Fourth
International
Conference
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Edited
The Fourth International at the University of
Conference Toronto from
on 1-3
organized The full Institutes
by the University of Wisconsin reports will appear in a volte of Health. Support for the
Amersham Electric;
Corp. ; Ayerst Laboratories; Marion Laboratories; Norland
Gamble
Miami
Valley
Lab.
; Upjohn
Bone June
Measurement 1978. The
ciba
Geigy Instrmients;
by Richard
was meeting
Bone Measurement published by the meeting was provided
on Bone B. Mazess
Ab#{149}orptiometry
held was
Laboratory. National by:
Bone
(Renal)
Mineral
R.B. Mazess, Bone Mineral
Corp. ; Geaeral Proctor &
Renal
H.A. Effect
CONTENTS
A Dual
(Methods)
Photon
Bo
-
System
Controller.
as Detector. Photon Absorption Content. An
A.
B.
Annotated
Report on Mineral
Using F.P.
and Y. of
(1976) N.
Between of Bone
Christensen,
L.
Absorptiometry
the
HpGe D.
Detector
Vartsky,
of
Ellis, A.M. of l,25(OH)2D3
Influence
Modern
of
Methods
of
Absorption
and
and Third Gebhardt
Fat
on
Bone
Hindlimb R.K.
Chamber
Applicability
Monoenergetic I. The on
Photon
Zanzi,
D.
Relationship Clinical
Hitchman Evaluation
Bone
and
Tissue
Scattering.
(1978)
German
Symposia
on
of
Compton
Bone
Mineral
Curves. and
Jr.
Bone
Mineral
Content S.H.
in
Content
Data
J. Dequeker, Weight-Lifting
Measured
Cohn,
J.F.
Bone Mineral Ezponential
A.G.
-
Using
Isowidth
L. Wielandts, Effects on
Infants.
to
J.J.
Mass Bone
C.C. Johnston Serial Measurements Growth. P.J.
in Loss
J. BMC.
Term
S.M.
the
of
Bone
Edwards,
and
Preterm
Infants
Cam,
G.H.
Changes J.M.H.
G.D.
-
in Bone Buckler,
S.M. Khairi,
Mineral Density L. Burkinshaw,
A
Cam
in
Acmomegaly. and
C.
Bone Disease. R.R. Recker Bone Mass in Lithium-Treated Manic Christiansen, P. Baastrup, I. Transbol
Mineral Caniggia,
Content Measurements C. Gennari, R. Nuti
Dequeker,
Secondary
K.D.
CT
0.
in
Paget’s
Depressive Disease
Hermanutz,
Diagnostic
Parfitt, with M.
D.S. the
Gebhardt,
Rao,
X-Ray H.
N. Bone
Value Kleerekoper, Scanner
A.
by Compton Weinreb,
R.L. Density
Using
Mineralization: Photon
White Mayor R.B.
Absorptometry.
Rabbit:
Effect
Mazess,
of
Bone
Density.
Scattering. G.C. Robin
Clarke,
D.
I.
Johnson,
Leichter,
M.E.
King,
Using 0.
Single
Source
Compton
Scattering
Bhaduri
Anliker
in
of
Study
of
Children.
Cortical
in Growing Rats by y-Ray W. Baumgartner of Trabecular and Compact Estrogen, Testosterone and
U.
Bone
by
Elsasser,
Bone
Changes
in S. in
Volz of
Multiple-Energy
G.U.
Computed
Lower
of Bones Bradley,
Extremities
A.
Prader,
C.S.
Revak,
and Their R. Ray
of
CT
Human
N. Kendrick, F. Suarez Computed Tomography.
C.R.
Computed
Exner,
Tomography.
J.
O’Malley, Vivo with
P.R. Moran Computed Tomography.
Wilson,
C.
Tomography
James,
Techniques
for
C.
Cann, by CT
B. Ettinger, Scanning. D.
G.S. Gordan Banzer, U.
