Assessment Of Osteoporosis In Patients Research Articles

The role of native vitamin D treatment in the clinical assessment of osteoporosis in patients with chronic kidney disease

The prevalence of vitamin D deficiency is high in patients with chronic kidney disease (CKD). Vitamin D deficiency is associated with various bone disorders such as osteoporosis by affecting bone mineralization. Current international guidelines recommend vitamin D supplementation in CKD as well as in the general population. However, the effect of various forms of vitamin D on bone health in CKD remains unclear. Few randomized controlled studies have evaluated the effects of vitamin D supplementation on bone mineral density and bone turnover markers; however, the findings of these studies are heterogeneous. This review aimed to present comprehensive and current findings on the effects of native vitamin D supplementation on bone biomarkers and bone mineral density in CKD. We infered that native vitamin D treatment could improve some bone biomarkers, particularly in predialysis CKD patients with severe vitamin D deficiency. Our findings also draw attention to the fact that vitamin D is an important factor in treatment. However, it is essential to design better-quality and comprehensive controlled studies to obtain clear findings.

Assessment of osteoporosis in patients with type 2 diabetes mellitus: A study from the central region of Saudi Arabia.

To understand the impact of diabetes on bone mineral density and whether it increases the likelihood of osteoporosis. This study was performed on 327 Saudis (aged >40 years) who were screened for osteoporosis and diabetes mellitus (DM). The levels of osteoporosis were determined by an estimation of Bone mineral density (BMD) using a DEXA scan examination. The data on BMD from diabetic subjects were compared with healthy nondiabetic controls. Out of 327 enrolled subjects, 38 (11.6%) were found to be osteoporotic, whereas 138 (42.2%) had DM. The data showed that the number of patients with osteoporosis in the DM group was 14 (36.8%), significantly lower than in nondiabetic patients, 21 (55.2%) (p=0.0015). Notably, the data showed no significant difference in the mean BMD of the femur in patients with DM (0.926 g/cm2) and non-diabetes (0.936 g/cm2) (p=0.280; T-score p=0.4746). The mean BMD levels in the spine of the DM study group (1.049 g/cm2) were significantly higher when compared with nondiabetic healthy controls (0.990 g/cm2) (p=0.0031). Patients with diabetes had higher lumbar BMD than nondiabetics, although femoral BMD was similar. Patients with diabetes have a lower osteoporosis risk than nondiabetics.

What is the role of CT-based Hounsfield unit assessment in the evaluation of bone mineral density in patients undergoing 1- or 2-level lumbar spinal fusion for degenerative spinal pathologies? A prospective study

Computed tomography-based vertebral attenuation values (CT-based HU) have been shown to correlate with T-scores on DEXA scan; and have been acknowledged as an independent factor for predicting fragility fractures. Most patients undergoing lumbar surgeries require CT as part of their preoperative evaluation. The current study was thus planned to evaluate the role of lumbar CT as an opportunistic investigation in determining BMD preoperatively in patients undergoing lumbar fusion. Prospective cohort study. Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions. Comparison of the quantitative assessment of osteoporosis using Hounsfield Units (HU) on CT (L1-L5) and mean lumbar T-scores on DEXA (Dual Energy X-ray Absorptiometry). HU on CT is comparable to T-score on DEXA as a suitable modality for the assessment of osteoporosis in patients undergoing one- to two-level lumbar fusion. A prospective cohort study was conducted between January and December 2021. Patients older than 45 years, who underwent one- to two-level lumbar (L3-S1 levels) fusions and had complete clinico-radiological records, were prospectively enrolled. A comparison was drawn between the HU (measured by placing an oval region of interest [ROI] over axial, sagittal and coronal images of lumbar vertebrae) on CT and T-scores on DEXA, and analyzed statistically. The HU values correlating best with normal (group A), osteopenia (B) and osteoporosis (C) categories (classified based on T-scores of lumbar spines) were determined statistically. Overall, 87 patients (mean age of 60.56±11.63 years; 63 [72.4%] female patients) were prospectively studied. There was a statistically significant difference in the mean age (p=.01) and sex distribution (predominantly female patients; p=.03) of patients belonging to groups B (osteopenic) and C (osteoporotic patients), as compared with group A. The greatest correlation between T-score (on DEXA) and HU (on CT) for differentiating osteopenia (group B) from group A was observed at levels L1 (p<.001), L2 (p<.001) and L3 (p<.001). Based on receiver-operating characteristic (ROC) curve analysis, the cut-off values for HU for identifying osteopenia were 159 (at L1; sensitivity 81.6 and specificity 80) and 162 (at L2; sensitivity 80 and specificity 71.1). In addition, there was statistically significant correlation between T-score (on DEXA) and HU at all the lumbar levels for distinguishing osteoporosis (group C), although the difference was most evident at the upper lumbar (L1 and L2) levels (p<.001). Based on ROC analysis, cut-off HU values for defining osteoporosis were 127 (at L1; sensitivity 71.3 and specificity 70) and 117 (at L2; sensitivity 65.5 and specificity 90). Based on our study, the measurement of HU on CT at upper lumbar levels can be considered as "surrogate marker" for BMD in the diagnosis of osteopenia (cut-off: 159 at L1, 162 at L2) and osteoporosis (cut-off: 127 at L1, 117 at L2) in patients undergoing lumbar fusion surgeries. The HU measurements on CT at the lower lumbar levels (L4 and L5) are less reliable in this preoperative scenario.

