Women with anorexia nervosa: finite element and trabecular structure analysis by using flat-panel volume CT.
OBJECTIVE
To use finite element modeling based on flat-panel volume computed tomography (CT) and bone mineral density (BMD) provided by dual-energy x-ray absorptiometry (DXA) to compare bone failure load, stiffness, and trabecular structure in women with anorexia nervosa (AN) and age-matched normal-weight control subjects.


METHODS
The study was approved by the institutional review board and complied with HIPAA guidelines. Informed consent was obtained. Fourteen women, eight with AN (mean age, 26.6 years) and six control subjects (mean age, 26.3 years), underwent flat-panel volume CT of the distal radius to determine apparent trabecular bone volume fraction (BV/TV), apparent trabecular number (TbN), apparent trabecular thickness (TbTh), and apparent trabecular separation (TbSp). Bone strength and stiffness were calculated from uniaxial compression tests by using finite element models created from flat-panel volume CT. DXA was used to determine BMD of the radius, lumbar spine, and hip. Means ± standard deviations of all variables were calculated for both groups and compared (Student t test). Univariate regression analysis and stepwise regression modeling were performed.


RESULTS
Patients with AN had lower values for stiffness (284.77 kN/mm ± 76.14 vs 389.97 kN/mm ± 84.90, P = .04), failure load (4.98 kN ± 1.23 vs 7.01 kN ± 1.52, P = .02), BV/TV (0.32% ± 0.09 vs 0.44% ± 0.02, P = .007), and TbN (1.15 mm(-3) ± 0.20 vs 1.43 mm(-3) ± 0.13, P = .008) and higher values for TbSp (0.62 mm ± 0.20 vs 0.40 mm ± 0.04, P = .02) compared with normal-weight control subjects. TbTh was lower in women with AN (P = .1). BMD measurements were significantly lower for the AN group. BMD measurements and trabecular parameters (except TbTh) correlated with stiffness and failure load (r = 0.58 to 0.83).


CONCLUSIONS
Failure load and stiffness are abnormal in women with AN compared with those in normal-weight control subjects and correlate with BMD and trabecular parameters.
Walsh
Conor J
CJ
Department of Mechanical Engineering, Massachusetts Institute of Technology, Room 3-470, Cambridge, MA 02139, USA. walshcj@alm.mit.edu
Phan
Catherine M
CM
Misra
Madhusmita
M
Bredella
Miriam A
MA
Miller
Karen K
KK
Fazeli
Pouneh K
PK
Bayraktar
Harun H
HH
Klibanski
Anne
A
Gupta
Rajiv
R
D015502:Absorptiometry, Photon; D000328:Adult; D000856:Anorexia Nervosa / Q000000981:diagnostic imaging*; D015519:Bone Density; D016022:Case-Control Studies; D005260:Female; D020342:Finite Element Analysis; D006801:Humans; D011884:Radius / Q000000981:diagnostic imaging*; D012044:Regression Analysis; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*