Schneider,
Wegener
Patients. Patients. Micromethods
Hyperparathyroidism:
Fracture
Measurements
Huddleston,
Hormone
D. Rosenfeld, Vertebral Mineral
of
Increase of Bone Mineral Content After Surgical Treatment of Primary Hyperparathyroidism. J.D. Ringe, H.P. Kruse, F. Kuhlencordt Proximal and Distal Radial Bone Mineral Measurements in Primary and Treatment. A.M. N. Levin Clinical Experiences
A
Hartnack,
the Measurement of Bone Mineral Content. D. Rosenfeld, H.K. Genant, Y. Abols Spinal Bone Mineral Determination Using Computerized Tomography in Patients, Controls and Phantoms. Y. Abols, H.K. Genant,
Metabolic
Decreased
Bone
Max
-
R.M. Witt, Quantitative
During D.A.
J.
Treatment
Scattering
Amputees. H.K. Huang, Calcium Content Analysie
Whedon
Bone-Mass and Soft-Tissue Measurements P. Geussens, C. Dc Proft, J. Nijs Photon Absorptiometry in the Investigation
Bone A.
B.
Overton
G.H. Alexander Correlation Between Calcium Concentration Numbers. H.K. Huang, R.S. Ledley,
Mayor Sanchez, M.R.A.
Tom
Bone Density Loewinger,
of
P. Ruegsegger Densitometry
Under
D.J. Analyses
(Clinical)
Osteodystrophy:
Christiansen,
Barzel
Quantification of Bone Mineralization Computed Tomography. M. Anliker, Gana-Ray CT for Selective Analysis Bone: Effects of Treatment with
Nilsson,
Measurement N.
-
A.L.
CT-Scanning
and
Brodie
Absorptiometry
Aird,
Based A.J.W.
Nijs B.E.
Steichen,
Blacks. G.H. Mayor, T.V. in Postmenopausal Women.
of Atkinson,
Renal
and E.G.A.
White
Growth in
Marsh,
Following
Stokes
of Experimental Hellewell
Densitometer.
Measurement
Aloia,
Routine and Increased Dietary Ca Intake. J. J. Steichen, T.L. Gratton, J. Russell, S.D. Minton, R.C. Tsang Bone Mineral Mass in Elderly Vegetarian Females. T.V. Sanchez,
0. Mickelsen,
Bone
M.W.
by
and Body Size: K.G. McNeill,
N.E. Westlin Absorptiometry
Content in Small Tsang Bone Mineralization
with
Chesney,
and
Haemodialyeed Tyne, England.
in Normal Beagle Dogs, Albright, G.A. Newsum
Compton
Methods.
Mineral Mass J.E. Harrison,
Havdrup, Photon
Upon
Uriel
-
Quantitation A.B.
Scattering
C.E. Webber Measurement of C. Hazan, E.
Ellis
Between Bone Rat Data.
S.M. Andersson, T. Adaptation of Direct Mineral R. C. Postnatal
K.J.
A. in
C.
R.W.
Bone
and Histonorphometric F. Melsen, N.E. Nielsen,
Johnston
Absorptiometry.
Vartsky, and
Percentile Ballet-Dancing
the
Bailey,
Pierides in Patients
Densitometry Martin, J.P.
Progress
Conrad
of
R.R.
Disease.
H.F. DeLuca Hemodialysis
Direct Photon Absorptiometry in the New Zealand of Lactation. R.C. Myers, T.V. Sanchez, G.H. Bone Mineral Content in Oophorectomized Monkeys. P. Rose, G.N. Rao and R. Larson
Mineral
X-Ray Clinical
Renal Jax, on
Absorptiometry in Newcastle
(Animals)
Absorptiometric A New Technique.
Mosekilde
-
Childhood
Therauptic Trial. I. Transbol
Absorptiometry
Pearlstein,
Errors Caused by Ellis, S.H. Cohn Using a Multiwire
K.J. Vivo
Photon-Absorptiotnetric Mass in the Forearm.
(Normals)
Rose, D.K. of Patients
and
T.B.
Naversten
Radiation Bolin
the Second Measurement.
Some Relations Measurements P.
Morsinan Profiles
Bibliography
Ellis,
for Elimination D. Vartsky, Content in
Lindergard,
Measurements L.E. Preuss,
Utilizing
K.J.
J.L. Alberi, 5.15. Cohn Numerical Filtering Method Finite Photon Beam Size. Measurements of Bone Mineral
in
P.C. Content
Nilsson
Absorptiometry
Microprocessor
Parfitt
Status
with Photon Patients
Controlled J. Naestoft, Absorptiometry
M.
-
Transplantation.
Experience Transplant
Company.
