Assessment Of Bone Mineral Density Research Articles

Bone mineral density and osteoporosis related risk factors in type 2 diabetes mellitus

Diabetes mellitus negatively affects bone tissue and unfavourably impacts bone mineral density (BMD), therfore increasing the probability of fractures through pathological mechanisms. This study aimed to explore the factors associated with BMD and osteoporosis risk in individuals with a diagnosis of type 2 diabetes mellitus (T2DM). An investigation was undertaken involving 49 patients diagnosed with T2DM who fulfilled the specified criteria. These individuals underwent BMD assessment as part of a cross-sectional study. The analysis encompassed both univariate and bivariate approaches, utilizing the Chi-square test (X2) and binary logistic regression methods. A total of 30 participants (61%) have decreased BMD. Among the participants aged 60 years and above, 83.4% exhibited a decreased BMD status (osteopenia and osteoporosis), in contrast to the under 60 years age group, in which 40% displayed decreased BMD status. Older age (>60 years) is a risk factor for decreasing bone density onset of diabetes mellitus (DM) diagnosis, duration of DM, glycemic control, body mass index (BMI), use of thiazolidinediones (TZD) drugs, kidney function, were not associated with lower BMD in T2DM patients.

The assessment of canal flare index and proximal femoral bone density can improve stem selection for peri-prosthetic bone maintenance after total hip arthroplasty.

Bone maintenance after total hip arthroplasty (THA) is important for implant success. This study aimed to investigate the relationship between patient characteristics and periprosthetic bone maintenance after THA for better implant selection. This retrospective cohort study enrolled 112 consecutive patients who underwent THA using full hydroxyapatite (HA) compaction with short (n = 55) or short-tapered wedge (n = 61) stems. Periprosthetic bone mineral density (BMD) was compared between the two groups after propensity score matching, and the relationship between periprosthetic BMD changes and patient background was analyzed. Both groups showed similar periprosthetic BMD changes after adjusting for patient background using propensity score matching. Canal flare index > 3.7 in patients that underwent THA using tapered-wedge stem (odds ratio (OR), 3.2; 95% confidence interval (CI), 1.3-7.9, p = 0.013) and baseline zone 1 BMD > 0.65 in patients that received with short HA compaction stems (OR, 430.0; 95% CI 1.3-1420, p = 0.040) were associated with proximal periprosthetic bone maintenance after THA. Considering their predictive value, canal flare index and zone 1 BMD assessment might be useful strategies for implant selection during THA.

Impact of pheochromocytoma or paraganglioma on bone metabolism: A systemic review and meta-analysis

Preclinical and animal studies have suggested that excess catecholamines can lead to bone mineral loss. However, to date, no systematic review is available that has analyzed the impact of catecholamine excess in the context of pheochromocytoma/paraganglioma (PPGL) on bone metabolism. We conducted this meta-analysis to address this knowledge gap. Electronic databases were searched for studies evaluating bone metabolism, including assessments of bone mineral density (BMD), quantitative computed tomography (qCT), trabecular bone score (TBS), or bone turnover markers in patients with PPGL. These markers included those of bone resorption, such as tartrate-resistant acid phosphatase 5b (TRACP-5b) and cross-linked C-telopeptide of type I collagen (CTx), as well as markers of bone formation, such as bone-specific alkaline phosphatase (BS ALP). Out of the initially screened 1614 articles, data from six studies published in four different patient cohorts with PPGL that met all criteria were analysed. Individuals with PPGL had significantly lower TBS [Mean Difference (MD) -0.04 (95% CI: -0.05--0.03); p < 0.00001; I2 = 0%], higher serum CTx [MD 0.13 ng/ml (95% CI: 0.08-0.17); p < 0.00001; I2 = 0%], and higher BS-ALP [MD 1.47 U/L (95% CI: 0.30-2.64); p = 0.01; I2 = 1%]. TBS at 4-7 months post-surgery was significantly higher compared to baseline [MD 0.05 (95% CI: 0.02-0.07); p < 0.0001]. A decrease in CTx has been documented post-surgery. Bone health deterioration is a major concern in patients with PPGL. In addition to providing a definitive cure for catecholamine excess, monitoring and treating osteoporosis is essential for individuals with secondary osteoporosis due to PPGL. Long-term studies on bone health outcomes in PPGL are warranted.

