FRACTAL ANALYSIS IN DIAGNOSTIC IMAGES FOR THE CHARACTERIZATION OF THE BONE MICROARCHITECTURE IN PATIENTS WITH OSTEOPOROSIS: A SYSTEMATIC REVIEW

K.M. Alvis-Gómez^1,2, C.A. Peña-Rodríguez^1,3, L.F. Rubio-Pachón^1,3, C. Rodríguez- Gaitan^1,3

¹Universidad Nacional de Colombia (National University of Colombia), Departamento del Movimiento Corporal Humano (Department of Human Body Movement), Bogotá, D.C., Colombia, ²Mechanics and Neuromechanics Movement Analysis Research Group, Department of Human Body Movement, National University of Colombia (Universidad Nacional de Colombia), Bogotá, D.C., Colombia, ³Physiotherapy Programme, Department of Human Body Movement, Bogotá, D.C., Colombia

Background: Osteoporosis is defined as a reduction in the amount of bone or atrophy of skeletal tissue (1); which leads to a decrease in bone mass and greater susceptibility to fractures; it is characterized by two factors: low bone mass and impaired microarchitecture (2). Currently, the diagnosis of osteoporosis is based mainly on the measurement of bone mineral density (BMD) measurement which is performed from dual-energy X-ray absorptiometry (DXA or DEXA) (3). In current days, the need to explore alternatives that allow us to give osteoporosis a broader diagnostic approach, and that makes it possible to analyze all the elements that make up its pathophysiology, as the fractal analysis, has been growing as an innovative method, although little implemented in clinical practice.

Purpose: Synthesize the best possible evidence on the use of fractal analysis in radiographic images for the characterization of bone microstructure and as a diagnostic method on the degree of bone resorption or remodeling.

Methods: A systematic review on the use of the fractal dimension in diagnostic images for the characterization of bone microarchitecture was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to develop the review protocol. Free access research articles were included whose target population is human adults or those of other species with a confirmed diagnosis of Osteoporosis, that use fractality in 2D bone radiographs as a primary intervention, and whose original language is English or Spanish. In addition, those with a descriptive observational study design, in vitro or ex vivo studies, as well as those involving patients with systemic conditions that would affect bone metabolism (ie, parathyroidism, hypoparathyroidism, Paget's disease), osteomalacia, renal osteodystrophy, osteogenesis imperfecta, chronic kidney disease, anemia, hyperthyroidism), cancers with bone metastases were excluded. The studies were reviewed and independently classified by 3 researchers.

Results: The search resulted in 876 studies, where after removing duplicates, 550 unique articles were obtained. The initial selection of titles and abstracts yielded 40 full texts, of which 27 articles were excluded. The final review included 13 studies that met the established criteria for the study. The analysis of research reports has been reported. In these reports, it is found that the fractal dimension is superior to the BMD when studying the 2D X-ray images of the control and osteoporotic groups. There are some reviews in the literature on fractality of medical radiographs, finding that fractal analysis could be a complementary indicator to BMD to monitor the course of osteoporosis and can serve as an indicator of fracture risk and fall risk. These prognostic and diagnostic levels will be useful for the prescription of the load during the physiotherapeutic interaction.

Conclusions: The fractal analysis seems to be a useful method for the diagnosis and prognosis of fall and fracture risk and to measure the impact of different methods different methods of osteoporosis care on bone microarchitecture.

Implications: The study provides evidence on the usability of fractal analysis to measure bone microstructure, as an alternative to the standard bone density method.

Funding acknowledgements: Universidad Nacional de Colombia (National University of Colombia.

Keywords:
Fractal Analysis
Bone Density
Bone Microstructure

Topics:
Orthopaedics
Older people
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: UNIVERSIDAD NACIONAL DE COLOMBIA

Committee: Ethics Committee Faculty of Medicine - National University of Colombia

Ethics number: CE-0147-22