Measurement
and
Response N.
Developed
Bone
to
and
F.
Melsen and
the
Rate
Non-Invasive of
Its
Quantitative Microradiographic of Bone-Tissue: Influence N.
Walczak, in
-
Histomorphometry
Bonn.
Automatic
Mattern
Cortical
539
Image Bone
Analysis Cavities.
Methods
Change. of
of
Bone R.K.
of
Z.F.G.
Studies Age,
of Sex
the Degree and Disease.
Biopsies: Martin,
Assessing
the
Amount
of
Jaworaki
Digital J.P.
Albright,
of
Mineralization C.A. Baud,
Processing R.
Flohr
of
BONE
540 Neutron
Activation
J.
-
MEASUREMENT
CONFERENCE Numerical
Harriion
Filtering
Finite In
Vivo of
Analysis
the
of
Hand;
Bone
Morphometry B. Maziere, In Vivo Neutron
in D.
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by
with
Bone
Controls, Ituntz, D. Activation
Using Californium-252. Partial-Body Activation The
Calcium
Correlation
Californium-252 Value of
Partial
Local
Osteoporotic Comar Analysis
M.A. Analysis
Source. Body
Neutron and
of
and
Uremic
Partial
LeBlanc, H.J. Measurements
and
Photon
Mineral J.
Absorptiometry Content.
Aloia,
S.
I.
Measurements Zanzi,
C.
of
Colbert,
bone
Evans, P.C. Johnson by IVNAA in
Bone
Bachtell,
K.
linear is
and
the from
Microradioscopic in Normals
and
-
Erik
Meema
Due
Measurement. A
Study
N.E.
of
Trabecular
D.C.
Factors Index.
Data
Bone Mass: Radiograninetry.
on and
Bone-Losing S.M. Cam, The Detection R.M. Neer,
the
S.
Comparison Radiographic J. Bailey,
of
and
of
Vukicevic,
J.
Cortical Indexes Photodensitometry. R. Spencer, J.H.
The
Uptakes
Development
-
and
Lambs,
M.
Between Dequeker,
Bone
Fracture
with
S.
Repair.
Vikic,
I.
Harry
the
13%
bone
Content by R.S. Bachtell,
Maintenance Smith, R.S.
Hemodialysis. Bachtell,
of
Spinal-Cord Injured Subjects N.E.Naftchi, A.T. Viau,
24-Hour
with G.H.
Department
of
Dual
Photon
Absorptiometry
Microprocessor Alberi
JL, The
energy
Cohn
SH
analysis photon beam
present, in bone ted beam
System
controller:
Utilizing
Ellis
(Brookhaven of bone assumes
KJ,
National
mineral that
D,
A
content there are
(BMC) only
extension constituents developed tion and analysis
Bone
TV to
are
Arnold,
Detector
and TB, NY
by measuring design insures
attenuates
The coemon
both
active axis.
multi-energy reports
used
femur,
to
human
(Supported Contract
by No.
determine
bone
the
United
EY-76-C-02-0016.)
BNC
radius,
are eliminated. 200mCi 1 I and
source capsules are of the two sources
was
response function. This tissue mass simultaneously
States
content and
of
different
bones
of
under
ulna).
Department
Energy
from
data
A
rather
diameter, to
the of the from
0.5%
in
7%
to
the
the
United
States
EY-76-C-02-00l6.)
In
(The
been
the
Vivo
Using
General
used
as
a Multiwire
Infirmary,
the
for the images
Leeds
is bone
detector
of
measurement of the site
transmission
frame which
data
and
experiments
were
42-keV
of bone under investidisplayed
then positioned mineral content
on the is to
performed
in
collimator between the object were obtained from exposures
Profiles
and
Lindergard
mineral
using
the B,
Influence
Naversten
and of
of Y
on
a
image be
vitro
using
chamber, the hand
Fat
on
and
Bone
(University
content
241An
(45
(BMC)
mCi).
was
of both forearms. beam intensity
The through
around the arm. An for each nsiasurensint.
