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Bone Trabecular Microstructural Properties Evaluation in Human Femur using Mechanical Testing, Digital X-ray and DXA

Sapthagirivasan V1, Anburajan M2
Research Scholar, Professor Department of Biomedical Engineering, SRM University, Chennai, Tamilnadu, India. sapthagiri.ece@gmail.com1, anbufelix@yahoo.com2
Abstract— Early detection of fracture risk is important for initiating treatment and improving outcomes from both physiologic and pathologic causes of bone loss. While bone mineral density has traditionally been used for this purpose, alternative structural imaging parameters (quality measures) are proposed to better predict bone’s true mechanical properties. To further elucidate this, trabecular bone from human femur were used to evaluate the interrelationship of mechanical and structural parameters using mechanical testing, dual energy X-ray absorptiometry (DXA) scanning and digital X-ray imaging. Directional specific structural properties were assessed and correlated to mechanical testing, texture feature analysis and DXA. Our study was performed on 20 post menopausal women with or/and osteoporotic fractures and 21 healthy pre menopausal women. For all subjects radiographs were obtained of the femur with a new high-resolution X-ray device. The bone mineral density measurements were assessed by DXA. Furthermore, the results of this study show that a loss of bone primarily affects the connectedness and overall number of trabeculae. Thus, this method seems to be a promising routine technique for the determination of osteoporosis fracture risk from radiographs of the femur independently from BMD. Keywords-BMD; DXA; osteoporosis; X-ray; trabecular
1 2

Venkatesh Mahadevan3,
Information Systems & eBusiness,

Swinburne University of Technology, Melbourne, Australia. Postmenopausal women, they lose bone mass and become more susceptible to osteoporosis and fracture [5]. BMD alone cannot accurately predict the fracture, as other factors such as the shape and structure of bone and the risk of falling are also important. The architecture of the bone is composed of the cortical bone shell and trabecular bone core. Trabecular bone is a spongy, porous type found at the ends of all bones, such as pelvis and spine [6]. In proximal femur, trabecular bone forms a pattern of net-like strands varying in thickness and numbers [7] shown in Fig 1.1. It has a complex three dimensional structure consisting of struts and plates.


Fig 1.1 Femur trabeculae

With the better of life expectancy the risk of facing diseases causes by aging process is increasing. One of those diseases is the loss of bone mass or osteoporosis. Osteoporosis is a worldwide medical condition affecting middle-aged and older populations, especially women. In the INDIA, one in three women and one in eight men over the age of 50 will suffer a fracture attributed to osteoporosis [1]. Fractures come at a great personal and socioeconomic cost. Twenty percent of people who have a hip fracture die within 12 months, half of those who survive can no longer live independently, almost half of those who could walk unaided are no longer able to do so and a quarter are still unable to prepare their own dinner [2-4]. Earlier detection of osteoporosis can be done by using Bone Mineral Densitometry (BMD) technique using various modes such as ultrasound or Dual Energy X-ray Absorptiometry (DXA). For the time being DXA is considered as a gold standard for detection of Osteoporosis. Osteoporosis is defined by the World Health Organization as a BMD lower by more than 2.5 standard deviations than the mean value for young adults. As people get older, particularly

Many lines of evidence indicate that the decreased bone strength characteristic of osteoporosis is dependent not only on BMD, but also on trabecular bone microarchitecture and mineralization. The correlation between bone strength and bone mass is well established but the relationship between trabecular microarchitecture and biomechanical properties are less explored. Trabecular patterns appearing on digital X-rays contain rich information about the bone status. The observation of trabecular pattern change for diagnosis of osteoporosis was first proposed in the 1960s using radiographs of proximal femur. The diagnosis was known as Singh Index grading system [3]. A number of physicians, due to the lack of diagnosis equipment like DXA, observe the trabecular change visualize in proximal femur recorded in radiographs to assess osteoporosis. On radiographs, femur (trabecular) bone structure appears as a distinct pattern. Fig 1.1 shows radiograph of proximal femur and its groups of trabeculae.