Vertebral and Femoral Bone Mineral Density (BMD) Assessment with Dual-Energy CT versus DXA Scan in Postmenopausal Females.

This study aimed to demonstrate the potential role of dual-energy CT in assessing bone mineral density (BMD) using hydroxyapatite-fat material pairing in postmenopausal women. A retrospective study was conducted on 51 postmenopausal female patients who underwent DXA and DECT examinations for other clinical reasons. DECT images were acquired with spectral imaging using a 256-slice system. These images were processed and visualized using a HAP-fat material pair. Statistical analysis was performed using the Bland-Altman method to assess the agreement between DXA and DECT HAP-fat measurements. Mean BMD, vertebral, and femoral T-scores were obtained. For vertebral analysis, the Bland-Altman plot showed an inverse correlation (R2: -0.042; RMSE: 0.690) between T-scores and DECT HAP-fat values for measurements from L1 to L4, while a good linear correlation (R2: 0.341; RMSE: 0.589) was found for measurements at the femoral neck. In conclusion, we demonstrate the enhanced importance of BMD calculation through DECT, finding a statistically significant correlation only at the femoral neck where BMD results do not seem to be influenced by the overlap of the measurements on cortical and trabecular bone. This outcome could be beneficial in the future by reducing radiation exposure for patients already undergoing follow-up for chronic conditions.

Sagittal Section Hounsfield Units of the Upper Instrumented Vertebrae as a Predictor of Proximal Junctional Vertebral Fractures Following Adult Spinal Deformity Surgery.

A retrospective observational study. This study aimed to determine an accurate and convenient screening method for predicting proximal junctional fractures (PJFr) following surgery for adult spinal deformity (ASD) using computed tomography (CT)-based measurement of Hounsfield units (HUs). CT-based measurement of HUs is an alternative tool for assessing bone mineral density. However, the optimal method for predicting adjacent vertebral fractures following spinal fusion using HUs remains unclear. This retrospective observational study included 42 patients who underwent reconstructive surgery for ASD. Elliptical regions of interest (ROIs) on the axial section and rectangular ROIs on the sagittal section were placed at the upper instrumented vertebrae (UIV), UIV+1, and UIV+2. In addition, the HU value of the L2 vertebra was used as the representative. PJFr occurred in 28.6% of patients within 2 years following surgery. The HU values obtained from the axial sections of L2, UIV, UIV+1, and UIV+2 were not significantly associated with the incidence of PJFr within 2 years, except for the ROI set in the lower region of the L2 vertebra. However, the HU value of the anterior third of the UIV in the sagittal section was significantly lower in the PJFr group than in the nonPJFr group (87.0 vs. 160.3, p =0.001). A UIV HU value of <100 was associated with a higher incidence of PJFr than an HU vaue of >100 (p <0.05). Measurements of HU in the anterior one-third of the UIV in the sagittal section demonstrated predictive ability for PJFr following ASD surgery. A UIV HU value of <100 emerged as a risk factor for PJFr.

An emergency department-based system intervention to improve osteoporosis screening for older adults at high-risk of fracture

Abstract Falls and osteoporosis are risk factors for fragility fractures. Bone mineral density (BMD) assessment is associated with better preventative osteoporosis care, but it is underutilized by those at high fracture risk. We created a novel electronic medical record (EMR) alert-driven protocol to screen patients in the emergency department (ED) for fracture risk and tested its feasibility and effectiveness in generating and completing referrals for outpatient BMD testing after discharge. The EMR alert was configured in two tertiary-care EDs and triggered by the term “fall” in the chief complaint, age (≥65 years for women, ≥70 years for men), and high fall risk (Morse score ≥ 45). The alert electronically notified ED study staff of potentially eligible patients. Participants received osteoporosis screening education and had BMD testing ordered. From November 15, 2020 to December 4, 2021, there were 2608 EMR alerts among 2509 patients. We identified 558 patients at high-risk of fracture who were screened for BMD testing referral. Participants were excluded for: serious illness (N = 141), no documented health insurance to cover BMD testing (N = 97), prior BMD testing/recent osteoporosis care (N = 58), research assistant unavailable to enroll (N = 53), concomitant fracture (N = 43), bedridden status (N = 38), chief complaint of fall documented in error (N = 38), long-term care residence (N = 34), participation refusal (N = 32), or hospitalization (N = 3). Of the 16 participants who had BMD testing ordered, 7 scheduled and 5 completed BMD testing. EMR alerts can help identify subpopulations who may benefit from osteoporosis screening, but there are significant barriers to identifying eligible and willing patients for screening in the ED. In our study targeting an innovative venue for osteoporosis care delivery, only about 1% of patients at high-risk of fracture scheduled BMD testing after an ED visit. Adequate resources during and after an ED visit are needed to ensure that older adults participate in preventative osteoporosis care.