absorption
the
the
radius
nsiasured
Hospital,
(rat
by
Measurements
gives
were
profile
porosis and endosteal excavation had signs with low BMC. Thus character Among
of normals
the
the photon be corrected
underlying fatter people
mass between
were thickness,
absorption for at
on
was
plotted
by
a
absorption
In normals the nsidullary medullary
dip
this dip in canal , was was not
renal patients Four patients had signs of
on with osteo-
resorption. Two patients without usidullary of secondary hyperparathyroidism together photon absorption profiles gave some clue to
body
intercorrelation the skinfold
absorp-
for nsiasurerubber-cuff
a double-contoured
bone disease. showed a
in the photon-absorption profile for lean-tissue and water. BMC of this “fat hump” and also with
fold thickness and decreasing absorption
photon
performed
baseline level a waterfilled
influenced by sex and age. In dialysis varying profiles were found. pronounced medullary excavation also
regular the most
index the
(BMI). two bones
found the
between BMt and
between least one
hump
signifying decreased increasing
the bones. of these
fat
adjacent
to
the
less
with
Also in
attenuation increasing values for skin-
BMC decreased the forearm.
the size negative
with
of the values
“fat for
BMC
must
The nsiasured parameters.
new An
the
filter. observed
filter,
of
No.
Content
has
rectangular ares within
Absorption
significantly
the
portion of the microprocessor allows for vanlength, step size, and counting time per step. for multiple measurements without changes in or collimator. The system has been success-
metacarpal,
the
vivo.
Normally
the on
sources.
The controller ation in total scan These options allow the detector, source, fully
volumes of the The congruence
the collimator that the same
the
effect of profile discrete
bone phantom in reduction 6%
auspices
curve caused by the tube-like structure. the absorption profile corresponding to 17 5% of the maximum absorption. This
Strong hump”,
241An on a
the
Horsman
Content: Sweden)
applied computer
ll97f1
source lOOmCi aligned
from
the beam uses
restoring in
bone
and
Contract
Mineral
Calibration
tionsitry
bone than size
verified holder
under
chamber
the
The Lowman
component. Errors in the transmitAlso,
on the detector was designed using
the
noise
external
152Gd in a system Two-dimensional
A
in
Mineral Lmd,
development of the device operated in the dual energy mode. The high purity germanium (HpGe) detector is an integral component of the scanner. Errors in BMC due to multiple small angle scatters are reduced due to the excellent energy resolution of the detector (530 eV at 60 keV). Also, the need to filter the or additional collimation A new dual source-holder
in
Biochemical
Upton,
to perform present work
used
least-squares
the
under
computed
monitor. define
Photon J.S.
additional energies further identify the separate of the soft-tissue component. We have designed and a multi-energy bone scanning apparatus with data acquisicapability sufficient mineral content. The
in
diameter
Bone
from content.
forearm
Disease.
to
analysis of bone
of the
is applied. on a circular curve results
0.8%
out
a rotating-focused and preliminary
using a singletwo materials
bone mineral and a uniform soft-tissue mineral content caused by adipose tissue are reduced by the dual energy technique.
or
bone
Energy
multiwire
gation Colbert
Pearlstein
Laboratory,
to
of
radiation mineral
C.
Periarticular Sell, E.W.
a HpGe
Vartsky
photon attenuation an dimensions are infinitely
transmission
derivation
constrained
as Detector: LSI 3EX)
the midahafta nsints was A
11973)
Winter
Bone Mineral C. Colbert,
Measurement
by
SH
mass.
evaluated.
of
by beam
photon
filtering performed transmitted
carried
Chamber England
the
a
internal
Measurements
Nikolic,
Genant
Validation
NY
Caused
Cohn
correspond to that of the central ray; the sum of the beam components weighed factors varying across the beam profile. errors in determination of bone mass.
errors
curve,
from
in
linear
in
V.
observed
for
direct inverse In measurements restoration of the 1%
Mimes and R.E.
Errors
KJ,
work describes a method of removing size by deconvoluting the collimated transmission curve. The technique
than
errors
Singh
Measurements
Uptake of 9”Tc HEDP as an Index of Metabolic Bone I. Fogelman, D.L. Citrin, R. Mazess Computerized Kinetic Analysis of Two 99m-Tc-Sn-Diphosphonates Demonstrating Different Binding Characteristics. W.E. Barnes, N. Khedkar, N. Nelson Effect of Thyrocalcitonin on ‘8F Uptake and Various Variables in Bone Formation.
