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Young adults with cystic fibrosis have altered trabecular microstructure by ITS-based morphological analysis

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Abstract

Summary

Young adults with cystic fibrosis have compromised plate-like trabecular microstructure, altered axial alignment of trabeculae, and reduced connectivity between trabeculae that may contribute to the reduced bone strength and increased fracture risk observed in this patient population.

Introduction

The risk of fracture is increased in patients with cystic fibrosis (CF). Individual trabecular segmentation (ITS)-based morphological analysis of high-resolution peripheral quantitative computed tomography (HR-pQCT) images segments trabecular bone into individual plates and rods of different alignment and connectivity, which are important determinants of trabecular bone strength. We sought to determine whether alterations in ITS variables are present in patients with CF and may help explain their increased fracture risk.

Methods

Thirty patients with CF ages 18–40 years underwent DXA scans of the hip and spine and HR-pQCT scans of the radius and tibia with further assessment of trabecular microstructure by ITS. These CF patients were compared with 60 healthy controls matched for age (±2 years), race, and gender.

Results

Plate volume fraction, thickness, and density as well as plate-plate and plate-rod connectivity were reduced, and axial alignment of trabeculae was lower in subjects with CF at both the radius and the tibia (p < 0.05 for all). At the radius, adjustment for BMI eliminated most of these differences. At the tibia, however, reductions in plate volume fraction and number, axially aligned trabeculae, and plate-plate connectivity remained significant after adjustment for BMI alone and for BMI and aBMD (p < 0.05 for all).

Conclusions

Young adults with CF have compromised plate-like and axially aligned trabecular morphology and reduced connectivity between trabeculae. ITS analysis provides unique information about bone integrity, and these trabecular deficits may help explain the increased fracture risk in adults with CF not accounted for by BMD and/or traditional bone microarchitecture measurements.

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Acknowledgments

ITS images were generously created by X. Edward Guo, PhD, and Ji Wang, PhD, at Columbia University. This study was supported in part by an Endocrine Society Amgen Fellowship Award, NIH T32 DK007699-29, and NIH K23 DK102600-01A1. A Vertex Pharmaceuticals Investigator Initiated Studies Grant provided partial support for procedures in this study. The HR-pQCT measurements were made possible by an NCRR Shared Equipment Grant (1S10RR023405-01). This project was also supported by the Harvard Clinical and Translational Science Center (Grant Numbers 8 UL1 TR000170-05, 1 UL1TR001102-01, and 1 UL1RR025758-04). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The authors gratefully acknowledge the support of the dedicated staff of the MGH Clinical Research Center, and the Research Groups of the MGH and BCH CF Centers.

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Authors and Affiliations

  1. Endocrine Unit, Department of Medicine, Massachusetts General Hospital, 50 Blossom Street, THR-1051, Boston, MA, 02114, USA

    M. S. Putman, L. B. Greenblatt, M. L. Bouxsein & J. S. Finkelstein

  2. Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA

    M. S. Putman

  3. Pulmonary Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    L. Sicilian

  4. Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, USA

    A. Uluer & G. Sawicki

  5. Pulmonary Division, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA

    A. Lapey

  6. Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    C. M. Gordon

  7. Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA

    M. L. Bouxsein

  8. Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA

    M. L. Bouxsein

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  1. M. S. Putman
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Putman, M.S., Greenblatt, L.B., Sicilian, L. et al. Young adults with cystic fibrosis have altered trabecular microstructure by ITS-based morphological analysis. Osteoporos Int 27, 2497–2505 (2016). https://doi.org/10.1007/s00198-016-3557-z

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