Assessment of jaw bone mineral density, resorption rates, and oral health in patients with severe hemophilia: a case-control study.

Knowledge about oral hygiene, gingival bleeding, mineral density, and resorption of jaw bones in patients with hemophilia is limited. We evaluated the periodontal and bone status in such patients. Material and methods: Forty-eight patients with severe type A/B hemophilia and 49 age- and sex-matched controls were included. Assessments included simplified oral hygiene index (OHI-S), calculus index, debris index, gingival index (GI), gingival bleeding time index (GBTI), and decayed, missing, and filled teeth index (DMFTI). Bone resorption was evaluated using panoramic mandibular index (PMI), mental index (MI), and alveolar crest ratio (ACR). Mineral density in the condyle, angulus, and premolar areas was assessed using fractal analysis, with fractal dimensions denoted as condyle fractal dimension (CFD) for the condyle, angulus fractal dimension (AFD) for angulus, and premolar fractal dimension (PFD) for premolar region. The mean scores were DMFTI = 11.77, OHI-S = 2.44, PMI = 0.268, MI = 5.822, GI = 3.02, GBTI = 2.64, ACR = 2.06, CFD = 1.31, AFD = 1.31, and PFD = 1.17 in the hemophilia group and DMFTI = 11.449, PMI = 0.494, MI = 7.43, GI = 0.67, GBTI = 0.98, OHI-S = 1.45, ACR = 2.87, CFD = 1.35, AFD = 1.35, and PDF = 1.23 in the control group. Differences were significant for all parameters (p < 0.005) except for the DMFTI index. Conclusions: Because of poor oral hygiene, high bone resorption, and low bone mineral density in these patients, clinicians should consider potential bone changes when planning to treat these patients.

Opportunistic screening for osteoporosis using computed tomography scans and its comparison with DXA findings: a two-center cross-sectional study

BackgroundOsteoporosis is a prevalent condition leading to an increased risk of bone fractures. Osteoporosis poses a worldwide public health concern, impacting over 200 million individuals and resulting in a staggering 1.66 million hip fractures each year. Opportunistic osteoporosis screening can be employed during CT scans to assess bone mineral density (BMD) through Hounsfield units (HU) without the need for additional imaging, radiation exposure, or appointments. This study aimed to investigate a CT scan's diagnostic value in the opportunistic osteoporosis screening through L1 vertebra densitometry and compare it with dual-energy x-ray absorptiometry (DXA) findings.ResultsOne hundred forty-nine patients with an average age of 67.70 ± 10.94 years were included in the study. The age of osteoporotic patients was significantly higher than osteopenic (p = 0.001) and normal individuals (p < 0.001). The HU of osteoporotic patients was found to be significantly lower compared to both osteopenic (p = 0.023) and normal individuals (p < 0.001). According to the ROC curve for osteoporosis prediction using the HU (AUC = 0.793 and p < 0.001), with a cut-off of 103 HU, the CT scan had a sensitivity of 69% and a specificity of 74% for the diagnosis of osteoporosis.ConclusionIndividuals with osteoporosis exhibit a significantly lower average HU compared to both osteopenic and healthy individuals. A CT scan can serve as an effective predictor of osteoporosis in patients. The CT images obtained for reasons unrelated to osteoporosis diagnosis can be employed to discern patients with osteoporosis without incurring the added cost or radiation exposure.

Predicting the Fracture Toughness of Human Cancellous Bone in Fractured Neck of Femur Patients Using Bone Volume and Micro-Architecture.