VI-1 978-1-4244-8318-1/10$26.00 c2010 IEEE

given each pixel p in the initial image and a small running window W then the image is filtered as follows to produce the new image I  Φ ( p ) − Φ w (min)  I [i. we proposed the texture analysis system for osteoporosis assessment by observing trabecular change in proximal femur. The extracted features will represent the quality or structure of the bone. and little enhancement when standard deviation is large. The average adult male femur is 48 centimeters (18. are then compared with their corresponding BMD obtained by DXA. They appear at various times from just before birth to about age 14. The shaft of femur is cylindrical with a rough line on its posterior surface (linea aspera). Bone trabecular feature extraction Typically. femoral shaft (FS-BMD). A. This operation was performed on the intensity channel of the image. Hence. It was performed on 20 healthy pre menopausal women (n=20.1 Anatomy of the human femur . better quality represents better bone strength.77 ± 14. India. or protuberances. j ] = N  w   Φ w (max) − Φ w (min)  From the equation (1) (1) N = 2n − 1 Φ w is sigmoid function. We performed this intensity normalization step using histogram specification [10]. while mean and standard deviation within each window produces significant contrast enhancement when standard deviation is small. wavelet transforms and fractal analysis algorithms will be applied to extract the features of trabecular pattern recorded on proximal femur radiographs. femoral trochanter (FTr-BMD) and total Femur (FT-BMD) were measured by dual-energy X-ray absorptiometry (GE Healthcare Lunar DPX). D3A®. Along with the temporal bone of the skull. lower quality leads to low bone strength and could be suspected as osteoporotic. 34. there is wide variation in the intensity of digital x-ray image from different patients. II.e.9 years). After normalization. the greater trochanter. Anatomy of the human hip In human anatomy. Hence.34 cm (0. There are four eminences. 55. in the form of energy. This modifies the image values through a histogram transformation operator which maps a given intensity distribution a(x. we were applied a local contrast enhancement method to improve both the contrasting attribute of bone and the overall intensity in the image. Fig 2. For all subjects the radiograph of the right femur was obtained with a new high-resolution X-ray device with direct digitization (BMATM. The extracted features of the samples. i. it is one of the two strongest bones in the body. The aim is to apply a transformation of the values inside small windows in the image in a way that all values are distributed around the mean and shows all possible intensities.y) as an intermediate stage. they are joined to the main body of the femur with cartilage. Initial research in features extraction of proximal femur trabecular pattern using Gabor filter and discrete wavelet transform (DWT) has been performed with quite promising result [7-9]. i.9 in) in length and 2. chennai. usually in early adulthood. Medical System. the contrast is low. femoral wards (FW-BMD).e.To solve the variability problem of Singh index grading system.8 years) with no fracture and 21 post menopausal women without fractures (n=21. the lesser trochanter. which gradually becomes ossified until the protuberances become an integral part of the femur bone. in the human femur: the head. it is necessary to identify a reference frame and normalize the intensities of all other images against it. C. MATERIALS AND METHOD B. Gabor filter.1. (2) where n is number of bits per pixel in the given image and The max and min refer to the maximum and minimum intensity values in the whole image. which is located above. Initially.67 ± 6. The protocol was a uni-center case-control study of Indian postmenopausal women recruited from the private scan center. France). This variation is strongly correlated to the person’s skin pigmentation and bone.92 in) in diameter and can support up to 30 times the weight of an adult [11] and which forms part of the hip joint (at the acetabulum) and also part of the knee joint. the femur is the longest and largest bone shown in Fig 2. and the lower extremity.y) into a desired distribution c(x. Subjects and Sources Right femur X-ray images of 41 Indian women were obtained with slight variations of X-ray exposure condition.y) using a histogram equalized image b(x. Orleans. This process is applied independently to each individual sub blocks of 3 x 3. contrast is high. Bone mineral density (BMD) (g/cm2) from the femoral neck (FN-BMD).

2 shows the ROI used in this paper.Once the image has been pre-processed as described above. femoral neck. The Ward’s triangle is the region that is most sensitive to bone mass lost. Therefore for the rest of the radiographs samples.2 Various ROI in right femur digital x-ray image III. shaft and greater trochanter. (d) BMI Vs BMD . The results of energy computation for 41 radiographic samples are plotted and shown in Fig 3. (b) Age Vs BMI. Fig 2. Gabor and wavelet features and mechanical properties were calculated on certain region of interest (ROI) of proximal femur known as Ward’s triangle. features extraction will be computed for approximation coefficient at 1st and 4th level decomposition. femoral head.1 (a) Age Vs BMD. The result of features extraction and energy computation by applying DWT in four scales or levels decomposition using Gabor wavelet for one radiograph sample is shown in Table 1 and from Table 2. Fig 2. The energy computed from trabecular pattern of normal bone samples appear to be higher than the energy from samples of the osteopenia and osteoporosis. which are having the lowest energy.2 and the osteoporotic bones. 3 and4. The healthiest bones. which are having the highest energy as shown in Fig 3. n ) (3) for image I(m. it is clear that significant energies were obtained from level 1st and 4th level decomposition for approximation coefficient. E(I ) = 1 MXN ∑∑ i =1 j =1 M N 2 I ( m. RESULT AND DISCUSSION In this paper we used four different trabecular pattern recorded in 41 patient’s radiograph were extracted.n) with 1 ≤ m ≤ M and 1 ≤ n ≤ N. we perform Gabor and wavelet (4 level decomposition) operation to the classification of osteoporosis based on the change of trabecular pattern. The feature extracted from wavelet features by energy computation and then compared to trabecular energy computation predetermined trabecular energy.2. The capability of wavelet features to assess the degree or level osteoporosis. The classification was based on features extracted by Gabor and wavelet in the form of energy based on the following equation (3). Fig 3. (c) BMI Vs Age .

