Search

The social costs of osteoporosis are huge and keep growing because of increased life expectancy. Although a low bone mineral density is considered to be associated with a higher risk of fracture, densitometry alone has been shown to be inadequate to predict a significant number of fractures, hence the need to develop innovative and inexpensive diagnostic methods to be used together with the consolidated systems. The Bone Structure Index is computed using a patented technique that virtually simulates the application of compressive loads on the trabecular structure’s reconstructions obtained from the patient’s digital radiographs. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. This configuration presents specific advantages but the use of a handheld portable X-ray device requires safety procedures specifically designed to protect the operator and the patient, which are discussed in the present paper.

Early phase endocrine-expansive breast and prostate cancers are treated with post-operative adjuvant hormonal therapies and chemotherapeutic drugs that have a negative impact on bone heath, blocking estrogen or androgen activity and increasing bone turnover leading to a progressively higher risk of fractures. At present, DXA monitoring of bone loss is widely recommended in prostate and breast cancer patients, but most fractures occur in patients whose DXA result falls outside the osteoporosis ranges, indicating that DXA might not be the elective exam for evaluating the degree of fracture risk in terms of microarchitecture alterations. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure. In this work, we discuss the preliminary results obtained in the evaluation of the BSI in female patients undergoing breast cancer treatment

It has been recently estimated that about 30% of women and 20% of men over 50 will develop osteoporosis, a disease characterized by decreasing bone strength. Although low bone mineral density is generally associated with higher fracture risk, the spatial arrangement of the trabecular structure is a second key factor of bone resistance [1] and about 40-60% of the fractures affect people that can be considered at moderate risk on the basis of densitometry (DXA) assessment alone [2, 3]. Hence the need to develop innovative and low-cost diagnostic methods that can be used together with the consolidated systems. The recently introduced Bone Structure Index (BSI) gives an indication of the quality of the bone structure: it measures the weight-bearing capacity of the bone structure, evaluated from simulated application of loads on a virtual biopsy of the patient. The bone structure images are acquired by planar radiograms in the proximal epiphysis of the three central proximal phalanges of the non-dominant hand, a peripheral site of the human body [4-7]. In this work, we describe a recent application of the BSI in a clinical setting.

Osteoporosis is a silent disease, characterized by a decreasing bone strength, which leads to a progressive increase in fracture risk. As mean average human lifespan is growing, a parallel rise in the rate of osteoporosis is observed. Currently, diagnosis is made on the basis of bone mineral density, which seems to be a poor fracture predictor in about 40-50% of cases, and of clinical risk factors, but the trabecular structure arrangement should be evaluated as well. The BSI (Bone Structure Index) is a new index computed from simulated application of loads on a virtual biopsy of the patient. In this work, we aim to identify the distributions of BSI and of fragility fracture risk factors recognized by the scientific community in a population of over 300 female volunteers.

Sebbene l'osso trabecolare rappresenti solo il 20% dello scheletro, la resistenza dell’osso è fortemente influenzata, oltre che dalla densità, anche dalla micro-architettura della struttura trabecolare. Un metodo diagnostico innovativo di recente introduzione, BESTEST®, mediante il BSI (Bone Structure Index) misura la risposta elastica alle sollecitazioni da parte della struttura ossea, ricavata da simulazioni di carico condotte con metodi ingegneristici su una biopsia virtuale del paziente, ottenuta da radiogrammi planari dell'epifisi prossimale della mano. I risultati dell’esame sono espressi in termini statistici, BSI_T-score e BSI_Z-score, di significato analogo ma non correlati a quelli utilizzati in densitometria. È ben noto che i regolatori ipofisari, gli inibitori dell'aromatasi e il tamoxifene nelle donne in pre-menopausa e i chemioterapici hanno tutti un impatto negativo sulla salute delle ossa poiché, bloccando l'attività degli estrogeni o degli androgeni, aumentano il turnover osseo portando ad un rischio crescente di fratture. L'incidenza globale del rischio di fratture nei pazienti in trattamento ormonale per carcinoma mammario varia dall'1,37% all'11%. In questo lavoro, vengono discussi i risultati preliminari ottenuti nella valutazione del BSI_T-score in 100 pazienti di sesso femminile sottoposte a trattamento per carcinoma del seno. I risultati dimostrano che la micro-architettura ossea è effettivamente influenzata dal trattamento oncologico e che il BESTEST® può fornire un prezioso aiuto alla densitometria nella valutazione di queste alterazioni, specialmente quando associate a fratture. Questo studio preliminare fornisce inoltre una base razionale per ulteriori e più approfondite indagini sull'uso di questa nuova tecnica, rapida e sicura, per monitorare l'effetto delle terapie contro il cancro della mammella sulle alterazioni della micro-architettura ossea.