The current protocol used to determine if an individual is osteoporotic relies on assessment of the individual's bone mineral density (BMD), which allows clinicians to judge the condition of a patient with respect to their peers. This, in essence, evaluates a person's fracture risk, because BMD is a good surrogate measure for strength and stiffness. In recent studies, the authors were the first to produce fracture toughness (FT) data from osteoporotic (OP) and osteoarthritic (OA) patients, by using a testing technique which basically analyzes the prerequisite stress conditions for the onset of growth of a major crack through cancellous bone tissue. FT depends mainly on bone quantity (BV/TV, bone volume/tissue volume), but also on bone micro-architecture (mArch), the inner trabecular design of the bone. The working research hypothesis of the present study is that mArch offers added prediction power to BV/TV in determining FT parameters. Consequently, our aim was to investigate the use of predictive models for fracture toughness and also to investigate if there are any significant differences between the models produced from samples loaded across (AC, transverse to) the main trabecular orientation and along (AL, in parallel) the trabeculae. In multilinear regression analysis, we found that the strength of the relationships varied for a crack growing in these two orthogonal directions. Adding mArch variables in the Ac direction helped to increase the R2 to 0.798. However, in the AL direction, adding the mArch parameters did not add any predictive power to using BV/TV alone; BV/TV on its own could produce R2 = 0.730. The present results also imply that the anisotropic layout of the trabeculae makes it more difficult for a major crack to grow transversely across them. Cancellous bone models and remodels itself in a certain way to resist fracture in a specific direction, and thus, we should be mindful that architectural quality as well as bone quantity are needed to understand the resistance to fracture.

Heterogeneity and high prevalence of bone manifestations, and bone mineral density in congenital generalized lipodystrophy subtypes 1 and 2.

Congenital Generalized Lipodystrophy (CGL) is a rare autosomal recessive disease caused by mutations in genes responsible for the formation and development of adipocytes. Bone abnormalities are described. However, there is a scarcity of data. To describe bone characteristics in a large CGL1 and 2 case series. Cross-sectional study that assessed bone radiological features of CGL patients of a reference hospital in Fortaleza (CE), Brazil. Patients underwent clinical and bone mineral metabolism evaluation, radiographs of the axial and appendicular skeleton and bone mineral density (BMD) assessment by DEXA (dual energy X-ray absorptiometry). Nineteen patients were included, fourteen were CGL1 and 5, CGL2. Median age was 20 years (8-42) and 58% were women. Median BMI and percentage of body fat were, respectively, 21 Kg/m² (16-24), and 10.5% (7.6-15). The median leptin concentration was 1 ng/mL (0.1-3.3). Diabetes mellitus and dyslipidemia were present in 79% and 63% of patients, respectively. Median calcium and phosphate were normal in almost all patients (95%). Median parathyroid hormone and 25-OH-vitamin D were 23 pg/mL (7-75) and 28 ng/mL (18-43). Osteolytic lesions, osteosclerosis and pseudo-osteopoikylosis, were present in 74%, 42% and 32% of patients, respectively. Lytic lesions were found predominantly in the extremities of long bones, bilaterally and symmetrically, spine was spared. Osteosclerosis was present in axial and appendicular skeleton. Pseudo-osteopoikilosis was found symmetrically in epiphyses of femur and humerus, in addition to the pelvis. BMD Z-score greater than +2.5 SD was observed in 13 patients (68.4%). BMD was higher in CGL1 compared to CGL2 in lumbar spine and total body in adults. No associations were found between high BMD and HOMA-IR (p=0.686), DM (p=0.750), osteosclerosis (p=0.127) or pseudo-osteopoikilosis (p=0.342), and, between pain and bone lesions. Fractures were found in 3 patients. Bone manifestations are prevalent, heterogeneous, and silent in CGL1 and CGL2. Osteolytic lesions are the most common, followed by osteosclerosis and pseudo-osteopoikilosis. Bone mass is high in most cases. There was no pain complaint related to bone lesions. Thus, systematic assessment of bone manifestations in CGL is essential. Studies are needed to better understand its pathogenesis and clinical consequences.

Quantitative computed tomography assessment of bone mineral density in adolescent idiopathic scoliosis: correlations with Cobb angle, vertebral rotation, and Risser sign.

Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder that can potentially influence bone mineral density (BMD), thereby increasing the susceptibility to osteoporosis and fractures. Early identification of reduced bone mass in AIS patients is crucial for clinicians to develop effective preventive strategies against fractures. This study aims to elucidate the correlation between BMD, as measured by quantitative computed tomography (QCT), and various clinical parameters in AIS, including the Cobb angle, vertebral rotation, and the Risser sign. By revealing the potential influences of these factors on BMD, our findings aim to assist clinicians in making informed and timely decisions regarding AIS management, particularly in situations where QCT is unavailable. A cross-sectional study was conducted on 129 adolescents with AIS who were enrolled at The Third People's Hospital of Chengdu, Sichuan, China, between 2021 and 2023. QCT was employed to assess BMD and vertebral rotation. The Cobb angle and Risser sign were determined through radiographic evaluation, while anthropometric and biochemical data were also collected. Statistical analyses, including Pearson and Spearman rank correlation and regression models, were used to investigate the associations between BMD and clinical measures. A significant negative correlation was found between BMD and Cobb angle (coefficient =-0.663; P<0.001), as well as between BMD and vertebral rotation angle (coefficient =-0.442; P<0.001) in patients with AIS. BMD was positively correlated with increased height (coefficient =0.355; P<0.001) and BMI (coefficient =0.199; P=0.02). A significant association was detected between BMD and the Risser sign (P=0.002). No significant sex-based differences in BMD were observed (P=0.052). No significant correlations were observed between BMD and levels of potassium (K), calcium (Ca), inorganic phosphate (P), and iron (Fe) (P>0.05 all). The binary logistic regression analysis identified Cobb angle as a risk factor of lower BMD presence in AIS patients (coefficient =0.072; OR=1.075; P<0.001). Furthermore, the receiver operating characteristic (ROC) analysis of the combined model for predicting low BMD in AIS patients yielded an area under the curve (AUC) value of 0.900, with an optimal threshold determined as 0.398. The sensitivity and specificity were calculated as 0.816 and 0.900, respectively, indicating a robust predictive capacity. This study highlights the significant inverse correlation observed between BMD measured by QCT and both Cobb angle and vertebral rotation angle in patients with AIS. Furthermore, a notable variation in BMD was found across different Risser sign categories, with BMD values generally increasing as Risser sign levels increased. Additionally, our findings indicate that Cobb angle serves as a risk factor for low BMD presence. Moreover, a combined model was developed to predict the likelihood of low BMD occurrence in AIS patients.

Fully automated deep learning system for osteoporosis screening using chest computed tomography images.

Osteoporosis, a disease stemming from bone metabolism irregularities, affects approximately 200 million people worldwide. Timely detection of osteoporosis is pivotal in grappling with this public health challenge. Deep learning (DL), emerging as a promising methodology in the field of medical imaging, holds considerable potential for the assessment of bone mineral density (BMD). This study aimed to propose an automated DL framework for BMD assessment that integrates localization, segmentation, and ternary classification using various dominant convolutional neural networks (CNNs). In this retrospective study, a cohort of 2,274 patients underwent chest computed tomography (CT) was enrolled from January 2022 to June 2023 for the development of the integrated DL system. The study unfolded in 2 phases. Initially, 1,025 patients were selected based on specific criteria to develop an automated segmentation model, utilizing 2 VB-Net networks. Subsequently, a distinct cohort of 902 patients was employed for the development and testing of classification models for BMD assessment. Then, 3 distinct DL network architectures, specifically DenseNet, ResNet-18, and ResNet-50, were applied to formulate the 3-classification BMD assessment model. The performance of both phases was evaluated using an independent test set consisting of 347 individuals. Segmentation performance was evaluated using the Dice similarity coefficient; classification performance was appraised using the receiver operating characteristic (ROC) curve. Furthermore, metrics such as the area under the curve (AUC), accuracy, and precision were meticulously calculated. In the first stage, the automatic segmentation model demonstrated excellent segmentation performance, with mean Dice surpassing 0.93 in the independent test set. In the second stage, both the DenseNet and ResNet-18 demonstrated excellent diagnostic performance in detecting bone status. For osteoporosis, and osteopenia, the AUCs were as follows: DenseNet achieved 0.94 [95% confidence interval (CI): 0.91-0.97], and 0.91 (95% CI: 0.87-0.94), respectively; ResNet-18 attained 0.96 (95% CI: 0.92-0.98), and 0.91 (95% CI: 0.87-0.94), respectively. However, the ResNet-50 model exhibited suboptimal diagnostic performance for osteopenia, with an AUC value of only 0.76 (95% CI: 0.69-0.80). Alterations in tube voltage had a more pronounced impact on the performance of the DenseNet. In the independent test set with tube voltage at 100 kVp images, the accuracy and precision of DenseNet decreased on average by approximately 14.29% and 18.82%, respectively, whereas the accuracy and precision of ResNet-18 decreased by about 8.33% and 7.14%, respectively. The state-of-the-art DL framework model offers an effective and efficient approach for opportunistic osteoporosis screening using chest CT, without incurring additional costs or radiation exposure.

