed tomography (HR-pQCT) (XtremeCT, Scanco Medical, Switzerland; voxel size 82 microm) provides a new approach to monitor micro-architectural bone changes longitudinally. The accuracy of HR-pQCT for three important determinants of bone quality, including bone mineral density (BMD), architectural measurements and bone mechanics, was determined through a comparison with micro-computed tomography (microCT) and dual energy X-ray absorptiometry (DXA). Forty measurements from 10 cadaver radii with low bone mass were scanned using the three modalities, and image registration was used for 3D data to ensure identical regions were analyzed. The areal BMD of DXA correlated well with volumetric BMD by HR-pQCT despite differences in dimensionality (R(2) = 0.69), and the correlation improved when non-dimensional bone mineral content was assessed (R(2) = 0.80). Morphological parameters measured by HR-pQCT in a standard patient analysis, including bone volume ratio, trabecular number, derived trabecular thickness, derived trabecular separation, and cortical thickness correlated well with muCT measures (R(2) = 0.59-0.96). Additionally, some non-metric parameters such as connectivity density (R(2) = 0.90) performed well. The mechanical stiffness assessed by finite element analysis of HR-pQCT images was generally higher than for microCT data due to resolution differences, and correlated well at the continuum level (R(2) = 0.73). The validation here of HR-pQCT against gold-standards microCT and DXA provides insight into the accuracy of the system, and suggests that in addition to the standard patient protocol, additional indices of bone quality including connectivity density and mechanical stiffness may be appropriate to include as part of a standard patient analysis for clinical monitoring of bone quality.
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              Bone microarchitecture is impaired in adolescent amenorrheic athletes compared with eumenorrheic athletes and nonathletic controls.

              Nara Mendes, Melissa Russell, William E. Ackerman … (2011)
              Bone mineral density (BMD) is lower in young amenorrheic athletes (AA) compared to eumenorrheic athletes (EA) and nonathletic controls and may contribute to fracture risk during a critical time of bone accrual. Abnormal bone microarchitecture is an independent determinant of fracture risk and has not been assessed in young athletes and nonathletes. We hypothesized that bone microarchitecture is impaired in AA compared to EA and nonathletes despite weight-bearing exercise. We conducted this cross-sectional study at the Clinical Research Center of Massachusetts General Hospital. We assessed BMD and bone microarchitecture in 50 subjects [16 AA, 18 EA, and 16 nonathletes (15-21 yr old)] using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Groups did not differ for chronological age, bone age, body mass index, or vitamin D levels. Lumbar BMD Z-scores were lower in AA vs. EA and nonathletes; hip and femoral neck BMD Z-scores were highest in EA. At the weight-bearing tibia, athletes had greater total area, trabecular area, and cortical perimeter than nonathletes, whereas cortical area and thickness trended lower in AA. Trabecular number was lower and trabecular separation higher in AA vs. EA and nonathletes. At the non-weight-bearing radius, trabecular density was lower in AA vs. EA and nonathletes. Later menarchal age was an important determinant of impaired microarchitecture. After controlling for covariates, subject grouping accounted for 18-24% of the variability in tibial trabecular number and separation. In addition to low BMD, AA have impaired bone microarchitecture compared with EA and nonathletes. These are the first data to show abnormal bone microarchitecture in AA.
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                Author and article information

                Contributors
                Daddy Mata-Mbemba:
                ORCID: http://orcid.org/0000-0002-0031-6473
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Taryn Rohringer: Role: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Ala Ibrahim: Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Thomasin Adams-Webberc: Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Rahim Moineddin: Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Andrea S. Doria: Role: Data curationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Reza Vali: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – review & editing
                Wisit Cheungpasitporn: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 13 December 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 12
                Electronic Location Identifier: e0225663
                Affiliations
                [1 ] Department of Diagnostic Imaging, IWK Health Centre, and Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
                [2 ] Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
                [3 ] University of Toronto, Toronto, Canada
                [4 ] Hospital Library and Archives (T.A.W.), Hospital for Sick Children, Toronto, Canada
                [5 ] Departments of Family and Community Medicine (R.M.), University of Toronto, Toronto, Canada
                University of Mississippi Medical Center, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-0031-6473
                Article
                Publisher ID: PONE-D-19-16974
                DOI: 10.1371/journal.pone.0225663
                PMC ID: 6910691
                PubMed ID: 31834887
                SO-VID: 8ace7a08-1e52-4f4e-85d1-dde4c30aade4
                Copyright © © 2019 Mata-Mbemba et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 14 June 2019
                Date accepted : 8 November 2019
                Page count
                Figures: 1, Tables: 5, Pages: 15
                Funding
                The author(s) received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Bone
                Subject: Bone Density
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Bone
                Subject: Bone Density
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Bone
                Subject: Bone Density
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Biological Tissue
                Subject: Connective Tissue
                Subject: Bone
                Subject: Bone Density
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Tibia
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Musculoskeletal System
                Subject: Skeleton
                Subject: Tibia
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Young Adults
                Subject: Research and Analysis Methods
                Subject: Mathematical and Statistical Techniques
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Physical Sciences
                Subject: Mathematics
                Subject: Statistics
                Subject: Statistical Methods
                Subject: Metaanalysis
                Subject: Medicine and Health Sciences
                Subject: Pediatrics
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: Adolescents
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: Adolescents
                Subject: Research and Analysis Methods
                Subject: Research Assessment
                Subject: Systematic Reviews
                Subject: Computer and Information Sciences
                Subject: Data Acquisition
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.

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