Osteoporosis (OP) is a silent disease, characterized by a decreasing bone strength, which leads to a progressive increase in fracture risk. Mechanical properties of bone depend on both its composition and its trabecular component micro-architectural arrangement. OP diagnosis is made on the basis of bone mineral density (BMD), possibly combined with algorithms based on the clinical risk factors, e.g. FRAX®, but about half of those at risk of OP still go undetected, since their OP risk is linked to alterations of the trabecular architecture. The BESTEST® is a test based on the simulated application of loads on a virtual biopsy of the patient. Briefly, the test uses planar X-rays projections to assess the mechanical properties of the patient’s trabecular bone tissue. In this work, we aim to identify the distributions of fragility fracture risk factors in a population of female volunteers.

Densitometry alone has been shown to be inadequate to predict all osteoporotic fractures, since 40-50% occur in people who do not have a low bone density. The BESTEST®, Bone Elastic Structure Test, virtually simulates compressive loads on the trabecular architecture’s reconstructions obtained from digital radiographs of first proximal epiphyses of the non-dominant hand. The radiograms are acquired by a hand-held portable x-ray system equipped with a digital sensor. While in certain cases these systems present risks that are no greater than with standard systems, issues related to: (i) position of the handheld X-ray device relative to the operator, (ii) risk of misalignment of the X-ray units during exposure, (iii) patient protection and (iv) correct positioning of the sensor must still be addressed. A special stand and a customized sensor holder have been therefore designed, so that safety for patient and operator and repeatability of the exam have been improved.

“Why should a professor of mechanical engineering decide to study bone tissue? Well, simply because she is interested in preventing any kind of breakage, and fractures are not an exception!” I think enabling structures to resist the applied loads is an innate desire of all engineers. The complex and highly organized inner architecture of bones makes this challenge even more exciting. In such a complex material, loss of bone mass alone cannot justify all osteoporosis-related fractures. Being aware of this I decided to focus my research on the fracture risk assessment and the impact of the complex trabecular structure of bone on internal force distribution, the ultimate goal being to improve knowledge of each patient’s specific conditions.

Osteoporosis is a very common disease in which the bones become weak and easily break. Besides the serious impact on a person’s health and quality of life, osteoporosis results in important costs for society. The current diagnosis considers the bone quantity, as evaluated by bone mineral density assessments, and the clinical risk factors, but cannot take into account the bone quality, defined as the structural soundness of the trabecular arrangement. An approach based on the numerical modeling of the behavior of bone architectures, acquired by planar radiograms in the proximal phalanges of the non-dominant hand, has been developed at the University of Trieste. The Bone Structure Index, BSI, summarizes the simulations results for the purpose of bone quality ranking in the clinical evaluation. In this work, we discuss the preliminary design of a portable low dose x-ray scanner intended to be used as a low cost, user-friendly device for imaging the trabecular pattern and for providing a radiogram suitable for BSI evaluation. As an example, two cases in which the chosen device is used to evaluate the BSI are also reported.

L'osteoporosi è una malattia silente ma molto comune e in rapida crescita visto l’allungarsi della vita, caratterizzata da una diminuzione della resistenza ossea, che porta ad un progressivo aumento del rischio di frattura. Attualmente, la diagnosi viene fatta sulla base della densità minerale ossea, che però nel 40-50% dei casi non è in grado di prevedere le fratture, e dei fattori di rischio clinici, ma non viene valutata la solidità strutturale della disposizione trabecolare. Il Bone Structure Index (BSI) nasce per dare un’indicazione clinica sulla qualità, cioè sulla capacità portante, della struttura trabecolare ed è in grado di aiutare a identificare i soggetti a rischio, integrando gli strumenti attualmente in uso a costi estremamente contenuti. In questo lavoro, ci proponiamo di identificare la distribuzione del BSI in una popolazione di oltre 300 volontari di sesso femminile e di discutere i fattori di rischio di frattura fragile riconosciuti dalla comunità scientifica

Osteoporosis (OP) is a very common disease in which the bones become weak and are more likely to break. Despite the huge costs in the EU and worldwide, the majority of individuals who have sustained an osteoporosis-related fracture or who are at high risk of fracture are left untreated. In effect, OP is a silent disease, with bones deteriorating without warning until fracture, and the current screening modalities are not significantly better than age alone, also because they consider only the bone quantity (bone mineral density, BMD) and the clinical risk factors, but disregard the bone quality, that is the structural soundness of the trabecular arrangement, which can be evaluated by simulations on virtual models. While 3D models can only be used in research because of high costs, an alternative approach based on the acquisition of planar hand radiograms for bone behaviour simulations, and the use of a Structural Index, SI, for bone quality ranking, have been developed at the University of Trieste. In this work, we discuss the preliminary design of a portable low dose X-ray hand scanner to be used as a low cost, user-friendly device (Fig.1) for imaging the trabecular pattern in the proximal phalanges of the non-dominant hand and for providing a radiogram suitable for the SI evaluation.