Femoral
Gamma PhotonP. Geussens,
Absorptiometric
Hancevic,
Radiographic Photodensitometry A.C. Chester, L.H. Diamond,
Radionuclide
R.S.
the
and Without Subperiostial Resorption. C. Mayor, J. Pottenger in Primary Hyperparathyroidism. M. Daley, D. Lans, J.T. Potts
Evaluation
Sajko,
Maini, Comparison J.
Hand Bones Versus
Meema Using
of
Ellis
Upton,
measurement the photon
experimental
(Research
Patients With A. Poznanski, of Bone Disease J.E. Mahaffey,
Photodensitometric
S.
Osteoporosis
P.S.
J. Nijs Radiograninetric
Resorption in Patients: Grading
Oreopoulos, in
Pattern
L. Wielandts, Comparison of
D.
Meema,
Etiological
Longitudinal Absorptiometry
of Intracortical Renal Failure
The
transforms
to
transmission Morphometry in Chronic
mass that
tissue.
Fourier Methods
bone made
The present finite beam the observed
Thompson,
Cohn
Radiographic
D,
Laboratory,
calculations is assumed to however, it corresponds to by non-uniform attenuation This effect causes significant dimensions and linear bone
K.G. McNeill, Williams Photodensitometry
Appendicular
R.
Elimination
Vantsky
small. In practice the beam has a finite width, usually with non-uniform distribution of photon intensity along its width. This beam is used to view a non-uniform bone or interfaces of
Calcium
Clinical Long-Term (5 Year) Longitudinal Studies. J.E. Harrison, T.A. Bayley, W.C. Sturtridge, C. Comparison of Total-Body Calcium with Radiographic
National
In assumption
Smith, P. Tothill, J.A. Strong of Skeletal Calcium Using a
A.D. Calcium
for
Size:
Histo-
Subjects.
Body
Method
Beam
(Brookhaven
Activation
Absorptiometry
Photon
Annotated
Measurements Bolin FP MI
Bibliography Using (Edsel B.
of
Modern
Methods
Radiation Absorption Ford Institute for
and Medical
of
Bone
and
Scattering: Research,
Tissue PreussLE, Detroit,
48202)
A reports,
bibliography organized
chronological Author address reference
format
has been by subject,
orientation, and is also provided. is
used.
The
assembled consisting cross-referenced,
of with
published a
carrying a first author index. American Institute of Physics bibliography
pertains
to
innovative
BONE methods This
using
penetrating
bibliography
radiation
provides
radiation absorptiometry sive topical coverage designed and
as
may
Report
on
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Bone
an
also
the
Second
Mineral
Bonn,
is use
to
the
(1976)
to
tissue
analysis.
on
recent
work
entering
Thevaniance
extenis the
(1978) N
analysis excess
field
German
Symposia Bonn,
of variance). can be drawn
aim of the of measurements
program had measurement used
of
served
were
mass
for tion
125-I and coefficient
absorption
The
The results on values obtained
0.41
up to a maximum that showed a of value
up
on bone step-wedges
(HA)
and
resin.
coefficient
HA-volume by the
within to bone
intensity difference This effect occurred
the
of
and
80
point-
for g/cm
he
apparent compared
,
125-I
HA
values teams of
was
and
These
measurements. density to the
of
proposed
to
be
presented by and Gebhardt
group content
of
Schuster of apatite.
whereas Scan
cm2/g
Relations
total
in
Nielsen ology,
HE, Arhus
Christensen Amtssygehus,
Mass
in
P,
Mosekilde DK-8000
and
the
L Arhus
Forearm:
The
determination
of
bone
mineral
tical bone in many states and know the normal proportion of various levels of the forearm of
the BMC Forty
measurents forearms,
investigation. level proximal logical
levels
for obtained
diseases cortical and to
average the mean
(BMC)
F, Path-
by
of
and
the
the
morphometnically: amount of cortical
radius
the total bone, and
at the to that. and
following
photon-
ulna
were
parameters
produced
were
cross-sectional the total amount
and
loss
bone of
at
Clinical
structure
Applicability
Monoenergetic Vartsky D, Bone
at
the
of
Photon Ellis KJ mineral
distal
the
Absorptiometry: (Brookhaven
content
(BMC)
Cohn National
Content SN, Lab. ,
measurements
Measured
Aloia Upton,
have
JF, NY
been
all
with
ed. The utilizing mass (as
“normal” values derived
characterize For the population.
the
levels
of
sex,
age
value (BMCN) is obtained of sex and age, and also from 40K measurement).
skeletal study, On the
tion, individuals osteoporosis were (on the basis of calcium
parameters
in
size and body 119 white women basis of physical
and
body
size
by Zanzi 11973)
I,
normal
range.
is
data When
than
total and
data in
femur
The
ganma-ray mass (BMC) which
show body
of
50 to 170 outer-volume
250
are
that size. rats
days (by
these varying
of age. The displacement)
totl
bone
mineral
(mineral/outerbut clinical
relationship.
