High-resolution peripheral quantitative computed tomography (HR-pQCT) is a noninvasive imaging modality for assessing volumetric bone mineral density (vBMD) and microarchitecture of cancellous and cortical bone. The objective was to (1) assess fracture-associated differences in HR-pQCT bone parameters; and (2) to determine if HR-pQCT is sufficiently precise to reliably detect these differences in individuals. We systematically identified 40 studies that used HR-pQCT (39/40 used XtremeCT scanners) to assess 1291 to 3253 and 3389 to 10,687 individuals with and without fractures, respectively, ranging in age from 10.9 to 84.7 years with no comorbid conditions. Parameters describing radial and tibial bone density, microarchitecture, and strength were extracted and percentage differences between fracture and control subjects were estimated using a random effects meta-analysis. An additional meta-analysis of short-term in vivo reproducibility of bone parameters assessed by XtremeCT was conducted to determine whether fracture-associated differences exceeded the least significant change (LSC) required to discern measured differences from precision error. Radial and tibial HR-pQCT parameters, including failure load, were significantly altered in fracture subjects, with differences ranging from -2.6% (95% confidence interval [CI] -3.4 to -1.9) in radial cortical vBMD to -12.6% (95% CI -15.0 to -10.3) in radial trabecular vBMD. Fracture-associated differences reported by prospective studies were consistent with those from retrospective studies, indicating that HR-pQCT can predict incident fracture. Assessment of study quality, heterogeneity, and publication biases verified the validity of these findings. Finally, we demonstrated that fracture-associated deficits in total and trabecular vBMD and certain tibial cortical parameters can be reliably discerned from HR-pQCT-related precision error and can be used to detect fracture-associated differences in individual patients. Although differences in other HR-pQCT measures, including failure load, were significantly associated with fracture, improved reproducibility is needed to ensure reliable individual cross-sectional screening and longitudinal monitoring. In conclusion, our study supports the use of HR-pQCT in clinical fracture prediction. © 2019 American Society for Bone and Mineral Research.

中文翻译：

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骨微结构的HR-pQCT措施可预测骨折：系统评价和荟萃分析。

高分辨率外周定量计算机断层扫描（HR-pQCT）是一种用于评估松质骨和皮质骨的体积骨矿物质密度（vBMD）和微结构的无创成像方法。目的是（1）评估与骨折相关的HR-pQCT骨参数差异；（2）确定HR-pQCT是否足够精确以可靠地检测出个体中的这些差异。我们系统地鉴定了40项使用HR-pQCT（39/40使用XtremeCT扫描仪）的研究，分别评估了有骨折和无骨折的1291至3253人和没有骨折的3687至10,687人，无合并症。描述radial骨和胫骨骨密度，微结构，使用随机效应荟萃分析提取强度和强度，并评估骨折与对照受试者之间的百分比差异。通过XtremeCT评估的骨骼参数的短期体内可重复性进行了另一项荟萃分析，以确定与骨折相关的差异是否超过了区分显着误差和精确度误差所需的最小显着变化（LSC）。径向和胫骨HR-pQCT参数（包括失败负荷）在骨折患者中发生了显着变化，差异在径向皮质vBMD的-2.6％（95％置信区间[CI] -3.4至-1.9）到-12.6％（95）径向小梁vBMD中的百分比CI -15.0至-10.3）。前瞻性研究报告的骨折相关差异与回顾性研究一致，表明HR-pQCT可以预测突发性骨折。对研究质量，异质性和出版偏倚的评估验证了这些发现的有效性。最后，我们证明了可以从HR-pQCT相关的精确度误差中可靠地辨别总和小梁vBMD与某些胫骨皮质参数相关的骨折相关缺陷，并且可以将其用于检测各个患者的骨折相关差异。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。异质性和出版偏见验证了这些发现的有效性。最后，我们证明了可以从HR-pQCT相关的精确度误差中可靠地辨别总和小梁vBMD与某些胫骨皮质参数相关的骨折相关缺陷，并且可以将其用于检测各个患者的骨折相关差异。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。异质性和出版偏见验证了这些发现的有效性。最后，我们证明了可以从HR-pQCT相关的精确度误差中可靠地辨别总和小梁vBMD与某些胫骨皮质参数相关的骨折相关缺陷，并且可以将其用于检测各个患者的骨折相关差异。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。我们证明，可以从HR-pQCT相关的精确度误差中可靠地识别出总和小梁vBMD的骨折相关缺陷和某些胫骨皮质参数，并可以用于检测各个患者的骨折相关差异。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。我们证明，可以从HR-pQCT相关的精确度误差中可靠地辨别出总和小梁vBMD与某些胫骨皮质参数相关的骨折相关缺陷，并且可以将其用于检测各个患者的骨折相关差异。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。尽管其他HR-pQCT措施的差异（包括失效载荷）与断裂显着相关，但仍需要提高重现性以确保可靠的单个横截面筛查和纵向监测。总之，我们的研究支持在临床骨折预测中使用HR-pQCT。©2019美国骨骼和矿物质研究学会。