Assessment and management of low bone mineral density in children with cerebral palsy

Cerebral palsy (CP) is an impairment in motor function and coordination due to a nonprogressive brain injury that occurs pre-, peri-, or postnatally until 2 years of age with a prevalence of one to four per 1,000 live births. Along with impaired motor function, decreased bone mineral density (BMD) in children with CP is of concern for providers. An algorithm has been created to help identify patients at risk for decreased BMD who are seen by providers. Factors included in the algorithm are medication history, fracture history, ketogenic diet, ambulation status, history of an endocrinopathy, and pubertal stage.BMD levels are measured using dual-energy x-ray absorptiometry (DXA) scans. Once a patient is identified as having decreased BMD several treatment options are available. BMD can be increased through stander use, diet, and bisphosphonate treatment. This paper serves as a summary of the current ways in which children with CP are assessed at each visit, as well as how to treat low BMD once it has been identified.

Reduced bone mineral density is associated to post-TIPS survival of female patients with decompensated cirrhosis

BackgroundMalnutrition is common in patients with cirrhosis, eventually leading to sarcopenia and loss of bone mass. AimsThe aims of this study was the assessment of body composition (BC) and bone mineral density (BMD) in patients with decompensated cirrhosis and the prognostic impact on survival after transjugular intrahepatic portosystemic shunt (TIPS) implantation. MethodsBMD and BC of 107 patients with cirrhosis undergoing TIPS implantation were prospectively analyzed by dual-energy X-ray absorptiometry. The prevalence and predisposing risk factors for reduced BMD and sarcopenia were assessed. Impact on 12-month survival after TIPS implantation was evaluated. ResultsSarcopenia was diagnosed in 48.6 % of the patients with a predominance of male patients (58.7% vs. 25.0 %, p = 0.001). 67.2 % had reduced BMD. Low BMI was independently associated with sarcopenia (OR 0.751 (95 % CI: 0.662;0.852), p < 0.001) and reduced BMD (OR 0.851 (0.773;0.937), p = 0.001). Patients with reduced BMD, but not sarcopenia, had impaired 12-month survival after TIPS-implantation (61.2% vs. 82.9 %, p = 0.030). Subgroup analysis showed that this was especially valid for female patients. ConclusionsSarcopenia and reduced BMD are frequently observed in patients with decompensated cirrhosis. Reduced BMD negatively affects post-TIPS survival. Since malnutrition is a leading cause, assessment of nutritional status and specific treatment should be included in clinical practice.

Abnormal Bone Turnover Observed in Obese Children Based on Puberty Stage -Specific Bone Turnover Marker Reference.

Childhood and adolescence are critical periods for lifelong bone health. The impact of obesity on these phases is controversial, which may be due to the lack of standards for age-, sex-, and puberty-specific Bone turnover markers (BTMs) which could sensitively reflect bone metabolism. To generate age-, sex, and puberty stage-specific BTMs reference curves in children and adolescents and to explore the effect of obesity on bone metabolism in the Chinese population. Our study was part of the Evaluation and Monitoring on School-based Nutrition and Growth in Shenzhen study. 800 participants aged 6∼18 years with normal body mass index (BMI) were selected to establish BTM reference curves for boys and girls at different ages under different pubertal development stages. Additionally, 200 participants with obesity (BMI >P95th) were matched with healthy children from the original cohort at a 1:1 ratio. All participants underwent bone mineral density assessment, and serum levels of P1NP and β-CTX were measured. The BTMs values presented significant age, sex, and puberty stage differences. Analysis of serum BTMs based on the established reference revealed a higher percentage of low-level P1NP in boys with obesity (P=0.005); no significant difference was observed in girls. However, the obese group showed a significantly higher proportion of high β-CTX levels for girls, not boys (P=0.022). We provide age-, sex-, and puberty stage-specific P1NP and β-CTX reference curve. According to these, obesity appeared to be a negative factor for bone formation in boys and for bone resorption in girls.

