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. 2012 Nov 13:13:221.
doi: 10.1186/1471-2474-13-221.

Age and gender as determinants of the bone quality of the greater tuberosity: a HR-pQCT cadaver study

Chlodwig Kirchhoff  1 , Volker Braunstein, Stefan Milz, Christoph M Sprecher, Sonja Kirchhoff, Mathias Graw, Andreas B Imhoff, Stefan Hinterwimmer
Affiliations

Age and gender as determinants of the bone quality of the greater tuberosity: a HR-pQCT cadaver study

Chlodwig Kirchhoff et al. BMC Musculoskelet Disord. .

Abstract

Background: Age-dependent trabecular changes of the humeral head might weaken the fixation of suture anchors used for rotator cuff (RC) repair. This might lead to suture anchor loosening and thus compromise the integrity of the repair. The aim of this study was to analyze whether the trabecular microstructure within the RC footprint is influenced by age, gender or handedness.

Methods: Axial HR-pQCT scans (Scanco Medical) of 64 freshly frozen cadaveric human humeral head specimens (age 72.3 ± 17.4 years) were analyzed to determine the bone volume-to-total volume ratio (BV/TV), trabecular thickness (Trab Th), trabecular number (Trab N) and connectivity density (Conn Dens). Within the RC footprint, 2 volumes of interest (VOI), posteromedial (PM) and anterolateral (AL) and one control VOI in the subarticular bone (SC) were set.

Results: The highest BV/TV was found in SC: 0.22 ± 0.06% vs. PM: 0.04 ± 0.05% vs. AL: 0.02 ± 0.04%; p < 0.05. Trab Th accounted for 0.26 ± 0.05 μm in SC, 0.23 ± 0.09 μm in AL and 0.21 ± 0.05 μm in PM. In parallel, Trab N and Conn Dens were found to be the highest in SC. Gender analysis yielded higher values for BV/TV, Trab Th, Trab N and Conn Dens for PM in males compared to females (p < 0.05). There were no significant findings when comparing both sides. We furthermore found a strong inverse correlation between age and BV/TV, which was more pronounced in the female specimens (r = -0.72, p < 0.00001).

Conclusions: The presented microarchitectural data allow for future subtle biomechanical testing comprising knowledge on age- and sex-related changes of the tuberosities of the humeral head. Furthermore, the insights on the trabecular structure of the humeral head of the elderly may lead to the development of new fixation materials in bone with inferior bone quality.

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Figures

Figure 1
Figure 1
Representative axial HR-pQCT scans of the humeral head.a) depicts the cross section of a left humeral head of a female patient (74 years) with inferior bone quality within the greater tuberosity (GT). b) depicts a section of the same height of a left humeral head of a male patient (65 years) with normal bone quality within the greater tuberosity (GT). For orientation the bicipital groove is labeled with *, the lesser tuberosity with LT.
Figure 2
Figure 2
Placement of the regions of interest.a) depicts an ap-view of the lesser tuberosity. Within the greater tuberosity, two rows were defined; one medial row adjacent to the articular surface, labeled with PM; and one lateral row along the lateral edge of the footprint, labeled with AL. Furthermore, a region was set into the subchondral region directly underneath the articular surface, marked with SC. b) gives an axial view of the humeral head with the lesser tuberosity on the bottom. The GT is divided into one posteromedial portion (PM) and one anterolateral part (AL).
Figure 3
Figure 3
Morphometric parameters of bone quality.a) the ratio bone volume/total volume (BV/TV) is given as percentage [%]. Data for the subchondral region are labeled as SC, followed by the posteromedial portion PM and the anterolateral AL. b) presents data for trabecular thickness (Trab Th) in μm. c) presents data for trabecular number (Trab N), given in [μm-1]. In d) data for connectivity density (Conn Dens) are presented in [μm-3]. Data are given as boxplots, * p < 0.05.
Figure 4
Figure 4
Gender analysis. Fig. a) presents results for BV/TV in [%], b) for Trab Th in [μm], c) for Trab N in [μm-1] and d) for Conn Dens in [μm-3]. Data for SC, PM and AL in males are depicted in light grey, for females in dark grey. Data are given as boxplots. # indicates differences within each gender group (p > 0.05). * marks inter-gender differences (p < 0.05).
Figure 5
Figure 5
Handedness analysis. Fig. a) presents results for BV/TV in [%], b) for Trab Th in [μm], c) for Trab N in [μm-1] and d) for Conn Dens in [μm-3]. Data for SC, PM and AL for the dominant (dom) side are depicted in light grey, for the non-dominant (non-dom) side in dark grey. Data are given as boxplots. # marks intra-group differences (p < 0.05).
Figure 6
Figure 6
Linear regression analysis correlating the results of HR-pQCT regarding the ratio bone volume/total volume (BV/TV) within AL and patients’ age (years). A correlation of −0.72 was found (p < 0.00001).
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