Kathryn L Bohnert1, David J Gutekunst, Charles F Hildebolt, David R Sinacore. 1. Applied Kinesiology Laboratory, Program in Physical Therapy, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108-2212, USA. Electronic address: bohnertk@wustl.edu.
Abstract
BACKGROUND: Fractures are common in foot bones, but clinicians lack adequate indices of bone strength. OBJECTIVES: We used dual-energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) and content (BMC) of excised human metatarsals, determined intra- and inter-rater measurement precision, and assessed associations between BMD/BMC and ex vivo bone fracture strength. METHODS: Two raters each made two measurements of whole-bone and sub-regional BMD and BMC in both second and third metatarsals from 10 cadavers. Variance components analysis was used to assess variability attributable to repeat measurements, raters, sub-regions, bones, sides, and cadavers. Root-mean-square standard deviation (RMS-SD) and least-significant change (LSC) were used to assess rater precision and ultimate forces during 3-point bending were tested for correlations with BMD and BMC. RESULTS: Variation due to repeat measurements and rater was low (<1% combined) for BMD and BMC. RMS-SD for whole metatarsal BMD of both metatarsals ranged from 0.004 to 0.010 g/cm(2) and 0.062 to 0.086 g for BMC. Whole metatarsal and sub-region BMD and BMC were strongly correlated to ex vivo fracture force (r(2)=0.67-0.93). CONCLUSIONS: DXA measurements of BMD and BMC have high intra- and inter-rater precision and are strongly correlated to ex vivo bone strength.
BACKGROUND:Fractures are common in foot bones, but clinicians lack adequate indices of bone strength. OBJECTIVES: We used dual-energy X-ray absorptiometry (DXA) to measure bone mineral density (BMD) and content (BMC) of excised human metatarsals, determined intra- and inter-rater measurement precision, and assessed associations between BMD/BMC and ex vivo bone fracture strength. METHODS: Two raters each made two measurements of whole-bone and sub-regional BMD and BMC in both second and third metatarsals from 10 cadavers. Variance components analysis was used to assess variability attributable to repeat measurements, raters, sub-regions, bones, sides, and cadavers. Root-mean-square standard deviation (RMS-SD) and least-significant change (LSC) were used to assess rater precision and ultimate forces during 3-point bending were tested for correlations with BMD and BMC. RESULTS: Variation due to repeat measurements and rater was low (<1% combined) for BMD and BMC. RMS-SD for whole metatarsal BMD of both metatarsals ranged from 0.004 to 0.010 g/cm(2) and 0.062 to 0.086 g for BMC. Whole metatarsal and sub-region BMD and BMC were strongly correlated to ex vivo fracture force (r(2)=0.67-0.93). CONCLUSIONS: DXA measurements of BMD and BMC have high intra- and inter-rater precision and are strongly correlated to ex vivo bone strength.
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