Age-related Changes with the Trabecular Bone of Ward's Triangle and Neck-shaft Angle in the Proximal Femur: A Radiographic Study.

OBJECTIVE: The Ward triangle is an important area used clinically to diagnose and assess osteoporosis and its fracture risk in the proximal femur. The main objective of this study was to investigate the rules of development and maturation of the trabeculae of Ward's triangle to provide a basis for the prevention and treatment proximal femur fracture. METHODS: From January 2018 to December 2019, individuals from 4 months to 19 years old who underwent hip growth and development assessments at the Third Hospital of Hebei Medical University were selected retrospectively. The outpatient electronic medical record system was used to collect information such as age, gender, imaging images, and clinical diagnosis. The development score and maturity characteristics of the trabecular bone were analyzed using hip radiograph data. Correlation analysis was performed to identify the relationship among age, neck-shaft angle and development and maturity score of the trabecular bone. RESULTS: A total of 941 patients were enrolled in this study, including 539 males and 402 females. Primary compression trabeculae were all present at 1 year of age and matured at 7 years of age and older; primary tension trabeculae were all present at 4 years of age and matured at 18 years of age. Secondary compression trabeculae were present at 4 years of age and matured at 18 years of age. In addition, the neck-shaft angle progressively decreases from 4 months to 14 years of age but barely changes between 15 and 19 years of age. CONCLUSION: In short, the development and maturation of the trabeculae in the ward' triangle followed a specific temporal pattern that was related to the neck-shaft angle. Therefore, these findings can help us understand structure and mechanical characteristics of proximal femoral trabeculae, and improve our understanding of the mechanism and treatment of proximal femoral fractures.

Relationship Between Ground Reaction Force Characteristics and Bone Mineral Density of the Hip and Spine in Male Runners.

The purpose of this study was to determine the relationship between running ground reaction force (GRF) characteristics and hip and lumbar spine bone mineral density (BMD) values in male runners. Individuals who ran at least 48.3 km per week and were injury-free were recruited. Kistler force plates collected running vertical and anteroposterior GRF data. A Hologic Discovery W bone densitometer measured lumbar spine and five regional hip BMD values. Only runners who consistently used a rear foot strike pattern were included (n = 32). Pearson correlation coefficients were calculated between BMD values and various GRF values and step-wise multiple regression was run to predict BMD values from the various GRF values. The vertical impact force was significantly correlated with the lumbar spine and four of the five hip BMD values (r > 0.374, p < 0.035). Both the peak early loading rate (ELR) and average ELR were significantly correlated with the lumbar spine and Ward's triangle BMD (r > 0.430, p < 0.014), while the average active loading rate was correlated only with the Ward's triangle BMD (r = 0.438, p = 0.012). Multiple regression revealed the peak impact force was the predictor for every hip region BMD other than the trochanter and the average ELR as a predictor for the lumbar spine BMD. The peak braking force was negatively correlated with the Ward's triangle BMD (r = -0.414, p = 0.019). It appears that the large forces and loading rates associated with rear foot striking may be advantageous and predictive for BMD at the hip and spine.

Genome-wide association meta-analyses identified 1q43 and 2q32.2 for hip Ward's triangle areal bone mineral density.

Aiming to identify genomic variants associated with osteoporosis, we performed a genome-wide association meta-analysis of bone mineral density (BMD) at Ward's triangle of the hip in 7175 subjects from 6 samples. We performed in silico replications with femoral neck, trochanter, and inter-trochanter BMDs in 6912 subjects from the Framingham heart study (FHS), and with forearm, femoral neck and lumbar spine BMDs in 32965 subjects from the GEFOS summary results. Combining the evidence from all samples, we identified 2 novel loci for areal BMD: 1q43 (rs1414660, discovery p=1.20×10(-8), FHS p=0.05 for trochanter BMD; rs9287237, discovery p=3.55×10(-7), FHS p=9.20×10(-3) for trochanter BMD, GEFOS p=0.02 for forearm BMD, nearest gene FMN2) and 2q32.2 (rs56346965, discovery p=7.48×10(-7), FHS p=0.10 for inter-trochanter BMD, GEFOS p=0.02 for spine BMD, nearest gene NAB1). The two lead SNPs rs1414660 and rs56346965 are eQTL sites for the genes GREM2 and NAB1 respectively. Functional annotation of GREM2 and NAB1 illustrated their involvement in BMP signaling pathway and in bone development. We also replicated three previously reported loci: 5q14.3 (rs10037512, discovery p=3.09×10(-6), FHS p=8.50×10(-3), GEFOS p=1.23×10(-24) for femoral neck BMD, nearest gene MEF2C), 6q25.1 (rs3020340, discovery p=1.64×10(-6), GEFOS p=1.69×10(-3) for SPN-BMD, nearest gene ESR1) and 7q21.3 (rs13310130, discovery p=8.79×10(-7), GEFOS p=2.61×10(-7) for spine BMD, nearest gene SHFM1). Our findings provide additional insights that further enhance our understanding of bone development, osteoporosis, and fracture pathogenesis.

A Qualitative Examination of the Ward Region of Interest as Imaged on Dual-Energy X-ray Absorptiometry Examinations: The "Wandering Ward Sign".

While analyzing dual-energy X-ray absorptiometry (DXA) examinations, we observed that, on occasion, the Ward region of interest (ROI) was positioned either unexpectedly or differently between successive examinations. When this occurred, it appeared to be either a marker of a compromised examination or of incident disease. This prompted a systematic inquiry. It became apparent that, while in general seeking the region of least areal density, the Ward ROI is positioned differently by the machines available to us from 2 particular manufacturers (General Electric Co. and Hologic Inc.). Three reviews were thus undertaken: (1) a prospective systematic examination of 200 unselected consecutive DXA examinations made with a General Electric Co. machine, 80 having had follow-up examinations and 245 made with a Hologic Inc. device; (2) a prospective systematic examination of 625 consecutive, unselected DXA examinations that were repeat examinations; and (3) a retrospective examination of a file of 86 cases collected for pedagogical purposes, predominantly made with a Hologic Inc. device. The commonest cause of an unusual position of the Ward area was compromised patient positioning or change in body habitus. Changes between examinations were, in addition if less often, apt to reflect physiological change or disease. Unusual positioning or a change in position of the Ward ROI is easily observed. It does not occur frequently, but, when it does, it may be useful in directing attention to either technical factors or incidental diseases. Observation of the position of the Ward ROI may thus be a quality assurance, and occasionally a diagnostic, tool.

Differences of Bone Mineral Density between Spine and Hip in Osteoporotic Patients

PURPOSE: To evaluate differences and correlations of spine and hip region BMD in osteoporotic patients with or without spine fracture. MATERIALS AND METHODS: From January 1999 to December 2002, We measured and evaluated BMD of L3 and hip by DXA in 52 patients with spine fracture (fracture group) and 96 osteoporotic patients without spine fracture (non-fracture group) above 60 years. RESULTS: The average age of patients with spine fracture is 72.1 years and without spine fracture is 66.9 years. There were no statistical significant differences of BMD of spine, neck of femur and trochanteric area between 2 groups. But the BMD of Ward triangle of fracture group decreased significantly in statistics. The correlation coefficient between the lumbar spine and trochanteric area were 0.674 in fracture group and 0.794 in non-fracture group. They had statistical significance (<0.01). CONCLUSION: The BMD of Ward triangle of fracture group had lower value, but the BMD of lumbar spine had no differences between 2 groups. Therefore in these persons who have decreased BMD in Ward triangle should be concerned about high vertebral compression fracture risk vertebral compression fracture.