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

Fourth International Conference on Bone Measurement [proceedings].

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