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QCT analysis of femoral bone: a 20-year review
DOI:10.1038/bonekey.2014.93
Quantitative computed tomography (QCT) has been used over the last two decades to assess how cortical thickness and density in the human proximal femur vary in men and women with age and drug treatment, and how this is related to fracture risk.
Earlier standard QCT analysis software exposed morphological variations in selected femoral regions but more recent statistical parametric mappings highlight changes at every volume or surface element of the proximal femur.
An asymmetric distribution of cortical bone in the femoral neck occurs with age. The reduction in cortical thickness of the superior region is three times greater than that of the inferior region and is twice as high in women compared to men of the same age, as is the rate of hip fractures. Like trabecular bone, cortical bone seems preserved in regions of high loading.
Anti-resorptive treatment in postmenopausal women cuts fractures by half; QCT data show that, despite some significant changes in the cortex, therapy has more impact on trabecular bone mineral density (BMD).
Editor’s comment: Despite statistical parametric mapping of QCT images being able to analyze changes of cortical thickness or BMD distribution at every anatomical location, this method has yet to be integrated into finite element analysis to assess the impact of the reported variations on bone strength. A major limitation of QCT is the partial volume effect on all cortical measurements; moreover, no proper comparison between techniques has yet been undertaken.
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