title: Voxel size dependency, reproducibility and sensitivity of an in vivo bone loading estimation algorithm.
abstract: A bone loading estimation algorithm was previously developed that provides in vivo loading conditions required for in vivo bone remodelling simulations. The algorithm derives a bone's loading history from its microstructure as assessed by high-resolution (HR) computed tomography (CT). This reverse engineering approach showed accurate and realistic results based on micro-CT and HR-peripheral quantitative CT images. However, its voxel size dependency, reproducibility and sensitivity still need to be investigated, which is the purpose of this study. Voxel size dependency was tested on cadaveric distal radii with micro-CT images scanned at 25 µm and downscaled to 50, 61, 75, 82, 100, 125 and 150 µm. Reproducibility was calculated with repeated in vitro as well as in vivo HR-pQCT measurements at 82 µm. Sensitivity was defined using HR-pQCT images from women with fracture versus non-fracture, and low versus high bone volume fraction, expecting similar and different loading histories, respectively. Our results indicate that the algorithm is voxel size independent within an average (maximum) error of 8.2% (32.9%) at 61 µm, but that the dependency increases considerably at voxel sizes bigger than 82 µm. In vitro and in vivo reproducibility are up to 4.5% and 10.2%, respectively, which is comparable to other in vitro studies and slightly higher than in other in vivo studies. Subjects with different bone volume fraction were clearly distinguished but not subjects with and without fracture. This is in agreement with bone adapting to customary loading but not to fall loads. We conclude that the in vivo bone loading estimation algorithm provides reproducible, sensitive and fairly voxel size independent results at up to 82 µm, but that smaller voxel sizes would be advantageous.
authors.affiliation: Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Christen
authors.affiliation: Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
authors.forename: Friederike A
authors.initials: FA
authors.lastname: Schulte
authors.affiliation: Institute for Biomechanics, ETH Zurich, Zurich, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Zwahlen
authors.affiliation: Orthopaedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: van Rietbergen
authors.affiliation: INSERM UMR 1033, Hôpital Edouard Herriot, Université de Lyon, Lyon, France.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Boutroy
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Khosla
authors.affiliation: Institute for Biomechanics, ETH Zurich, Zurich, Switzerland Novartis, Institutes for BioMedical Research (NIBR), Basel, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Goldhahn
authors.affiliation: Institute for Biomechanics, ETH Zurich, Zurich, Switzerland ram@ethz.ch.
authors.forename: Ralph
authors.initials: R
authors.lastname: Müller
mesh_terms: D000465:Algorithms; D016723:Bone Remodeling; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000378:metabolism*; D006801:Humans; D008297:Male; D008954:Models, Biological; D016474:Weight-Bearing; D055114:X-Ray Microtomography
keywords: HR-pQCT; bone loading estimation; human distal radius; reproducibility; sensitivity; voxel size dependency