MRI-based vertebral bone quality score for the assessment of osteoporosis in patients undergoing surgery for lumbar degenerative diseases

PurposeTo explore the value of vertebral bone quality (VBQ) scores in diagnosing osteoporosis in patients with lumbar degeneration.MethodsA retrospective analysis was conducted of 235 patients treated with lumbar fusion surgery at the age of ≥ 50; they were divided into a degenerative group and a control group according to the severity of degenerative changes on three-dimensional computed tomography. The L1-4 vertebral body and L3 cerebrospinal fluid signal intensities in the T1-weighted lumbar magnetic resonance imaging (MRI) image were recorded, and the VBQ score was calculated. Demographics, clinical data, and dual-energy X-ray absorptiometry (DXA) indicators were recorded, and the VBQ value was compared with bone density and T-score using the Pearson correlation coefficient. The VBQ threshold was obtained according to the control group and compared with the efficacy of osteoporosis diagnosis based on DXA.ResultsA total of 235 patients were included in the study, and the age of the degenerative group was older than that of the control group (61.8 vs. 59.4, P = 0.026). The VBQ score of the control group suggested a higher correlation with the bone mineral density (BMD) value and T-score (r = − 0.611 and − 0.62, respectively). The BMD value and T-score in the degenerative group were higher than those in the control group (P < 0.05). Receiver-operating characteristic curve analysis showed that the VBQ score had a good predictive ability for osteoporosis (AUC = 0.818), with a sensitivity of 93% and a specificity of 65.4%. Among the undiagnosed osteoporosis patients with T-score, the VBQ score after adjusting the threshold was higher in the degenerative group (46.9% vs. 30.8%).ConclusionsEmerging VBQ scores can reduce the interference caused by degenerative changes compared to traditional DXA measures. Screening for osteoporosis in patients undergoing lumbar spine surgery provides new ideas.

Quantitative ultrasound and dual energy X‐ray absorptiometry in the assessment of osteoporosis in patients with haemophilia

Quantitative ultrasound and dual energy X‐ray absorptiometry in the assessment of osteoporosis in patients with haemophilia

Assessment of osteoporosis in patients with chronic obstructive pulmonary disease

BackgroundCOPD is a widely distributed disease with high morbimortality, associated with important pathologies, among which is osteoporosis. However, osteoporosis is often undiagnosed in these patients. ObjectivesTo evaluate the prevalence of osteoporosis among COPD patients and to determine its relation to demographic data and disease severity. Subjects and methodsThis study was conducted on 30 male patients with severe to very severe COPD, in addition to 30 age and sex matched lifelong nonsmoker healthy volunteers. Spirometric indices, serum Ca, phosphorous, ALP, albumin, and PTH were measured. BMD was measured by broadband heel ultrasound method. ResultsCorrected Ca was significantly decreased, PTH was significantly increased and ALP showed non-significant increase in the COPD group. As regards BMD; BUA, Z-score and T-score were significantly decreased while RRF was significantly increased in the COPD group. In addition 56.6% of COPD patients had low BMD. Both COPD group either with normal BMD or with low BMD were matched as regards all demographic data. VC%, FVC% and FEV1%, BUA, T-score, and Z-score were significantly decreased while PTH and RRF were significantly increased in the COPD group with low BMD. Z-score was negatively correlated with FEV1 and PTH while BUA was positively correlated with ALP and negatively correlated with FEV1/FVC. ConclusionLow BMD is prevalent among men with COPD (GOLD stage III–IV) than age matched males. The degree of the loss of BMD has been found to be proportionate to the COPD severity. COPD patients with low BMD have threefold increase in fracture risk.

Multinational survey of osteoporotic fracture management

Osteoporosis is characterized by a decreased bone mass and an increased bone fragility and susceptibility to fracture. Patients with a fragility fracture at any site have an increased risk of sustaining future fractures. Orthopedic surgeons manage most of these fractures and are often the only physician seen by the patient. Mounting evidence that orthopedic surgeons are not well attuned to osteoporosis led the Bone and Joint Decade (BJD) and the International Osteoporosis Foundation (IOF) to survey 3,422 orthopedic surgeons in France, Germany, Italy, Spain, the United Kingdom, and New Zealand. The majority of the respondents in all countries had the opinion that the orthopedic surgeon should identify and initiate the assessment of osteoporosis in patients with fragility fractures. Heterogeneous practice pattern exist in different countries; however, identification and treatment of the osteoporotic patient seems to be insufficient in many areas: half of the orthopedic surgeons surveyed received little or no training in osteoporosis. Only approximately one in four orthopedic surgeons in France, the UK and New Zealand regarded themselves as knowledgeable about treatment modalities. Less than one-fifth of the orthopedic surgeons arranged for a surgically treated patient with a fragility fracture to have a bone mineral density (BMD) test. Twenty percent said that they never refer a patient after a fragility fracture for BMD. Only half of the orthopedic surgeons in southern Europe know about the importance of some external risk factors for hip fractures (cataracts, poor lighting, pathway obstacles, poor balance). In summary, this survey clearly indicates that many orthopedic surgeons still neglect to identify, assess and treat patients with fragility fractures for osteoporosis. More educational opportunities need to be offered to orthopedic surgeons through articles, web-based learning and educational seminars. Development of a simple clinical pathway from evidence-based guidelines is an important step to ensure that optimal care is provided for patients with fragility fractures.