2 0 O A1 Gr. (d) Original ROI of femur head.64 3 A2 0. (e) Enhanced Trabecular ROI pattern Table 1 Approximation Coefficient values up to 4 levels Region Gr.2 plotting of energy Vs Approximation Co.A1 T r.2 0 O A1 O A4 T r.58 9 0.T Neck Hea d (b) 1 0. (c) Trabecular enhanced ROIs. Fig 3.549 .62 1 0.A4 Gr.1 0.eff.Troc Lsr.6 0.A4 Gr.A4 (c) Fig 3.T N eck H d ea 1 0.T r Ls r .A1 T r.3 Implementation results (a) original femur x-ray image.4 0.557 0.55 4 A4 0. (c) Osteoporosis. (b) Osteopenia.6 0.Troc A1 0.T Neck Hea d O A4 T r. (a) Normal.4 0.8 0.4 0.2 0 O A1 O A4 T r.8 0.64 7 A3 0.8 0.A1 T r. (b) Marked Region of Interests.6 0.49 6 0.T r Ls r .T r Ls r .

53 ± 0.Gr Group Normal n=8.56 ± 0.Gr Group Normal n=8.34 ± 1.03 A1 0.5 21.89 ± 0.64 ± 0.21 A1 0.66 ± 0.41 ± 0.09 0.51 ± 0. 34.17 0.76 ± 0.2 ± 11.55 ± 0.8 BMI 27.65 21.12 Neck 0.37 ± Head A4 0.65 1 0.98 ± 0.64 ± 0.65 7 0.81 ± 0.13 0.11 A4 0.07 Osteopenia n=8.17 0. 72.5 21.87 ± 0. 72.58 ± 0.92±2. 55 ± 3.41 ± Troc.57 ± 0.35 ± 0.83 ± 0.91 ± 0.11 A1 0.17 A1 0. 46 ± 15.05 ± 0.17 0.5 ± 4.7 Osteoporosis n=5.66 5 0.02 0.01 0.6 BMI A1 0.03 0.06 0.Neck Head 0.65 21.01 0.14 0.69 ± 0.58 4 0.62 24.83 ± 0.11 0.64 ± 0.02 ± 0.12 A1 0.76 ± 0.21 0.36 ± 0.68 ± 0.07 0.6 ± 0.92± 2.12 0.65 ± 0.7 Osteoporosis 27.08 0.58 ± 0.38 ± Neck A4 0.41 ±2.54 ± 0.18 0.2 0.Lsr A4 0.61 ± 0.87 ± 0.21 0.07 0.42 ± 0.06 0.36 0.02 0.Lsr A4 0.05 0.15 0.16 0.17 Ward 0.59 ± 0.81 ± 0.41 ± 2.58 ± 0.67 0 0.5 ± 4. 55 ± 3. 46 ± 15.22 0.94 0.56 ± 0.16 T-score -0.57 ± 0.61 ± 0.66 ± 0.63 -1.87 ± 0.65 21. 0.8 ± 0.34 ± 0.73 ± 0.23 ± 0.16 Troc.39 ± 0.17 0.7 Troc.13 Table 4 Energy calculated by Gabor Wavelet for trabecular enhanced images Proximal Femur Energy by Wavelet for trabecular enhanced images Troc.54 ± 0.61 ± 0.17 0.58 ± 0.5 ± 4.41 ±2.08 1.11 0.05 0.16± 3.21 0.8 ± 0.33 ± A4 0.2 ± 11.37 ± 0.82 ± 0.59 5 0.08 0.09 Neck A4 0.01 0.5 21.53 ± 0.67 ± 6.11 0.14 . 55 ± 3.88 ± A1 0.83 ± 0.17 1.534 Table 2 DXA BMD of Right femur Proximal Femur BMD by DXA (g/cm2) Group Normal n=8.583 0.17 Head A4 0.16 0.06 0.58 ± 0.28 0.95 27.0.18 Total 0.1 0.07 Osteopenia n=8. 46 ± 15.21 0.36 ± 0.6 2 BMI A1 0.1 Osteopenia n=8.9 Young Adult n=20.21 ± 0.68 ± 0.21 Shaft 1.08 0.35 ± 0.21 0.12 1.91 ± 0.38 -3.19 ± 0.6 ± 0.09 0.25 Table 3 Energy calculated by Gabor Wavelet for original images Proximal Femur Energy by Wavelet for original images Troc.15 0.7 Osteoporosis n=5.56 ± 0.5 ± 0.28 ± 0.92±2.54 ± 0.

18 0. 72.95 2 0.19 0.2 ± 11.17 .n=5.09 0.19 0.

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