Theoretical and experimental study of attenuation in cancellous bone.

Photoacoustic (PA) technology shows great potential for bone assessment. However, the PA signals in cancellous bone are complex due to its complex composition and porous structure, making such signals challenging to apply directly in bone analysis. We introduce a photoacoustic differential attenuation spectrum (PA-DAS) method to separate the contribution of the acoustic propagation path to the PA signal from that of the source, and theoretically and experimentally investigate the propagation attenuation characteristics of cancellous bone. We modified Biot's theory by accounting for the high frequency and viscosity. In parallel with the rabbit osteoporosis model, we build an experimental PA-DAS system featuring an eccentric excitation differential detection mechanism. Moreover, we extract a PA-DAS quantization parameter-slope-to quantify the attenuation of high- and low-frequency components. The results show that the porosity of cancellous bone can be evaluated by fast longitude wave attenuation at different frequencies and the PA-DAS slope of the osteoporotic group is significantly lower compared with the normal group (**). Findings demonstrate that PA-DAS effectively differentiates osteoporotic bone from healthy bone, facilitating quantitative assessment of bone mineral density, and osteoporosis diagnosis.

Assessment of Bone Mineral Density in a cohort of Juvenile Idiopathic Arthritis patients

Introduction: Low bone mass is encountered in patients with Juvenile idiopathic arthritis (JIA) as a serious long-term complication of this pediatric condition and may be associated with fractures and its complications.&#x0D; The present study aimed to evaluate the frequency of low bone mineral density (BMD) and fragility fractures in patients with JIA in its polyarticular or oligo articular forms. Secondary, our aim was to identify factors associated with low bone mass.&#x0D; Patients and methods: This is a retrospective study conducted on 26 patients with JIA meeting the ILAR criteria for poly or oligoarticular form. Patients were divided into two groups according to their age : group1 including patients aged over 16 years-old and group 2 including patients aged under 16 years-old. Sociodemographic, clinical, biological and functional data were collected by consulting patient’s medical records. Bone mineral density was measured at three different sites: whole body, lumbar spine and hip using the dual-energy X-ray absorptiometry (DXA) equipment. Data were entered and analyzed using SPSS version 11.5 software.&#x0D; Results: Twenty-six JIA patients including 20 females (74.1%) and six males (22.2%) were enrolled with a mean disease duration of 20.23 years [2-54 years]. The mean age was 28.2 years [7-58 years]. The distribution of JIA subtypes among patients was as follows: 6 with oligo articular JIA and 20 with polyarticular JIA. Sixteen patients (59%) practiced regular physical activity. In our series, the frequency of low bone mineral density was 41% in children with JIA and 68 % in adults with JIA. Only two patients presented a fragility fracture in adulthood represented by a hip fracture following low-energy trauma and treated surgically in both cases. No patient received an anti-osteoporotic treatment. In-group 1, there was a significant correlation between low bone mass and weight (p=0.020), BMI (p=0.028), disease duration (p=0.045), positivity of AAN (p=0.050), disease activity (p=0.019), oral corticosteroid (p=0.034) and biologic treatment (p=0.043). In-group 2, a statistically significant correlation was found between low bone mass and age at the time of JIA diagnosis (p=0.041), weight (p=0.03), physical activity (p=0.05), disease duration (p=0.021), functional impact of the disease assessed by the HAQ score (p=0.018), oral corticosteroid therapy (p=0.014) and biological therapy (p=0.012).&#x0D; Conclusion: our study showed that a combination of factors contributed to compromise bone health in patients with JIA. Fragility fractures were rare and occurring mainly in adulthood. An adequate control of disease activity, proper management of treatment, adequate calcium and vitamin D intake, as well as regular physical activity, may contribute to preserve bone health in those patients.