In
a 60-cm length The 49Ca counts years of age)
the
mean
of
length (length)4
around the 49Ca
fall they
the so
humans
height
and
that total as observed
the regression counts were
the
emphasize size for
The
age
data
50.
was
This
the reliable
function body
this function value. In loss had
between less
consistent
may
be
with
compared
which
importance of interpretation
span.
difference children
limits of mean adult
osteoporotics years.
arm
this for
was no significant data on 21 normal
adults.
cal-
body calcium in rat data.
line of normalized
within the normal are 15% below the
after
data
the
of a subject covering obtained from measurewas proportional to
there was no evidence of bone Older subjects (50-70 years)
younger
Bone
Mineral
Content
queker of Leuven,
influence
of
and
differs
constant ratio
Data
was
to
30%
a the
below
adequate normalof bone mass
Using
J, Wielandts B 3000 Leuven,
bone
width with
(BMC/width)
using
our
these
on sex
does
own
curves
heterogeneity
an
not
L,
bone
and
Isowidth
Nijs J Belgium)
data
from
and
content
Therefore
data
are
based
on
size
order to on BMC fourthhave been from
cross-sectional
is
bone
for
In size and age
and
(BMC) the
compensate
Belgium
Per-
(Academic
mineral
age.
always
may be involved. of skeletal size on and again was most larger the skeletal
in
Using mine
for
the a
bone
loss
isowidth
given
for at
a
given
that
within
and
individual
Dr.
Ringe
data
much with
and
the percentile curves also pronounced in the younger size, the higher the per-
age
is
the
any
curves
age
skeletal size the corresponding be determined.
found
by
population.
percentile at
corresponding to given Knowing the bone width width at adult age can
the
one
now
expected
can BMC
detervalue
percentile at adult age. B?C percentile for this The “normative” BMC value
extrapolating
to
the
width
percentile
age.
evaluatBallet-Dancing Andersson SM, 01
a
the
or
bone)
centile value. The percentile curves, in contrast to the isowidth curves, did not come closer in the older age groups and were not influenced by the skeletal size thus indicating a
in
Malmo,
larger examina-
with evidence of metabolic calcium disorders or excluded. Additionally, these women were judged total body neutron activation analysis) to have the
of
factors The effect was not constant, age-group. The
by an algorithm height and lean-body The latter two variables
habitus, respectively. were selected from and roentgenological
Our present to variations
a similar IVNAA in thighs. (20-50
0.5%/year
of
However,
employed
is
Based MW
and Kuhlencordt in Germany. These isowidth curves are very separated from each other in the younger age group, but come together in the older age group. This suggested that people larger bones lose more bone than those with smaller bones.
by age and sex (mean value denoted BMCM). However, of skeletal size has generally not been used. study, the clinical usefulness of relative BMC
obtained
or exceed
Size: Hitchman
x-ray mineral of
extractions.
a constant to go with
Curves: Univ.
computed,
total bone.
two types of studies. In the first type, serial measurements on individual are used to monitor bone changes. In the second type, BMC of an individual is determined and compared to a “standard” value. Generally, the standards are derived from “normal” populations grouped the parameter In our
on
HC1
length
secular
Ilineral
deficit body-size often
Body KG,
(by bone
differences between individuals or populations. study in more detail the influence of skeletal degree percentile and isowidth curves on BMC
level.
Bone
shows
These results for body
mineral
The investigation demonstrated a highly significant relation between the total amount of bone and BMC at all three levels. At the standard site and at the level above the relation was dommated by the amount of cortical bone. Trabecular bone was the dominating
from
of age) average
of
The not
histo-
area; the trabecular
P
mass in
outer-volume
weight length,
bone mass value in 74 value for adults