Effect of Denosumab on Bone Health, Vascular Calcification, and Health-Related Quality of Life in Hemodialysis Patients with Osteoporosis: A Prospective Observational Study.

Background: Osteoporosis is common in hemodialysis (HD) patients, contributing to cardiovascular risks. Limited research exists on denosumab's efficacy in this group. Our study explores denosumab's effects on bone turnover markers (BTMs) and vascular calcification in chronic kidney disease-mineral bone disorder (CKD-MBD) patients. Methods: In a prospective single-center study, we investigated the effects of denosumab over 2 years on 30 HD patients from a cohort of 185. Annual assessments of bone mineral density (BMD), vascular calcification, and health-related quality of life (HRQL) were conducted and compared with an untreated group. Mineral and bone parameters were analyzed at specific intervals in the treatment group. Results: Denosumab notably raised femoral BMD in the initial year. Most bone turnover markers (BTMs) decreased, except for osteocalcin. Changes in T50 correlated with BTMs. Pre-denosumab supplementation of calcium and vitamin D helped manage mineral imbalances. Post denosumab, parathyroid hormone (PTH) levels increased initially, stabilizing after 3 months. No significant changes occurred in vascular calcification or HRQL. Conclusions: Denosumab exhibited varying effects on BMD improvement, with a stronger impact in the first year that diminished in the second year. Early PTH monitoring was crucial, and extending the administrative period may enhance BMD outcomes compared to the general population.

Osteoporosis management in patients with chronic kidney disease (ERCOS Study): A challenge in nephrological care

Fracture risk assessment in patients with chronic kidney disease (CKD) has been included in the CKD-MBD ("Chronic Kidney Disease-Mineral and Bone Disorders") complex in international and national nephrology guidelines, suggesting for the first time the assessment of bone mineral density (BMD) if the results can influence therapeutic decision-making. However, there is very little information on actual clinical practice in this population. The main objective of the ERCOS (ERC-Osteoporosis) study is to describe the profile of patients with CKD G3-5D with osteoporosis (OP) and/or fragility fractures treated in specialized nephrology, rheumatology and internal medicine clinics in Spain. Fifteen centers participated and 162 patients (mostly women [71.2%] postmenopausal [98.3%]) with a median age of 77 years were included. Mean estimated glomerular filtration rate (eGFR) was 36 mL/min/1.73 m2 and 38% of the included patients were on dialysis. We highlight the high frequency of prevalent fragility fractures [37.7%), mainly vertebral (52.5%) and hip (24.6%)], the disproportionate history of patients with glomerular disease compared to purely nephrological series (corticosteroids) and undertreatment for fracture prevention, especially in nephrology consultations. This study is an immediate call to action with the dissemination of the new, more proactive, clinical guidelines, and underlines the need to standardize a coordinated and multidisciplinary care/therapeutic approach to these patients in an efficient way to avoid current discrepancies and therapeutic nihilism.

Discordance between dual-energy X-ray absorptiometry bone mineral density and spinal computed tomography texture analysis: An investigation into low correlation rates

ObjectivesThis research delves into the application of texture analysis in spine computed tomography (CT) scans and its correlation with bone mineral density (BMD), as determined by dual-energy X-ray absorptiometry (DXA). It specifically addresses the discordance between the 2 measurements, suggesting that certain spinal-specific factors may contribute to this discrepancy. MethodsThe study involved 405 cases from a single institution collected between May 6, 2012 and June 30, 2021. Each case underwent a spinal CT scan and a DXA scan. BMD values at the lumbar region (T12 to S1) and total hip were recorded. Texture features from axial cuts of T12 to S1 vertebrae were extracted using gray-level co-occurrence matrices, and a regression model was constructed to predict the BMD values. ResultsThe correlation between CT texture analysis results and BMD from DXA was moderate, with a correlation coefficient ranging between 0.4 and 0.5. This discordance was examined in light of factors unique to the spine region, such as abdominal obesity, aortic calcification, and lumbar degenerative changes, which could potentially affect BMD measurements. ConclusionsEmerging from this study is a novel insight into the discordance between spinal CT texture analysis and DXA-derived BMD measurements, highlighting the unique influence of spinal attributes. This revelation calls into question the exclusive reliance on DXA scans for BMD assessment, particularly in scenarios where DXA scanning may not be feasible or accurate.